Medical Education Online™Manuscripts organized by VolumeVolume 11, 2006 |
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Attitudes Towards Biopsychosocial Concerns in Primary Care: Prediction, Gender and Changes Across Cohorts
Douglas Brock, PhD*, Douglas Schaad, PhD*, and Incho Lee, PhD*
*Medical Education and Biomedical Informatics, School of Medicine
University of Washington
Abstract - The Washington Primary Care Interest Inventory (WPCII) assesses student attitudes
regarding the appropriateness of a range of biopsychosocial concerns for which a patient might
seek care from a primary care provider. The WPCII holds promise for understanding the
relationship between attitudes, career choice, gender, and cohort. Methods: We longitudinally examined WPCII scores across medical school cohorts and by gender. We also explored the influence of attitudes in predicting career choice.
Results: Four findings emerged. First, WPCII scores were positively associated with student
preferences for primary care specialties. Second, across 14 years, there has been a significant
upward trend in WPCII scores. Third, women exhibit higher scores on the WPCII. Finally,
WPCII scores at the start of medical school show some ability to predict student residency match.
Discussion: We discuss the WPCII’s promise for understanding shifts in career choice and the
influence of gender in selecting primary care specialties.
Training Medical Students in the Community - Memoirs and Reflections of the University of Transkei Medical School
Ehi U Igumbor, MPH, Amalio del RíoMD, MSc, David L Buso, FCPHM and Jose M Martínez, MD, MPhil
Department of Community Medicine,
Faculty of Health Sciences,
Walter Sisulu University for Technology and Science,
Mthatha, Eastern Cape Province, South Africa.
Abstract: Not long after its inception, the undergraduate medical program at the University of Transkei (UNITRA) departed from the traditional hospicentric medical education approach to one tailored around a Community-Based Medical Education (CBME) curriculum adopting the Problem-based Learning (PBL) pedagogy. This article reflects on the experiences of the faculty in establishing and implementing CBME, exploring what it has meant to train medical students in the community. It further appraises CBME by reviewing its impact on students, the faculty, and the community at large.
Teaching Advanced Interviewing Skills to Residents: A Curriculum for Institutions with Limited Resources
Peter F. Weissmann, MD FACP
University of Minnesota Medical School
Department of Medicine P7
Hennepin County Medical Center
Minneapolis, MN USA
Abstract: Residency program directors currently face new requirements from the Accreditation Council for Graduate Medical Education (ACGME), including the mandate to demonstrate their residents’ proficiency in communication skills. Such skills can be improved through an educational intervention, but few residencies specifically offer formal instruction in communication. Furthermore, the only formal instruction in communication skills described thus far for internal medicine residents requires hundreds of hours per month of faculty and resident time. This paper describes a time-efficient seminar series in communication skills for first-year internal medicine residents, which has been received well by faculty and learners as evidenced by post-seminar surveys and focus groups.
Evaluating Technology-Enhanced Continuing Medical Education
Dr. Allison Rossett* and Dr. Julie A. McDonald†
*Professor of Educational Technology
San Diego State University
San Diego, CA USA
†Centre for Medical Education
University of Dundee
Dundee, Scotland
Abstract - Technology is changing the face of continuing medical education (CME). However, will it improve the quality of CME? No longer is it sufficient to count heads or ask if participants liked the experience. It is time to look at CME’s influence on performance, habits, and perhaps even outcomes, and to use data to continuously improve CME programs and practices. As CME experiences integrate into professional life in the forms of online knowledge tools streamed to the bed side, mobile advice and e-coaching, all of which pay scant attention to time or place, evaluation methods and questions must evolve to provide meaningful feedback.
Medical Education in Iran: An Exploration of Some Curriculum Issues
Mohsen Tavakol, Ph.D.*, Roger Murphy, Ph.D.† Sima Torabi, Ph.D.‡
*Medical Education Unit
Nottingham University, UK
†School of Education
Nottingham University, UK
‡Ministry of Science, Research and Technology
Institute for Research, and Planning in Higher Education, Tehran, Iran
Abstract:
Background: Although Iran is a large and populous country, the state of medical education is poorly understood and under researched. However, it is apparent that, in recent years, calls for reform in medical education have not tended to lead to major changes. As a result, the curricula used are in danger of being perceived as dated and less effective than they should be.
Purpose: This exploratory study is designed to investigate the perspectives and experiences of a group of the most influential medical education course planners in Iran. Its aim is to investigate their views about the nature of the undergraduate medical curriculum in Iran and explore with them ways in which such curricula could be modernized and improved.
Methods: In-depth, semi-structured interviews were used to explore the perceptions of an elite group of medical education course planners who all work in prestigious universities in Tehran. Each of these 10 individuals was interviewed twice, over a period of several months, in order that an in-depth view of their perceptions could be unraveled.
Results: A deep concern about the lack of an innovative medical education curriculum in Iran emerged as the strongest theme from the interviews. There is widespread agreement that the current curriculum is too oriented towards the students passively learning facts. There is also a perceived lack of integration between the two-year basic science courses and clinical learning. Furthermore, participants feel that poor teaching facilities and overcrowding of students has provided an unsuitable learning environment. Both positive and negative attitudes toward educational strategies in curriculum development were demonstrated. Some of the barriers to curriculum change were also discussed.
Conclusions: There is a real need for major changes in the medical education curriculum in Iran. The results of this study suggest that a move towards a curriculum that engages students as active participants in a process of lifelong learning would be highly beneficial. As clinically qualified doctors they will face many challenges in the years ahead, and a modernized curriculum should help them to acquire the necessary knowledge and develop the clinical skills and problem solving abilities they will need.
The Intentions of Letter Writers for Applicants to a Baccalaureate-M.D. Program: Self-Report and Content Analyses of Letters of Reference
Brian E. Mavis, Christine L. Shafer and Belinda M. Magallanes
College of Human Medicine
Michigan State University
East Lansing, MI 48824
Abstract:
Background: The purpose of this study was to determine how individuals providing reference letters framed the task and the specific attributes used to describe applicants.
Methods: Participants were letter writers (N=106) for accepted or alternate applicants. Participants received a brief anonymous survey and a return postcard to release their past letter for content analysis.
Results: Seventy-six percent of letter writers (N=81) returned a survey. Most (64%) intended to describe applicants’ positive accomplishments. According to respondents’ they were most likely to write about academic accomplishments (85%), work ethic (78%), dependability (70%) and motivation (70%). Seventy-four respondents (70%) released their letter for content analysis. Academic accomplishments (77%), motivation (41%) and leadership (41%) were the attributes most frequently mentioned in the letters.
Conclusions: Most letter writers see their role as supportive rather than evaluative. Academic accomplishments, though often mentioned, are available from other sources. Many non-cognitive attributes of most interest to admissions committees are least likely to appear in reference letters.
Student-Led Objective Tutorial (SLOT) in Medical Education
Gurusamy Sivagnanam, MD*, Simansalam Saraswathi, M Pharm†, Aiyalu Rajasekaran, M Pharm, PhD‡
*Senior Associate Professor
†Lecturer
‡Additional Professor
Asian Institute of Medicine, Science & Technology
Kedah Darul Aman, Malaysia.
Abstract:
Purpose - To assess an innovative tutoring program named ‘Student-Led Objective Tutorial’ (SLOT) among undergraduate medical students.
Method - The program was conceptualized by the Pharmacology Unit of Faculty of Medicine and Health Sciences, Asian Institute of Medicine Science & Technology (AIMST), Malaysia and implemented in the middle of 2005. A cohort of 246 medical undergraduate students (spread across 5 consecutive batches) participated. Following a brief explanation on the purpose and nature of SLOT, each batch was divided into small groups and was given a reading assignment on 4 previously delivered lecture topics. Each group was asked to prepare 3-5 multiple choice questions (MCQs) of their own in PowerPoint format to be presented, in turns, to the whole class on the day of SLOT. The proceedings were facilitated by 2 lecturers. Student feedback on the efficacy and benefits were assessed through an anonymous self administered questionnaire.
Results - About 76% (188) of the students favored SLOT. The acceptance rate of SLOT was higher among males. There was no significant difference between batches in their opinions on whether to pursue SLOT in future. The most prevalent positive comment was that SLOT enhanced learning skills, and the negative comment being, it consumed more time.
Conclusions - SLOT is a novel tutorial method which can offset faculty shortage with advantages like enhanced interest among teachers and learners, uniform reach of content, opportunities for group learning, and involvement of visual aids as teaching-learning (T-L) method. SLOT unraveled the students’ potential of peer tutoring both inside as well as outside the classroom. Consumer tutors (students) can be tapped as a resource for SLOT for all subjects and courses in healthcare teaching.
Assessing Medical Student Professionalism: An Analysis of a Peer Assessment
Scott Cottrell, EdD*, Sebastian Diaz, PhD, JD†,
Anne Cather, M.D‡, and James Shumway, PhD§
*Assistant Professor, Department of Community Medicine and the Office of Medical Education. West Virginia University
†Assistant Professor, School of Human Resources and Education. West Virginia University
‡Associate Dean, Student Services. West Virginia University
§Associate Dean, Medical Education. West Virginia University
Abstract:
Purpose: Students’ professional development is an essential aim of medical school. The purpose of this paper is to report how an assessment of first-year medical students’ professional behavior was designed and to investigate its measurement characteristics.
Methods: The assessment was implemented as a peer assessment of professional skills, which were delineated according to a formal professional code developed by our curriculum committee. During the last week of the Fall 2005 semester, the professionalism assessment was administered online to students in a problem-based learning course.
Results: The internal consistency of the assessment is adequate. The generalizability study found that raters nested within persons accounted for the majority of variance. While the inter-rater reliability is relatively low, using multiple raters may yield an acceptable estimate of the relative reliability.
Conclusions: The results suggest that this peer assessment is a practical assessment, evidenced by the 91% compliance rate. However, future research and modifications will be needed to address the variance of responses, helping to discriminate between “poor” and “good” observations of professionalism. In addition, multiple raters are required to supply reliable estimates of students’ professional behavior. Coupling this evaluation with other professionalism evaluations may help reveal a more complete picture of students’ professional behavior.
The Effect of an Interactive Tutorial on the Prescribing Performance of Senior Medical Students
Anne L Tonkin, David Taverner, Jenny Latte, Christopher Doecke
Medical Education Unit
The University of Adelaide
Abstract:
Objectives: To evaluate the effectiveness of small group tutorials in teaching senior medical students the requirements of prescription writing.
Design: Random allocation to interactive tutorial or didactic lecture with blinded evaluation.
Subjects: All 1999 6th year medical students, the University of Adelaide.
Results: The Tutorial Attenders (mean 13.3, SD 2.6) performed significantly better than the Lecture Group (mean12.2, SD 3.0) p=0.041 and the Non-attenders (mean10.7, SD 3.1) p=<0.001. The 13 individual OSCE items formed four logical subgroups, and the Tutorial Attenders performed significantly better in Prescription Writing in all comparisons.
Conclusion: A single, one-hour interactive tutorial is likely to be the minimum amount of intervention that will be effective in improving prescribing skills.
A Problem-Based Learning Approach to Incorporating Nutrition into the Medical Curriculum
Marilyn S. Edwards, Ph.D., R.D.* and Gary C. Rosenfeld, Ph.D.†
*Department of Internal Medicine and
†Department of Integrated Biology and Pharmacology
University of Texas Medical School
Houston, Texas 77030
Abstract: Problem Based Learning (PBL) provides a unique opportunity for medical students to learn nutrition principles in the context of evidence-based clinical cases. At the University of Texas Medical School at Houston (UTMSH), PBL is a major component during the second year of the four year undergraduate medical curriculum. A recent review of forty-two clinical cases has shown that over half of the cases include nutrition-specific objectives related to diagnosis, therapy, prognosis, or disease prevention. Thus, these PBL cases provide students the opportunity to study a broad range of nutrition topics in a clinically relevant context. The students’ nutrition knowledge is evaluated using clinically-oriented, multiple-choice questions. In order for students to develop fully their competency in clinical nutrition topics, they are also provided a foundation in basic nutrition principles. This report describes a comprehensive approach through a case-based curriculum to help prepare students in their pre-clinical years for the nutritional care of patients in their clerkships, residency, and as practicing physicians.
Study of Selected Outcomes of Medical Students Who Fail USMLE Step 1
Diane M. Biskobing, MD*, Sonya R. Lawson, PhD†, James M. Messmer, MD, MEd‡,
J. Dennis Hoban, EdD†
*Department of Medicine and Dean’s Office
†Dean’s Office
‡Department of Radiology and Dean’s Office
Virginia Commonwealth University
School of Medicine
Richmond, VA
Abstract
Purpose: Passage of the United States Medical Licensing Exam (USMLE) is required to obtain a medical license in the United States. Currently the majority of US medical schools require passage of USMLE Step 1 for either promotion to the third year or graduation from medical school. Virginia Commonwealth University School of Medicine (VCUSOM) requires that students take the USMLE but does not require passing of USMLE Step 1 for promotion or graduation. This policy enabled the authors to analyze performance outcomes during clinical rotations and monitor the residency match for a group of students who failed USMLE Step 1 on the first attempt.
Methods: Third year clerkship grades and residency match results were reviewed for 64 students of the graduating classes of 1999-2005 who failed Step 1 on the first attempt. An equal number of students who passed Step 1 were randomly selected from each class as a comparison group. Average clinical performance ratings, NBME subject exam scores and final third year clerkship grades for the two groups were compared. Residency match rates and specialty certification were also compared.
Results: The USMLE Fail Group had more Pass and fewer Honors clerkship grades than the comparison group. Subject exam scores were significantly lower in the USMLE Fail Group in all clerkships. Clinical performance ratings were significantly lower in the Fail group in three out of six clerkships: Internal Medicine, Pediatrics, and Psychiatry. However, 82% of the USMLE Fail Group later passed USMLE Step 1 and 2. Fifty-nine of the 64 students in the USMLE Fail Group matched for a residency, whereas all of the students in the Pass Group matched for a residency.
Conclusion: Students who fail USMLE Step 1 have lower final clerkship grades due in part to lower NBME subject exam scores. The majority of these students, however, successfully pass USMLE Step 1 prior to graduation, go on to graduate medical training, and become board certified in their specialty.
The Premedical Student: Training and Practice Expectations
Virginia Adams O’Connell, PhD and Jyoti Gupta
Department of Sociology and Anthropology
Swarthmore College
Abstract: Occupational burnout is a substantial and growing problem among current medical practitioners. Many practicing physicians lament the encroachment of managed care, infringement of physician autonomy by insurers, decreasing salaries, and decreasing prestige. In light of this unfavorable review of the profession, why are thousands of undergraduates all over the country still on the premedical track? Do these young men and women really know what kind of work environment awaits them at the end of their arduous training program? What motivates them to become physicians? In this case study, we explore the reasons for pursuing a career in medicine among a sample of premedical students at a liberal arts college on the East Coast. College administrators agree that the pre-medical curriculum is one of the most demanding and arduous study programs. What do these pre-medical students see as the ultimate goal? As a result of various volunteer, training, and shadowing experiences in the medical field, many of these students have a realistic perception of the current environment of medical practice. Although they recognize the challenges that await them, they are driven to become doctors by a deep vocational calling to serve. However, not all of the students expressed this calling. Results from this study suggest that eventual career satisfaction may be correlated with baseline career motivations. Students who are becoming doctors to fulfill parents’ aspirations, for upward mobility, and/or for prestige and high salaries may be disenchanted once they complete their training program.
Development and Implementation of a Health Literacy Training Program for Medical Residents
Sunil Kripalani, MD, MSc*, Kara L. Jacobson, MPH, CHES†, Samatha Brown, MA‡,
Kimberly Manning, MD*, Kimberly J. Rask, MD, PhD†, Terry A. Jacobson, MD*
*Department of Internal Medicine, Emory University School of Medicine
†Emory Center on Health Outcomes and Quality, Department of Health Policy and Management, Rollins School of Public Health of Emory University
‡Children’s Healthcare of Atlanta
Abstract - Nearly 50 percent of Americans lack the literacy skills needed to function effectively in today’s health care environment. Experts recommend that health professionals be trained to better communicate with low-literacy patients, but few educational programs have been described. We developed a training program for medical residents that includes a videotaped standardized patient encounter, interactive small-group workshop, one-on-one feedback with a faculty member, and an individual behavioral prescription for improved communication. The program employs key principles of adult learning theory and evidence-based teaching approaches. Residents felt that the topic was relevant and that their communication skills benefited from the intervention. They enjoyed the teaching methods, particularly the individual feedback on their videotaped encounter. A qualitative process evaluation is provided to facilitate the teaching of similar programs elsewhere. Response to this curriculum indicates that residency appears to be a suitable time to raise awareness of health literacy and build appropriate communication skills.
Development and Evaluation of a Mandatory Course in Geriatric Medicine for Fourth Year Medical Students
Susan Freter, MD FRCPC, Janet Gordon, MD FRCPC, and Laurie Mallery, MD FRCPC
Centre for Health Care of the Elderly and
Division of Geriatric Medicine
Halifax, Nova Scotia
Canada B3H 2E1
Abstract
Background and Objectives: As the population ages, older adults will make up an increasing proportion of the practices of most physicians. Because of this, education of medical students in Geriatric Medicine is essential, yet there is considerable variability in the amount, timing within the curriculum, and content of geriatric training in Medical Schools. Our goal was to develop and evaluate an integrated, mandatory 3-week geriatric medicine course for fourth year medical students with emphasis on knowledge acquisition.
Methods: All fourth year medical students at Dalhousie Medical School underwent 2 ½ days of didactic teaching on core geriatric topics and a 2-week clinical rotation. Pre-rotation knowledge testing occurred on the first day of the rotation. On the final examination, students were retested on the 15 pre-rotation questions, as well as 5 additional questions that they had not encountered previously.
Results: There was a statistically significant improvement in examination performance from 46.9% on the pretest to 78.6% on the final examination (t=24.7, p<.001). It is unlikely that the significant improvement in scores is simply a result of repeat testing, as students tended to score better on the five additional questions that they had not seen before.
Discussion: We developed a geriatric medicine course for fourth year medical students, in one integrated 3-week block, using a combination of didactic teaching and clinical encounters. We used students as their own controls, using the same questions pre- and post-rotation, and demonstrated significant knowledge acquisition on a variety of topics pertaining to geriatric medicine and care of the older patient. Future research should address the issue of translating acquired knowledge in geriatric medicine into demonstrated clinical skills when caring for the elderly.
A Description of a Validated Effective Teacher-Training Workshop for Medical Residents
Jamiu O. Busari, Albert J.J.A. Scherpbier, Cees P.M. van der Vleuten, Gerard G.M. Essed, Robert Rojer
Department of Paediatrics, Atrium Medical Center
The Netherlands
Abstract - A teacher-training program for residents was designed and piloted in the St. Elisabeth Hospital in Curaçao, Netherlands Antilles. The program comprised of six modules namely: effective teaching, self-knowledge and teaching ability, feedback, assessing prior knowledge, trouble shooting and time management.
Method: Instruction was provided during a two-day workshop with eight hours instruction time per day. Residents in the first three years of training participated, and the instructors were experienced clinicians. Lectures, group discussions, case simulations, video presentations and role-plays were the forms of instruction.
Results: Using standardized questionnaires, the participants rated the quality of the workshop highly. They considered it to be a feasible and appropriate educational intervention and that it had a positive impact on their teaching skills.
Conclusion: This workshop was developed based on careful analysis of medical residents’ perceived educational needs and systematically implemented and evaluated. The results show that it is a suitable and effective educational intervention.
Appraisal and Consequences of Cadaver Dissection
Martin Dempster*, Alexander Black†, Noleen McCorry*, David Wilson‡
*School of Psychology, Queen’s University Belfast
†Department of Anatomy, National University of Ireland, Galway
‡Department of Anatomy, Queen’s University Belfast
Abstract: First exposure to human cadaver dissection has the potential to be an actual stressor which can cause psychological trauma. This study examines the relationship between anatomy students’ experience of this potential stressor and various psychological and personal factors. Questionnaires measuring emotional reactions to cadaver dissection, coping strategies, personality and attitudes to death were administered to anatomy students at two medical schools immediately after their first exposure to human cadaver dissection. Emotional reactions to recalling this experience were assessed 4 months later. Data on these variables were obtained from 141 students. Students found the experience mostly challenging and, on average, did not report serious emotional difficulties. However, a minority of students (10/141) experienced serious adverse consequences. It is possible that the typical student who undertakes an anatomy course is already psychologically prepared for such transactions. However, low cost desensitization programs could be made available for the minority of individuals who may experience adverse reactions in this situation.
Effect of Brief Behavioral Intervention Program in Managing Stress in Medical Students from Two Southern California Universities
Stephanie A. Bughi, BS*, Jennifer Sumcad, BA, BS† & Stefan Bughi, MD‡†
*Health Promotion and Disease Prevention, University of Southern California, Los Angeles
†Rancho Los Amigos National Rehabilitation Center, Downey, California
‡Keck School of Medicine, University of Southern California, Los Angeles
Abstract: The study aims to assess 1) the prevalence of stress among a group of third and fourth year medical students (MS) from two Southern California universities and 2) the effect of a brief behavioral intervention program (BBIP) on stress management among the students instructed on stress intervention techniques. The stress level was determined by using the General Well Being Scale (GWBS), a self-report questionnaire designed by the National Center for Health Statistics.1 The stress testing was done prior to the psycho-educational lecture on stress. The prevalence of stress and the variation of stress based on gender, academic year (third vs. fourth year) and time of testing (beginning vs. end of rotation) was measured in 104 medical students. To assess the effect of the psycho-educational lectures on stress, the last 32 students who rotated in our service had the pre-test and the lecture at the beginning of the rotation and the post-test at the end of the rotation. Among the medical students studied, 53/104 (51%) reported stress; among this group, 20/53 (37.7%) reported severe stress or distress. The prevalence of stress in this group of students was not significantly different if the stress level was measured at the beginning (46.9%) vs. the end of the rotation (52.8%, p = 0.57). The total stress score was lower (suggesting higher stress) in the fourth vs. third year MS (69.7+/-16.3 vs. 73.2+/-12.7, p=0.2), and in female students vs. male students (69.9+/-14.5 vs. 73.7+/-13.8, p=0.17). Female students, when compared to their male counterparts, had a lower anxiety score (12.2+/-4.4 vs. 15.4+/-4.3, p<0.005), consistent with higher anxiety level, since the polarity for the anxiety questions is reversed. Among the students who had both a pre and post-test (N=32) after the BBIP (deep diaphragmatic breathing, self-control relaxation, walking meditation), the reported stress decreased from 46.9 % (15/32) to 21.9% (7/25) (p< 0.05). In addition, scores indicated that the brief behavioral intervention program significantly decreased the anxiety level and improved the positive well-being. Our study showed that stress is very prevalent among the medical students tested, affecting 51% of the students. Among those who reported stress, 37.7% reported distress. Female students reported a higher level of anxiety compared to their male colleagues. Following the implementation of a brief behavioral program, the prevalence of stress in this group of students decreased by 46.7 %. This was associated with a decrease in the reported anxiety and an increase in the positive well-being. Since stress is very prevalent among medical students, increased awareness of stress and early intervention may prevent burnout, improve job satisfaction and ultimately improve health care delivery.
Medical Student Attitudes Toward Communication Skills Training and Knowledge of Appropriate Provider-Patient Communication: A Comparison of First-Year and Fourth-Year Medical Students
Kevin B. Wright, PhD*, Carma Bylund, PhD†, Jennifer Ware, MA‡, Patricia Parker, PhD§, Jim L. Query, Jr, PhD||, Walter Baile, MD§
*Department of Communication, University of Oklahoma
†Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center
‡Department of Communication, University of Memphis
§Department of Psychiatry, M. D. Anderson Cancer Research Center
||School of Communication, University of Houston
Abstract - Drawing upon Bloom’s taxonomy of educational objectives as a theoretical framework, this study examines attitudes toward communication skills training, knowledge of appropriate provider-patient communication, and confidence communicating with patients between first-year and fourth-year medical students at a large medical school in the southern United States. The study findings indicate that fourth-year medical students do not differ from first-year medical students in terms of attitudes towards communication skills training or knowledge of appropriate provider-patient communication, but they have significantly higher confidence scores about communicating with patients. In addition, positive attitudes towards communication skills training are significantly related to perceived importance of communication skills and confidence when communicating with patients. Finally, female medical students have more positive attitudes towards communication skills training than male medical students. The implications of the study findings and directions for future research are also discussed.
“Windshield Tour” – A Journey Towards Cultural Competency
D. Kay Taylor, PhD, Laura Carravallah, MD, Melissa Hamp, MD,
James Buterakos, MSA, and Ramin Motarjemi, MD
Hurley Medical Center, Flint, MI and
Michigan State University College of Human Medicine,
East Lansing, MI
Abstract
Purpose: Medical educators are directing greater attention to the promotion of cultural competency when prioritizing educational program goals. An innovative educational approach is described here in a community hospital where nearly one-third of its citizens fall below the poverty level. The intent was to provide a very personal, first-hand learning experience via witnessing living conditions of patients from poverty-stricken neighborhoods.
Method: Hospital educators worked with the community organization FACED (Faith Access to Community Economic Development). This grassroots group developed an educational driving excursion—entitled the “Windshield Tour”—of the city hospital’s poorest areas. A knowledge/attitude questionnaire was administered as a pre- and post-test to 80 residents and medical students.
Results: Significant changes were observed in participants’ understanding of personal/financial hardships faced by their patients, perceptions of availability of resources, understanding of issues related to health care benefits, and rankings of patient/physician characteristics deemed important.
Conclusion: Hospital educators have met with FACED leaders to explore future collaborative projects that would increase exposure to the community for the residents and students.
Perceived Biases and Prejudices Experienced by International MedicalGraduates
in the US Post-Graduate Medical Education System
Scott E. Woods MD, MPH, M.Ed., FAAFP. Aaron Harju MD,
Shoba Rao MD, Julie Koo MD, Divya Kini MD
Bethesda Family Medicine Residency Program
Cincinnati, Ohio USA
Abstract
Purpose – The purpose of this project was to collect qualitative data on the types of bias and prejudices experienced by international medical graduates (IMGs) in the US graduate medical education system.
Methods – We conducted thirty-six qualitative interviews from a single internal medicine residency program in a large mid-western city over a four-year time period. The study population consisted of 33 IMGs and 3 USMGs.
Results – The data aggregated into four major themes; the externship requirements of residency programs for IMGs, difficult interview experiences, US medical students are critical of residency programs with IMGs, and greater difficulties for IMGs finding employment after residency.
Conclusion – The IMGs from one Internal Medicine residency program in the US post-graduate medical system self-reported considerable bias and prejudice.
A Clinical and Ethical Investigation of Pre-medical and Medical Students’ Attitudes, Knowledge, and Understanding of HIV
Julie M. Aultman, PhD*, and Nicole J. Borges, PhD†
*Human Values and Medicine Program
Northeastern Ohio Universities College of Medicine
Rootstown, Ohio, USA
†Department of Community Health
Boonshoft School of Medicine
Wright State University
Dayton, Ohio, USA
Abstract: Ninety-five students participated in a qualitative study examining pre-medical and first-year medical students’ knowledge, understanding, and attitudes surrounding HIV. Participants were given a questionnaire to assess general knowledge and to assess students’ ability to identify and discern psychosocial and ethical dilemmas using 2 case studies about fictionalized HIV patients and the issues they face in disclosing their diagnosis of HIV and adhering to prescribed treatment regimens. A content analysis was used to examine the students’ responses for themes. Results suggested that most students have a general understanding of HIV. Many students, however, are unable to identify and differentiate psychosocial factors from ethical factors when presented with HIV case studies. Answers reflecting students’ attitudes of HIV varied and contained identifiable biases and prejudices, such as placing blame on individuals who acquire the disease through “risky” behaviors. Pedagogical strategies for improving HIV education and developing students’ professional and moral growth as future healthcare providers are identified.
Problem-Based Learning at the Faculty of Medicine of the Université de Montréal: A Situated Cognition Perspective
Marie-Pierrette Ntyonga-Pono, MD., MEd.
Université de Montréal,
Faculty of Education Sciences,
Department of Psycho-pedagogy and Andragogy
Abstract
Purpose: This study describes the typical case of problem-based learning (PBL) application at the Faculty of Medicine of the Université de Montréal and its analysis from the perspective of situated cognition.
Method: I used a typical case study to determine the general model of PBL application and performed my analysis by a global processing of information, against to the conceptual model of situated cognition.
Results: A typical PBL tutorial case consists of a meeting of a group of about 8 students with a tutor to discuss a medical problem. Learning objectives are predetermined by faculty and recorded in the tutor’s handbook. Broadly speaking, the analysis revealed a certain kind of scaffolding within a “zone of proximal development” (ZPD).
Conclusion: The adaptation of PBL at the Faculty of Medicine of the University of Montreal is hybrid, original, and can be related to the model of cognitive apprenticeship, but the tutor’s role, however, does not fit the model of cognitive apprenticeship completely.
Resident Perception of a Newsletter’s Impact on Residency Morale and Collegiality
Troy E. Madsen, MD and Daniel R. Martin, MD
Department of Emergency Medicine
Ohio State University Medical Center
Columbus, Ohio, USA
Abstract
Study Objective: While several residency programs have created residency newsletters, no study has evaluated resident perception of a newsletter’s impact. The objective of this study was to evaluate the impact of a newly implemented residency newsletter on resident morale and attitude toward fellow residents.
Methods: At a Midwestern PGY1-3 emergency medicine residency program, a four-page monthly newsletter was implemented in April of 2005. The newsletter included features on residents, stories on residency events, and information on upcoming events. The newsletter was designed as a resident project in which residents contributed stories and photos. Content and editorial decisions were independent of residency faculty. Ten months after implementation of the newsletter, the program’s residents were surveyed to assess the newsletter’s impact on their morale and attitude toward fellow residents. They also reported their interest in participating as a formal newsletter staff and they provided their opinion on faculty oversight. The survey was conducted anonymously, was distributed in both paper and electronic forms, and was based on a five-point Likert scale (1-negative, 5-positive).
Results: Of the 37 eligible residents, 32 (86.5%) responded to the survey; 84.6% of PGY-3 residents, 83% of PGY-2, and 91.6% of PGY-1 residents participated. When asked to rate the newsletter’s impact on their general morale, the mean rating for all residents was 4.6 (range 2-5, standard deviation 0.64, median 4). PGY-3 residents’ mean rating was 4.7, PGY-2 mean was 4.5, and PGY-1 mean was 4.6. Residents were asked to rate the newsletter’s impact on their attitudes toward fellow residents; the mean rating for all residents was 4.7 (range 3-5, standard deviation 0.53, median 4). PGY-3 residents’ mean rating was 4.7, PGY-2 was 4.7, and PGY-1 was 4.6. When asked if they would be willing to contribute to the newsletter as part of a formal staff, 53% of residents responded “yes”; 27% of PGY-3, 60% of PGY-2, and 70% of PGY-1 answered “yes.” Residents were queried as to whether they would like more faculty oversight of the newsletter; no residents (0%) responded “yes.” 100% of residents (32/32) stated that they read the newsletter monthly.
Conclusion: In a relatively large Midwestern PGY-1-3 emergency medicine residency program, nearly all residents perceived a monthly residency newsletter as having a positive impact on their general morale and on their attitudes toward fellow residents. Most junior residents were interested in joining a formal newsletter staff, and residents unanimously expressed their interest in maintaining the independent format of the newsletter. While results will vary across programs, a residency newsletter may be a relatively inexpensive means of improving resident morale and positively impacting residents’ attitudes toward their colleagues.
Study Skills and Academic Performance among Second-Year Medical Students in Problem-Based Learning
Deborah A. Sleight, PhD and Brian E. Mavis, PhD
Office of Medical Education Research and Development
College of Human Medicine, Michigan State University
East Lansing, MI, USA
Abstract
Purpose: This research study highlights the relationship between study aid use and exam performance of second year medical students. It also discusses how students used study aids in preparing for PBL exams and whether students who used others’ study aids performed as well as students who created their own.
Methods: A questionnaire was distributed to second-year medical students after completion of their exam. The data from the questionnaire were linked to students’ examination scores and other academic indicators.
Results: The study habits were more similar than different when compared by exam performance. A majority of students used study aids as a memory aid or for review, but students who performed in the top third of the class were less likely to use them at all. Pre-existing differences related to academic achievement and study strategies were found when students at the top, middle and bottom of exam performance were compared.
Conclusions: A better understanding of the differences in study habits and study aid use in relation to examination performance can help in providing future students with appropriate academic support and advising.
Creating a New Paradigm for Premedical Undergraduate Studies: Physicians’ Perceptions of Subjects and Skills Critical for Success in Medical School and Practice
Christopher Duffrin, PhD, CHES, EMT-P*, Darlene Berryman, PhD, RD, LD†, Jennifer Shu, MD‡
*East Carolina University
†Ohio University
‡Dartmouth-Hitchcock Medical Center
Abstract:
Background/Purpose: The purpose of this study is to determine subjects and skills that are perceived by practicing physicians as essential for success in medical training and practice. Previous studies suggest that better premedical preparation for a future career as a physician may reduce the need for expanded study of non-clinical subjects and skills in the graduate medical curriculum.
Methods: The study was performed with a random sample of licensed physicians in Ohio (n=2,100), who were queried utilizing a survey instrument of 54 questions including demographics and perceptions on eight subjects and sixteen skills essential for success in medical school and practice. Completed surveys (n=356) were found to be representative of the national demographics of practicing physicians, including similar age, education, gender, type of practice, and specialty.
Results: Respondents indicated that the subjects of business, communications, and technology were rated as most important for physician success, while communications, natural sciences and technology were most important for students. Skills identified as most essential to both training and practice included the ability to utilize technology, being honest and truthful, ability to explore, self-educate and research, and ability to communicate orally.
Conclusions: The findings of the study support previous research and indicate that some students entering medical school may not have the breadth of study that practitioners identify as best preparing them for success as a student and practitioner.
Child Abuse Training, Comfort, and Knowledge Among Emergency Medicine, Family Medicine, and Pediatric Residents
Kurt W. Heisler, Suzanne P. Starling, Hailey Edwards, and James F. Paulson
Department of Pediatrics
Center for Pediatric Research
Children’s Hospital of The King’s Daughters
Eastern Virginia Medical School
Norfolk, VA, USA
Abstract:
Purpose: To assess the training, comfort, and knowledge related to the medical management of child abuse among emergency medicine, family medicine, and pediatric residents.
Method: In 2004, a 25-item survey was distributed to 274 pediatric, emergency medicine, and family medicine residents at two medical schools in Norfolk, Virginia and Dallas, Texas. Analyses focused on identifying differences in training, comfort, and knowledge by specialty and site, and identifying factors associated with greater knowledge and comfort.
Results: Pediatric residents reported receiving the most hours of instruction in child abuse during residency. Training experiences of family medicine residents differed significantly by site. Clinical and overall knowledge and comfort with handling exams correlated strongly with the number of abuse patients seen during residency. On both clinical and overall knowledge, family medicine residents performed significantly worse than pediatric and emergency medicine residents. Knowledge of genital anatomy and comfort with sexual abuse exams was poor among all specialties.
Conclusion: The results support the need for improvements in and a more systematic approach to residency training in child abuse.
Learning Skills of Professionalism: a Student-Led Professionalism Curriculum
Margaret Horlick, MD†, Deirdre Masterton, MD*, Adina Kalet, MD, MPH†
Department of Medicine†
New York University School of Medicine
New York, New York, USA
Department of Obstetrics and Gynecology*
Brown University School of Medicine
Providence, RI, USA
Abstract
Background: Medical schools must address the fact that students embarking on careers in medicine are idealistic but have a vague understanding of the values and characteristics that define medical professionalism. Traditionally, we have relied primarily on unsystematic role modeling and lectures or seminars on related topics to teach professionalism.
Methods: A committee of students and a faculty advisor created a curriculum, based on a needs assessment of the targeted learners, to raise students’ awareness of professional tenets and provide them with the skills to recognize and analyze conflicts between the values of professionalism and the daily pressures of medical school training. The student-run professionalism curriculum begins during medical school orientation and is followed by three student-facilitated case-based workshops over the next two years. All of the workshops involve small group discussions led by trained upperclass student facilitators. The workshops address the application of professional values to both the preclinical and clinical situations and prepare students for self-reflection, self-assessment and peer evaluation. We evaluated students’ satisfaction following each workshop and pre/post attitudes for the first workshop.
Results: Twenty five upper-class student facilitators were trained in the first year. Student attendance ranged from 80-100% of the class (N=160), the proportion of students who agreed or strongly agreed that the workshops were educationally useful ranged from 60-75% for each workshop. Certain student attitudes improved immediately after the first workshop. These workshops continue annually.
Conclusions: Students have been a driving force behind this curriculum, which is a model for professionalism education. It was accepted by students and, although somewhat controversial, created a level of awareness and discussion regarding professional behavior in medical school that had previously been absent.
Development of a Tool to Assess the Team Leadership Skills of Medical Residents
Jay D. Orlander, MD, MPH*, Joyce E. Wipf, MD†, Robert A. Lew, PhD‡
*Section of General Internal Medicine and Clinical Epidemiology
VA Boston Healthcare System, Boston Division,
Evans Department of Medicine
Boston University School of Medicine
Boston, MA, USA
†Section of General Internal Medicine
Seattle VA Puget Sound Health Care System
University of Washington School of Medicine
Seattle, WA, USA
‡MAVERIC, VA Boston Healthcare System
Boston Division
Boston University School of Public Health
Boston, MA, USA
Abstract
Purpose: To develop a tool to assess the team leadership skills of internal medicine residents.
Method: A 27-item pilot instrument developed by two authors was distributed to interns on ward and intensive care unit teams at the end of rotations from a single institution’s internal medicine residency program. These items were factor analyzed and reduced to a seven-item resident leadership scale (RLS). Validity of the instrument was assessed by comparing the rating on the RLS to scores on a validated measure of teaching skills provided at the same time and by the program director’s global rating of team leadership skill for each resident at the completion of data collection.
Results: The three principal components from the factor analysis explained 82 percent of the variance. By introspection we reduced the scale to the final 7-item RLS that had a Cronbach alpha reliability estimate of 0.95. 490 ratings on 134 individual residents were available for analysis. The RLS scores correlated highly with both the validated measure of teaching skill and the program director’s ratings.
Conclusion: The RLS has robust psychometric properties. It may provide a useful tool for a broader assessment of trainee skill if validated in other settings.
Scholarly Activities of Family Medicine Faculty: Results of a National Survey
Jose Hinojosa, MD*, Kristen L. Benè, MS†, Colleen Hickey, M2‡, Kim Marvel, PhD†
*Corpus Christi Family Practice Residency
†Fort Collins Family Medicine Residency Program
‡Case School of Medicine
Abstract:
Background and Objectives: This survey examined how family medicine residency programs define scholarly activity, the productivity of programs, and perceived barriers to scholarly work. Five types of residency programs are compared: university-based, community-based (unaffiliated, university-affiliated, university-administered), and military.
Methods: A 13 item web-based questionnaire was sent to all 455 U. S. family medicine residency programs. The survey solicited demographic information as well as program expectations of faculty, presence of a research coordinator/director, activities considered scholarly, productivity, and perceived barriers.
Results: A total of 177 surveys were completed for a response rate of 38%, similar to response rates of web-based surveys in the literature. 67.6% of programs encouraged, but did not require scholarly activity, and 44.5% indicated their program had no research coordinator/ director. University-based programs had the highest levels of productivity compared to other program types. Primary barriers to scholarly activity noted were lack of time (73/138, 53%) and lack of supportive infrastructure (37/138, 27%).
Conclusions: While interpretations are limited by the response rate of the survey, results provide an increased understanding of how programs define scholarly activity as well as reference points for faculty productivity. This information can help program directors when setting criteria for scholarly work.
Pre-precepting Residents on Matters of Importance for Today – The PROMPT Study
Stephen Elgert, MD MS
NH Dartmouth Family Practice Residency at Concord, NH
Abstract:
Context: Achieving the goals proposed in national screening guidelines for colon cancer is difficult, especially in a primary care residency. The major vehicle for teaching outpatient medicine is the precepting process. Preceptors use their influence to teach guideline principles. Unfortunately, most precepting occurs after the visit and lost opportunities occur frequently.
Objective: To test whether having preceptors discuss screening guidelines with residents prior to patient encounters (pre-precepting) could improve adherence to colon cancer prevention guidelines.
Design: Intervention trial: An historical control group of 100 randomly chosen patient charts were studied to see if United States Preventative Services Task Force (USPSTF) guidelines for colon cancer screening were achieved. Faculty then pre-precepted 100 randomly chosen eligible patients with residents. Discussion with the patient and/or orders for screening tests were calculated from the residents’ notes. A survey of all participants was also done to gauge acceptance.
Setting: A community health center for the medically underserved with approximately 13,000 patients. We limited our intervention to active patients over the age of 50.
Intervention: Preceptors selected eligible patients from resident appointment lists. USPSTF colon cancer screening guidelines were discussed prior to resident-patient encounters.
Outcome Measures: A review of the pre-precepted charts determined the documented rate of discussion and /or screening. A satisfaction survey of residents and faculty was used to determine acceptance.
Results: A statistically significant improvement was noted in the pre-precepted group as compared to the historical controls (p<0.05, X2 testing). Surveys of participants showed they accepted the new intervention.
Conclusions: Screening for colon cancer can be improved by pre-precepting. A pilot study for quality improvement via pre-precepting was well accepted by both faculty and residents. A multi-center blinded trial should be considered to further test this technique.
Grounded Theory in Medical Education Research
Mohsen Tavakol, PhD*, Sima Torabi, PhD† , Ali Akbar Zeinaloo, MD*
*Educational Development Centre,
Tehran University of Medical Science, Iran
†Ministry of Science, Research and Technology
Institute for Research, and Planning in Higher Education, Iran
Abstract: The grounded theory method provides a systematic way to generate theoretical constructs or concepts that illuminate psychosocial processes common to individual who have a similar experience of the phenomenon under investigation. There has been an increase in the number of published research reports that use the grounded theory method. However, there has been less medical education research, which is based on the grounded theory tradition. The purpose of this paper is to introduce basic tenants of qualitative research paradigm with specific reference to ground theory. The paper aims to encourage readers to think how they might possibly use the grounded theory method in medical education research and to apply such a method to their own areas of interest. The important features of a grounded theory as well as its implications for medical education research are explored. Data collection and analysis are also discussed. It seems to be reasonable to incorporate knowledge of this kind in medical education research.
Adapting an Effective Counseling Model from Patient-centered Care to Improve Motivation in Clinical Training Programs
Hisayuki Hamada MD, PhD* † , Dawn Martin, MSW, MEd, PhD candidate†, Helen P. Batty , MD, CCFP, MEd, FCFP †
*Department of Medical Education,
National Nagasaki Medical Center, Japan
† Department of Family and Community Medicine,
University of Toronto, Canada
Abstract: The value of establishing a patient-centered relationship within the context of the clinical encounter is well documented. The learner-centered method of medical education parallels the patient-centered clinical method; therefore, it should be explored as a method for teaching in the context of the learning encounter. In Japan and other Asian countries, rotations through services not related to the learner’s chosen medical specialty are mandatory parts of the medical internship. Participation and effort in these rotations are often met with resistance from learners and are a common problem for medical educators. We adapted the counseling method for patients based on patient-centered methods such as motivational interviewing and solution-focused therapy to address this common problem.
We show one case of a medical resident who lost his motivation to learn during his training. A resident has many kinds of mental and physical stress. One such problem arises from the gap between what they want to do and what they have to do. Strategies from motivational interviewing and solution-focused therapy were adapted to successfully resolve a common teaching problem in Japan. A physician teacher (preceptor) helped this resident solve the issue for himself instead of arguing in favor of change. The positive aspects of the counseling method were based on patient-centered medicine and proved useful and effective in counseling for medical residents. We may take the lessons learned from using patient-centered counseling methods to further develop a clear and systematic process of counseling methods for residents to conduct learner-centered medical education.
Learning Activities and Third-Year Medical Student Ratings of High Quality Teaching Across Different Clerkships
Dario M. Torre, MD, MPH*, Deborah Simpson, Ph.D†‡, D. Bower MD†, P. Redlich MD§, P. Palma-Sisto, MD||, Michael R. Lund, MD¶, James L. Sebastian, MD*
*Department of Internal Medicine
†Department of Family Medicine
‡Department of Office of Educational Services
§Department of Surgery
||Department of Pediatrics
¶Department of Obstetrics/Gynecology
Medical College of Wisconsin and the Clement J. Zablocki Veterans Affairs Medical Center
Milwaukee, Wisconsin
Abstract
Objective: To identify and compare learning activities that students associate with high quality teaching across clerkships.
Methods: For six months, 110 third year medical students recorded data on learning activities and teaching quality using personal digital assistants (PDAs) during five different required clinical clerkships. Univariate and multivariate analyses were performed to assess the association between learning activities and student ratings of high teaching quality.
Results: 11,450 teaching interactions were recorded. Univariate analysis revealed that feedback was associated with perceptions of high quality teaching in all clerkships. Proposing a plan, formulating an assessment and giving an oral case presentation were associated with high quality teaching in 80% of the clerkships (p<0.01). Multivariate analysis demonstrated that receiving high quality feedback was an independent predictor of student ratings of high quality teaching for all clerkships.
Conclusion: Receiving high quality feedback is the learning activity most strongly associated with students’ ratings of high quality teaching across four different clerkships.
Inner City Community Oriented Primary Care to Improve Medical Student Skills and Combat Obesity
José E. Rodríguez, MD*; Alice B. Fornari, EdD, RD†
*Department of Family Medicine and Rural Health
Florida State University College of Medicine
Tallahassee, Florida
†Department of Family Medicine and Social Medicine
Albert Einstein College of Medicine
Bronx, New York
Abstract:
Background: Efforts to increase medical student knowledge regarding obesity are needed in medical school curriculum. This article examines a third year medical student intervention utilizing obesity group visits.
Description In our third-year family medicine clerkship, we implemented the Health not Cosmetics pilot :intervention as part of a Community Oriented Primary Care experience. The intervention consisted of weekly group visits run by third and fourth year medical students to teach lifestyle modification. To evaluate the intervention, medical students filled out an anonymous departmental evaluation form and patients were surveyed using a short questionnaire during a group visit.
Evaluation: Medical students rated the intervention as meeting or exceeding expectations and as improving Community Oriented Primary Care skills, especially in the following areas: identifying community needs, participating in an intervention, collecting data and presenting results. Patients adopted more active lifestyles and healthier eating habits.
Conclusion: This intervention was well received by medical students and patients.
A Graduate Medical Education Initiative to Promote Professional Excellence Among Residency Program Coordinators
Ann D. Norwood, BS*, Elizabeth K. Hicks, BA†, Carol R. Thrush, EdD†, Majka B. Woods, PhD†, and James A. Clardy, MD*
*Graduate Medical Education, College of Medicine
University of Arkansas for Medical Sciences
Little Rock, Arkansas, USA
†Office of Educational Development
University of Arkansas for Medical Sciences
Little Rock, Arkansas, USA
Abstract:
Background: The authors describe the scope and impact of a professional development program for residency and fellowship program coordinators (PCs) at the University of Arkansas for Medical Sciences (UAMS) College of Medicine. PCs are vital in the success of their residency programs, yet few articles to date have addressed their increasingly complex roles.
Purpose: This exploratory study examines PCs’ professional characteristics, perceptions that influence professional development meeting attendance, and the impact of the Program Coordinators’ Organization (PCO).
Methods: All 44 PCs serving 53 residency and fellowship programs at UAMS were surveyed about their perceptions of the PCO in January 2006.
Results: The majority of respondents agreed that the PCO has improved their abilities and interactions with their supervisors, colleagues, and residents and that the PCO has made an institution-wide impact on residency education.
Conclusions: Sponsoring a PCO may be an effective tool for organizations to enhance the role of PCs and their graduate medical education programs.