Medical Education Online™Manuscripts organized by VolumeVolume 12, 2007 |
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Using Bedside Rounds to Teach Communication Skills in the Internal Medicine Clerkship
Regina Janicik, MD; Adina L. Kalet, MD, MPH; Mark D. Schwartz, MD; Sondra Zabar, MD; Mack Lipkin, MD
Section of Primary Care
Division of General Internal Medicine
Department of Medicine, New York
University School of Medicine
Abstract:
Background: Physicians’ communication skills, which are linked to important patient outcomes, are rarely explicitly taught during the clinical years of medical school. This paper describes the development, implementation, and evaluation of a communication skills curriculum during the third-year Internal Medicine Clerkship.
Methods: In four two-hour structured bedside rounds with trained Internal Medicine faculty facilitators, students learned core communication skills in the context of common challenging clinical situations. In an end-of-clerkship survey students evaluated the curriculum’s educational effectiveness.
Results: Over the course of a year, 160 third-year students and 15 faculty participated. Of the 75/160 (47%) of students who completed the post-clerkship survey, almost all reported improvement in their communication skills and their ability to deal with specific communication challenges.
Conclusions: The curriculum appears to be a successful way to reinforce core communication skills and practice common challenging situations students encounter during the Internal Medicine Clerkship.
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Student Course Evaluations: Common Themes across Courses and Years
Mark Sadoski, PhD,†§ Charles W. Sanders, MD§
†Texas A&M University
§Texas A&M University Health Science Center
Abstract - Student course evaluations were analyzed for common themes across five different basic science, clinical, and innovative courses from the first and third years of medical school. Each course had both unique and common numerically scaled items including an overall quality rating item. A principal components analysis was conducted for each course to determine the items that loaded most heavily on the same component as the overall quality item. Across courses and years, the items that consistently loaded on the same component as the overall quality item were (1) administrative aspects including course organization, (2) clearly communicated goals and objectives, and (3) instructional staff responsiveness. These results concur with recent medical education literature in this area. Faculty interested in increasing student ratings of the overall quality of their courses might best attend primarily to carefully organizing course goals and objectives and clearly communicating them. The limitations of these conclusions are discussed.
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Wellness and Impairment Content in Schools of Medicine Curricula in the United States and Canada
Shannon B. Moss, PhD,† Patrick O. Smith, PhD§
†Baylor Family Medicine Residency at Garland
§University of Mississippi Medical Center
Abstract - Medical students experience numerous stressors, ranging from academic demands to financial strain. These stressors contribute to medical students having a substantial incidence of psychological problems, substance abuse, and seeking of mental health treatment. Left untreated, these problems can result in dysfunctional habit development and subsequent professional impairment. Research has demonstrated the benefits of wellness-impairment educational programs in medical education, but it is unknown to what degree the topics of wellness and impairment are included in medical school curricula. To assess this, a 13-item survey instrument was sent to associate deans in 142 schools of allopathic medicine; 71 (50.0%) responded. The majority of respondents reported that physician impairment (95.8%) and wellness (77.5%) are addressed in their school of medicine curricula, although the degree to which these topics were included varied. Access to other health-promoting resources on campus was also assessed and is discussed. Results suggested that there is a disparity between primary and secondary prevention approaches on school of medicine campuses. Implications for curricula and directions for future research are discussed.
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Prescribing of Controlled Substances for Non-Patients in the Educational Setting: Review of the Ethical, Legal, and Moral Dilemma for Residents
Ari Halldorsson, M.D.
Department of Surgery
Texas Tech University Health Sciences Center
Lubbock, Texas, USA
Abstract: Prescription drug abuse is an enormous problem in modern society. Studies have shown that it results in more injuries and deaths to Americans than all illegal drugs combined.1
In this review, the author discusses the prescribing of controlled substances by residents as it relates to intercollegial and other non-patient workplace encounters. Physician drug abuse, medical/legal issues regarding controlled substance prescriptions, and ethical conflicts will be discussed. These issues will be specifically addressed as they relate to the academic institutions where residents can potentially be placed in a moral, ethical and legal dilemma by supervisors and co-workers.
Finally, a recommendation for an institutional policy will be suggested to help residents and other physicians recognize and deal with drug seeking behavior by coworkers. Also, a recommendation regarding strict institutional regulation of resident prescription practices regarding controlled substances will be presented.
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Integrating Emerging Infections Education into Medical Education: An Innovative Approach
Larissa May, MD* Rodney Omron, MD, MPH* Marsha Piller, MS, MPH† Tenagne Haile-Mariam, MD* James Scott, MD*
*Department of Emergency Medicine
†Student, School of Medicine
The George Washington University
Washington, DC, USA
Abstract
Introduction: All graduating physicians should be competent with the basic principles of contagious disease outbreak detection and management. In order to educate our students and residents on this important topic, we created a three-hour workshop that included a case-based simulation exercise, and we offered a two-week medical student course in Emerging Infections and Bioterrorism.
Methods: Twenty-two emergency medicine residents and sixty-four senior medical students rotating in the emergency department of an urban university tertiary referral center participated in a three-hour workshop between July 2005 and April 2006. Pre- and post- workshop surveys given immediately before and immediately following each session were used to determine participant satisfaction and self-reported knowledge and confidence in outbreak response. In March 2006 we offered a medical student elective course in Emerging Infections and Bioterrorism. Thirteen fourth-year medical students from a variety of specialties attended the two-week course. The course focused on selected topics in emerging and re-emerging infections and addressed general principles of infection control and biological disaster planning for healthcare facilities. A survey was given to all graduating fourth-year medical students in 2005 and 2006, before and after creation of the didactic course, to evaluate their comfort and perceived knowledge of outbreak detection and containment.
Results: Overall, both students who participated in the workshop and those who participated in the didactic course (with or without the workshop) showed improvement in self-reported knowledge of outbreak detection and management, although the effect was statistically significant only for those participating in the didactic course. Due to the small numbers of emergency medicine residents who completed the surveys, we cannot comment on the effectiveness of the resident workshop, although there was a trend toward improved self-reported knowledge after the workshop. Students pursuing internal medicine, pediatrics, emergency medicine, and ENT were most likely to report that outbreak education was very important. Nearly all participants felt outbreak preparedness was not covered in existing curricula, and 92% thought the workshop was beneficial.
Conclusions: Most participants felt that outbreak preparedness was not adequately addressed in their curricula and almost all wanted more instruction. In addition, the didactic course and workshop improved self-reported student knowledge of the basic principles of contagious disease outbreak detection and management. Based on the results of our study, we propose integration of a three-hour simulation-based workshop with other instructional endeavors in emerging infections and biopreparedness into medical education curricula. We recommend the offering of a more comprehensive course for those pursuing emergency medicine and the primary care specialties, as they will be the most likely to encounter an outbreak. A web-based course may be a desirable alternative for institutions that could not otherwise add this training to their curriculum due to logistical reasons or time constraints. Further research is needed to determine the feasibility and effectiveness of these educational strategies.
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Attitudes, Practice and Educational Preferences Towards Evidence-Based Medicine among Physicians in a Large Teaching Hospital
Zubair Amin, Marion Aw, Ross Soo, Shirley Ooi, Pary Sivaraman, Yeo Jin Fei, Edwin Chan, Lim Seng Gee
Evidence-Based Medicine Committee
National University Hospital
Singapore
Yong Loo Lin School of Medicine
National University of Singapore
Abstract - Evidence-based medicine (EBM) is an emerging must-know topic for today’s physicians. The present literature is inadequate in identifying the attitudes, practice, and educational needs and preferred interventions of EBM. The objectives of this survey were to identify a) the attitude toward and practice of EBM among physicians, b) perceived benefits of EBM in daily practice, c) barriers to EBM practice, and d) preferred educational interventions.
Methods: This was a questionnaire-based cross-sectional survey of physicians in a single large teaching hospital.
Results: Overall, 56% of the physician respondents described the attitude towards EBM in their institution as positive. A similar number of physicians also reported the attitude of their colleagues towards EBM as favourable. 67% of the physicians believed EBM was useful in daily management of patients. In contrast, only 45% of the physicians actually practiced EBM in their daily patient management. The factors that discouraged them from actual practice include a lack of time, lack of exposure to EBM during their undergraduate curriculum, lack of endorsement, and fear of criticism by seniors. Physicians preferred less time consuming and less rigorous educational interventions such as clinical practice guidelines, journal club, and case review and discussion for teaching and learning EBM.
Interpretation: There are disconnects between belief and actual practice and between preferred and ideal educational interventions of EBM among physicians surveyed.
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Personality Profiles of Incoming Male and Female Medical Students: Results of a Multi-Site 9-Year Study
Scott S. Meit, PsyD,* Nicole J. Borges, PhD,† and Larry A. Early, PhD‡
*Cleveland Clinic Foundation
Department of Psychiatry & Psychology
Cleveland, OH, USA
†Boonshoft School of Medicine Wright State University
Department of Community Health
Dayton, OH, USA
‡Northeastern Ohio Universities College of Medicine
Department of Behavioral Science
Rootstown, OH
Abstract:
Purpose: This study conveys findings of a 9-year multi-site study of personality traits among incoming medical students. The purpose of the study was twofold. First, it assessed gender differences by exploring personality traits of incoming male and female medical students. Second, it sought to illuminate personality factors associated with those who choose a career in medicine by comparing personality characteristics of medical students to those of the general population. Methods: The Sixteen Personality Factor Questionnaire (16PF) was administered at four medical schools to two thousand one hundred seventy seven first-year medical students (1021 females; 1156 males). Results: Study findings revealed significant personality differences between male and female medical students on 11 of 16 personality factors as well as substantial differences in personality functioning between medical students and the general population. Findings are described and future directions for analyses are presented.
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Pre-Clinical Medical Students’ Exposure to and Attitudes Toward Pharmaceutical Industry Marketing
Eric H. Fein, BA*, Michelle L. Vermillion, BA†, Sebastian H.J. Uijtdehaage, PhD‡
*Rising MS 3
Office of Student Affairs
†Staff Research Associate
Center for Education Development and Research
‡Adjunct Associate Professor of Medicine
Director of Research
Center for Education Development and Research
David Geffen School of Medicine at UCLA
Abstract
Background - Recent studies have examined the exposures and attitudes of physicians and third- and fourth-year medical students toward pharmaceutical industry marketing, but fewer studies have addressed these topics among pre-clinical medical students. Thus, the purpose of this study was to assess pre-clinical students’ level of exposure to the pharmaceutical industry and their attitudes toward marketing.
Method - First and second-year medical students at UCLA completed a 40-item survey based on previous studies.
Results - Over three quarters of pre-clinical students (78.5% or 226 of 288) responded to the survey. Exposure to pharmaceutical industry marketing started very early in medical school. Most second-year students (77%) had received gifts including drug samples after three semesters. Most felt that this would not affect their future prescribing behavior.
Conclusions - These findings and findings from related studies, coupled with the students’ desire to learn more about the issue, suggest that an early educational intervention addressing this topic may be warranted in American medical schools.
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Design and Implementation of a Video-based Clinical Examination
Connie A Valdez, PharmD, MSEd, Susan Paulsen, PharmD
Department of Clinical Pharmacy
University of Colorado at Denver and Health Sciences Center
Denver, Colorado, USA
Abstract
Objectives: To (1) describe the development of a Video-based Clinical Examination (VCE) as a formal testing format to evaluate student ability to make an accurate pharmaceutical assessment and recommendation, and (2) determine student perception of the VCE testing format.
Methods: Descriptive study of first-year pharmacy students.
Results: One hundred and twenty-nine students were included in the study. Students perceived that the VCE testing format provided a real life/interactive environment but felt rushed as the video segments of the patient/pharmacist interaction occurred quickly.
Implications: Based on the findings of this project, we will continue to pursue further research related to validity, reliability and application of VCEs. However, the University of Colorado will continue to incorporate VCEs in the performance based evaluations in the Professional Skills Development 1 course, as it appears to be an effective stepping-stone for first-year students to begin developing their active listening, higher level learning and problem-solving skills. Results of this project will be shared with the faculty and curriculum committee at the University of Colorado School of Pharmacy to encourage further use and research of VCEs in other courses.
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A study of Two Clinical Performance Scores: Assessing the Psychometric Characteristics of a Combined Score Derived from Clinical Evaluation Forms and OSCEs
Clarence D. Kreiter, PhD*, George R. Bergus, MD, MA(Ed)†
*Office of Consultation and Research in Medical Education, Department of Family Medicine
†Department of Family Medicine, Performance Based Assessment Program, Office of Student Affairs and Curriculum
Carver College of Medicine, The University of Iowa
Iowa City, Iowa, USA
Abstract:
Background/Purpose - It is important to improve the quality of clinical skill assessments. In addition to using the OSCE, the clinical skills of medical students are assessed with clinical evaluation forms (CEFs). The purpose of this study is to examine the psychometric characteristics of an OSCE/CEF composite score.
Methods - This study included 2 medical student classes from a large medical school. Students completed approximately 12 OSCEs and were rated over 33 times on a CEF. The reliability of the CEF and OSCE were estimated. A correlation between the mean OSCE score and the mean CEF was calculated and corrected for attenuation. Classical methods were used to examine composite score reliability.
Results - For both classes there was a statistically significant correlation between the CEF and OSCE (r = .27 & .42, p = .003 & .0001). The disattenuated correlations were .44 and .68. Weighting the OSCE in the composite score as high as .4 was associated with only a small decrease in composite reliability.
Conclusion - These results demonstrate that assessment information based on simulated and actual patient encounters can be combined into a composite. Since a composite score may provide a more valid measure of clinical performance, this study supports using a combined CEF and OSCE measure.
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Complementary and Alternative Medicine: Perceptions of Medical Students from Pakistan
Kashif Majeed†, Hussain Mahmud†, Hussain Raza Khawaja†, Saba Mansoor†, Sana Masood†, Farhad Khimani*
* Department of Medicine, Aga Khan University Hospital, Karachi, 74800, Pakistan.
† The Medical College, Aga Khan University, Karachi, 74800, Pakistan.
Abstract:
Background: In view of the increasing popularity of complementary and alternative medicine (CAM), it is imperative that medical students, the health professionals of tomorrow, possess adequate knowledge on the topic.
Objectives: This is a descriptive study designed to assess the knowledge, attitudes and behavior of medical students about CAM and to capture their perceptions and opinions about its integration into the medical curriculum.
Methods: A questionnaire-based cross-sectional survey was done on 198 medical students selected randomly from a Pakistani medical college. Associations between different variables were tested using the χ2-test of significance.
Results: Among the 198 participants, a majority believed that some of the CAM modalities are useful; they lacked knowledge, however, about their safety and efficacy. Most of the students believed that it should be used in conjunction with conventional medicine and that, if given adequate training, they would incorporate it in their future medical practice. One-third of the respondents voted in favor of incorporation of CAM into the medical curriculum.
Conclusion: Despite being aware of the usefulness of CAM only a few medical students had pursued further knowledge. In order to prepare the medical students of today to better fulfill their duties as tomorrow’s physicians, consideration should be given to incorporating CAM in the medical curriculum.
Acknowledgement: All the authors have equal contributions in the study design, data collection, data analyses and paper writing.
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Katherine A. Julian, MD*, Patricia S. O’Sullivan, PhD*, Margo H. Vener, MD†, and Maria A. Wamsley, MD*
*Department of Internal Medicine
†Department of Family and Community Medicine
University of California, San Francisco
San Francisco, California
Abstract
Background: Residents have primary responsibility for teaching medical students, yet many receive no formal teaching instruction. This study evaluated the impact of a longitudinal multidisciplinary
teaching curriculum on resident participants’ self-perceived teaching skills.
Methods: Residents received instruction on teaching and leadership skills during a four-month longitudinal teaching course. Participants completed a validated pre-post self-assessment inventory
for teaching and a teaching self-efficacy survey.
Results: Participants’ self-rated teaching skills significantly increased in all categories of the self-assessment inventory for teaching. Self-efficacy survey results revealed statistically significant increased participant confidence in all teaching skills. Residents were very satisfied with course content.
Conclusion: Residents are eager to improve their teaching skills and benefit from a multidisciplinary
learning group. A successful teaching curriculum increases resident interest in teaching and impacts self-efficacy and self-assessed teaching skills.
Keywords: Internship and residency, teaching, curriculum.
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