Teaching Physicians Procedural Skills at a National Professional Meeting
Patrick C. Alguire, MD
Director of Education and
Career Development
American College of Physicians
Philadelphia, PA
Abstract: Background: Practicing physicians often wish to improve their
procedural skills but have limited educational opportunities to do so.
Description: To summarize the effects of two procedural
workshops on participants’ confidence, proficiency, and practice
patterns.
Evaluation: Following completion of a skin biopsy or
arthrocentesis workshop, participants completed a post-course and an 8-month
follow up evaluation. Recipients of this training rated it highly and
reported that following training they performed more procedures, referred
less, and noted an increase in their confidence that was still evident
eight months after the workshop.
Conclusion: Skin biopsy and arthrocentesis/joint injection
skills can be taught to practicing physicians in a workshop setting at
national professional meetings. Key Words: clinical competence; internal
medicine; teaching; educational measurement
HTML (Browser) version of the article
PDF version of the article.
Making the Most of Medical Orientation – A New Approach
Dr Jonathan Taitz, FRACP* Dr Michael Brydon, FRACP, Mr Damian Duffy†
*Sydney
Children’s Hospital,
High Street, Randwick,
Sydney, Australia
†Children’s
and Women’s Health Centre of British Columbia,
Oak Street,
Vancouver, Canada.
Abstract: Orientating new junior medical staff can be a complex and time consuming task. Traditional models have typically involved a day or longer of lectures. This involves a large number of senior staff being available on the first day of term. It also means that junior staff not present on the first day had any access to an orientation program at all. Evaluation of our program confirmed the belief that the day was dull and that there was simply too much information for new staff to absorb. As a result of this feedback we extensively updated our orientation program. Pre-reading of the junior staff manual became compulsory. We departed from the traditional lecture style program and devised a new ten- station scenario based interactive program. The stations were designed to cover aspects of the hospital’s mandatory education and key educational requirements in order to function effectively on our campus. Station leaders were selected and trained in the goals of the new process. Several of our secondment sites were engaged in the development of the project topics. We hoped that our secondment sites would be relieved of some orientation responsibility if core material was delivered centrally.
The strength of the new orientation is that it is portable, reproducible and uniform. It is also available via video conferencing. A single person can educate new staff in three hours if the need arises. Most importantly all new staff will have access to the program within a week of starting a term at our hospital.
HTML (Browser) version of the article
PDF version of the article.
Holly Cronau, MD, Danell J. Haines, PhD
Department of
Family Medicine
The Ohio State University
Abstract: Background and Objectives. The number of US allopathic medical
school graduates choosing a residency in family medicine has fallen from
13.4% in 1999 to 10.5% in 2002. Concern about declining numbers has led
to the development of programs to provide medical students exposure to
family medicine outside the clerkship. This paper reports on the development
and longitudinal achievements of a clinical summer externship program
1993 to 1999.
Methods. The program description, practice settings,
students’ experiences, and department commitment are described.
The purpose of this prospective study is to determine the percentage of
family medicine summer externship participants (n=115) who match into
family medicine.
Results. During the six years studied, 49 (43.4%) of
the participants matched into family medicine. Program participants viewed
the program favorably, mean = 5.82 out of 6.
Conclusions. The Ohio State University Department of
Family Medicine Medical Student Summer Externship Program demonstrates
an effective educational experience that can increase and/or attain the
proportion of students going into family medicine at the time of graduation.
HTML (Browser) version of the article
PDF version of the article
Adolfo Peña, MD, Ofelia Paco, MD
San Marcos National University. Lima-Peru.
Abstract: Objectives: To know opinions, attitudes and interest of medical students toward science
and pseudoscience.
Design: A questionnaire was administered to 124 medical students of the
San Marcos University in Lima, Peru.
Results: 173 students were surveyed. The response rate
was 72%. Eighty-three percent (100/121) of respondents said that science
is the best source of knowledge, 67% (82/123) said they were interested
in science and technology news, 76% said they had not read any science
magazine or book (other than medical texts and journals) in the last five
years. Thirteen percent (16/124) of respondents said that astrology is
“very scientific” and 40% (50/124) stated that it is “sort
of scientific.” 50% of respondents shared the opinion that some
people possess psychic powers.
Conclusions: Medical students' attitudes toward science
are generally not favorable.
HTML (Browser) version of the article
PDF version of the article
Development, Implementation and Evaluation of an M3 Community Health Curriculum
Barbra Beck, PhD, Marie Wolff
PhD, Tovah Bates, PhD, Sarah Beverdorf, MPH/MSW,
Staci Young, MS and Syed Ahmed, MD, MPH, DrPH
Center for Healthy Communities
Department of Family and Community Medicine
Medical College of Wisconsin
Abstract: Objectives: This paper describes the development, implementation
and evaluation of an M3 community health curriculum that responds to recent
changes within the health care finance and delivery system.
Methods: The new curriculum was developed based on AAMC
recommendations, LCME requirements, a national review of undergraduate
community health curricula, and an internal review of the integration
of community health concepts in M3 clerkships.
Results: The M3 curriculum teaches: 1) the importance
of being a community responsive physician; 2) SES factors that influence
health; 3) cultural competency; and 4) the role of physicians as health
educators. Student evaluations for the first twelve months of implementation
indicate that students are most satisfied with presentations and less
satisfied with required readings and a patient interview project.
Discussion: Most students agree that at the completion
of the course they understand what it means to be a community-responsive
physician, and they have developed skills to help them become more community
responsive. Evaluation tools need to be developed to assess if students’
behavior has changed due to course participation
HTML (Browser) version of the article
PDF version of the article
Academic Support Services in U.S. and Canadian Medical Schools
Norma S. Saks, EdD*, Sarah Karl, PhD†
*Assistant Dean
for Educational Programs
UMDNJ-Robert Wood Johnson Medical School
†Director, Office of Academic Development
UMDNJ - New Jersey Medical School
Abstract:
Background: Academic support services play a critical but largely
undocumented role in helping medical students meet the challenges of the
curriculum.
Purpose: To determine the prevalence of academic support programs in medical
schools,
and to find out how these are conceptualized and implemented.
Methods: Questionnaires were sent to medical schools
in the US and Canada. Questions addressed specific services, providers,
and funding.
Results: The survey was returned by 86 of the 135 (67.7%)
schools. Almost all (95.3%) provide academic support in the first two
years, and a large majority in third (82.6%) and fourth (79%) year. Great
variability exists in the infrastructure and funding of the programs,
and in the training of the providers.
Conclusions: Academic support is common, but has broad
interpretation; services are varied. Programs are conceptualized differently,
some to provide specific assistance to pass courses, and others for skill
development, to enhance self-directed, life-long learning.
HTML (Browser) version of the article
PDF version of the article
The Value of the Subinternship: A Survey of Fourth Year Medical Students
Eric H. Green†, MD MSc, Warren Hershman†, MD MPH; Suzanne Sarfaty†,‡, MD MPH
†Section
of General Internal Medicine,
Evans Department of Medicine and
‡Office of Student Affairs,
Boston University School of Medicine
Boston, MA
Abstract: Background: Although the subinternship is often regarded as an
important part of many fourth year curricula it is rarely studied.
Purpose: We aimed to understand the how well the subinternship
prepared medical students to perform core clinical skills.
Methods: Senior medical students at Boston University
School of Medicine rated their perception of the effectiveness of the
subinternship and “medical school overall” in preparing them
to perform core clinical skills using a written survey.
Results: Overall, 69% (101) of students responded. Students
believe that the subinternship prepares them to perform most key skills
involved in day-to-day medical care. However, students feel less prepared
by either their subinternship or overall medical school experience to
carry out some complex patient communication skills including delivering
“bad news” and discussing end-of-life wishes.
Conclusions: The subinternship appears to be effective
in preparing students for many of the challenges they will face as an
intern and beyond. However, students identified several complex communication
skills that could be addressed in part by the subinternship for which
they felt unprepared. Student learning would likely be enhanced by creating
a longitudinal program to teach these higher-level communication skills
during medical school and by integrating practice and feedback of these
skills into the subinternship.
HTML (Browser) version of the article
PDF version of the article
An Evaluation on Medical Students' Satisfaction with Clinical Education and its Effective Factors
Vahid Ziaee*, Zahra Ahmadinejad†, Ali Reza Morravedji‡
*Department of
Pediatrics Diseases
†Department of Infectious Diseases
‡General Physician
Tehran University of Medical Sciences
Abstract: Purpose: To evaluate medical students' satisfaction with clinical
education during medical internship and the effects of variables in the
organizational domain on satisfaction.
Method: A cross-sectional descriptive analytic study
in 2000 identified students' satisfaction with clinical education in medical
students of Tehran University of Medical Sciences. Students' satisfaction
was assessed by a modified job satisfaction questionnaire. Clinical education
was classified into; outpatient, bedside and theoretical teaching.
Results: Overall satisfaction with clinical education
was 38.8%; outpatient and bedside teaching 52% each and theoretical education
70.8%. Overall satisfaction had a significant association with approach
to common and epidemic diseases, class size, and the course planning.
Conclusion: Based on the present study, we conclude that
clinical education should be reevaluated in our university with the specific
attention to the class size, variety of diseases and course planning considered
for each session in clinical education.
HTML (Browser) version of the article
PDF version of the article
Psychological Variables for Identifying Susceptibility to Mental Disorders in Medical
Students at the University of Barcelona
Rosa Sender*, Manel Salamero*†, Antoni Vallés‡, Manuel Valdés*†
*Dept. of Psychiatry
and Clinical Psychobiology, University of Barcelona, Spain
†Institut Clínic of Psychiatry and Psychology,
IDIBAPS, Hospital Clínic of Barcelona
‡Dept. of Public Health, University of Barcelona
Abstract Introduction: This study analyses some psychological variables
related to susceptibility to mental disorders in medical students.
Methods: A sample of 209 first- and second-year medical
students was evaluated using the State and Trait Anxiety Inventory (STAI),
and three questionnaires: Sensitivity to Punishment and Sensitivity to
Reward Questionnaire (SPSRQ), General Health Questionnaire (GHQ-28) and
UNCAHS scale of STRAIN.
Results: Thirty percent of the students suffered from
emotional distress as measured by de GHQ-28, and showed significantly
higher scores on trait anxiety, sensitivity to punishment and reward scales,
and had higher levels of strain both in the academic environment and their
personal life. Women scored significantly higher than men on trait anxiety
and sensitivity to reward. Logistical regression found that trait anxiety
and strain in non-academic life were the best predictors of the development
of a mental disorder.
Conclusions: The study confirms the usefulness of the
STAI for detecting psychological distress and the validity of the SPSRQ
for identifying subjects likely to present emotional distress when facing
high environmental demands. Subjects most likely to present with mental
illness are those who evaluate their personal (non-academic) lives as
more stressful.
HTML (Browser) version of the article
PDF version of the article
Community
Health Care Reform and General Practice Training in China –
Lessons Learned
Liang Wannian, MD* and Daniel Kam Yin Chan, MD†
*Professor
Executive Director, National Training Centre for General Practice, Ministry
of Health
Capital University of Medical Sciences
Beijing, China
†Associate
Professor
University of New South Wales (School of Public Health & Community
Medicine)
Bankstown-Lidcombe Hospital
Bankstown, NSW 2200 Australia
Abstract: Vast changes have occurred in China in the last five years since the decision of the Chinese Government to reform its health system. Many district and community hospitals in the city have been converted into community health centers. The hospital-based doctors who used to work in these centers are being retrained to become general practitioners (GPs). The reform had encountered many problems. The community has not embraced the concept of general practice readily. Lack of fair remuneration and lack of recognition of the importance of the reform by bureaucrats of local government are other problems encountered. The Ministry of Health meanwhile has also introduced a system of retraining hospital-based doctors to become GPs. A medical education curriculum for GPs has been developed. A nationwide network of GP training centers is progressively being formed. The GP training program has also extended to under-graduate medical students. Despite the progress made, many difficulties remained especially in regional areas. The speed and quality of GP training in wealthy, developed places is better than poorer regional areas. The issuing of national license and registration examinations for GPs has not been synchronized with GP training, leading to uneven standard of GP practice. Staff morale is also poor due to the lack of chance for promotion and professional development. Although a number of strategies have been proposed to improve the situation, problems are enormous that China may welcome international collaboration.
HTML (Browser) version of the article
PDF version of the article
Virginia A. Reed, PhD,* G. Christian Jernstedt, PhD, * Thomas R. McCormick, DMin†
*The
Center for Educational Outcomes at Dartmouth,
The Department of Psychological & Brain Sciences, Dartmouth College,
and the
The Department of Community & Family Medicine Dartmouth Medical School
†University of Washington School of Medicine
Abstract:
Context: There is evidence of significant career dissatisfaction
among practicing physicians and those considering medicine as a profession.
Most research on career satisfaction has examined practicing physicians.
This study was undertaken to look at determinants of satisfaction in those
at the earliest stage of their medical careers – medical students.
Methods: As part of a larger study, students comprising
one class at the University of Washington School of Medicine were surveyed
three times over the course of their medical education. For the present
study we examined measures specifically related to determinants of career
satisfaction.
Findings: Over time, students’ sense of the importance
of most measured determinants of satisfaction showed significant change,
the majority of which were in the direction of decreased importance. However,
most of the change was relative. That is, factors that students considered
to be most important at the start of medical school continued to be most
important throughout the educational experience and those factors students
considered to be least important at Year 1 continued to be least important
at Years 2 and 4.
Discussion: These findings have implications for medical
education, a time when students are forming expectations that will impact
their career satisfaction. In addition to information on career satisfaction,
students should understand the professional values of medicine, their
own values and expectations, current practice patterns, economics, and
the role of advocacy.
HTML (Browser) version of the article
PDF version of the article
Determining Component Weights in a Communications Assessment Using Judgmental Policy Capturing
Leo M. Harvill, PhD, F. Forrest Lang, MD, Ronald S. McCord, MD (deceased)
Departments of Medical Education
and Family Medicine
James H. Quillen College of Medicine
East Tennessee State University
Abstract Objectives: Tools are needed for determining appropriate weights
for complex performance assessment components in medical education. The
feasibility of using judgmental policy capturing (JPC), a procedure to
statistically describe the information processing strategies of experts,
for this purpose was investigated.
Methods: Iterative JPC was used to determine appropriate
weighting for the six core communication skill scores from a communications
objective structured clinical examination (OSCE) for medical students
using a panel of four communication skill experts.
Results: The mean regression weights from the panel indicated
they placed less importance on information management (8.5%), moderate
and nearly equal importance on rapport building (15.8%), agenda setting
(15.4%), and addressing feelings (14.1%), and greater importance on active
listening (20.1%) and reaching common ground with the patient (25.5%).
Discussion: JPC is an effective procedure for determining
appropriate weights for complex clinical assessment components. The derived
weights may be very different for those assessment components.
HTML (Browser) version of the article
PDF version of the article
Pathways to “Involved Professionalism”: Making Processes of Professional Acculturation Intentional and Transparent
Debra Boyask*, Ruth Boyask†, Tim Wilkinson‡
*University of
the West of England
Frenchay Campus
Bristol, BS16 1QY, UK
†Cardiff
University,
Cardiff, CF10 3XQ, Wales, UK
‡Christchurch
School of Medicine & Health Sciences
Christchurch, New Zealand
Abstract-
Context - An increase in managerialism and a decrease in trust
of the professions have challenged traditional concepts of professionalism.
The market model of professionalism espoused by some critics also poses
problems for professions, professionals and recipients of professional
services. Professional development is now an important component of medical
curricula. We believe professionalism is evolving and suggest a concept
of involved professionalism as a framework for understanding the complex
relationships between professional practice, community and responsibility.
Purpose - The purpose of this article is to unpack and
compare varying concepts of professionalism, and examine how these concepts
can impact on the health care professions and on professional acculturation
of new recruits on entry to their medical work environment.
Summary - In a changing socio-political climate, traditional notions of
professionalism have met criticism in that the autonomy of a profession
can disempower the consumers of its service. In New Zealand and elsewhere,
market reformers have introduced business oriented decision making structures
accompanied by the rhetoric of consumer choice. This shift has constrained
the professional decision making ability of medical professionals.
Conclusion - We suggest that a further model of professionalism
is required to address the challenges of the need for community responsiveness,
collaboration, high quality health care and a hospitable professional
environment. 'Involved professionalism' ties together knowledge, individual
responsibility, collective responsibility and responsiveness to society.
It is offered as a framework for health practitioners, policy makers and
medical educators.
HTML (Browser) version of the article
PDF version of the article
Windsor Westbrook Sherrill, Ph.D., MBA
Assistant Professor
Department of Public Health Sciences
Clemson University
Clemson, South Carolina USA
Background: An increasing
number of medical schools are offering dual degree MD/MBA programs. Career
choices and factors influencing students to enter these programs provide
an indicator of the roles in which dual degree students will serve in
health care as well as the future of dual degree programs.
Purpose: Using career choice theory as a conceptual framework, career
goals and factors influencing decisions to enter dual degree programs
were assessed among dual degree medical students.
Methods: Students enrolled at dual degree programs at six medical schools
were surveyed and interviewed. A control group of traditional medical
students was also surveyed.
Results: Factors influencing students to seek both medical and business
training are varied but are often related to a desire for leadership opportunities,
concerns about change in medicine and job security and personal career
goals. Most students expect to combine clinical and administrative roles.
Conclusions: Students entering these programs do so for a variety of reasons
and plan diverse careers. These findings can provide guidance for program
development and recruitment for dual degree medical education programs
HTML (Browser) version of the article
PDF version of the article
Development and Validation of an Instrument to Measure Knowledge of Evidence-Based Practice and Searching Skills.
Peter Bradley†, Jeph Herrin‡
†Norwegian
Medicines Agency, Oslo, Norway
‡Flying Buttress Associates, Charlottesville, VA, USA
Abstract: The aim of this study was to develop and validate three instruments which measure knowledge about searching for and critically appraising scientific articles (evidence-based practice-EBP). Twenty-three questions were collected from previous studies and modified by an expert panel. These questions were then administered to 55 delegates before and after two international conferences in EBP; the responses were assessed for discriminative ability and internal consistency. Five questions were discarded and three instruments of six questions each were developed. Finally, the instruments were re-validated in a randomized controlled trial comparing two educational interventions at the University of Oslo, Norway by 166 of 175 eligible medical students. In the re-validation, the instruments showed satisfactory level of discriminate validity (p<0.05), but borderline levels of internal consistency (Cronbach’s a 0.52-0.61). More research is needed to develop a suitable instrument which includes questions on searching for evidence.
HTML (Browser) version of the article
PDF version of the article
Marja GH Nieuwhof*‡, Olle ThJ ten Cate, Paul Oosterveld*, Marc BM Soethout†
*University Medical
Center Utrecht, School of Medical Sciences
†VU University Medical Center Amsterdam, Department of
Public and Occupational health.
‡deceased
Abstract - Purpose. Students vary in their strength of motivation
to start and pursue medical training. This study was conducted to investigate
the psychometric properties of a Strength of Motivation for Medical School
(SMMS) questionnaire.
Method. The questionnaire was designed using an iterative
method. The instrument was applied to medical students (N= 296) at the
start of medical school and to potential applicants (N= 147). The stability
of the concept over a six month’s time and associations with other
motivation measures were studied. A separate group of potential applicants
and their parents (N= 169) were asked to validate the items of the questionnaire.
Results. Cronbach’s alpha reliability of .79 was
found. Test-retest reliability of SMMS-scores with a six months interval
was .71. Little to no association with specific dimensions of motivation
was found, except for a negative correlation with ‘ambivalence towards
studying’. SMMS-scores were associated with potential applicants’
plans to apply for medical school (Spearman’s rho .65) and differentially
with potential applicants’ and their parents’ judgements of
item validities (.13 to .57).
Conclusions. The SMMS-questionnaire appears to be a reliable
and valid instrument to measure strength of motivation for medical training
in students who have just entered medical school. It may be used to evaluate
the validity of selection procedures and to identify associated variables
that could be used in selection procedures.
HTML (Browser) version of the article
PDF version of the article
Medical Education and Curriculum Reform: Putting Reform Proposals in Context
Rick Iedema,
PhD*, Pieter Degeling, PhD†, Jeffrey Braithwaite,
PhD‡, Daniel Chan, MD, MB.BS, MHA**
*Centre for Clinical Governance Research in Health
School of Public Health and Community Medicine
University of New South Wales
Sydney, NSW, 2052, Australia
†Centre for
Clinical Management Improvement,
Wolfson Research Institute
University of Durham Stockton Campus
University Boulevard, Thornaby
Stockton on Tees TS17 6BH, U.K.
‡Centre for
Clinical Governance Research in Health
School of Public Health and Community Medicine
Faculty of Medicine
University of New South Wales
Sydney, NSW, 2052, Australia
**Bankstown-Lidcombe
Hospital
School of Public Health and Community Medicine
Faculty of Medicine
University of New South Wales
Sydney, NSW, 2052, Australia
Abstract: The purpose of this paper is to elaborate criteria by which the principles of curriculum reform can be judged. To this end, the paper presents an overview of standard critiques of medical education and examines the ways medical curriculum reforms have responded to these critiques. The paper then sets out our assessment of these curriculum reforms along three parameters: pedagogy, educational context, and knowledge status. Following on from this evaluation of recent curriculum reforms, the paper puts forward four criteria with which to gauge the adequacy medical curriculum reform. These criteria enable us to question the extent to which new curricula incorporate methods and approaches for ensuring that its substance: overcomes the traditional opposition between clinical and resource dimensions of care; emphasizes that the clinical work needs to be systematized in so far as that it feasible; promotes multi-disciplinary team work, and balances clinical autonomy with accountability to non-clinical stakeholders.
HTML (Browser) version of the article
PDF version of the article
The Efficacy of Standardized Patient Feedback in Clinical Teaching:
A Mixed Methods Analysis
Lisa Doyle Howley, PhD*, James Martindale, PhD†
*The University
of North Carolina at Charlotte
†The
University of Virginia
Abstract: Introduction.
The purpose of the current study was to investigate the effects of oral
feedback from standardized patients on medical students’ overall
perceptions of an educational exercise. We chose a mixed-methods approach
to better understand the following research questions: Does satisfaction
with the standardized patient exercise differ among those students who
receive oral feedback and those who do not? What is the quality of oral
feedback provided by standardized patients?
Procedures. In order to address the first question, a
basic randomized design comparing treatment (or those receiving SP feedback)
to control (those not receiving SP feedback) was conducted. To address
the second question, students in the treatment group were surveyed about
their impressions of the quality of the feedback provided to them by their
SP. One hundred and thirty six first year medical students were divided
into treatment and control groups and interviewed one standardized patient
during a single 20-minute encounter. Standardized patients were trained
to simulate one of two outpatient cases and provide feedback using standard
training materials. Both treatment and control groups completed a rating
scale and questionnaire regarding their satisfaction with the encounter
and students in the treatment group responded to additional questions
regarding the quality of the SP feedback.
Results. A one-way multivariate analysis of variance
(MANOVA) revealed significant differences among control and treatment
groups on the seven combined dependent variables, Wilks’ ?=.890,
F(7, 127)=2.25, p<.034, ?2=.110. Students reported that the quality
of SP feedback was very strong and additional qualitative analysis revealed
further evidence to support the efficacy of providing oral SP feedback
in a formative pre-clinical educational activity.
HTML (Browser) version of the article
PDF version of the article
*Hawthorn Lodge,
Moorgreen Hospital, West End,
Southampton, SO14 3ED
†McColl Clinic, Prudho Hospital, Prudho, UK
Abstract - High rates of mental illness, particularly depression have been reported in Pakistan. The health system is both under developed and poorly resourced. It is therefore not surprising that psychiatric training is at its very early stages, at both undergraduate and the postgraduate level. In order to look after the mentally ill patients radical changes need to be implemented in training of doctors. Medical curriculum needs to place more focus on psychiatry. This should not only help junior doctors in understanding the need for psychiatry, but will also prepare them for the challenges they will face as a General Practitioner or a Family Physician. Similarly, postgraduate training can be made more useful by placing more emphasis on community based and primary care psychiatry and psychotherapy; especially family interventions. The training needs to aim towards preparing psychiatrists who are not only clinicians, but can be agents of change in the society, through health education.
HTML (Browser) version of the article
PDF version of the article
Meldon Kahan, MD*,†,‡, Eleanor Liu,
MASc†, Diane Borsoi, MASc*,†, Lynn Wilson,
MD*,†,
Joan M. Brewster, PhD**, Mark B. Sobell, PhD††,
and Linda C. Sobell, PhD††
*Department
of Family Medicine, University of Toronto, Ontario, Canada
†Centre for Addiction and Mental Health, Ontario, Canada
‡Department of Family Medicine, St. Joseph’s Health
Centre, Ontario, Canada
**Department of Public Health Sciences, University of Toronto,
Ontario, Canada
††Center for Psychological Studies, Nova Southeastern
University, Fort Lauderdale, Florida, USA
Abstract - Background: Simulated patients are commonly used to evaluate
medical trainees. Unannounced simulated patients provide an accurate measure
of physician performance.
Purpose: To determine the effects of detection of SPs
on physician performance, and identify factors leading to detection.
Methods: Fixty-six family medicine residents were each
visited by two unannounced simulated patients presenting with alcohol-induced
hypertension or insomnia. Residents were then surveyed on their detection
of SPs.
Results: SPs were detected on 45 out of 104 visits. Inner
city clinics had higher detection rates than middle class clinics. Residents’
checklist and global rating scores were substantially higher on detected
than undetected visits, for both between-subject and within-subject comparisons.
The most common reasons for detection concerned SP demographics and behaviour;
the SP “did not act like a drinker” and was of a different
social class than the typical clinic patient.
Conclusions: Multi-clinic studies involving residents
experienced with SPs should ensure that the SP role and behavior conform
to physician expectations and the demographics of the clinic. SP station
testing does not accurately reflect physicians’ actual clinical
behavior and should not be relied on as the primary method of evaluation.
The study also suggests that physicians’ poor performance in identifying
and managing alcohol problems is not entirely due to lack of skill, as
they demonstrated greater clinical skills when they became aware that
they were being evaluated. Physicians’ clinical priorities, sense
of responsibility and other attitudinal determinants of their behavior
should be addressed when training physicians on the management of alcohol
problems.
HTML (Browser) version of the article
PDF version of the article
Linda
Snetselaar, Katherine Malville-Shipan, Lois Ahrens, Karen Smith, Cathy
Chenard,
Phyllis Stumbo, Joel Gordon, Alexandra Thomas
College of Public Health and
Department of Internal Medicine
College of Medicine
University of Iowa
Abstract: At the University of Iowa we devised a learning experience, called the Nutrition and Fitness Program, for third-year medical students. The program was designed to raise awareness of the role of nutrition and exercise in the prevention and treatment of disease. Students spent one afternoon learning about their personal health risk factors, such as body mass index, percent body fat, other anthropometric measures such as waist, hip and mid-arm circumference, blood lipids, bone-mass density, dietary analysis, and fitness assessment. Students spent another afternoon visiting the cardiac rehabilitation center. At the end of each rotation, students gathered for a heart-healthy meal that served as a focus for a discussion with dietitians about important nutrition issues.
The literature and our work with medical students support the need and acceptance of a personalized, practical approach to nutrition education. By offering medical students the opportunity to learn about their own nutrition and fitness risk factors, this Nutrition and Fitness Program appears to have played an important role in the students’ medical education by narrowing the gap between the “science of nutrition” and the “application of nutrition”. Students appreciated learning more about their own health factors and felt that personalizing the information made the learning more valuable and would help in counseling their future patients more effectively
HTML (Browser) version of the article
PDF version of the article
An Assessment of the Impact of Multimedia, Technology-Based Learning Tools on the Cardiac Auscultation Skills of Third-Year Medical Students
Dario M. Torre,
MD, MPH*‡, Kurt J. Pfeifer, MD*, Geoffrey
C. Lamb, MD*,
Matthew P. Walters **, James L. Sebastian, MD*‡,
Deborah E. Simpson, PhD†
*Department of
Medicine
Division of General Internal Medicine
Medical College of Wisconsin
†The Office
of Educational Services
Medical College of Wisconsin
‡Clement
J. Zablocki Veterans Affairs Medical Center
Milwaukee, Wisconsin
**Medical student
Medical College of Wisconsin
Abstract: Background: Previous studies have shown that medical
students and post-graduate trainees need to improve their proficiency
in cardiac auscultation. Technologic advances have created new learner-centered
opportunities to enhance proficiency in this important physical examination
skill.
Objectives: We sought to determine if technology-based,
self-directed learning tools improved the cardiac auscultation skills
of third-year medical students.
Methods: Sixteen (16) third-year medical (M3) students
were exposed to three educational interventions: a one-hour cardiac auscultation
lecture that featured computer-generated heart sounds, a PDA-based heart
sounds/murmur form and a web-based cardiac auscultation program. Thirteen
(13) internal medicine (IM) residents who served as a comparison group
attended a cardiac auscultation lecture identical in content and format
to the student lecture. At the end of the study period, we evaluated the
ability of both groups to accurately identify heart sounds and cardiac
murmurs via a twelve-item performance-based examination utilizing computer-generated
heart sounds.
Results: Following our teaching interventions, findingsM3
students correctly identified 80% of the computer-simulated heart sounds/murmurs
while the comparison group of IM residents accurately detected 60% of
the same cardiac findings (p <. 005). .
Conclusions: The combination of traditional lecture and
multi-media, technology-based, self-directed learning tools appears to
be an effective and efficient strategy for teaching and reinforcing cardiac
auscultation skills to third year medical students.
HTML (Browser) version of the article
PDF version of the article
Development and Evaluation of a Nutrition and Physical Activity Counseling Module for First-Year Medical Students
Pat F. Bass III,
MD, MS* Barbara A. Stetson, PhD†, William
Rising, PhD†,
Gina C. Wesley, PhD
*Louisiana State
University Health Science Center-Shreveport
†University of Louisville, Louisville, KY
‡University of Alabama, Birmingham
Abstract - Introduction: Few Americans follow recommendations
regarding nutrition or physical activity, and few physicians provide nutritional
counseling (NC) or physical activity counseling (PAC) to patients. Clinical,
systems-based, and institutional barriers to teaching and providing NC
and PAC exist, but theoretical models of behavior change and principles
of adult learning theory (ALT) can enable medical educators to overcome
these barriers.
Methods: We developed an educational intervention consisting
of interactive lectures and two standardized patient experiences to provide
first-year medical students with practical experience in PAC and NC. Students
completed pre and post educational assessments of attitudes, knowledge,
and self-efficacy with the counseling techniques.
Results: Knowledge scores increased from 6.1 to 8.5 (p<.001)
on a 13-item test. Self-confidence scores for NC increased from 45 to
78 (p<.001), and self-confidence scores for PAC increased from 51 to
82 (p<.001). While overall attitudes regarding the necessity and utility
of counseling with specific disease states were not different pre/ post
test (necessity pre/post 6.3 to 6.2 p= .71; utility pre/post 5.8 to 5.7
p=.88), necessity and utility scores for disease states treated primarily
with counseling were different compared to disease states students perceive
to be primarily pharmacologically treated (counseling vs. pharmacological
necessity 5.9 vs. 6.6 p<.001; utility 5.4 vs. 6.1 p<.001).
Conclusion: An educational intervention based on theoretical
models of behavior change and ALT can increase knowledge and self confidence
scores regarding counseling for NC and PAC.
HTML (Browser) version of the article
PDF version of the article
M.B.M. Soethout*, Th.J. ten Cate†, G. van der Wal‡
*VU University Medical Center Amsterdam The Netherlands
†University Medical Center Utrecht The Netherlands
‡VU University Medical Center Amsterdam The Netherlands
Abstract: The
aim of this study was to identify factors that are associated with
the choice of a specialty, the moment of the definitive choice, and
the stability of the choice over time. The focus was on recently
graduated doctors in European countries. A review of the literature
from October 1994 to October 2004 was conducted.
Most of the identified studies were of good quality. Enthusiasm, self-appraisal
of skills, human interest and domestic circumstances were the main factors
associated with the choice for medical specialization. Female doctors paid
a great deal of attention to reasonable working hours and part-time jobs.
They were also less certain about their career choice, and made this choice
later than men.
Most doctors with a preference for general practice at the time of qualification
as a medical doctor achieved their aim. Women, who preferred a clinical specialization,
had less opportunity than men to achieve their career satisfactorily
HTML (Browser) version of the article
PDF version of the article
Medical Education Online Editor@Med-Ed-Online.org