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Held N, Jimenez S, Lockspeiser T, Adams JE. Designing a Shortened Preclinical Basic Science Curriculum: Expert-Derived Recommendations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:922-928. [PMID: 36972132 DOI: 10.1097/acm.0000000000005221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE To generate an expert-derived list of recommendations for how medical schools should approach decisions about the placement of basic science topics within shortened preclinical curricula, which allow for early clinical immersion. METHOD A modified Delphi process was used to develop consensus on recommendations (March-November 2021). The authors performed semistructured interviews with national undergraduate medical education (UME) experts from institutions that previously underwent curricular reforms involving shortened preclinical curricula to elicit perspectives on how decisions were made at their institutions. The authors condensed the findings into a preliminary list of recommendations and distributed this list in 2 survey rounds to a larger group of national UME experts (from institutions that previously underwent curricular reforms or held positions of authority within national UME organizations) to gauge their level of agreement with each recommendation. Recommendations were revised based on participant comments, and those with at least 70% somewhat or strong agreement after the second survey were included in the final comprehensive list of recommendations. RESULTS Interviews were conducted with 9 participants and resulted in 31 preliminary recommendations that were then sent via survey to the 40 recruited participants. Seventeen/40 (42.5%) participants completed the first survey, after which 3 recommendations were removed, 5 were added, and 5 were revised based on comments-resulting in 33 recommendations. Twenty-two/38 (57.9%) participants responded to the second survey, after which all 33 recommendations met inclusion criteria. The authors removed 3 recommendations that did not directly address the curriculum reform process and consolidated the final 30 recommendations into 5 succinct, actionable takeaways. CONCLUSIONS This study generated 30 recommendations (summarized by the authors in 5 succinct takeaways) for medical schools designing a shortened preclinical basic science curriculum. These recommendations reinforce the importance of vertically integrating basic science instruction with explicit clinical relevance into all curricular phases.
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Affiliation(s)
- Natalie Held
- N. Held is currently assistant professor in pulmonary sciences and critical care medicine, University of Colorado School of Medicine, Aurora, Colorado. At the time of the study, she was a pulmonary and critical care fellow and a Department of Medicine medical education fellow, University of Colorado School of Medicine, Aurora, Colorado
| | - Sheilah Jimenez
- S. Jimenez is a research services senior professional and curriculum research assistant, Office of Assessment, Evaluation, and Outcomes, Office of Medical Education, University of Colorado School of Medicine, Aurora, Colorado
| | - Tai Lockspeiser
- T. Lockspeiser is associate professor of pediatrics and assistant dean of medical education for assessment, evaluation, and outcomes, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer E Adams
- J.E. Adams is professor of medicine and assistant dean of medical education for clinical curriculum, University of Colorado School of Medicine, Aurora, Colorado; ORCID: https://orcid.org/0000-0002-5433-8600
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Melton JL, Hemmer CPA, Pock CA, Moores CLK, Pangaro CLN, Durning SJ, Witkop CCT, Zapota R, Schreiber-Gregory DN, Dong T. "Primum Non Nocere"-First, Do No Harm: A Retrospective Review of the Impact of Curricular Reform on USUHS Graduates' Performance During Their PGY-1 Year. Mil Med 2023; 188:63-68. [PMID: 37201495 DOI: 10.1093/milmed/usad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/18/2023] [Accepted: 02/07/2023] [Indexed: 05/20/2023] Open
Abstract
PURPOSE To determine whether medical school curricular change impacted the assessment of graduates in their first year of postgraduate training. METHODS The authors examined for differences in the survey of postgraduate year one (PGY-1) program directors for Uniformed Services University (USU) medical school graduates from the Classes of 2011 and 2012 (pre-curriculum reform, pre-CR), Classes of 2015, 2016, and 2017 (curriculum transition), and Classes of 2017, 2018, and 2019 (post-curriculum reform, post-CR). Multivariate analysis of variance was used to explore for differences among the cohorts in the 5 previously identified factors on the PGY-1 survey (Medical Expertise; Professionalism; Military Unique Practice, Deployments and Humanitarian Missions; System-Based Practice and Practiced-Based Learning; Communication and Interpersonal Skills). Nonparametric tests were used when the error variance between cohorts was found to be unequal across samples. Kruskal-Wallis (a rank ordered analysis of variance) and Tamhan's T2 were used to characterize specific differences. RESULTS There were 801 students included: 245 (pre-CR); 298 (curricular transition); and 212 (post-CR). Multivariate analysis of variance demonstrated significant differences in all survey factors among the comparison groups. From pre-CR to the curricular transition, ratings in all factors declined, but none reached the level of a statistical significance. Ratings of all 5 factors showed significant improvement from the curricular transition to post-CR, and scores from pre-CR to post-CR trended in the positive direction with Practice-Based Learning (effect size 0.77), showing significant gains. CONCLUSION Ratings by PGY-1 program directors of USU graduates over time demonstrated a very small decline soon after curriculum reform but later showed a large improvement in domains reflecting areas of emphasis in the curriculum. In the eyes of a key stakeholder, the USU curriculum reform did no harm and led to improved PGY-1 assessments.
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Affiliation(s)
- John L Melton
- CHPE and the School of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Col Paul A Hemmer
- CHPE and the School of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Col Arnyce Pock
- CHPE and the School of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Col Lisa K Moores
- CHPE and the School of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Col Louis N Pangaro
- CHPE and the School of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Steven J Durning
- CHPE and the School of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Col Catherine T Witkop
- CHPE and the School of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Ramon Zapota
- CHPE and the School of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Deanna N Schreiber-Gregory
- CHPE and the School of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Ting Dong
- CHPE and the School of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
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Kercheval JB, Mott NM, Kim EK, Boscardin CK, Klein BA, Hauer KE, Daniel M. Students' Perspectives on Basic and Clinical Science Integration When Step 1 is Administered After the Core Clerkships. TEACHING AND LEARNING IN MEDICINE 2023; 35:117-127. [PMID: 35138966 DOI: 10.1080/10401334.2022.2030235] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
Phenomenon: According to adult learning theories, effective cognitive integration of basic and clinical science may promote the transfer of knowledge to patient care. The placement of the U.S. Medical Licensing Examination (USMLE) Step 1 after the core clerkships is one strategy intended to facilitate cognitive integration, though learner experiences with this model are unexplored. The purpose of this study is to understand students' perspectives on basic and clinical science integration in a post-clerkship Step 1 curriculum. Approach: Focus groups were conducted between August and September 2020 with senior medical students from the University of California, San Francisco School of Medicine and University of Michigan Medical School. Data were analyzed using a constructivist approach to thematic analysis. Findings: Thirty-three students participated in six focus groups. Participants described multiple barriers to cognitive integration in the clerkship learning environment, though they also identified examples of teaching and learning that facilitated integration. Early in their clerkships, students struggled to integrate because of their tenuous basic science foundation, cognitive overload, and difficulty perceiving the relevance of basic science to patient care. They felt that educators primarily focused on clinical science, and many basic science teaching sessions during clerkships felt irrelevant to patient care. However, students also described experiences that made the connection between basic and clinical science more explicit, including modeling by educators and clerkship learning activities that more overtly encouraged the application of basic science to clinical care. In addition, the return to basic science studying during the post-clerkship dedicated Step 1 study period offered powerful integration opportunities. These facilitators of cognitive integration helped students recognize the value of integration for enduring learning. Insights: There are myriad barriers to cognitive integration of basic and clinical science during clerkships in a post-clerkship Step 1 curriculum. The relevance of basic science to patient care needs to be made more explicit to students through modeling by clinician educators to augment the potential benefits of curricular change. The post-clerkship Step 1 study period appears to offer a unique opportunity for cognitive integration later in a learner's trajectory that may be related to curricular design. When learners recognize the applicability of basic science to patient care, they may more intentionally transfer basic science knowledge to clinical practice.
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Affiliation(s)
- Jacquelyn B Kercheval
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nicole M Mott
- Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Eric K Kim
- Department of Undergraduate Medical Education, University of California, San Francisco School of Medicine, California, USA
| | - Christy K Boscardin
- Department of Medicine, University of California, San Francisco School of Medicine, California, USA
| | - Barbie A Klein
- Department of Anatomy, University of California, San Francisco School of Medicine, California, USA
| | - Karen E Hauer
- Department of Medicine, University of California, San Francisco School of Medicine, California, USA
| | - Michelle Daniel
- Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Emergency Medicine, University of California, San Diego School of Medicine, California, USA
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Haudek SB, Bahner I, Belovich AN, Bonaminio G, Brenneman A, Brooks WS, Chinn C, El-Sawi N, Habal S, Haight M, Ikonne U, McAuley RJ, McKell D, Rowe R, Taylor TAH, Thesen T, Vari RC. How Science Educators Still Matter: Leveraging the Basic Sciences for Student Success. MEDICAL SCIENCE EDUCATOR 2022; 32:747-753. [PMID: 35531349 PMCID: PMC9066389 DOI: 10.1007/s40670-022-01549-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 06/14/2023]
Affiliation(s)
| | - Ingrid Bahner
- Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | | | | | | | - William S. Brooks
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL USA
| | - Cassie Chinn
- International Association of Medical Science Educators, Huntington, WV USA
| | - Nehad El-Sawi
- Des Moines University Medicine & Health Sciences, Des Moines, IA USA
| | - Shafik Habal
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA USA
| | - Michele Haight
- Sam Houston State University College of Medicine, Huntsville, TX USA
| | - Uzoma Ikonne
- Eastern Virginia Medical School, Norfolk, VA USA
| | - Robert J. McAuley
- Oakland University William Beaumont School of Medicine, Auburn Hills, MI USA
| | | | - Rebecca Rowe
- University of New England College of Osteopathic Medicine, Biddeford, ME USA
| | - Tracey A. H. Taylor
- Oakland University William Beaumont School of Medicine, Auburn Hills, MI USA
| | - Thomas Thesen
- University of Houston College of Medicine, Houston, TX USA
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Burton E, Assi L, Vongsachang H, Swenor BK, Srikumaran D, Woreta FA, Johnson TV. Demographics, clinical interests, and ophthalmology skills confidence of medical student volunteers and non-volunteers in an extracurricular community vision screening service-learning program. BMC MEDICAL EDUCATION 2022; 22:143. [PMID: 35246114 PMCID: PMC8894556 DOI: 10.1186/s12909-022-03194-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 02/22/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND Medical school curricular hours dedicated to ophthalmology are low and declining. Extracurricular ophthalmology activities, such as participation in community vision screenings, may serve an important adjunctive role in medical school curricula. The Johns Hopkins University (JHU) Vision Screening In Our Neighborhoods (ViSION) Program is an example of a voluntary medical student-directed community service-learning program. METHODS We used a mixed-methods cross-sectional approach, including an online survey and semi-structured interviews. JHU School of Medicine students enrolled in MD or MD/PhD programs during the 2019-2020 academic year were surveyed regarding demographics, career and service interests, involvement in ophthalmology-related activities, and confidence in their ophthalmology-related skills. Survey responses were compared between ViSION volunteers and non-volunteers using Fisher's exact chi-square tests. Semi-structured interviews were conducted via webconference with 8 prior or current ViSION volunteers and responses analyzed using inductive thematic analysis. Data were collected when ViSION volunteers were in variable stages of their medical education and involvement with the ViSION program. RESULTS A total of 118 medical students were included, representing an overall response rate of 24.6% of JHU medical students. ViSION volunteers reported greater involvement in ophthalmology-related research (42% vs. 4%, p < 0.001), intent to apply to ophthalmology residency programs (35% vs. 1%, p = 0.001), and confidence with multiple ophthalmology knowledge and clinical skill domains. In particular, ViSION volunteers were more likely to feel confident estimating cup-to-disc ratio using direct ophthalmoscopy (20% vs. 0%, p < 0.001). In open-ended survey and interview questions, most volunteers attributed at least some degree of their ophthalmology skill development and desire to pursue ophthalmology and public health careers to their ViSION experience. CONCLUSIONS Medical students who volunteered with a student-led community vision screening program were more likely to have a prior interest in ophthalmology than those who did not volunteer, but only 1/3 of volunteers planned to pursue a career in ophthalmology. Overall, volunteers reported higher confidence performing ophthalmology-related clinical skills, suggesting that student-led community vision screening programs may provide an important avenue for medical students to explore public health aspects of ophthalmology, while practicing ophthalmology exam skills and learning about common ophthalmic pathologies, regardless of their career intentions.
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Affiliation(s)
- Eleanor Burton
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lama Assi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA
| | | | - Bonnielin K Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA
| | - Thomas V Johnson
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA.
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Daniel M, Hauer KE, Chandran L, Pock A, Morrison G, Santen SA. The Optimal Timing of Step 1 in Medical Education Following the Transition to Pass/Fail: A Unique Perspective from Post-clerkship Step 1 Schools. MEDICAL SCIENCE EDUCATOR 2021; 31:905-910. [PMID: 34457932 PMCID: PMC8368741 DOI: 10.1007/s40670-021-01237-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
The National Board of Medical Examiners' decision to change Step 1 of the United States Medical Licensing Examination (USMLE) from a three-digit score to Pass/Fail (P/F) represents a disruptive change for students, faculty, and leaders in the academic community. In the context of this change, some schools may re-consider the optimal timing of Step 1 as they strive to align their assessment practices with sound educational principles. Currently, over 20 schools administer USMLE Step 1 after the core clerkships. In this commentary, we review the educational rationale for a post-clerkship Step 1, highlighting how adult learning theories support this placement. We discuss some short-term challenges post-clerkship Step 1 schools may encounter due to the proposed timing of the change in scoring, which creates three unique scenarios for learners that can introduce inequity in the system and provoke anxiety. We review outcomes of potentially heightened importance when Step 1 is P/F, including lower clinical subject exam scores in some clerkships, lower failure rates on Step 1 and stable Step 2 Clinical Knowledge scores with implications for the residency match. We outline the future potential for performance-based time-variable Step 1 study periods that are facilitated by post-clerkship placement of the exam. Finally, we discuss opportunities to achieve the goal of enhancing student well-being, which was a major rationale for eliminating the three-digit score.
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Affiliation(s)
- Michelle Daniel
- San Diego School of Medicine, University of California, San Diego, CA USA
- University of Michigan Medical School, Ann Arbor, MI USA
| | - Karen E. Hauer
- Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, CA, USA
| | - Latha Chandran
- University of Miami Miller School of Medicine, Miami, FL USA
- School of Medicine at Stony, Brook University, Stony Brook, NY USA
| | - Arnyce Pock
- University of the Health Sciences, Bethesda, MD USA
| | - Gail Morrison
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Sally A. Santen
- Virginia Commonwealth University School of Medicine, Richmond, VA USA
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Swan Sein A, Daniel M, Hauer KE, Santen SA. Educational and Practical Implications of Step 1 Timing in the Context of COVID-19. MEDICAL SCIENCE EDUCATOR 2021; 31:911-916. [PMID: 33777488 PMCID: PMC7987737 DOI: 10.1007/s40670-021-01255-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Aubrie Swan Sein
- Columbia Vagelos College of Physicians and Surgeons, Center for Education Research and Evaluation, New York, NY USA
| | - Michelle Daniel
- San Diego School of Medicine, University of California, San Diego, CA USA
- Medical School, University of Michigan, Ann Arbor, MI USA
| | - Karen E. Hauer
- San Francisco School of Medicine, University of California, San Francisco, CA USA
| | - Sally A. Santen
- School of Medicine, Virginia Commonwealth University, Richmond, VA USA
- College of Medicine, University of Cincinnati, Cincinnati, OH USA
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