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Bosch J, Maaz A, Hitzblech T, Holzhausen Y, Peters H. Medical students' preparedness for professional activities in early clerkships. BMC MEDICAL EDUCATION 2017; 17:140. [PMID: 28830418 PMCID: PMC5568232 DOI: 10.1186/s12909-017-0971-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 07/30/2017] [Indexed: 05/17/2023]
Abstract
BACKGROUND Sufficient preparedness is important for transitions to workplace participation and learning in clinical settings. This study aims to analyse medical students' preparedness for early clerkships using a three-dimensional, socio-cognitive, theory-based model of preparedness anchored in specific professional activities and their supervision level. METHODS Medical students from a competency-based undergraduate curriculum were surveyed about preparedness for 21 professional activities and level of perceived supervision during their early clerkships via an online questionnaire. Preparedness was operationalized by the three dimensions of confidence to carry out clerkship activities, being prepared through university teaching and coping with failure by seeking support. Factors influencing preparedness and perceived stress as outcomes were analysed through step-wise regression. RESULTS Professional activities carried out by the students (n = 147; 19.0%) and their supervision levels varied. While most students reported high confidence to perform the tasks, the activity-specific analysis revealed important gaps in preparation through university teaching. Students regularly searched for support in case of difficulty. One quarter of the variance of each preparedness dimension was explained by self-efficacy, supervision quality, amount of prior clerkship experience and nature of professional activities. Preparedness contributed to predicting perceived stress. CONCLUSIONS The applied three-dimensional concept of preparedness and the task-specific approach provided a detailed and meaningful view on medical students' workplace participation and experiences in early clerkships.
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Affiliation(s)
- Josefin Bosch
- Dieter Scheffner Center for Medical Education and Educational Research, Department of Study Affairs, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Asja Maaz
- Dieter Scheffner Center for Medical Education and Educational Research, Department of Study Affairs, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Tanja Hitzblech
- Dieter Scheffner Center for Medical Education and Educational Research, Department of Study Affairs, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Ylva Holzhausen
- Dieter Scheffner Center for Medical Education and Educational Research, Department of Study Affairs, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Harm Peters
- Dieter Scheffner Center for Medical Education and Educational Research, Department of Study Affairs, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Dal Santo TS, Scharlach AE, Nielsen J, Fox PJ. A stress process model of family caregiver service utilization: factors associated with respite and counseling service use. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2007; 49:29-49. [PMID: 17953061 DOI: 10.1300/j083v49n04_03] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study examines whether caregivers' differential utilization of respite and counseling support services is associated with different situational stress processes. A multinomial regression analysis was conducted to compare respite users, counseling users, and those who used neither service, using data collected on a statewide random sample of 1,643 California caregivers providing assistance to individuals aged 50 or older. Compared with caregivers who used neither service, respite service users were more likely to have demanding care situations giving rise to physical symptoms of stress, and were more likely to use community services for the care recipient to augment their care. In contrast, counseling service users were more likely to be managing the meaning of their care situation by seeking out information about services and talking with a confidant about their situation, while coping with both emotional and physical symptoms of stress. Tailoring caregiver interventions to meet the support needs and coping strategies stemming from diverse caregiving situations and caregiver characteristics may increase the likelihood that those interventions will be effective in alleviating or preventing deleterious secondary stress frequently experienced by family caregivers.
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Affiliation(s)
- Teresa S Dal Santo
- Center for the Advanced Study of Aging Services, University of California, 120 Haviland Hall, #7400, Berkeley, CA 94720-7400, USA.
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Diachun LL, Hillier LM, Stolee P. Interest in Geriatric Medicine in Canada: How Can We Secure a Next Generation of Geriatricians? J Am Geriatr Soc 2006; 54:512-9. [PMID: 16551322 DOI: 10.1111/j.1532-5415.2005.00610.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In Canada, there is minimal training of geriatrics for physicians, a shortage of geriatricians, and extremely low numbers of students entering geriatrics. This study explored student interest in and barriers and enticements to geriatric medicine as a career choice. Medical students attending a university in Ontario, Canada, were surveyed in their first year (N=121), after a geriatric education session, and again in their second year (N=118) about their interest in a career in geriatrics. In the first year, less than 20% of students were interested in geriatrics; in the second year this decreased to 16%. In both years, female students were more interested than male students. Those students interested in geriatrics had higher hopes that their practice would involve primarily adults and seniors. Students not interested in geriatrics rated performing procedures and technical skills, not wanting to work with chronically ill patients, and caring for younger patients as important practice characteristics. Although the importance of prestige was low for all students, it was significantly higher for those not interested in geriatrics. Although changes to prestige, income, lifestyle, and length of residency training were identified as potential enticements to geriatrics, they were not major deterrents to a career in geriatrics. The findings suggest strategies that may affect student interest in geriatrics, such as increased and early student exposure to geriatrics with emphasis on fostering and nurturing student interest, consideration of various enticements to this specialty, and the development of health system-specific solutions to this problem. Knowledge of student and practice characteristics that increase the likelihood of selecting geriatrics as a specialty may allow for early identification and support of future geriatricians.
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Affiliation(s)
- Laura L Diachun
- Southwestern Ontario Regional Geriatric Program, London, Ontario, Canada.
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Biernat K, Masluk M. Getting to Carnegie Hall: using standardized patients in palliative care education. J Palliat Med 2005; 2:221-5. [PMID: 15859819 DOI: 10.1089/jpm.1999.2.221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Biernat
- Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
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Nagoshi M, Williams S, Kasuya R, Sakai D, Masaki K, Blanchette PL. Using standardized patients to assess the geriatrics medicine skills of medical students, internal medicine residents, and geriatrics medicine fellows. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2004; 79:698-702. [PMID: 15234924 DOI: 10.1097/00001888-200407000-00018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE Medical schools and residency programs are placing additional emphasis on including clinical geriatrics competencies within their curricula. An eight-station, Geriatric Medicine Standardized Patient Examination (GSPX) was studied as a method to assess bedside geriatrics clinical skills over the continuum of medical education from medical school through residency and fellowship training. METHOD The GSPX was administered to 39 medical students, 49 internal medicine residents, and 11 geriatrics medicine fellows in 2001-02. Reliability of standardized patient (SP) checklists and rating scales used to assess examinees' performance was measured by Cronbach's alpha. Validity was measured by surveying the examinees' assessment of fairness, individual case length, difficulty, and believability, and by faculty standard setting for each level of trainee. RESULTS Reliability was high (alpha =.89). All levels of examinees found the SPs to be believable, station lengths to be adequate, and rated the GSPX as a fair assessment. Students rated the cases as more difficult. Previous experience with similar real patients increased significantly with level of training (Pearson's r =.48, p <.0001). Faculty set passing scores that increased from students to residents to fellows. However, GSPX scores decreased with level of training (r = -.25, p =.01). CONCLUSION The GSPX is a reliable measure of geriatrics medicine skills with adequate face validity for examinees at all levels. However, GSPX scores did not increase with level of training, suggesting that a single form of the examination cannot be used across the continuum of training. Potential modifications to the GSPX that might provide more discrimination between levels of training are currently being explored.
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Affiliation(s)
- Michael Nagoshi
- Center for Clinical Skills, Department of Medicine, Univesity of Hawaii John A. Burns School of Medicine, Honolulu 96817, USA
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Newell DA, Raji M, Lieberman S, Beach RE. Integrating geriatric content into a medical school curriculum: description of a successful model. GERONTOLOGY & GERIATRICS EDUCATION 2004; 25:15-32. [PMID: 15778143 DOI: 10.1300/j021v25n02_02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Most medical school curricula do not equip students with adequate attitudes, knowledge and skills to care for elderly populations. We describe an effective geriatric curricular infusion model compatible with preserving the overall curricula schema. Course and clerkship directors, staff and faculty from the Office of Educational Development, Center on Aging, curriculum committee and Associate/Assistant Deans of Education, and faculty from the schools of medicine, nursing, and allied health collaborated in the effort. Each of these components and institutional financial commitment were critical to successful basic science and clinical geriatric content infusion addressing the American Geriatric Society (AGS) Core Competencies. Delivery modalities included problem- based learning cases, lectures, standardized patient portrayals for teaching and assessment, and experiential activities with elderly. Assessments were conducted and outcomes tracked in several ways, including: (1) annual course reviews, focus groups, and student evaluations; (2) mandatory geriatrics 4th year graduation competency exam; and, (3) AAMC Graduation Questionnaire responses. Initial data indicate that student knowledge and competencies have increased with increasing exposure in the desired areas, and support infusion as a viable approach to enhancing gerontology and geriatric curricular content.
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Affiliation(s)
- Debra A Newell
- Geriatric Research, Education and Clinical Center, North Florida South Georgia VA, USA.
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Fitzgerald JT, Wray LA, Halter JB, Williams BC, Supiano MA. Relating Medical Students' Knowledge, Attitudes, and Experience to an Interest in Geriatric Medicine. THE GERONTOLOGIST 2003; 43:849-55. [PMID: 14704384 DOI: 10.1093/geront/43.6.849] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study examined medical students' interest in geriatrics: Are knowledge, positive attitudes, and prior experience with older adults associated with an interest in geriatric medicine? DESIGN AND METHODS Entering University of Michigan medical students completed three surveys: the Revised Facts on Aging Quiz, the University of California at Los Angeles Geriatric Attitudes Scale, and the Maxwell-Sullivan Attitudes Scale. The students were also asked questions about their prior experience with older adults and their interest in geriatric medicine. RESULTS The results indicate that incoming medical students have minimal knowledge about aging, moderately positive attitudes toward older adults, and low interest in geriatric medicine. Having more positive attitudes toward older adults (ss =.28) and having cared for older persons prior to medical school (ss =.14) were associated with greater interest in geriatric medicine. IMPLICATIONS These findings suggest that interventions to increase the number of geriatric-oriented physicians should focus on influencing learners' attitudes through experiences in the care of older adults.
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Affiliation(s)
- James T Fitzgerald
- Department of Medical Education, The University of Michigan Medical School, 1107 Towsley Center, Box 0201, Ann Arbor, MI 48109-0201, USA.
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Mallery L, Gordon J, Freter S. A 3 Week Geriatric Education Program for 4 th Year Medical Students at Dalhousie University. MEDICAL EDUCATION ONLINE 2003; 8:4342. [PMID: 28253164 DOI: 10.3402/meo.v8i.4342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose -Population demographics are shifting towards an increased average age. Yet, many medical schools still do not have mandatory comprehensive education in Geriatric Medicine. In 2001, the Division of Geriatric Medicine at Dalhousie University developed a required three-week geriatric course for fourth year medical students. This paper describes the details of the curriculum so that it can be reproduced in other settings. Results - The curriculum was successfully implemented. An examination, held at the end of each 3- week rotation, documented extensive learning of important concepts in Geriatric Medicine. The students gave positive feedback about the benefits of this training program. Conclusion -A well developed formal education program teaches students specific skills in Geriatric Medicine, which may improve the care of the growing elderly population. Key words: geriatric, geriatrics, elderly, curriculum, medical school education.
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Affiliation(s)
- Laurie Mallery
- a Dalhousie University , Department of Medicine Division of Geriatric Medicine Halifax , Nova Scotia , Canada
| | - Janet Gordon
- a Dalhousie University , Department of Medicine Division of Geriatric Medicine Halifax , Nova Scotia , Canada
| | - Susan Freter
- a Dalhousie University , Department of Medicine Division of Geriatric Medicine Halifax , Nova Scotia , Canada
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Duque G, Gold S, Bergman H. Early clinical exposure to geriatric medicine in second-year medical school students--the McGill experience. J Am Geriatr Soc 2003; 51:544-8. [PMID: 12657077 DOI: 10.1046/j.1532-5415.2003.51166.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study examined the effect of a curriculum change on early clinical exposure to geriatrics for second-year medical students at McGill University and its effects on learning and students' appreciation of geriatrics as a subspecialty. Second-year medical students (N = 200) were exposed to a change in the curriculum involving the integration of 10 weekly sessions into one integrated week in geriatric medicine. Students participating in 10 weekly sessions were Group 1 and students participating in one integrated week were Group 2. Students rated their rotation using two different scales. The students completed 12-item questionnaires during their feedback sessions at the end of the 10-week session experience or the integrated week. The first six items assessed the students' appreciation of their improvement of knowledge in the subject of geriatrics and aging. The second and third part of the survey (questions 7 and 8) included the students' opinions about the quality of the instruction (teaching feedback) and evaluation. Students in Group 2 found their rotation more effective as a learning experience and expressed greater satisfaction with interaction with the tutors, community settings, and multidisciplinary team sessions. Grades obtained on final examinations showed a better and more-effective acquisition of knowledge by Group 2. The integrated week is a more-effective learning tool in the early clinical experience for medical students in geriatric medicine than 10 weekly sessions as the first introductory experience to the field of geriatric medicine.
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Affiliation(s)
- Gustavo Duque
- Division of Geriatric Medicine-McGill University, Montreal,Quebec, Canada.
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Metheny WP, Ernest JM, Bachicha J, Bienstock J, Ciotti MC, Cox S, Erickson S, Hartmann D, Krueger P, Puscheck E. Have we met the educational challenges of obstetrics and gynecology? A response to the Association of Professors of Gynecology and Obstetrics Initiative of 1986. Am J Obstet Gynecol 2002; 187:1405-12. [PMID: 12439539 DOI: 10.1067/mob.2002.127903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the progress that has been made toward meeting the educational challenges in obstetrics and gynecology that were made at an Association of Professors of Obstetrics and Gynecology special forum in 1986. STUDY DESIGN We placed the five major issues and specific problems that were identified within the context of developments that have occurred in medical education, the Association of Professors of Obstetrics and Gynecology, and the specialty over the last 15 years. We used the medical education literature and the accomplishments of the members of the Association of Professors of Obstetrics and Gynecology to measure progress. RESULTS Many of the challenges that were raised at the original forum remain. Significant progress, much of it spearheaded by the Association of Professors of Obstetrics and Gynecology, has been made in the areas of teaching methods and skills, evaluation techniques, faculty development, computer usage, teaching recognition, counseling for the fourth-year student, and an integrated curriculum in women's health. CONCLUSION Progress has occurred within the context and demands of a changing health care system that constricts the time and funding that are available for medical education.
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Affiliation(s)
- William P Metheny
- Department of Obstetrics, Brown Medical School, Providence, RI, USA.
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O'Connor FW, Albert ML, Thomas MD. Incorporating standardized patients into a psychosocial nurse practitioner program. Arch Psychiatr Nurs 1999; 13:240-7. [PMID: 10565057 DOI: 10.1016/s0883-9417(99)80034-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Interactions with standardized patients (SPs) provide customized, immediate clinical learning for graduate nursing students. SPs are lay persons trained to portray a role in a faculty-designed health care scenario for a series of students. Student learning results from the experience of the encounter, performance feedback from the SP, subsequent classroom discussion with peers, faculty critique, and review of the videotaped interaction. Design and implementation of an SP experience involves clarification of goals for the encounter, development of the clinical scenario, recruitment and training of SPs, preparation of students, and management of the logistics of the exercise. Although the process is labor-intensive, we have found SP experiences versatile, valuable, and popular with students.
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Sachdeva AK, Wolfson PJ, Blair PG, Gillum DR, Gracely EJ, Friedman M. Impact of a standardized patient intervention to teach breast and abdominal examination skills to third-year medical students at two institutions. Am J Surg 1997; 173:320-5. [PMID: 9136788 DOI: 10.1016/s0002-9610(96)00391-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study examined whether a single intervention with standardized patients (SPs) as a supplement to traditional teaching during the surgery clerkship would enhance the breast and abdominal examination skills of third-year medical students. METHODS During the academic year 1994-1995, 153 students from two institutions were assigned to control or experimental groups. At institution A, all students underwent pretests and posttests with SPs; at institution B, no pretest was conducted. All experimental students received group and one-to-one instruction with SPs during the intervention session. RESULTS At posttest, the experimental group performed better than the control group on breast examination (P = 0.002), professionalism during this examination (P <0.001), abdominal examination (P <0.001), and professionalism during the latter examination (P = 0.050). The improvement from pretest to posttest at institution A was significantly greater in the experimental group than the control group for the breast examination (P = 0.036) and the abdominal examination (P <0.001). Analyses on a variety of specific tasks within each examination were also performed. CONCLUSION A single intervention with SPs teaching breast and abdominal examinations resulted in significant enhancement of these clinical skills.
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Affiliation(s)
- A K Sachdeva
- Department of Surgery, Medical College of Pennsylvania and Hahnemann University, Philadelphia 19129, USA
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