1
|
Congdon M, Goldstein L, Maletsky KD, Craven M, Rose S, Devon EP. Pediatric Intersession: An Upfront Flipped-Classroom Curriculum to Promote Pediatric Clerkship Readiness. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241229774. [PMID: 38327827 PMCID: PMC10848795 DOI: 10.1177/23821205241229774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES Best practices for content selection, mode of delivery, and timing of pediatric clerkship readiness curricula for medical students have, by and large, not been established. Capitalizing on changes in structure of the clinical clerkships during the COVID-19 pandemic, we created an upfront clerkship readiness curriculum, termed Pediatric Intersession (PI), to replace the existing weekly lecture-based clerkship didactics. METHODS Our goal was to develop an interactive curriculum with innovative instructional design methodology intended to promote broad foundational pediatric knowledge and clerkship preparedness using case-based learning. We first conducted a needs assessment and crafted curriculum content using guiding principles from the 2019 Council on Medical Student Education in Pediatrics (COMSEP) curriculum. We then organized material into four daily modules prior to the start of the clerkship and employed flipped classroom (FC) methodology. RESULTS Sixty-six percent of students completed course evaluations, and >90% of the 100 respondents reported that the PI enhanced their clinical learning. Pre-/post-testing demonstrated some knowledge gain following the small-group sessions and there was no change on the National Board of Medical Examiners (NBME) Subject Exam mean scores compared to prior cohorts of students. CONCLUSIONS The global pandemic provided an opportunity to re-envision our pediatric clerkship didactics content, while also incorporating instructional design methodology preferred by students. Our curriculum promotes a small group-based, interactive approach to clerkship readiness that fosters learning in the clinical environment that can be adapted for various settings. Our evaluation suggests that the transition to a FC readiness curriculum can be done successfully while effectively preparing students for their pediatric clerkship.
Collapse
Affiliation(s)
- Morgan Congdon
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Laura Goldstein
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Kristin D. Maletsky
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Meghan Craven
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Stacey Rose
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Erin Pete Devon
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
2
|
Kulkarni B, Dua H. Evaluation of the preclinical hospital visit programme with students' feedback at the University of Nottingham, UK. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:97-103. [PMID: 38692599 DOI: 10.25259/nmji_47_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Background . The General Medical Council's publication Tomorrow's Doctors recommends that medical students should attain professional awareness at an early stage of their education. Accordingly, in the University of Nottingham, basic science teaching is integrated with clinical practice, by attaching medical students to hospital specialty teams and general practices in the community, as regular timetabled 'hospital visits' from the beginning of their medical education. We evaluated the feedback forms of the preclinical (1st and 2nd years) medical students retrospectively based on their experience of the hospital-based clinical teaching programme over 2 years. The hospital visit programme was modified based on the student feedback following which the effectiveness of the modified programme was revaluated post-test. Methods . This study was based on a quasi-experimental design in which comparisons of pre-test and post-test feedbacks with 337 feedback forms in each group were analysed in the study period. Quantitative response questions in the feedback were statistically analysed using independent t-test, and free text questions were qualitatively analysed and grouped into themes. Results . Data analyses showed significant difference (p<0.001) between the pre- and post-test groups. The main feedback themes identified were number of the patients examined, organization of the visit, patient selection, introductory talk, and briefing and debriefing before and after the visit. Conclusion . The structure of the hospital visit programme was influenced by the available infrastructure, flexibility of access and delivery of clinical teaching. The programme helped build professional attitudes in both staff and students and encouraged independent learning.
Collapse
Affiliation(s)
- Bina Kulkarni
- Department of Ophthalmology, B-Floor, Eye and ENT Building, Queen's Medical Centre, Derby Road, Nottingham, NG72UH, UK
| | - Harminder Dua
- Department of Ophthalmology, B-Floor, Eye and ENT Building, Queen's Medical Centre, Derby Road, Nottingham, NG72UH, UK
| |
Collapse
|
3
|
Khalil MS, Alrumaihi N, Feda J, Alnuaim L, Abdulghani H, Fouda K, AlDahri S, Soliman M. Students, faculty perceptions and effectiveness of the early introduction of clinical skills teaching in the medical curriculum. J Taibah Univ Med Sci 2022; 18:310-320. [PMID: 37102079 PMCID: PMC10124110 DOI: 10.1016/j.jtumed.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022] Open
Abstract
Objective We hypothesized that the early introduction of clinical skills (CS) would help students to develop and apply clinical skills appropriately during the clinical years. Evaluating the perceptions of medical students and faculty regarding the early introduction of CS teaching and its effectiveness are important. Methods The CS curriculum was designed by integration with the system-oriented problem-based curriculum in years 1 and 2 at the College of Medicine, KSU, from January 2019 to December 2019. Students and faculty questionnaires were also designed. The impact of CS teaching effectiveness was assessed by comparing OSCE results for year-3 students who received early CS sessions with those who did not. The total number of student respondents was 461/598; and 259 (56.2%) were male and 202 (43.8%) were female. The first- and second-year respondents were 247 (53.6%) and 214 (46.4%), respectively. The number of faculty respondents was 35/43. Results The majority of students and faculty were satisfied that the early introduction of CS increased student confidence when dealing with real patients, provided the opportunity to master skills, consolidated theoretical knowledge and clinical skills, motivated learning, and increased the enthusiasm of students to become doctors. The third-year students who received CS teaching in years 1 and 2 (during 2017-2018 and 2018-2019) showed a significant increase in mean grades (p value; 0.00) in OSCE tests during their courses in surgery (from 32.6 to 37.4 for females; 35.2 to 35.7 for males) and medicine (31.2-34.1 for females; 34.3 to 37.7 for males), respectively, when compared to students who did not receive CS teaching during the academic year 2016-2017 (in surgery, 22.2 and 23.2; in medicine 25.1 and 24.2) for females and males respectively. Conclusion Early exposure of medical students to CS is a positive intervention that bridges the gap between basic sciences and clinical practice.
Collapse
|
4
|
Gripay B, André T, De Laval M, Peneau B, Secourgeon A, Lerolle N, Annweiler C, Justeau G, Connan L, Martin L, Bière L. Benefits of semiology taught using near-peer tutoring are sustainable. BMC MEDICAL EDUCATION 2022; 22:26. [PMID: 35012540 PMCID: PMC8744339 DOI: 10.1186/s12909-021-03086-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Near-peer tutoring appears to be an efficient approach for teaching clinical skills. However, the clinical experience gained in the form of student medical internships may offset any interest in such tutoring programme. We then investigated the long-term benefits of this programme. METHODS This study was conducted in a medical school that experimented in near-peer tutoring for semiology intended for undergraduate medical students. Objective Structured Clinical Examinations and a written semiology test were used to assess students' clinical skills immediately on its conclusion and repeated one and 2 years after the tutoring was completed. RESULTS 116 students were evaluated initially (80 tutored and 36 untutored), 38 at 1 year (16 tutored and 22 untutored), 42 at 2 years (21 tutored and 21 untutored). In the global score for Objective Structured Clinical Examinations: at 1 year, the tutored group scored 14.0 ± 1.05 and the untutored group scored 11.3 ± 2.3 (p < 0.001), at 2 years, the tutored group scored 15.1 ± 1.5 and the untutored group scored 12.4 ± 2.2 (p < 0.001). We found a similar but smaller difference for the written semiology test. The difference for Objective Structured Clinical Examinations between tutored and untutored students vanished over time for cross-cutting skills. CONCLUSIONS Near-peer tutoring in semiology for undergraduate medical students led to better results that remained with the passing of time. Though internships do allow an improvement in the clinical skills of untutored students, they did not reach the level of tutored students.
Collapse
Affiliation(s)
| | - Thomas André
- Faculty of Health, Univ Angers, 49000, Angers, France
| | | | - Brice Peneau
- Faculty of Health, Univ Angers, 49000, Angers, France
| | | | - Nicolas Lerolle
- Faculty of Health, Univ Angers, 49000, Angers, France
- All'Sims Centre for Simulation in Healthcare, Faculty of Health, University Hospital of Angers, 49000, Angers, France
| | | | - Grégoire Justeau
- Faculty of Health, Univ Angers, 49000, Angers, France
- All'Sims Centre for Simulation in Healthcare, Faculty of Health, University Hospital of Angers, 49000, Angers, France
| | | | - Ludovic Martin
- Faculty of Health, Univ Angers, 49000, Angers, France
- All'Sims Centre for Simulation in Healthcare, Faculty of Health, University Hospital of Angers, 49000, Angers, France
| | - Loïc Bière
- Faculty of Health, Univ Angers, 49000, Angers, France.
- All'Sims Centre for Simulation in Healthcare, Faculty of Health, University Hospital of Angers, 49000, Angers, France.
- School of Medicine, University Hospital of Angers, 28 rue Roger-Amsler, 49045, Angers Cedex 01, France.
| |
Collapse
|
5
|
Sharaf K, Felicio-Briegel A, Widmann M, Huber J, Eggersmann TK, Stadlberger U, Schrötzlmair F, Canis M, Lechner A. [ToSkORL: self- and objective assessment of examination skills in the head and neck region]. HNO 2021; 70:295-303. [PMID: 34622305 PMCID: PMC8964619 DOI: 10.1007/s00106-021-01097-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/27/2022]
Abstract
Hintergrund Ein zentrales Ziel des Medizinstudiums ist der Erwerb theoretischer und praktischer Kompetenzen. Es mangelt jedoch an Evidenz, wie der Erwerb von Kompetenzen in speziellen Untersuchungstechniken gemessen werden kann. ToSkORL (Teaching of Skills in Otorhinolaryngology) ist ein Projekt, das die studentische Selbstwahrnehmung ihrer Kompetenz bei speziellen Untersuchungstechniken der Hals-Nasen-Ohren-Heilkunde und des Kopf-Hals-Bereichs aus didaktisch-wissenschaftlicher Sichtweise beleuchtet. Methodik Im Rahmen des Untersuchungskurses erfolgte eine standardisierte mündlich-praktische Prüfung zu neun verschiedenen Untersuchungstechniken. Vor der Prüfung erfolgte eine Evaluation der studentischen Selbsteinschätzung mittels Fragebogen, die Prüfung wurde mittels Checkliste durch die Prüfenden standardisiert geprüft. Selbst- und Fremdeinschätzung nach der Likert-Skala wurden korreliert. Die neun Untersuchungstechniken wurden jeweils 42-mal von insgesamt 91 Studierenden in gegenseitiger Untersuchung durchgeführt. Ergebnisse Die Selbsteinschätzung der Kompetenz in den Untersuchungstechniken variiert erheblich, insgesamt schätzten Studierende ihre eigene Untersuchungskompetenz weitgehend unabhängig von Alter und Geschlecht meist realistisch ein. Studierende mit einem hohen Interesse an der Hals-Nasen-Ohren-Heilkunde gaben bessere Selbsteinschätzungen an, neigten jedoch auch eher zur Selbstüberschätzung. Bei Untersuchungen des mittleren Schwierigkeitsniveaus ergab sich die größte Divergenz von Selbst- und Fremdeinschätzung. Schlussfolgerung Die studentische Selbsteinschätzung ist ein geeignetes Instrument zur Messung der Untersuchungskompetenz in der Hals-Nasen-Ohren-Heilkunde. Es sollte ein besonderer Fokus auf die Lehre vermeintlich mittelschwerer Untersuchungstechniken gelegt werden, da diese am stärksten über- und unterschätzt werden. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00106-021-01097-y) enthält zwei Mini-Clinical-Exam(CEX)-Evaluationsbögen für Studenten und Untersucher. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte scannen Sie den QR-Code, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“. ![]()
QR-Code scannen & Beitrag online lesen
Collapse
Affiliation(s)
- Kariem Sharaf
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland.
| | - Axelle Felicio-Briegel
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland
| | - Magdalena Widmann
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland
| | - Johanna Huber
- Institut für Didaktik und Ausbildungsforschung in der Medizin, LMU Klinikum, Pettenkoferstraße 8a, 80336, München, Deutschland
| | - Tanja Kristina Eggersmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, LMU München, Marchioninistraße 15, 81377, München, Deutschland
| | - Ursula Stadlberger
- Institut für Didaktik und Ausbildungsforschung in der Medizin, LMU Klinikum, Pettenkoferstraße 8a, 80336, München, Deutschland
| | - Florian Schrötzlmair
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland
| | - Martin Canis
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland
| | - Axel Lechner
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland.
| |
Collapse
|
6
|
Bhai SA, Poustinchian B. The flipped classroom: a novel approach to physical examination skills for osteopathic medical students. J Osteopath Med 2021; 121:475-481. [PMID: 33694343 DOI: 10.1515/jom-2020-0198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/10/2020] [Indexed: 11/15/2022]
Abstract
CONTEXT Medical students are faced with the challenge of synthesizing large volumes of information quickly. With the increasing accessibility of technology, a "flipped classroom" allows students to learn foundational material independently. Class time is instead devoted to in-depth skill building with instructors, promoting an active learning environment. This method of content delivery is also relevant given the current COVID-19 pandemic. OBJECTIVES To comprehensively evaluate the benefit of adopting a flipped classroom approach in teaching physical exam skills (PES) to first-year osteopathic medical students. METHODS A cohort study was conducted comparing first-year osteopathic students in the class of 2022 (n=201), who had taken the PES course traditionally, with the class of 2023 (n=203), who experienced the flipped classroom approach. Objective metrics such as cumulative grades, objective structural clinical examination performance (OSCE), and practical exam performance were compared using nonparametric Mann-Whitney U rank sum tests. Subjective measures such as student course evaluations were used to analyze course perceptions using independent sample t-tests assuming unequal variances. A faculty survey was administered to faculty who taught both cohorts to assess instructor attitudes toward the flipped classroom approach. Due to the COVID-19 pandemic, Spring 2020 quarter data was not included, given the transition of all classes to an online learning environment. RESULTS The flipped classroom approach significantly improved objective student performance for the Fall (p=0.009) and Winter (p<0.001) student cumulative grades and the History-Taking OSCE (p=0.010). Performance on Fall and Winter practical exam scores had no significant association with the flipped classroom. General student perceptions of the course remained unchanged between both cohorts. Faculty survey results from 10 faculty members showed that six (60%) faculty members preferred the traditional classroom, while four (40%) preferred the flipped classroom. CONCLUSIONS The flipped classroom approach showed some statistically significant improvement in student PES. Further studies are needed to evaluate the benefits of a flipped classroom approach using skills-based assessments styles to measure student performance, with a focus on standardization of in-classroom groupwork.
Collapse
Affiliation(s)
- Sahar Amin Bhai
- Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, IL, USA
| | - Brian Poustinchian
- Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, IL, USA
| |
Collapse
|
7
|
Nelson E, Ireland K, Krapf JM. Baseline Clinical Skill of Medical Students Entering the Obstetrics and Gynecology Core Clinical Clerkship. MEDICAL SCIENCE EDUCATOR 2021; 31:59-65. [PMID: 34457865 PMCID: PMC8368773 DOI: 10.1007/s40670-020-01091-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 06/13/2023]
Abstract
PURPOSE Determine baseline clinical skills of medical students entering the Obstetrics and Gynecology (OB/GYN) clerkship with prior clinical curricular exposure. BACKGROUND Students are introduced to clinical correlates sooner in the preclinical curriculum to facilitate adult learning. There are few studies determining clerkship-specific clinical skills readiness in OB/GYN, a specialty with historically limited previous exposure. METHODS An anonymous 15-question clinical readiness survey (1-5 Likert scale) was administered to medical students during their OB/GYN Orientation at the University of Texas Health Science Center San Antonio over four academic years, 2014-2018, to determine baseline OB/GYN clinical skill knowledge and confidence. Statistical analysis included Spearman rank correlation and Kruskal-Wallis tests, with significance defined as p < 0.05. RESULTS The survey was completed by 346 students (77% participation). Overall, students felt most confident in knot tying skills (17%) and closed gloving technique (7%) and least confident in knowledge of labor curve (86%), Leopold's maneuvers (88%), and Montevideo units (MVU) (90%). Confidence in performing closed gloving (4% vs. 11%, p < 0.01) and tying knots (8% vs. 27%, p < 0.01) was significantly higher during rotations later in the academic year. Students who expressed a higher level of interest felt more prepared for the clerkship (rs = 0.21, p < 0.01). DISCUSSION Results indicate that confidence in obstetric-specific clinical skills is relatively low throughout the academic year; however, baseline surgical skills show improvement. It is important for teaching faculty to know baseline clinical skills of the medical student with earlier clinical exposure to enhance adult learning and optimize clinical competency. In medical students receiving earlier clinical exposure, confidence in baseline obstetric-specific clinical skill is relatively low throughout the academic year. Confidence in general surgical skills demonstrates improvement over the academic year.
Collapse
Affiliation(s)
- Erin Nelson
- The University of Texas Health Science Center at San Antonio, Joe R. & Teresa Lozano Long School of Medicine, 7703 Floyd Curl Drive, Mail code 7836, TX 78229-3900 San Antonio, USA
| | - Kayla Ireland
- The University of Texas Health Science Center at San Antonio, Joe R. & Teresa Lozano Long School of Medicine, 7703 Floyd Curl Drive, Mail code 7836, TX 78229-3900 San Antonio, USA
| | - Jill M. Krapf
- The University of Texas Health Science Center at San Antonio, Joe R. & Teresa Lozano Long School of Medicine, 7703 Floyd Curl Drive, Mail code 7836, TX 78229-3900 San Antonio, USA
| |
Collapse
|
8
|
Lander L, Baxter SL, Cochran GL, Gali HE, Cook K, Hatch T, Taylor R, Awdishu L. Self-Perceptions of Readiness to Use Electronic Health Records Among Medical Students: Survey Study. JMIR MEDICAL EDUCATION 2020; 6:e17585. [PMID: 32442135 PMCID: PMC7320310 DOI: 10.2196/17585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/05/2020] [Accepted: 04/09/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Although several national organizations have declared the ability to work with electronic health records (EHRs) as a core competency of medical education, EHR education and use among medical students vary widely. Previous studies have reported EHR tasks performed by medical students, but students' self-perceived readiness and comfort with EHRs are relatively unknown. OBJECTIVE This study aimed to better understand medical students' self-perceived readiness to use EHRs to identify potential curricular gaps and inform future training efforts based on students' perspectives. METHODS The authors deployed a survey investigating self-perceived comfort with EHRs at 2 institutions in the United States in May 2019. Descriptive statistics were generated regarding demographics, comfort level with various EHR-related tasks, and cross-institutional comparisons. We also assessed the impact of extracurricular EHR experience on comfort level. RESULTS In total, 147 medical students responded, of which 80 (54.4%) were female, with equal distribution across all 4 years of training. Overall confidence was generally higher for students with longer extracurricular EHR experience, even when adjusted for age, gender, year of training, and institution. Students were most comfortable with tasks related to looking up information in the EHR and felt less comfortable with tasks related to entering new information and managing medications. Fourth-year students at both schools reported similar levels of comfort with EHR use, despite differences in preclinical EHR training. Open-ended comments emphasized the value of experiential training over didactic formats. CONCLUSIONS Information entry and medication management in the EHR represent areas for future curricular development. Experiential training via extracurricular activities and early clinical exposure may be high-yield approaches to help medical students achieve critical EHR competencies.
Collapse
Affiliation(s)
- Lina Lander
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - Sally L Baxter
- Department of Biomedical Informatics, University of California San Diego Health, La Jolla, CA, United States
- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, United States
| | - Gary L Cochran
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, United States
| | - Helena E Gali
- School of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Kristen Cook
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, United States
| | - Thomas Hatch
- Information Services Department, University of California San Diego Health, La Jolla, CA, United States
| | - Regan Taylor
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Linda Awdishu
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, United States
| |
Collapse
|
9
|
Roussel D, Anderson K, Glasgow T, Colbert-Getz JM. Evaluation of a Preclerkship Learning Community Model for Delivering Clinical Skills Curriculum. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519855061. [PMID: 31259252 PMCID: PMC6585236 DOI: 10.1177/2382120519855061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Medical schools are increasingly using learning communities (LCs) for clinical skills curriculum delivery despite little research on LCs employed for this purpose. We evaluated an LC model compared with a non-LC model for preclerkship clinical skills curriculum using Kirkpatrick's hierarchy as an evaluation framework. METHODS The first LC cohort's (N = 101; matriculating Fall 2013) reaction to the LC model was assessed with self-reported surveys. Change in skills and learning transfer to clerkships was measured with objective structured clinical examinations (OSCEs) at the end of years 2 and 3 and first and last clerkship preceptor evaluations; the LC cohort and the prior cohort (N = 86; matriculating Fall 2012) that received clinical skills instruction in a non-LC format were compared with Mann-Whitney U tests. RESULTS The LC model for preclerkship clinical skills curriculum was rated as excellent or good by 96% of respondents in Semesters 1 to 3 (N = 95). Across multiple performance domains, 96% to 99% of students were satisfied to very satisfied with their LC faculty preceptors (N varied by item). For the end of preclerkship OSCE, the LC cohort scored higher than the non-LC cohort in history gathering (P = .003, d = 0.50), physical examination (P = .019, d = 0.32), and encounter documentation (P ⩽ .001, d = 0.47); the non-LC cohort scored higher than the LC cohort in communication (P = .001, d = 0.43). For the end of year 3 OSCE, the LC cohort scored higher than the non-LC cohort in history gathering (P = .006, d = 0.50) and encounter note documentation (P = .027, d = 0.24); there was no difference in physical examination or communication scores between cohorts. There was no detectable difference between LC and non-LC student performance on the preceptor evaluation forms at either the beginning or end of the clerkship curriculum. CONCLUSIONS We observed limited performance improvements for LC compared with non-LC students on the end of the preclerkship OSCE but not on the clerkship preceptor evaluations. Additional studies of LC models for clinical skills curriculum delivery are needed to further elucidate their impact on the professional development of medical students.
Collapse
Affiliation(s)
- Danielle Roussel
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Katherine Anderson
- Department of Internal Medicine, Division of Geriatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Tiffany Glasgow
- Department of Pediatric, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jorie M Colbert-Getz
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
10
|
Johnson M, Goldberg C, Willies-Jacobo L, Wan L, Guluma K, Smith S. Implementation and Outcomes of a Community Assessment Service-Learning Activity Within Academic Learning Communities. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519864403. [PMID: 31523714 PMCID: PMC6728661 DOI: 10.1177/2382120519864403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/14/2019] [Indexed: 06/10/2023]
Abstract
A community needs assessment and engagement activity was implemented in 2013 in the core preclinical curriculum as part of the doctoring course within Academic Communities at UC San Diego School of Medicine. This required educational experience included curricular learning objectives as well as goals to strengthen community service within academic communities. This activity was implemented and sustained within the academic communities with each community serving a different community of San Diego. Survey data from preclinical students from 2014 to 2017 consistently reported that the community assessment activity helped sustain or develop a service project in the academic community (67.1%-79.6% strongly agree or agree) and increased students' knowledge of the needs in the assigned San Diego community (76.3%-80.6% strongly agree or agree). Students felt that the community assessment and engagement activity was a valuable learning experience (62.5%-77.8% strongly agree or agree). As a result of this educational intervention, 14 projects were implemented in the community. A subset of particularly interested and motivated medical students then took on leadership roles in these projects. Student-led scholarly assessment of the impact of some of these interventions resulted in 2 peer-reviewed publications thus far and 9 national presentations at the time of this publication. These assessments demonstrate not only educational impact, but health-system-level changes and meaningful change in patient outcomes.
Collapse
Affiliation(s)
- Michelle Johnson
- University of California, San Diego
School of Medicine, La Jolla, CA
| | - Charlie Goldberg
- University of California, San Diego
School of Medicine, La Jolla, CA
| | | | - Lori Wan
- University of California, San Diego
School of Medicine, La Jolla, CA
| | - Kama Guluma
- University of California, San Diego
School of Medicine, La Jolla, CA
| | - Sunny Smith
- University of California, San Diego
School of Medicine, La Jolla, CA
| |
Collapse
|
11
|
Gheihman G, Jun T, Young GJ, Liebman D, Sharma K, Brandes E, Ogur B, Hirsh DA. A review of longitudinal clinical programs in US medical schools. MEDICAL EDUCATION ONLINE 2018; 23:1444900. [PMID: 29542394 PMCID: PMC5907349 DOI: 10.1080/10872981.2018.1444900] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Longitudinal clinical experiences are a common component of undergraduate medical curricula, yet these programs have not been systematically characterized in US medical schools. OBJECTIVE Our study sought to identify and characterize longitudinal clinical programs (LCPs) in US medical schools and measure associations between programs' structures and goals. DESIGN Using a mixed-methods approach, we conducted a secondary analysis of data from publicly available websites. We conducted a systematic keyword search of the websites of 137 LCME-accredited US medical schools to identify LCPs. We included programs with student-patient interactions of at least six months. We categorized programs using qualitative thematic analysis and compared associations between program structures and goals. RESULTS We identified 98 LCPs in 69 schools. Half (52.0%) of LCPs occurred during the core clinical year. Program structures included 'clinic attachments' (50.0%), 'longitudinal integrated clerkships' (26.5%), and 'patient attachments' (20.4%). We identified goals in 89 programs, including 'exposing students to specific topics, patient demographics, or practice settings' (78.7%); 'clinical or professional skill development' (65.2%); and 'understanding the patient experience' (19.1%). Patient attachments were associated with 'exposure to specific patient demographics' (P = .04) and 'understanding the patient experience' (P = .03). Pre-clinical programs were associated with clinical skills development (P = .01). CONCLUSIONS Our study identifies the scope and nature of LCPs in US medical schools. Understanding connections between educational structures and goals may guide program design and research investigations of educational processes and outcomes.
Collapse
Affiliation(s)
| | - Tomi Jun
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | - Barbara Ogur
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
| | - David A. Hirsh
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- CONTACT David A. Hirsh Department of Medicine, Cambridge Health Alliance (CHA), Macht Building 4th floor, 1493 Cambridge St, Cambridge, MA02139, United States
| |
Collapse
|
12
|
Westermann L, Zisimidou B, Simons M, Zellweger R, Baschera D. Self-evaluation of present clinical skills by medical students in the years 3 to 6 - a pilot study in four European countries. GMS JOURNAL FOR MEDICAL EDUCATION 2018; 35:Doc36. [PMID: 30186946 PMCID: PMC6120160 DOI: 10.3205/zma001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/07/2018] [Accepted: 04/17/2018] [Indexed: 06/08/2023]
Abstract
Background: Clinical training concepts of medical students differ in the various European countries. The goal of this paper is to study the differences at the beginning of medical practice in specific clinical skills on an international level. Methods: The data were collected by a publically accessible online questionnaire online from February to June 2010. The participants in the study were recruited through the official letter sent by deaneries and student organisations. Two thousand nine hundred and seven medical students participated in the online survey. From study years 1 to 6, 2406 valid data records (67.3 percent female; 32.7 percent male) from four different European countries were sent. The skills in the questionnaire included patient consultation and anamnesis, physical examination, auscultation, gypsum and bandage dressing, suture techniques, venepuncture, and laying of indwelling catheters. Results: One thousand six hundred and twenty-nine data records of medical students in their training years 3 to 6 were assessed. The average age of the students was 24.7 years. On a scale from 1 to 10, the average satisfaction of the students with their medical faculty was 6.47 (±2.07); the assessment of the preparation for the clinical activities was 4.72 (±2.13). By comparison, British students indicated most satisfaction with their training (6.70±1.85). With respect to the clinical skills, the students interviewed felt safest in patient consultation and anamnesis (7.63±2.13) followed by blood sampling (7.46±2.29). The topics of surgical suturing techniques (4.40±2.81) and the gypsum and bandaging techniques (2.63±2.23) were taught worst subjectively. Discussion: The training of medical students in basic clinical skills is an essential part of the studies. This study was able to demonstrate that the subjective trust of medical students in their personal skills positively correlated with the satisfaction with their own university. The results pointed out that future curricula of universities could profit from an increased focus on clinical skills.
Collapse
Affiliation(s)
- Leonard Westermann
- University Hospital Cologne, Department for Orthopaedics and Traumatology, Cologne, Germany
| | - Barbara Zisimidou
- University Hospital Cologne, Department for Orthopaedics and Traumatology, Cologne, Germany
| | - Marvin Simons
- University Hospital Cologne, Department for Orthopaedics and Traumatology, Cologne, Germany
| | - Rene Zellweger
- Royal Perth Hospital, Department of Orthopaedics and Trauma Surgery, Perth, Australia
| | - Dominik Baschera
- Kantonsspital Winterthur, Department for Neurosurgery, Winterthur, Switzerland
| |
Collapse
|
13
|
Connor DM, Conlon PJ, O’Brien BC, Chou CL. Improving clerkship preparedness: a hospital medicine elective for pre-clerkship students. MEDICAL EDUCATION ONLINE 2017; 22:1307082. [PMID: 28395598 PMCID: PMC5419300 DOI: 10.1080/10872981.2017.1307082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 06/01/2023]
Abstract
BACKGROUND Medical students often struggle to apply their nascent clinical skills in clerkships. While transitional clerkships can orient students to new roles and logistics, students may benefit from developing clinical skills in inpatient environments earlier in their curriculum to improve readiness for clerkships. INTERVENTION Our four- to six-session elective provides pre-clerkship students with individualized learning in the inpatient setting with the aim of improving clerkship preparedness. Students work one-on-one with faculty who facilitate individualized learning through mentoring, deliberate practice, and directed feedback. Second-year medical students are placed on an attending-only, traditionally 'non-teaching' service in the hospital medicine division of a Veterans Affairs (VA) hospital for half-day sessions. Most students self-select into the elective following a class-wide advertisement. The elective also accepts students who are referred for remediation of their clinical skills. OUTCOME In the elective's first two years, 25 students participated and 47 students were waitlisted. We compared participant and waitlisted (non-participant) students' self-efficacy in several clinical and professional domains during their first clerkship. Elective participants reported significantly higher clerkship preparedness compared to non-participants in the areas of physical exam, oral presentation, and formulation of assessments and plans. CONCLUSIONS Students found the one-on-one feedback and personalized attention from attending physicians to be a particularly useful aspect of the course. This frequently cited benefit points to students' perceived needs and the value they place on individualized feedback. Our innovation harnesses an untapped resource - the hospital medicine 'non-teaching' service - and serves as an attainable option for schools interested in enhancing early clinical skill-building for all students, including those recommended for remediation. ABBREVIATIONS A&P: Assessment and plan; H&P: History and physical; ILP: Individual learning plan.
Collapse
Affiliation(s)
- Denise M. Connor
- Division of Hospital Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Paul J. Conlon
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bridget C. O’Brien
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Calvin L. Chou
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
14
|
Smith SD, Dunham L, Dekhtyar M, Dinh A, Lanken PN, Moynahan KF, Stuber ML, Skochelak SE. Medical Student Perceptions of the Learning Environment: Learning Communities Are Associated With a More Positive Learning Environment in a Multi-Institutional Medical School Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1263-1269. [PMID: 27119332 DOI: 10.1097/acm.0000000000001214] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Many medical schools have implemented learning communities (LCs) to improve the learning environment (LE) for students. The authors conducted this study to determine whether a relationship exists between medical student perceptions of the LE and presence of LCs during the preclerkship years. METHOD Students from 24 schools participating in the American Medical Association Learning Environment Study completed the 17-item Medical Student Learning Environment Survey (MSLES) at the end of their first and second years of medical school between 2011 and 2013. Mean total MSLES scores and individual item scores at the end of the first and second years in schools with and without LCs were compared with t tests, and effect sizes were calculated. Mixed-effects longitudinal models were used to control for student demographics and random school and student effects on the relationship between LC status and MSLES score. RESULTS A total of 4,980 students (81% of 6,148 matriculants) from 18 schools with LCs and 6 without LCs participated. Mean [SD] MSLES scores were significantly higher in LC schools compared with non-LC schools at the end of year one (3.72 [0.44] versus 3.57 [0.43], P < .001) and year two (3.69 [0.49] versus 3.42 [0.54], P < .001). The effect size increased from 0.35 (small) at the end of year one to 0.53 (medium) at the end of year two. CONCLUSIONS This large multi-institutional cohort study found that LCs at medical schools were associated with more positive perceptions of the LE by preclerkship students.
Collapse
Affiliation(s)
- Sunny D Smith
- S.D. Smith is associate clinical professor, Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, San Diego, California. L. Dunham is data analyst II, Medical Education Outcomes, American Medical Association, Chicago, Illinois. M. Dekhtyar is research associate, Medical Education Outcomes, American Medical Association, Chicago, Illinois. A. Dinh is institutional research analyst, Office of Institutional Research, Evaluation, and Assessment, University of Massachusetts Medical School, Worcester, Massachusetts. P.N. Lanken is professor of medicine and medical ethics and health policy and associate dean for professionalism and humanism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. K.F. Moynahan is professor and deputy dean for education, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona. M.L. Stuber is professor and assistant dean for well-being and career advising, Department of Psychiatry, David Geffen Medical School, University of California, Los Angeles, California. S.E. Skochelak is group vice president, Medical Education, American Medical Association, Chicago, Illinois
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Osterberg LG, Goldstein E, Hatem DS, Moynahan K, Shochet R. Back to the Future: What Learning Communities Offer to Medical Education. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2016; 3:10.4137_JMECD.S39420. [PMID: 29349325 PMCID: PMC5736294 DOI: 10.4137/jmecd.s39420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 05/15/2023]
Abstract
Learning communities (LCs) have increasingly been incorporated into undergraduate medical education at a number of medical schools in the United States over the past decade. In an Association of Medical Colleges survey of 140 medical schools, 102 schools indicated that they had LC (described as colleges or mentorship groups; https://www.aamc.org/initiatives/cir/425510/19a.html). LCs share an overarching principle of establishing longitudinal relationships with students and faculty, but differ in the emphasis on specific components that may include curriculum delivery, advising/ mentoring, student wellness, and community. The creation of LCs requires institutional commitment to reorganize educational processes to become more student centered. LCs are beginning to show positive outcomes for students including benefits related to clinical skills development, advising, and student wellness, in addition to positive outcomes for LC faculty.
Collapse
Affiliation(s)
| | - Erika Goldstein
- University of Washington School of Medicine, Seattle, WA, USA
| | - David S. Hatem
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Kevin Moynahan
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Robert Shochet
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
16
|
LaRochelle JS, Dong T, Durning SJ. Preclerkship Assessment of Clinical Skills and Clinical Reasoning: The Longitudinal Impact on Student Performance. Mil Med 2015; 180:43-6. [DOI: 10.7205/milmed-d-14-00566] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
ABSTRACT
Purpose: Many medical schools across the United States are undergoing curriculum reform designed, in part, to integrate basic sciences and clinical skills. Evidence has suggested that preclerkship courses in clinical skills and clinical reasoning are predictive of student performance on the clerkship. We hypothesized that a combination of outcome measures from preclerkship clinical skills and clinical reasoning courses (Objective Structured Clinical Examination scores, preceptor evaluations, National Board of Medical Examiners subject examination scores, and small group participation grades) would be correlated to performance in internship (program director [PD] evaluation form at end of first postgraduate year). Methods: Outcome measures from preclerkship clinical skills and clinical reasoning courses and PD evaluation forms from 514 medical students graduating between 2009 and 2011 were analyzed in a multiple linear regression model. Results: Preclerkship clinical skills and clinical reasoning outcome measures were significant contributors to the linear regression model and were able to explain 13.9% of the variance in expertise and 7.6% of the variance in professionalism as measured by the PD evaluation form. Conclusion: Clinical skills and clinical reasoning courses during the preclerkship period explained a significant amount of performance at the graduate medical education level. Our data suggest that these courses provide valuable information regarding student abilities in internship. Early recognition of struggling students may provide an opportunity to break a cycle of poor performance that can persist into residency training.
Collapse
Affiliation(s)
- Jeffrey S. LaRochelle
- Department of Medicine, F. Edward Hébert Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Ting Dong
- Department of Medicine, F. Edward Hébert Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Steven J. Durning
- Department of Medicine, F. Edward Hébert Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| |
Collapse
|
17
|
Wenrich MD, Jackson MB, Wolfhagen I, Ramsey PG, Scherpbier AJJ. What are the benefits of early patient contact?--A comparison of three preclinical patient contact settings. BMC MEDICAL EDUCATION 2013; 13:80. [PMID: 23731514 PMCID: PMC3674974 DOI: 10.1186/1472-6920-13-80] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 05/29/2013] [Indexed: 05/10/2023]
Abstract
BACKGROUND Despite increasing attention to providing preclinical medical students with early patient experiences, little is known about associated outcomes for students. The authors compared three early patient experiences at a large American medical school where all preclinical students complete preceptorships and weekly bedside clinical-skills training and about half complete clinical, community-based summer immersion experiences. The authors asked, what are the relative outcomes and important educational components for students? METHODS Medical students completed surveys at end of second year 2009-2011. In 2009, students compared/contrasted two of three approaches; responses framed later survey questions. In 2010 and 2011, students rated all three experiences in relevant areas (e.g., developing comfort in clinical setting). Investigators performed qualitative and quantitative analyses. RESULTS Students rated bedside training more highly for developing comfort with clinical settings, one-on-one clinical-skills training, feedback, active clinical experience, quality of clinical training, and learning to be part of a team. They rated community clinical immersion and preceptorships more highly for understanding the life/practice of a physician and career/specialty decisions. CONCLUSIONS Preclinical students received different benefits from the different experiences. Medical schools should define objectives of early clinical experiences and offer options accordingly. A combination of experiences may help students achieve clinical and team comfort, clinical skills, an understanding of physicians' lives/practices, and broad exposure for career decisions.
Collapse
Affiliation(s)
- Marjorie D Wenrich
- Office of the CEO, UW Medicine and Executive Vice President for Medical Affairs, University of Washington, Box 356350, Seattle, WA 98195-6350, USA
| | - Molly B Jackson
- Department of Medicine, University of Washington School of Medicine, Box 356429, Seattle, WA 98195-4328, USA
| | - Ineke Wolfhagen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Paul G Ramsey
- Office of the CEO, UW Medicine and Executive Vice President for Medical Affairs, University of Washington, Box 356350, Seattle, WA 98195-6350, USA
| | - Albert JJ Scherpbier
- Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| |
Collapse
|
18
|
Guiot AB, Baker RC, Dewitt TG. When and How Pediatric History and Physical Diagnosis Are Taught in Medical School: A Survey of Pediatric Clerkship Directors. Hosp Pediatr 2013; 3:139-43. [PMID: 24340414 DOI: 10.1542/hpeds.2012-0058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Backround:
History and physical diagnosis skills (HPDS) are required curriculum in medical schools (MS) with pediatric HPDS (PHPDS) necessitating instruction in addition to adult HPDS. Perceived deficiencies in these skills on the pediatric clerkship prompted investigation of when and how other MS taught PHPDS. The concern of whether medical students are adequately taught PHPDS needed to be addressed.
Methods:
With the use of the Council on Medical Student Education in Pediatrics listserv, pediatric clerkship directors from 129 US, 15 Canadian, and 2 Puerto Rican MS were contacted via e-mail to complete an anonymous online questionnaire, focused on MS demographics, PHPDS timing, teaching methods, and barriers.
Results:
Seventy-two (49%) of 146 MS responded to the survey; 18.1% of MS responders did not offer PHPDS in the first 2 years. Methodologies used to educate students included didactic lectures, physician shadowing, hands-on with patients, pairing with preceptor, instructional video, and examination of newborns. Each teaching method had <3 hours dedicated to medical students during their first 2 years at a majority of the MS. Of the responders, 85.1% concurred that medical students should be exposed to PHPDS before starting the clerkship. Barriers to providing PHPDS included MS time allotment, preceptor availability, and total number of students to accommodate.
Conclusions:
This study demonstrated striking variability among MS in how and when medical students were taught PHPDS. Clarification of the role of PHPDS instruction in preclinical years and standardized effective approaches to PHPDS instruction are both needed so that MS curriculum optimizes physician training.
Collapse
Affiliation(s)
- Amy B.L. Guiot
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | |
Collapse
|
19
|
Xu X, Wang Z, Pan H, Yang P, Yu J. One-week experience in the general surgery outpatient clinic for preclinical medical students. JOURNAL OF SURGICAL EDUCATION 2012; 69:599-604. [PMID: 22910156 DOI: 10.1016/j.jsurg.2012.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 04/07/2012] [Accepted: 05/07/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To evaluate whether the early introduction of observership in general surgery outpatient clinic for preclinical students could increase their interest in general surgery and ease their concerns, and to assess its potential effect on their careers in general surgery. STUDY DESIGN A structured observership program was conducted at the Peking Union Medical College. A total of 83 preclinical students were observed in the general surgery outpatient clinic. Students were given a format survey before and after the observership. RESULTS All students completed the early observing experience in general surgery. All students thought it worthwhile and recommended more such observership. Students had more interest in general surgery and higher possibility in choosing general surgery as a career. Their level of comfort and confidence in future clerkship was also improved. Most of the students thought the observership could improve their communication with surgeon teachers and patients. CONCLUSIONS The observership in general surgery outpatient clinic for preclinical medical students can increase their interest and career possibility in general surgery. It can also significantly boost their confidence and comfort in their future surgical clerkship and improve communication with surgeon teachers and patients.
Collapse
Affiliation(s)
- Xiequn Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | | | | | | | | |
Collapse
|
20
|
Taylor JS, Hunter N, Basaviah P, Mintz M. Developing a national collaborative of medical educators who lead clinical skills courses. TEACHING AND LEARNING IN MEDICINE 2012; 24:361-364. [PMID: 23036005 DOI: 10.1080/10401334.2012.730452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The majority of US medical schools now have pre-clerkship clinical skills (PCCS) courses. Course directors for these often logistically complicated courses may be in different medical specialties and, historically, have had few formal opportunities for communication and collaboration with their counterparts at other institutions. As such, we hypothesized that leaders of PCCS courses would benefit from a national network. SUMMARY In this paper, we outline the methodology used to form a national collaborative from grass roots interest. Over three years, a self-identified eleven-person task force with national representation has created an organization for PCCS course directors from US medical schools called Directors Of Clinical Skills courses (DOCS) that meets annually. CONCLUSIONS Through iterative presentations at regional and national medical education meetings, we have produced an inventory of educational issues for those developing, administering, and evaluating PCCS courses. Further development of this nascent organization is ongoing. Our process is generalizable.
Collapse
Affiliation(s)
- Julie Scott Taylor
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA. Julie
| | | | | | | |
Collapse
|
21
|
Oswald AE, Bell MJ, Wiseman J, Snell L. The impact of trained patient educators on musculoskeletal clinical skills attainment in pre-clerkship medical students. BMC MEDICAL EDUCATION 2011; 11:65. [PMID: 21939562 PMCID: PMC3190339 DOI: 10.1186/1472-6920-11-65] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 09/23/2011] [Indexed: 05/15/2023]
Abstract
BACKGROUND Despite the high burden of musculoskeletal (MSK) diseases, few generalists are comfortable teaching MSK physical examination (PE) skills. Patient Partners® in Arthritis (PP®IA) is a standardized patient educator program that could potentially supplement current MSK PE teaching. This study aims to determine if differences exist in MSK PE skills between non-MSK specialist physician and PP®IA taught students. METHODS Pre-clerkship medical students attended 2-hour small group MSK PE teaching by either non-MSK specialist physician tutors or by PP®IA. All students underwent an MSK OSCE and completed retrospective pre-post questionnaires regarding comfort with MSK PE and interest in MSK. RESULTS 83 students completed the OSCE (42 PP®IA, 41 physician taught) and 82 completed the questionnaire (42 PP®IA, 40 physician taught). There were no significant differences between groups in OSCE scores. For all questionnaire items, post-session ratings were significantly higher than pre-session ratings for both groups. In exploratory analysis PP®IA students showed significantly greater improvement in 12 of 22 questions including three of five patient-centred learning questions. CONCLUSIONS PP®IA MSK PE teaching is as good as non-MSK specialist physician tutor teaching when measured by a five station OSCE and provide an excellent complementary resource to address current deficits in MSK PE teaching.
Collapse
Affiliation(s)
- Anna E Oswald
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Mary J Bell
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Jeffrey Wiseman
- Centre for Medical Education and Department of Medicine, McGill University, Montreal, Canada
| | - Linda Snell
- Centre for Medical Education and Department of Medicine, McGill University, Montreal, Canada
| |
Collapse
|
22
|
Wenrich M, Jackson MB, Scherpbier AJ, Wolfhagen IH, Ramsey PG, Goldstein EA. Ready or not? Expectations of faculty and medical students for clinical skills preparation for clerkships. MEDICAL EDUCATION ONLINE 2010; 15:10.3402/meo.v15i0.5295. [PMID: 20711483 PMCID: PMC2919534 DOI: 10.3402/meo.v15i0.5295] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 07/07/2010] [Accepted: 07/13/2010] [Indexed: 05/16/2023]
Abstract
BACKGROUND Preclerkship clinical-skills training has received increasing attention as a foundational preparation for clerkships. Expectations among medical students and faculty regarding the clinical skills and level of skill mastery needed for starting clerkships are unknown. Medical students, faculty teaching in the preclinical setting, and clinical clerkship faculty may have differing expectations of students entering clerkships. If students' expectations differ from faculty expectations, students may experience anxiety. Alternately, congruent expectations among students and faculty may facilitate integrated and seamless student transitions to clerkships. AIMS To assess the congruence of expectations among preclerkship faculty, clerkship faculty, and medical students for the clinical skills and appropriate level of clinical-skills preparation needed to begin clerkships. METHODS Investigators surveyed preclinical faculty, clerkship faculty, and medical students early in their basic clerkships at a North American medical school that focuses on preclerkship clinical-skills development. Survey questions assessed expectations for the appropriate level of preparation in basic and advanced clinical skills for students entering clerkships. RESULTS Preclinical faculty and students had higher expectations than clerkship faculty for degree of preparation in most basic skills. Students had higher expectations than both faculty groups for advanced skills preparation. CONCLUSIONS Preclinical faculty, clerkship faculty, and medical students appear to have different expectations of clinical-skills training needed for clerkships. As American medical schools increasingly introduce clinical-skills training prior to clerkships, more attention to alignment, communication, and integration between preclinical and clerkship faculty will be important to establish common curricular agendas and increase integration of student learning. Clarification of skills expectations may also alleviate student anxiety about clerkships and enhance their learning.
Collapse
Affiliation(s)
- Marjorie Wenrich
- Office of the Dean, University of Washington School of Medicine, Seattle, WA, USA.
| | | | | | | | | | | |
Collapse
|
23
|
Kim SH, Yang EB, Ahn DS, Jeon WT, Lyu CJ. The present conditions of clinical clerkship management in Korea. KOREAN JOURNAL OF MEDICAL EDUCATION 2009; 21:373-383. [PMID: 25813442 DOI: 10.3946/kjme.2009.21.4.373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 09/18/2009] [Indexed: 06/04/2023]
Abstract
PURPOSE This study investigated the present conditions of clinical clerkship management in Korea to make recommendations for it. METHODS The data were collected between April 15 and May 30 in 2009 using questionnaires that were sent to the clerkship directors of 41 colleges of medicine and medical graduate schools. RESULTS The elective course system was established in 78% of the institutions; the 6 core specialties were found in all medical schools. The duration of clerkship was longest in internal medicine, followed by surgery, pediatrics, obstetrics and gynecology, psychiatry, and emergency medicine. There were differences between the planning and monitoring agencies. Preclinical courses existed in 92.7% of the institutions. However, much more remains to be done ie, with regard to the issues of student assessment in clinical clerkship, faculty development programs for the faculty and residents, incentive systems for educational involvement, provisions for yearly systematic clerkships, integration of basic-clinical science-medical humanities, and community-based education. CONCLUSION Because clinical clerkship education is very important as a core curriculum, curriculum planning and its management must be given adequate attention. The following measures are suggested: elective systems that allow students to choose by career planning; concerns over faculty development programs for residents as a teacher; consensus on the concept, objectives, duration, content, evaluation tools of pre-clinical clerkship and clinical clerkship, and student well-being; and emphasis on community-based education.
Collapse
Affiliation(s)
- Sang Hyun Kim
- BK21 project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Bae Yang
- Department of Medical Education, Yonsei University College of Medicine, Seoul, Korea
| | - Duck Sun Ahn
- Department of Physiology, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Tack Jeon
- Department of Medical Education, Yonsei University College of Medicine, Seoul, Korea
| | - Chuhl Joo Lyu
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
24
|
Jackson MB, Keen M, Wenrich MD, Schaad DC, Robins L, Goldstein EA. Impact of a pre-clinical clinical skills curriculum on student performance in third-year clerkships. J Gen Intern Med 2009; 24:929-33. [PMID: 19521738 PMCID: PMC2710476 DOI: 10.1007/s11606-009-1032-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 02/09/2009] [Accepted: 05/08/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Research on the outcomes of pre-clinical curricula for clinical skills development is needed to assess their influence on medical student performance in clerkships. OBJECTIVE To better understand the impact of a clinical-skills curriculum in the pre-clinical setting on student performance. DESIGN We conducted a non-randomized, retrospective, pre-post review of student performance evaluations from 3rd-year clerkships, before and after implementation of a clinical-skills curriculum, the Colleges (2001-2007). MAIN RESULTS Comparisons of clerkship performance data revealed statistically significant differences favoring the post-Colleges group in the Internal Medicine clerkship for 9 of 12 clinical-skills domains, including Technical Communication Skills (p < 0.023, effect size 0.16), Procedural Skills (p < 0.031, effect size 0.17), Communication Skills (p < 0.003, effect size 0.21), Patient Relationships (p < 0.003, effect size 0.21), Professional Relationships (p < 0.021, effect size 0.17), Educational Attitudes (p < 0.001, effect size 0.24), Initiative and Interest (p < 0.032, effect size 0.15), Attendance and Participation (p < 0.007, effect size 0.19), and Dependability (p < 0.008, effect size 0.19). Statistically significant differences were identified favoring the post-Colleges group in technical communication skills for three of six basic clerkships (Internal Medicine, Surgery, and Pediatrics). CONCLUSIONS Implementation of a pre-clinical fundamental skills curriculum appears to be associated with improved clerkship performance in the 3rd year of medical school, particularly in the Internal Medicine clerkship. Similar curricula, focused on teaching clinical skills in small groups at the bedside with personalized mentoring from faculty members, may improve student performance. Continued efforts are needed to understand how to best prepare students for clinical clerkships and how to evaluate outcomes of similar pre-clinical skills programs.
Collapse
Affiliation(s)
- Molly Blackley Jackson
- Department of Medicine, University of Washington, 1959 N.E. Pacific St., Campus Box 356429, Seattle, WA 98195, USA.
| | | | | | | | | | | |
Collapse
|
25
|
Chittenden EH, Henry D, Saxena V, Loeser H, O'Sullivan PS. Transitional clerkship: an experiential course based on workplace learning theory. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:872-6. [PMID: 19550179 DOI: 10.1097/acm.0b013e3181a815e9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Starting clerkships is anxiety provoking for medical students. To ease the transition from preclerkship to clerkship curricula, schools offer classroom-based courses which may not be the best model for preparing learners. Drawing from workplace learning theory, the authors developed a seven-day transitional clerkship (TC) in 2007 at the University of California, San Francisco School of Medicine in which students spent half of the course in the hospital, learning routines and logistics of the wards along with their roles and responsibilities as members of ward teams. Twice, they admitted and followed a patient into the next day as part of a shadow team that had no patient-care responsibilities. Dedicated preceptors gave feedback on oral presentations and patient write-ups. Satisfaction with the TC was higher than with the previous year's classroom-based course. TC students felt clearer about their roles and more confident in their abilities as third-year students compared with previous students. TC students continued to rate the transitional course highly after their first clinical rotation. Preceptors were enthusiastic about the course and expressed willingness to commit to future TC preceptorships. The transitional course models an approach to translating workplace learning theory into practice and demonstrates improved satisfaction, better understanding of roles, and increased confidence among new third-year students.
Collapse
Affiliation(s)
- Eva H Chittenden
- Palliative Care Service, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | | | | | | | | |
Collapse
|
26
|
Alexander EK. Perspective: moving students beyond an organ-based approach when teaching medical interviewing and physical examination skills. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2008; 83:906-9. [PMID: 18820518 DOI: 10.1097/acm.0b013e318184f2e5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Medical interviewing and physical examination skills are core pillars of clinical medicine. Though nearly all U.S. medical students participate in preclinical courses designed to teach these skills, medical school faculty often comment that students' abilities remain limited on entering their clinical clerkships. The reason for this contention is not clear.The author briefly describes the current preclinical curricula at most medical schools that are designed to teach patient interviewing and examination. An organ-based curriculum is commonly employed, although the limitations of such an approach readily become apparent. For example, many hospitalized patients do not suffer from single-organ illnesses, but rather from infections or metabolic derangements, which cause numerous abnormalities to several body systems. Furthermore, clinical reasoning skills are rarely taught in such preclinical courses, though these abilities form the foundation for effective doctoring. These findings suggest an opportunity for content development surrounding patient interviewing and examination. The author proposes an educational approach that depicts how the confluence of both content knowledge skills and clinical reasoning skills can work synergistically to enhance preclinical teaching of the medical interview and physical examination.
Collapse
Affiliation(s)
- Erik K Alexander
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
| |
Collapse
|
27
|
Poncelet A, O'Brien B. Preparing medical students for clerkships: a descriptive analysis of transition courses. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2008; 83:444-51. [PMID: 18448897 DOI: 10.1097/acm.0b013e31816be675] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Students have reported several challenging aspects of the transition to clerkships, such as applying clinical knowledge, learning experientially, using clinical skills, adjusting to clinical settings, and understanding roles. In an effort to address some of these challenges, a number of medical schools have added transition courses to their curricula, but little information about these courses has been published. The authors draw on findings from a study of the design and content of 30 transition courses offered in U.S. medical schools, to examine various approaches and provide a framework to guide the design of transition courses. Most courses (83%) were between one day and one week long. The authors identified three primary course themes: presentation of new information and skills, review and application of content covered in the preclerkship curriculum, and student well-being. All courses presented new information and skills, and more than half of the courses (53%) addressed all three themes. The most common curricular topics were technical/procedural skills, safety precautions, orientation to clinical settings, review of clinical skills, and stress management. Hands-on experience was the most frequently used instructional approach. Few courses had explicit goals and objectives, and evaluation of students was rare. Transition courses can address some of the needs and challenges associated with early clerkship experiences. These courses should explicitly target areas of need that are described in the literature as well as those identified within one's own institution. They should include clear objectives, learning activities tailored to the areas of need and objectives, and student and course evaluations.
Collapse
Affiliation(s)
- Ann Poncelet
- Department of Neurology, University of California-San Francisco, San Francisco, California 94143, USA.
| | | |
Collapse
|
28
|
Ottenheijm RPG, Zwietering PJ, Scherpbie AJJA, Metsemakers JFM. Early student-patient contacts in general practice: an approach based on educational principles. MEDICAL TEACHER 2008; 30:802-8. [PMID: 18608956 DOI: 10.1080/01421590802047265] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Clinical teaching and learning is generally seen as an educationally sound approach, but the clinical environment does not always offer optimal conditions to facilitate students' learning processes. AIMS To show how insights on constructing a good learning environment for student-patient contacts in real practice can be translated into an undergraduate clinical general practice programme in Year 3 and to study its feasibility. METHOD Literature search, yielding starting points for the development of the new programme and questionnaire evaluation of the programme. RESULTS Six starting points for a good learning environment for early student-patient contacts: continuing exposure to patients,transformation of experience into knowledge, active role of students, supervision and feedback, time and space for teaching and teacher training were translated into a the new programme. The evaluation showed that the programme was feasible and well received by students and GPs, although some improvements are possible. CONCLUSION In a curriculum with clear goals for early student-patient contacts, it is feasible to implement an early clinical programme in general practice based on educational principles.
Collapse
Affiliation(s)
- Ramon P G Ottenheijm
- Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | | | | | | |
Collapse
|
29
|
O'Brien B, Cooke M, Irby DM. Perceptions and attributions of third-year student struggles in clerkships: do students and clerkship directors agree? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2007; 82:970-8. [PMID: 17895662 DOI: 10.1097/acm.0b013e31814a4fd5] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE To explore the congruence between students' and clerkship directors' perceptions and attributions of students' struggles during the transition to clerkships. METHOD Focus groups and interviews were conducted with third- and fourth-year medical students and clerkship directors at 10 U.S. medical schools in 2005 and 2006. Schools were selected to represent diverse locations, sizes, and missions. Interviews and focus groups were recorded, transcribed, and analyzed thematically. RESULTS Students' struggles included understanding roles and responsibilities, adjusting to clinical cultures, performing clinical skills, learning the logistics of clinical settings, and encountering frequent changes in staff, settings, and content. Clerkship directors recognized students' struggles with roles and responsibilities, performing clinical skills, and adjusting to clinical cultures, but they also focused on students' difficulties applying knowledge to clinical reasoning and engaging in self-directed learning. CONCLUSIONS Clerkship directors and students recognize many challenges associated with learning and performing in the clerkships. Students' perspectives suggest that these challenges may be more complex than clerkship directors and clinical teachers realize and/or are capable of addressing. The areas in which clerkship directors' and students' perspectives are not congruent point to directions for future research that can guide curricula and teaching strategies.
Collapse
Affiliation(s)
- Bridget O'Brien
- The Carnegie Foundation for the Advancement of Teaching, Stanford, California 94305, USA.
| | | | | |
Collapse
|