Medical students' perceptions of the elements of effective inpatient teaching by attending physicians and housestaff

Perceptions of homelessness: Is there variation across medical careers and specialties?

INTRODUCTION

Medical students, residents and faculty are all capable of holding biases towards stigmatised groups like people experiencing homelessness. This study sought to investigate how the level of training may influence perceptions of homelessness among medical students, residents and faculty. Additionally, we sought to understand how different specialities perceive people experiencing homelessness and whether this changes at various points in a career.

METHODS

The Health Professionals' Attitudes Towards the Homeless Inventory (HPATHI) was administered to medical students, residents and faculty at one institution in the United States. Basic demographics as well as length of time spent in practice were collected in addition to HPATHI responses.

RESULTS

A total of 1,141 individuals were invited to complete the survey, including 736 medical students, 214 residents and 191 faculty. Two hundred and ninety individuals participated in the survey and 238 recorded complete responses were analysed for a sample response rate of 238/1141 (20.9%.) Overall perceptions of homelessness across the entire sample were positive and not greatly influenced by the level of training during a medical career. Medical students across classes were largely in agreement and there was a noticeable increase in positive perceptions for students engaged in clinical rotations. However, clinical specialties demonstrated wide variation in perceptions, with the most prominent differences amongst individuals from surgical subspecialties of General Surgery and Obstetrics & Gynaecology.

CONCLUSION

Our study demonstrates the largely favourable attitudes physicians, residents and students have towards people experiencing homelessness with implications for future work to support greater exposure to underserved populations during training. Specialty choice appears to play a larger role in the formation of attitudes towards underserved populations rather than the length of time spent in a particular specialty.

Applying effective teaching and learning techniques to nephrology education

The interest in nephrology as a career has declined over the last several years. Some of the reasons cited for this decline include the complexity of the specialty, poor mentoring and inadequate teaching of nephrology from medical school through residency. The purpose of this article is to introduce the reader to advances in the science of adult learning, illustrate best teaching practices in medical education that can be extrapolated to nephrology and introduce the basic teaching methods that can be used on the wards, in clinics and in the classroom.

An academic hospitalist model to improve healthcare worker communication and learner education: results from a quasi-experimental study at a Veterans Affairs medical center

BACKGROUND

Although hospitalists may improve efficiency and quality of inpatient care, their effect on healthcare-worker communication and education has been less well-studied.

OBJECTIVE

To test various approaches to improving healthcare-worker communication and learner education within the context of a newly designed academic hospital medicine program.

DESIGN

Before-and-after design with concurrent control group.

SETTING

A Midwestern Veterans Affairs medical center.

INTERVENTION

Multimodal systems redesign of 1 of 4 medical teams (Gold team) that included clinical modifications (change in rounding structure, with inclusion of nurses, a Clinical Care Coordinator, and a pharmacist) and educational interventions (providing explicit expectations of learners and providing a reading list for both learners and attending physicians).

MEASUREMENTS

Number of admissions, length of stay, readmissions, house officer and medical student ratings of attendings' teaching, medical student internal medicine National Board of Medical Examiners Subject Examination ("shelf" exam) scores, and clinical staff surveys.

RESULTS

Length of stay was reduced by about 0.3 days on all teams after the initiative began (P = 0.004), with no significant differences between Gold and non-Gold teams. The majority of physicians (83%) and nurses (68%) felt that including nurses during rounds improved healthcare-worker communication; significantly more nurses were satisfied with communication with the Gold team than with the other teams (71% vs 53%; P = 0.02). Gold attendings generally received higher teaching scores compared with non-Gold attendings, and third-year medical students on the Gold team scored significantly higher on the shelf exam compared with non-Gold team students (84 vs 82; P = 0.006).

CONCLUSIONS

Academic hospitalists working within a systems redesign intervention were able to improve healthcare-worker communication and enhance learner education without increasing patient length of stay or readmission rates.

Effect of medical students' experiences with residents as teachers on clerkship assessment

BACKGROUND

We assessed the impact of resident teaching in medical students' overall assessment of an obstetrics and gynecology clerkship.

METHODS

Between September 2007 and March 2010, third-year medical students completed a questionnaire at the end of their clerkship. Questions covered the number of topics they recalled learning about from residents, perceptions of the quality of education received from residents, perceptions of the experience with the residents as teachers, and overall rating of the obstetrics and gynecology clerkship.

RESULTS

Questionnaires were completed by all medical students (N  =  74), with 63 students returning complete surveys. There was a small correlation between the number of topics students recalled learning about from residents and ratings of quality of education (r  =  0.249, P  =  .03), a small correlation between the number of topics students recalled learning about from residents and level of satisfaction with the clerkship (r  =  0.262, P  =  .04), and a larger correlation between assessment of the overall experience with residents as teachers and ratings of quality of education received from residents (r  =  0.687, P < .001). Overall experience with residents as teachers and perceived quality of education from residents were both associated with satisfaction with the clerkship (r  =  0.756, P < .001 and r  =  0.603, P < .001, respectively). A regression model with these variables accounted for 58% of the variability in students' ratings of the clerkship (F  =  27.103, P < .001, R  =  .761, R(2)  =  .579). The only significant independent variable was assessment of the overall experience with residents as teachers (t  =  5.350, P < .001).

CONCLUSION

Quality of interactions between residents and medical students is a key factor in medical students' assessment of their clerkship.