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Sinha T, Parish A, Lein DH, Wylie E, Carver C, Brooks WS. Integration of Disability Awareness Improves Medical Students' Attitudes Toward People with Disabilities. MEDICAL SCIENCE EDUCATOR 2024; 34:561-569. [PMID: 38887426 PMCID: PMC11180063 DOI: 10.1007/s40670-024-02004-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 06/20/2024]
Abstract
Persons with disabilities (PWD) often require special accommodations and more comprehensive healthcare yet frequently have encounters with physicians who are unprepared to provide tailored and complete care. A multipronged disability awareness curriculum for second-year medical students was implemented, including content on disability etiquette, patient-centered and interprofessional learning sessions for individuals with physical disabilities and intellectual and developmental disabilities, and a debriefing session with physiatrists. The objective of this study was to utilize a mixed methods approach to evaluate the disability awareness curriculum in undergraduate medical education (UME). Assessment was conducted using course evaluations, pre- and post-surveys including the Attitudes and Perspectives Towards Persons with Disabilities (APPD) scale and Multidimensional Attitudes Scale Toward Persons with Disabilities (MAS), and student focus groups. The mean scores from both the APPD (2.11 ± 0.43 pre-score vs. 1.7 ± 0.39 post-score) and MAS (2.45 ± 0.43 pre-score vs. 2.25 ± 0.55 post-score) indicate the curriculum improved medical students' attitudes toward PWD (p < 0.05), with lower numbers representing more favorable attitudes. After completing the curriculum, medical students' attitudes were comparable to those of doctor of physical therapy (DPT) students. Qualitative analysis from focus groups highlighted four major themes: education, comfort level, impact on future practice, and disability differences. This curriculum has potential as a valuable framework for delivering effective disability education to medical students to prepare future physicians to serve PWD and their unique needs. It meets core competencies, provides an opportunity to learn in interprofessional environments, and integrates PWD into the educational process. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-024-02004-0.
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Affiliation(s)
- Tanvee Sinha
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | - Ashley Parish
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL USA
| | - Donald H. Lein
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL USA
| | - Elizabeth Wylie
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL USA
- Spain Rehabilitation Center, University of Alabama at Birmingham, Birmingham, AL USA
| | - Cathy Carver
- Spain Rehabilitation Center, University of Alabama at Birmingham, Birmingham, AL USA
| | - William S. Brooks
- Department of Cell, Developmental & Integrative Biology, Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, 1720 2nd Ave. S, Volker Hall 611, Birmingham, AL 35294-0019 USA
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Kapur S, Lichten L, Ali N, Garber KB. Poor recall of genetics curriculum by medical students highlights barriers to use in clinical practice. J Genet Couns 2024; 33:179-188. [PMID: 37735936 DOI: 10.1002/jgc4.1795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/12/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
Many current and upcoming healthcare providers do not feel comfortable ordering or discussing genetic tests and using genetic information in medicine. Nationally, a little over a quarter of medical students indicate that they do not feel prepared to use genetic information in clinical rotations, despite attempts at many schools to remodel the genetics curriculum. This study was conducted at Emory University School of Medicine to identify gaps within the medical curriculum that may contribute to student reports that they feel underprepared to apply genetic knowledge in clinical practice. The analysis included a comprehensive curriculum inventory of genetic content that was then compared to the responses from focus groups of randomly selected second- and fourth-year medical students without a prior genetics degree or background. This joint analysis of precisely what was taught and how it was perceived by students was informative in the development of targeted interventions in our curriculum, and it highlighted the important role of genetic counselors in the education of medical students. Our curriculum has a structure similar to that at many other schools, in which core genetics concepts are concentrated in a brief segment in the first year. We believe our results will be useful for other medical schools to address the perception by medical students that they are underprepared to use genetic information and other basic sciences clinically.
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Affiliation(s)
- Sunaina Kapur
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lauren Lichten
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nadia Ali
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kathryn B Garber
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
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Tannenbaum AP, Lilley CM. Perspectives from two recent medical school graduates on exposure to pathology during undergraduate medical education: A narrative inquiry. Acad Pathol 2023; 10:100094. [PMID: 37840650 PMCID: PMC10568268 DOI: 10.1016/j.acpath.2023.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/04/2023] [Accepted: 08/05/2023] [Indexed: 10/17/2023] Open
Abstract
The field of pathology is facing an inflection point where the demand for pathology services is not being met by a corresponding rise in recruitment into the field. Many of the myths about the field of pathology have been dispelled elsewhere, but there have not been many formal accounts of the experience medical students' face when finding their path to pathology. Because of challenges in the visibility of pathology as a specialty and not simply a subject required for United States Medical Licensing Examination Step 1, students tend to fall into one of two categories: early differentiators or late discoverers. Here, we provide anecdotal accounts of these two paths at institutions with different curricular designs and provide a first-hand account of the challenges we faced and opportunities discovered in our journeys to pathology. Based on these experiences, we offer suggestions for ways to address some of the issues medical students must navigate when trying to explore pathology in curricula not built for such exploration.
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Affiliation(s)
- Alex P. Tannenbaum
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Fulton TB, Collins S, van der Schaaf M, O'Brien BC. Connecting Biochemistry Knowledge to Patient Care in the Clinical Workplace: Senior Medical Students' Perceptions about Facilitators and Barriers. TEACHING AND LEARNING IN MEDICINE 2023; 35:398-410. [PMID: 35796605 DOI: 10.1080/10401334.2022.2084400] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
Phenomenon: Medical students have difficulties applying knowledge about biomedical mechanisms learned before clerkships to patient care activities. Many studies frame this challenge as a problem of basic science knowledge transfer predominantly influenced by students' individual cognitive processes. Social cognitive theory would support extending this framing to the interplay between the individual's cognition, the environment, and their behaviors. This study investigates senior medical students' experiences of biochemistry knowledge use during workplace learning and examines how their experiences were influenced by interactions with people and other elements of the clinical learning environment. Approach: The authors used a qualitative approach with a constructivist orientation. From September to November 2020 they conducted semi-structured interviews with 11 fourth-year medical students at one institution who had completed the pre-clerkship curriculum, core clinical clerkships, and the United States Medical Licensing Exam Step 1. The authors identified themes using thematic analysis. Findings: Participants reported that they infrequently used or connected to biochemistry knowledge in workplace patient care activities, yet all had examples of such connections that they found valuable to learning. Most participants felt the responsibility for making connections between biochemistry knowledge and activities in the clinical workplace should be shared between themselves and supervisors, but connections were often recognized and acted on only by the student. Connections that participants described prompted their effort to retrieve knowledge or fill a perceived learning gap. Participants identified multiple barriers and facilitators to connecting, including supervisors' behaviors and perceived knowledge, and "patients seen" in clerkships. Participants also reported learning biochemistry during USMLE Step 1 study that did not connect to patient care activities, underscoring a perception of disconnect. Insights: This study identifies specific personal, social, and physical environmental elements that influence students' perceived use of biochemistry during patient care activities. Though these findings may be most significant for biochemistry, they likely extend to other basic science disciplines. Students' self-directed efforts to connect to their biochemistry knowledge could be augmented by increased social support from clinical supervisors, which in turn likely requires faculty development. Opportunities for connection could be enhanced by embedding into the environment instructional strategies or technologies that build on known authentic connections between biochemistry and "patients seen" in clerkships. These efforts could strengthen student learning, improve clinical supervisors' self-efficacy, and better inform curriculum design.
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Affiliation(s)
- Tracy B Fulton
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | - Sally Collins
- Center for Faculty Educators, University of California, San Francisco, California, USA
| | - Marieke van der Schaaf
- Faculty of Medicine, Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bridget C O'Brien
- Department of Medicine, University of California, San Francisco, California, USA
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Held N, Jimenez S, Lockspeiser T, Adams JE. Designing a Shortened Preclinical Basic Science Curriculum: Expert-Derived Recommendations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:922-928. [PMID: 36972132 DOI: 10.1097/acm.0000000000005221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE To generate an expert-derived list of recommendations for how medical schools should approach decisions about the placement of basic science topics within shortened preclinical curricula, which allow for early clinical immersion. METHOD A modified Delphi process was used to develop consensus on recommendations (March-November 2021). The authors performed semistructured interviews with national undergraduate medical education (UME) experts from institutions that previously underwent curricular reforms involving shortened preclinical curricula to elicit perspectives on how decisions were made at their institutions. The authors condensed the findings into a preliminary list of recommendations and distributed this list in 2 survey rounds to a larger group of national UME experts (from institutions that previously underwent curricular reforms or held positions of authority within national UME organizations) to gauge their level of agreement with each recommendation. Recommendations were revised based on participant comments, and those with at least 70% somewhat or strong agreement after the second survey were included in the final comprehensive list of recommendations. RESULTS Interviews were conducted with 9 participants and resulted in 31 preliminary recommendations that were then sent via survey to the 40 recruited participants. Seventeen/40 (42.5%) participants completed the first survey, after which 3 recommendations were removed, 5 were added, and 5 were revised based on comments-resulting in 33 recommendations. Twenty-two/38 (57.9%) participants responded to the second survey, after which all 33 recommendations met inclusion criteria. The authors removed 3 recommendations that did not directly address the curriculum reform process and consolidated the final 30 recommendations into 5 succinct, actionable takeaways. CONCLUSIONS This study generated 30 recommendations (summarized by the authors in 5 succinct takeaways) for medical schools designing a shortened preclinical basic science curriculum. These recommendations reinforce the importance of vertically integrating basic science instruction with explicit clinical relevance into all curricular phases.
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Affiliation(s)
- Natalie Held
- N. Held is currently assistant professor in pulmonary sciences and critical care medicine, University of Colorado School of Medicine, Aurora, Colorado. At the time of the study, she was a pulmonary and critical care fellow and a Department of Medicine medical education fellow, University of Colorado School of Medicine, Aurora, Colorado
| | - Sheilah Jimenez
- S. Jimenez is a research services senior professional and curriculum research assistant, Office of Assessment, Evaluation, and Outcomes, Office of Medical Education, University of Colorado School of Medicine, Aurora, Colorado
| | - Tai Lockspeiser
- T. Lockspeiser is associate professor of pediatrics and assistant dean of medical education for assessment, evaluation, and outcomes, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer E Adams
- J.E. Adams is professor of medicine and assistant dean of medical education for clinical curriculum, University of Colorado School of Medicine, Aurora, Colorado; ORCID: https://orcid.org/0000-0002-5433-8600
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Miloslavsky EM, Besche HC, Calderwood SB, Chang BS, Dienstag JL, King RW, Mitchell RN, Schwartzstein RM, Thomas H, Hundert EM, Flanagan JG. Advanced Integrated Science Courses: Building a Skill Set to Engage With the Interface of Research and Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1467-1473. [PMID: 35108233 DOI: 10.1097/acm.0000000000004612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Scientific research has been changing medical practice at an increasing pace. To keep up with this change, physicians of the future will need to be lifelong learners with the skills to engage with emerging science and translate it into clinical care. How medical schools can best prepare students for ongoing scientific change remains unclear. Adding to the challenge is reduced time allocated to basic science in curricula and rapid expansion of relevant scientific fields. A return to science with greater depth after clinical clerkships has been suggested, although few schools have adopted such curricula and implementation can present challenges. The authors describe an innovation at Harvard Medical School, the Advanced Integrated Science Courses (AISCs), which are taken after core clerkships. Students are required to take 2 such courses, which are offered in a variety of topics. Rather than factual content, the learning objectives are a set of generalizable skills to enable students to critically evaluate emerging research and its relationship to medical practice. Making these generalizable skills the defining principle of the courses has several important advantages: it allows standardization of acquired skills to be combined with diverse course topics ranging from basic to translational and population sciences; students can choose courses and projects aligned with their interests, thereby enhancing engagement, curiosity, and career relevance; schools can tailor course offerings to the interests of local faculty; and the generalizable skills delineate a unique purpose of these courses within the overall medical school curriculum. For the 3 years AISCs have been offered, students rated the courses highly and reported learning the intended skill set effectively. The AISC concept addresses the challenge of preparing students for this era of rapidly expanding science and should be readily adaptable to other medical schools.
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Affiliation(s)
- Eli M Miloslavsky
- E.M. Miloslavsky is assistant professor of medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Henrike C Besche
- H.C. Besche is lecturer in cell biology, Harvard Medical School, Boston, Massachusetts
| | - Stephen B Calderwood
- S.B. Calderwood is professor of medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bernard S Chang
- B.S. Chang is professor of neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Jules L Dienstag
- J.L. Dienstag is professor of medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Randall W King
- R.W. King is professor of cell biology, Harvard Medical School, Boston, Massachusetts
| | - Richard N Mitchell
- R.N. Mitchell is professor of pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Richard M Schwartzstein
- R.M. Schwartzstein is professor of medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Horatio Thomas
- H. Thomas was an MD student at Harvard Medical School, Boston, Massachusetts, during initial design of the AISC curriculum. He is a resident in radiation oncology, University of California, San Francisco, California
| | - Edward M Hundert
- E.M. Hundert is dean for medical education and professor in residence of global health and social medicine and medical education, Harvard Medical School, Boston, Massachusetts
| | - John G Flanagan
- J.G. Flanagan is professor of cell biology, Harvard Medical School, Boston, Massachusetts
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