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Mazotti LA, Adams JE, DeWitt DE. A value analysis of longitudinal integrated clerkships: consideration of costs and benefits. EDUCATION FOR PRIMARY CARE 2024:1-7. [PMID: 38565150 DOI: 10.1080/14739879.2024.2329887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
Longitudinal Integrated Clerkships (LICs) prioritise longitudinal relationships with faculty, patients, and place. Research shows that LICs benefit students and faculty, but most medical schools have limited LIC programmes. This is likely due to perceptions that LICs are more costly and complex than traditional block rotations (TBRs). The perceived cost versus evidence-based value related to clerkship education has not been examined in detail. Until recently, no 'All-LIC' medical school exemplars existed in the US, limiting the value of this model as well as the ability to examine relative cost and complexity. In this paper, we draw on our experience launching three 'All-LIC' medical schools in the United States - schools in which the entire clerkship class participates in a comprehensive clerkship-year LIC. We propose that the known benefits of LICs coupled with cost-mitigation strategies related to running an 'All LIC' model for core clinical clerkships, rather than block and LIC models simultaneously, results in a higher value for medical schools.
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Affiliation(s)
- Lindsay A Mazotti
- Clinical education, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Jennifer E Adams
- Medical education and clinical clerkships, University of Colorado School of Medicine, Aurora, CO, USA
| | - Dawn E DeWitt
- Interprofessional health education, research, and scholarship, Washington State University College of Medicine, Spokane, WA, USA
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Nandiwada DR, Farkas AH, Nikiforova T, Leung PB, Donovan AK, Killian K, Thomas ML, Singh MK, Gallagher B, Callender DM. Exploring Models of Exposure to Primary Care Careers in Training: a Narrative Review. J Gen Intern Med 2024; 39:277-282. [PMID: 37989819 PMCID: PMC10853099 DOI: 10.1007/s11606-023-08532-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
Multiple models of clinical exposure to primary care exist within undergraduate medical education (UME) and graduate medical education (GME). In this narrative review, we explore the evidence behind these different models of exposure, their alignment with positive promoters of primary care careers, and the pros and cons of each. Without positive exposure to primary care during training, sustaining the future primary care work force becomes increasingly challenging. Here, we explore multiple models of clinical exposure in UME, including longitudinal integrated clerkships, primary care tracks, and primary care clerkships. Within GME, we will review the impact of primary care tracks, Area Health Education Centers, block scheduling models, and continuity clinic scheduling models. The goal of this narrative review is to allow educators to think broadly and intentionally about the array of models to develop positive primary care experiences and perceptions in training, ultimately sustaining the primary care workforce.
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Affiliation(s)
- D Rani Nandiwada
- Perelman School of Medicine, University of Pennsylvania, 51 North 39Th Street, MAB 102, Philadelphia, PA, 19104, USA
| | - Amy H Farkas
- Milwaukee VA Medical Center, 5000 W National Ave, Milwaukee, WI, 53211, USA
| | - Tanya Nikiforova
- Division of General Internal Medicine, UPMC Montefiore Hospital, 9 West 921, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Peggy B Leung
- Weill Cornell Internal Medicine Associates, 505 East 70Th St, HT-4, New York, NY, 10021, USA
| | - Anna K Donovan
- Division of General Internal Medicine, UPMC Montefiore Hospital, 9 West 930, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Katherine Killian
- Weill Cornell Internal Medicine, 178 East 85Th Street, Floor 2, New York, NY, 10028, USA
| | - Mary L Thomas
- University of Tennessee, 920 Madison Ave, Suite 531, Memphis, TN, 38163, USA
| | - Mamta K Singh
- Case Western Reserve University, VA Northeast Ohio Healthcare System, 1620 Magnolia Drive, Administrative Building, RM 5M678, Cleveland, OH, 44106, USA
| | | | - David M Callender
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA.
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Latessa RA, Galvin SL, Swendiman RA, Onyango J, Ostrach B, Edmondson AC, Davis SA, Hirsh DA. Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study. BMC MEDICAL EDUCATION 2023; 23:760. [PMID: 37828469 PMCID: PMC10571297 DOI: 10.1186/s12909-023-04622-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Psychological safety and accountability are frameworks to describe relationships in the workplace. Psychological safety is a shared belief by members of a team that it is safe to take interpersonal risks. Accountability refers to being challenged and expected to meet expectations and goals. Psychological safety and accountability are supported by relational trust. Relational continuity is the educational construct underpinning longitudinal integrated clerkships. The workplace constructs of psychological safety and accountability may offer lenses to understand students' educational experiences in longitudinal integrated clerkships. METHODS We performed a qualitative study of 9 years of longitudinal integrated clerkship graduates from two regionally diverse programs-at Harvard Medical School and the University of North Carolina School of Medicine. We used deductive content analysis to characterize psychological safety and accountability from semi-structured interviews of longitudinal integrated clerkship graduates. RESULTS Analysis of 20 graduates' interview transcripts reached saturation. We identified 109 discrete excerpts describing psychological safety, accountability, or both. Excerpts with high psychological safety described trusting relationships and safe learning spaces. Low psychological safety included fear and frustration and perceptions of stressful learning environments. Excerpts characterizing high accountability involved increased learning and responsibility toward patients. Low accountability included students not feeling challenged. Graduates' descriptions with both high psychological safety and high accountability characterized optimized learning and performance. CONCLUSIONS This study used the workplace-based frameworks of psychological safety and accountability to explore qualitatively longitudinal integrated clerkship graduates' experiences as students. Graduates described high and low psychological safety and accountability. Graduates' descriptions of high psychological safety and accountability involved positive learning experiences and responsibility toward patients. The relational lenses of psychological safety and accountability may inform faculty development and future educational research in clinical medical education.
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Affiliation(s)
- Robyn A Latessa
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC, USA
| | - Shelley L Galvin
- Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, NC, USA
| | - Robert A Swendiman
- Department of Pediatric General Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joshua Onyango
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Bayla Ostrach
- University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC, USA
- Departments of Family Medicine and Medical Anthropology, Boston University School of Medicine, Boston, MA, USA
| | | | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Asheville, NC, USA
| | - David A Hirsh
- Harvard Medical School, Boston, MA, USA.
- Department of Medicine, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA, 02139, USA.
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Eddings SK, Brown LL, Godin S. Qualitative Findings of a Nominal Group Process to Identify Critical Factors in New LIC Implementation. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231217894. [PMID: 38106517 PMCID: PMC10725107 DOI: 10.1177/23821205231217894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/19/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Medical schools considering longitudinal integrated clerkships (LICs) have access to literature that provides recommendations for planning, implementation, and sustainability. However, LIC development and implementation remain notoriously challenging. University of Utah's LIC development process was informed by the documented experiences of long-established LIC programs. A literature gap was identified pertaining to more recently implemented LICs. The aim of this study was to explore the experiences of faculty in the early stages of LIC development. METHODS Thirteen representatives from eight LICs implemented after 2015 participated in 2 Zoom focus groups (5 participated in the first and the other 8 participated in the second). Participants were asked questions to assess key supports, barriers, and recommendations. Following the focus groups, participants were asked to rank the responses based on their level of importance. RESULTS Highest ranked supports included stakeholder and partner involvement; a dedicated coordinator or team; and strong, committed leadership. Highest ranked barriers included difficulty recruiting preceptors and clinical sites; underestimation of the amount of work required to coordinate the LIC; and challenges in providing the needed faculty development. Top recommendations for new LICs included investing in the needs of clinical partners; staffing or assigning a dedicated coordinator early in the development and implementation process; and frequent communication with all stakeholders. CONCLUSION Despite variation among the types of new LICs represented, there was consensus among participants on the importance of key supports, barriers, and recommendations. Knowledge of these factors can help new schools plan and allocate resources during their LIC development process. Participants found the focus group process and follow-up discussions useful and have formed an ongoing workgroup which meets quarterly.
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Affiliation(s)
- Stacy K. Eddings
- Dean's Office, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, United States
| | - Laura L. Brown
- Department of Pediatrics, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, United States
| | - Steven Godin
- Division of Public Health, Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, United States
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Kracaw RA, Hernandez-Moreno J, Estrada Munoz OI, Sullivan CC, Haycocks N, Shen GK. The Perception of Surgery Program Directors of Residency Applicants From Longitudinal Integrated Curriculum Medical Schools: A Survey of the Association of Program Directors in Surgery Members. Cureus 2023; 15:e34375. [PMID: 36874662 PMCID: PMC9977080 DOI: 10.7759/cureus.34375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 01/31/2023] Open
Abstract
Research statement This study explores whether longitudinal integrated clerkship (LIC) students are competitive general surgery applicants and if they are perceived as adequately prepared for general surgery residency compared to traditional block rotation (BR) students. Background/relevance of the study There is increasing interest in LIC models of clinical education versus BR models. LIC students have been shown to perform similarly on examinations to BR students. However, while LICs seem well suited for students pursuing primary care specialties, little is known about how this approach impacts clinical education for surgery. Design and methods An electronic survey was prepared and approved by the Association of Program Directors in Surgery (APDS) and our university's institutional review board (IRB). Ten multiple-choice questions were administered along with an option for narrative comments. Surveys were sent over a one-month period to members of APDS Listserv. Returned emails were de-identified, and the results were tabulated. Results From 43 responses, the majority identified as program directors (PDs) (65%) and reported being somewhat familiar or very familiar with LICs (90%). When asked about the statement "LIC students are prepared for surgical residency," 22% "disagreed" or "strongly disagreed." When asked "How would you rank a LIC prospective applicant in comparison to a BR student?" 35% responded that they would rank the LIC student lower or not at all. Of the respondents, 47% reported that they have current residents who were LIC students. Most of these residents (65%) are graded as "average" for current performance. Conclusions The results suggest that medical students who are trained using LICs may be disadvantaged when applying to general surgery residencies. Interpretation is limited by the small number of respondents, and it only reflects the opinions of active APDS Listserv members. Further study is needed to confirm these findings and elucidate the basis of perceived deficiencies in LICs. Students from these schools should be advised to obtain additional surgery experience.
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Affiliation(s)
- Rachel A Kracaw
- Medical Education, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (UNLV), Las Vegas, USA
| | - Jessica Hernandez-Moreno
- Medical Education, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (UNLV), Las Vegas, USA
| | - Oscar I Estrada Munoz
- General Surgery, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (UNLV), Las Vegas, USA
| | - Corrin C Sullivan
- Medical Education, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (UNLV), Las Vegas, USA
| | - Neil Haycocks
- Medical Education, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (UNLV), Las Vegas, USA
| | - Gary K Shen
- Surgery, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (UNLV), Las Vegas, USA
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The Impact of Internal Medicine Clerkship Characteristics and NBME Subject Exams on USMLE Step 2 Clinical Knowledge Exam Performance. J Gen Intern Med 2022; 37:2208-2216. [PMID: 35764759 PMCID: PMC9296728 DOI: 10.1007/s11606-022-07520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/25/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Residency program directors will likely emphasize the United States Medical Licensing Exam (USMLE) Step 2 clinical knowledge (CK) exam more during residency application given the recent USMLE Step 1 transition to pass/fail scoring. We examined how internal medicine clerkship characteristics and NBME subject exam scores affect USMLE Step 2 CK performance. DESIGN The authors used univariable and multivariable generalized estimating equations to determine associations between Step 2 CK performance and internal medicine clerkship characteristics and NBME subject exams. The sample had 21,280 examinees' first Step 2 CK scores for analysis. RESULTS On multivariable analysis, Step 1 performance (standardized β = 0.45, p < .001) and NBME medicine subject exam performance (standardized β = 0.40, p < .001) accounted for approximately 60% of the variance in Step 2 CK performance. Students who completed the internal medicine clerkship last in the academic year scored lower on Step 2 CK (Mdiff = -3.17 p < .001). Students who had a criterion score for passing the NBME medicine subject exam scored higher on Step 2 CK (Mdiff = 1.10, p = .03). There was no association between Step 2 CK performance and other internal medicine clerkship characteristics (all p > 0.05) nor with the total NBME subject exams completed (β=0.05, p = .78). CONCLUSION Despite similarities between NBME subject exams and Step 2 CK, the authors did not identify improved Step 2 CK performance for students who had more NBME subject exams. The lack of association of Step 2 CK performance with many internal medicine clerkship characteristics and more NBME subject exams has implications for future clerkship structure and summative assessment. The improved Step 2 CK performance in students that completed their internal medicine clerkship earlier warrants further study given the anticipated increase in emphasis on Step 2 CK.
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Kracaw RA, Dizon W, Antonio S, Simanton E. Predicting United States Medical Licensing Examination Step 2 Clinical Knowledge Scores from Previous Academic Performance Measures within a Longitudinal Interleaved Curriculum. Cureus 2021; 13:e18143. [PMID: 34584812 PMCID: PMC8457316 DOI: 10.7759/cureus.18143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 11/26/2022] Open
Abstract
Background United States Medical Licensing Examination (USMLE) Step 1 is a common metric looked at by residency programs to determine invitations for candidates to interview. However, USMLE Step 2 Clinical Knowledge (CK) has also been an important factor for selecting applicants to interview and plays a significant role during applicant selection. This study aims to identify academic performance measures that correlate with USMLE Step 2 CK scores and to develop a model to predict USMLE Step 2 CK scores using previous academic measures from the first two cohorts in the longitudinal interleaved clerkship (LInC) at the Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (KSOM). Setting The KSOM is a newly accredited US allopathic medical school that accepted its first class in 2017. At KSOM, a LInC model is used in the primary clinical year. In this model, rotations are two weeks in duration before moving on to the next specialty. Students complete the National Board of Medical Examiners (NBME) subject examinations in all six specialties in one week at the midpoint and the end of the LInC. Students who passed an exam at the midpoint can opt out of that exam at the end as the higher of the two exam scores is recorded. However, most students choose to take all the exams again to improve their scores and prepare for USMLE Step 2 CK. Methodology Academic performance measures were gathered from the class of 2021 and 2022 (n = 101) including undergraduate grade point average (GPA), undergraduate science GPA, medical college admission test score, USMLE Step 1 score, NBME clinical subject exam scores, and USMLE Step 2 CK scores. Pearson correlations were run between the performance variables and USMLE Step 2 CK scores to measure influence variables individually, then a regression model measured impacts of variables together. Results All variables except undergraduate science GPA significantly correlated with USMLE Step 2 CK score. USMLE Step 1 had the strongest correlation (r = 0.752, p < 0.001). The regression model had an R of 0.859 with the internal medicine subject exam showing the highest beta coefficient (0.327, p < 0.001). Conclusions This study determined that USMLE Step 2 CK scores can be effectively predicted using available performance measures. With USMLE Step 1 becoming pass/fail in January 2022, the importance of USMLE Step 2 CK as a screening tool in the residency application process will likely increase. This study was conducted within a LInC curriculum and may have limited value in the prediction of scores within other clinical year curricula.
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Affiliation(s)
- Rachel A Kracaw
- Medical Education, University of Nevada, Las Vegas School of Medicine, Las Vegas, USA
| | - Wynona Dizon
- Medical Education, University of Nevada, Las Vegas School of Medicine, Las Vegas, USA
| | - Sabrina Antonio
- Medical Education, University of Nevada, Las Vegas School of Medicine, Las Vegas, USA
| | - Edward Simanton
- Medical Education, University of Nevada, Las Vegas School of Medicine, Las Vegas, USA
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Eshel R, Hershkovitz R, Katz A, Orkin J, Amar S. Educational outcomes of the first longitudinal integrated clerkship program in Israel. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2021; 12:152-153. [PMID: 34449438 PMCID: PMC8411348 DOI: 10.5116/ijme.60f5.ef72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/19/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Ron Eshel
- Division of Anesthesia, Intensive Care, and Pain Management, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Reli Hershkovitz
- Faculty of Health Sciences, Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Amos Katz
- Faculty of Health Sciences, Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jacob Orkin
- Faculty of Health Sciences, Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shimon Amar
- Faculty of Health Sciences, Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Pradhan A, Bliss S, Buery-Joyner S, Craig L, Everett E, Forstein D, Graziano S, Hopkins L, McKenzie M, Morgan H, Page-Ramsey S, Hampton S. To the Point: Integrating the Obstetrics and Gynecology Core Clerkship into a Longitudinal Integrated Curriculum in US Medical Schools. MEDICAL SCIENCE EDUCATOR 2020; 30:1605-1610. [PMID: 33078082 PMCID: PMC7556763 DOI: 10.1007/s40670-020-01093-x] [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: 06/11/2023]
Abstract
This article, from the "To the Point" series that is prepared by the Association of Professors of Gynecology and Obstetrics (APGO) Undergraduate Medical Education Committee, is a review of issues to consider when integrating obstetrics and gynecology into a Longitudinal Integrated Clerkship (LIC) model. The background, objectives, and outcomes related to LIC are discussed. Specific challenges and solutions for structuring an LIC in the context of obstetrics and gynecology are examined, which include student/faculty issues as well as process matters such as general infrastructure and specific curriculum concerns.
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Affiliation(s)
- Archana Pradhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ USA
| | - Susan Bliss
- Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, NC USA
| | - Samantha Buery-Joyner
- Department of Obstetrics and Gynecology, Virginia Commonwealth University INOVA Campus, Fairvax, VA USA
| | - LaTasha Craig
- Department of Obstetrics and Gynecology, Oklahoma University College of Medicine, Oklahoma City, OK USA
| | - Elise Everett
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at University of Vermont, Burlington, VT USA
| | - David Forstein
- Department of Obstetrics and Gynecology, Touro College of Osteopathic Medicine-Harlem, Manhattan, NY USA
| | - Scott Graziano
- Department of Obstetrics and Gynecology, Loyola School of Medicine, Chicago, IL USA
| | - Laura Hopkins
- Department of Obstetrics and Gynecology, Ottawa University, Ottawa, Canada
| | - Margaret McKenzie
- Department of Obstetrics and Gynecology, Cleveland Clinic Lerner College of Medicine, University of Michigan School of Medicine, Cleveland, OH USA
| | - Helen Morgan
- Department of Obstetrics and Gynecology, University of Michigan School of Medicine, Ann Arbor, MI USA
| | - Sarah Page-Ramsey
- Department of Obstetrics and Gynecology, UT Health San Antonio, San Antonio, TX USA
| | - Star Hampton
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI USA
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Rashid H, Coppola KM, Lebeau R. Three Decades Later: A Scoping Review of the Literature Related to the United States Medical Licensing Examination. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S114-S121. [PMID: 33105189 DOI: 10.1097/acm.0000000000003639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To conduct a scoping review of the timing, scope, and purpose of literature related to the United States Medical Licensing Examination (USMLE) given the recent impetus to revise USMLE scoring. METHOD The authors searched PubMed, PsycInfo, and ERIC for relevant articles published from 1990 to 2019. Articles selected for review were labeled as research or commentaries and coded by USMLE Step level, sample characteristics (e.g., year(s), single/multiple institutions), how scores were used (e.g., predictor/outcome/descriptor), and purpose (e.g., clarification/justification/description). RESULTS Of the 741 articles meeting inclusion criteria, 636 were research and 105 were commentaries. Publication totals in the past 5 years exceeded those of the first 20 years.Step 1 was the sole focus of 38%, and included in 84%, of all publications. Approximately half of all research articles used scores as a predictor or outcome measure related to other curricular/assessment efforts, with a marked increase in the use of scores as predictors in the past 10 years. The overwhelming majority of studies were classified as descriptive in purpose. CONCLUSIONS Nearly 30 years after the inception of the USMLE, aspirations for its predictive utility are rising faster than evidence supporting the manner in which the scores are used. A closer look is warranted to systematically review and analyze the contexts and purposes for which USMLE scores can productively be used. Future research should explore cognitive and noncognitive factors that can be used in conjunction with constrained use of USMLE results to inform evaluation of medical students and schools and to support the residency selection process.
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Affiliation(s)
- Hanin Rashid
- H. Rashid is associate director, Office for Advancing Learning, Teaching, and Assessment, and assistant professor, Cognitive Skills Program, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Kristen M Coppola
- K.M. Coppola is assistant professor, Cognitive Skills Program, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Robert Lebeau
- R. Lebeau is director, Office for Advancing Learning, Teaching, and Assessment, and Cognitive Skills Program, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
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Fitz MM, Adams W, Haist SA, Hauer KE, Ross LP, Raff A, Agarwal G, Vu TR, Appelbaum J, Lang VJ, Miller C, Grum C. Which Internal Medicine Clerkship Characteristics Are Associated With Students' Performance on the NBME Medicine Subject Exam? A Multi-Institutional Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1404-1410. [PMID: 32195693 DOI: 10.1097/acm.0000000000003322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To identify which internal medicine clerkship characteristics may relate to NBME Medicine Subject Examination scores, given the growing trend toward earlier clerkship start dates. METHOD The authors used linear mixed effects models (univariable and multivariable) to determine associations between medicine exam performance and clerkship characteristics (longitudinal status, clerkship length, academic start month, ambulatory clinical experience, presence of a study day, involvement in a combined clerkship, preclinical curriculum type, medicine exam timing). Additional covariates included number of NBME clinical subject exams used, number of didactic hours, use of a criterion score for passing the medicine exam, whether medicine exam performance was used to designate clerkship honors, and United States Medical Licensing Examination Step 1 performance. The sample included 24,542 examinees from 62 medical schools spanning 3 academic years (2011-2014). RESULTS The multivariable analysis found no significant association between clerkship length and medicine exam performance (all pairwise P > .05). However, a small number of examinees beginning their academic term in January scored marginally lower than those starting in July (P < .001). Conversely, examinees scored higher on the medicine exam later in the academic year (all pairwise P < .001). Examinees from schools that used a criterion score for passing the medicine exam also scored higher than those at schools that did not (P < .05). Step 1 performance remained positively associated with medicine exam performance even after controlling for all other variables in the model (P < .001). CONCLUSIONS In this sample, the authors found no association between many clerkship variables and medicine exam performance. Instead, Step 1 performance was the most powerful predictor of medicine exam performance. These findings suggest that medicine exam performance reflects the overall medical knowledge students accrue during their education rather than any specific internal medicine clerkship characteristics.
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Affiliation(s)
- Matthew M Fitz
- M.M. Fitz is vice chair for faculty development, Department of Medicine, Loyola University Stritch School of Medicine, Maywood, Illinois
| | - William Adams
- W. Adams is assistant professor of medical education and public health sciences, Loyola University Chicago, Chicago, Illinois
| | - Steven A Haist
- S.A. Haist was vice president, Test Development Services, NBME, Philadelphia, Pennsylvania, when this work began. He is currently associate dean, University of Kentucky School of Medicine-Northern Kentucky Campus, Highland Heights, Kentucky
| | - Karen E Hauer
- K.E. Hauer is associate dean, Competency Assessment and Professional Standards, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Linette P Ross
- L.P. Ross is senior psychometrician, NBME, Philadelphia, Pennsylvania
| | - Amanda Raff
- A. Raff is internal medicine clerkship director, Albert Einstein College of Medicine, The Bronx, New York
| | - Gauri Agarwal
- G. Agarwal is associate dean for clinical curriculum, University of Miami Miller School of Medicine, Miami, Florida
| | - T Robert Vu
- T.R. Vu is associate professor of clinical medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jonathan Appelbaum
- J. Appelbaum is chair, Department of Clinical Sciences, and education director and professor of internal medicine, Florida State University College of Medicine, Tallahassee, Florida
| | - Valerie J Lang
- V.J. Lang is internal medicine hospitalist, Director of Meliora in Medicine, and director, Hospital Medicine Faculty Development Program, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Chad Miller
- C. Miller is associate dean of undergraduate medical education, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Cyril Grum
- C. Grum is vice chair for undergraduate medical education, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Beck Dallaghan GL, Gilliland KO, Steiner B, Byerley JS. University of North Carolina School of Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S383-S386. [PMID: 33626726 DOI: 10.1097/acm.0000000000003375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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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.
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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
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Career destinations of graduates from a medical school with an 18-week longitudinal integrated clerkship in general practice: a survey of alumni 6 to 8 years after graduation. Ir J Med Sci 2020; 190:185-191. [PMID: 32462491 PMCID: PMC7846533 DOI: 10.1007/s11845-020-02260-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 05/16/2020] [Indexed: 01/05/2023]
Abstract
Background There is a worldwide recruitment and retention crisis in general practice. Workforce planning has identified the need to train more general practitioners as an urgent priority. Exposure of medical students to general practice as part of the formal and hidden curriculum, the use of longitudinal integrated clerkships, and positive experiences and role models in general practice are all thought to be contributing factors to doctors choosing careers in general practice. Aim The aim of this study was to identify career destinations of medical school graduates in a medical school with an 18-week longitudinal integrated clerkship in general practice. Design and setting This study was conducted in a single graduate entry medical school at the University of Limerick, Ireland. Participants Medical school alumni 6–8 years after graduation. Method A survey of graduating cohorts of the medical school from 2011 to 2013 was conducted through email and telephone. Results There were a total of 175 alumni for the period 2011 to 2013. Data was collected on 92% (161/175) through an online survey, follow-up email and telephone interview, and was triangulated with searches of professional registration databases and information from key informants. Between 6 and 8 years after graduation, a total of 43% of alumni were engaged in general practice as a career. Conclusion The reform of the delivery of general practice within medical school curricula should be considered by medical schools, curriculum designers and policy-makers as part of an overall strategy to address the recruitment and retention of general practitioners as part of the global healthcare workforce.
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Brown MEL, Anderson K, Finn GM. A Narrative Literature Review Considering the Development and Implementation of Longitudinal Integrated Clerkships, Including a Practical Guide for Application. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519849409. [PMID: 31206031 PMCID: PMC6537286 DOI: 10.1177/2382120519849409] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/15/2019] [Indexed: 05/31/2023]
Abstract
Hailed by supporters as the answer to many challenges facing medical schools and the wider health care system, longitudinal integrated clerkships (LICs) offer a practical and sustainable alternative to more traditional block rotational models. Given this, their popularity as a curricular measure is increasing, although such clerkships remain relatively novel within the United Kingdom. This narrative literature review of international work provides a comprehensive introduction to developing and implementing LICs within medical education. This review generates a practical guide for medical educators with a focus on the development and implementation of LICs within the United Kingdom, on which there is little work. Using illustrated examples and with reference to contemporary literature, it outlines the rationale for considering an LIC within a curriculum, the different types of LIC, barriers and enabling factors to LIC implementation and considers the contemporary application of LIC models within the United Kingdom. The practical guide details key questions educators must consider when developing and implementing an LIC, particularly within the landscape of UK medical education.
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Affiliation(s)
- Megan EL Brown
- Health Professions Education Unit, Hull York Medical
School, University of York, York, UK
| | - Kevin Anderson
- Health Professions Education Unit, Hull York Medical
School, University of York, York, UK
| | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical
School, University of York, York, UK
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Joshi A, Haidet P. Time for a Change? How Rethinking Delivery of Undergraduate Medical Education in Psychiatry May Add Value to Healthcare Systems. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2018; 42:552-554. [PMID: 28589329 DOI: 10.1007/s40596-017-0732-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/11/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Aditya Joshi
- Penn State College of Medicine, Hershey, PA, USA.
| | - Paul Haidet
- Penn State College of Medicine, Hershey, PA, USA
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Latessa RA, Swendiman RA, Parlier AB, Galvin SL, Hirsh DA. Graduates' Perceptions of Learning Affordances in Longitudinal Integrated Clerkships: A Dual-Institution, Mixed-Methods Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1313-1319. [PMID: 28248695 DOI: 10.1097/acm.0000000000001621] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The authors explored affordances that contribute to participants' successful learning in longitudinal integrated clerkships (LICs). METHOD This dual-institutional, mixed-methods study included electronic surveys and semistructured interviews of LIC graduates who completed their core clinical (third) year of medical school. These LIC graduates took part in LICs at Harvard Medical School from 2004 to 2013 and the University of North Carolina School of Medicine-Asheville campus from 2009 to 2013. The survey questions asked LIC graduates to rate components of LICs that they perceived as contributing to successful learning. A research assistant interviewed a subset of study participants about their learning experiences. The authors analyzed aggregate data quantitatively and performed a qualitative content analysis on interview data. RESULTS The graduates reported multiple affordances that they perceive contributed to successful learning in their LIC. The most reported components included continuity and relationships with preceptors, patients, place, and peers, along with integration of and flexibility within the curriculum. CONCLUSIONS As LIC models grow in size and number, and their structures and processes evolve, learners' perceptions of affordances may guide curriculum planning. Further research is needed to investigate to what degree and by what means these affordances support learning in LICs and other models of clinical education.
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Affiliation(s)
- Robyn A Latessa
- R.A. Latessa is director and assistant dean, University of North Carolina (UNC) School of Medicine-Asheville Longitudinal Integrated Clerkships Program, Asheville, North Carolina, and professor of family medicine, UNC School of Medicine, Chapel Hill, North Carolina. R.A. Swendiman is a general surgery resident, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. A.B. Parlier is a research project coordinator, Center for Research at Mountain Area Health Education Center, Asheville, North Carolina. S.L. Galvin is director of research, Center for Research at Mountain Area Health Education Center, Asheville, North Carolina, and adjunct assistant professor, Department of Obstetrics/Gynecology, UNC School of Medicine, Chapel Hill, North Carolina. D.A. Hirsh is director, Harvard Medical School Cambridge Integrated Clerkship, Cambridge Health Alliance, Cambridge, Massachusetts, director, Harvard Medical School Academy Medical Education Fellowship, and associate professor of medicine, Harvard Medical School, Boston, Massachusetts
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Royal K. Robust (and Ethical) Educational Research Designs. JOURNAL OF VETERINARY MEDICAL EDUCATION 2017; 45:11-15. [PMID: 28581916 DOI: 10.3138/jvme.1015-162r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Educational research can be quite confusing to individuals without formal training in educational research methods. Many educators trained in "high-consensus" fields such as the health and medical sciences often expect to utilize the same esteemed experimental and quasi-experimental designs in their educational research efforts, but are surprised to learn that this is often impossible for ethical reasons. This article presents five robust research designs that generally are compatible with education studies, and discusses how each design may be used in a variety of educational research scenarios.
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Birden H, Barker J, Wilson I. Effectiveness of a rural longitudinal integrated clerkship in preparing medical students for internship. MEDICAL TEACHER 2016; 38:946-956. [PMID: 26691824 DOI: 10.3109/0142159x.2015.1114594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND We interviewed graduates from the first two cohorts of a postgraduate medical program that had a senior year longitudinal integrated clerkship (LIC) in a practice setting in rural New South Wales, Australia to determine how well their training prepared them to be junior doctors (3-4 years after graduation), and what aspects of that training they thought were particularly useful. METHODS In-depth interviews. RESULTS Fourteen junior doctors were interviewed. Participants reported feeling well prepared in ability to develop close relationships with clinical supervisors, good clinical and procedural skills, ability to work autonomously and work in teams, knowledge of health systems, ability to ensure self-care, and professionalism. Consensus view was that a rural placement was an excellent way to learn medicine for a variety of reasons including relationships with clinicians, less competition for access to patients, and opportunities to extend their clinical skills and act up to intern level. CONCLUSION The advantages we found in the training these junior doctors received which prepared them well for internship were integral both to the longitudinal, unstructured placement, and to the fact that it was carried out in a rural area. The two aspects of these placements appear to act synergistically, reinforcing the learning experience.
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Affiliation(s)
- Hudson Birden
- a James Cook University , Australia
- d University of Sydney , Australia
| | - Jane Barker
- b University of Western Sydney School of Medicine , Australia
| | - Ian Wilson
- c University of Wollongong Graduate School of Medicine , Australia
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