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Gonzalo JD, Graaf D, Wolpaw DR, Lehman E, Thompson BM. Non-physician and physician preceptors in Landscapes of Practice: a mixed-methods study exploring learning for 1 st-year medical students in clinical experiences. Med Educ Online 2023; 28:2166386. [PMID: 36642918 PMCID: PMC9848231 DOI: 10.1080/10872981.2023.2166386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 02/22/2022] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
Medical education has traditionally relied on physician educators. With expanding Health Systems Science competencies, non-physician healthcare providers are required. To investigate preceptor-role types, communication frequency, and importance of preceptors in value-added patient navigator roles (PN) and clinical preceptorships (CP). Using a mixed-methods approach, medical students participating in PN and CP during the first year of medical school (n=191) identified individuals with whom they communicated and communication frequency (1=never, 7=frequently), and importance of preceptors to work/education (1=not important, 7=extremely important; open-ended responses). Quantitative data were analyzed via repeated measures using a mixed-effects model and McNemar's test; effect size was calculated via Cohen's d or Cohen's h; qualitative data was analyzed using thematic analysis. Comparing ratings for non-physicians to physician healthcare professionals in PN, communication frequency (5.54 vs 3.65; p<0.001, d=1.18), importance to work (5.77 vs 4.28, p<0.001, d=0.89) and education (5.02 vs 4.12, p<0.001; d=0.49) were higher for non-physician educators. Comparing ratings for non-physicians to physician healthcare professionals in CP, communication frequency (4.93 vs. 6.48, p<0.001, d=1.33), importance to work (5.12 vs 6.61 vs, p<0.001, d=1.29) and education (4.32 vs 6.55, p<0.001, d=1.89) were higher for physician educators. Qualitative analysis indicated that non-physician healthcare providers in PN focused on Health Systems Science concepts, including social determinants of health and healthcare delivery. In PN, students observed collaboration from the perspective of multiple providers. In CP, healthcare providers, mainly physicians, focused on physician-centric clinical skills and interprofessional collaboration from the physician's perspective. Educational benefits of non-physician healthcare professionals related to Health Systems Science in work-based clinical settings - or Landscapes of Practice - can help students understand systems-based concepts such as social determinants of health, healthcare delivery systems, and interprofessional collaboration. Differences in the educational value of non-physician healthcare educators perceived by students should be further explored.
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Affiliation(s)
- Jed D. Gonzalo
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Deanna Graaf
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Daniel R. Wolpaw
- Department of Medicine, Penn State College of Medicine in Hershey, Pennsylvania, USA
| | - Erik Lehman
- Penn State College of Medicine, Hershey, Pennsylvania, USA
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Gonzalo JD, Hamilton M, DeWaters AL, Munyon R, Miller E, Wolf H, Wolpaw DR, Thompson BM. Implementation and Evaluation of an Interprofessional Health Systems Science Professional Development Program. Acad Med 2023; 98:703-708. [PMID: 36634613 DOI: 10.1097/acm.0000000000005144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PROBLEM Few interprofessional development programs focused on learning knowledge and skills in health systems science (HSS) have been described. The authors implemented a professional development program (the HSS Academy) for interprofessional clinicians and trainees. The authors describe the HSS Academy, report preliminary outcomes, and describe strategies for use in other programs. APPROACH The HSS Academy (an 8-month active learning classroom and project-based curriculum) was implemented at Penn State College of Medicine in 2015. To create an interprofessional environment, participants were selected from various professions and phases of training. The curriculum was anchored in HSS competencies (e.g., high-value care, quality improvement, social determinants of health, health system strategy and delivery) and included 2 distinct threads focused on systems thinking competencies and academic skill development. It featured course speakers and faculty from diverse roles and disciplines both inside and outside the health system, application of HSS competencies in local system contexts, and networking with interprofessional colleagues. OUTCOMES From 2015 to 2021, 121 of 128 participants, including physicians, medical students, and nurses, completed the HSS Academy (95% completion rate). Over 90 individuals, including faculty and system leaders, contributed to the HSS Academy as educators. Comparisons of pre-post evaluations demonstrated statistically significant self-perceived improvements in HSS knowledge and skills, systems thinking, and HSS teaching knowledge and skills. Projects (n = 110) most commonly focused on health care delivery, quality improvement, or patient safety. Teaching strategies to meet each objective, several barriers encountered, and strategies to address those barriers are described. NEXT STEPS Next steps will be to address financial support for creating and sustaining the HSS Academy, ensure a mutually shared understanding of the HSS Academy's goals among all stakeholders, facilitate meaningful change from scholars' work, and provide networking and opportunities for scholars to continue work in HSS after completion of the HSS Academy.
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Affiliation(s)
- Jed D Gonzalo
- J.D. Gonzalo is professor of medicine and health systems and implementation science and senior associate dean for medical education, Virginia Tech Carilion School of Medicine, Roanoke, VirginiaORCID: https://orcid.org/0000-0003-1253-2963
| | - Maria Hamilton
- M. Hamilton is director, Quality Programs/Quality Academy, Milton S. Hershey Medical Center, Penn State Healthcodirector, Health Systems Science Academy, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ami L DeWaters
- A.L. DeWaters is assistant professor of medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ryan Munyon
- R. Munyon is associate professor of medicine and codirector, Health Systems Science Academy, Penn State College of Medicine, Hershey, Pennsylvania
| | - Erin Miller
- E. Miller is research associate, Health Systems Science Office, Penn State College of Medicine, Hershey, PennsylvaniaORCID: https://orcid.org/0000-0002-9570-5307
| | - Heidi Wolf
- H. Wolf was assistant professor of pediatrics and codirector, Health Systems Science Academy, Penn State College of Medicine, Hershey, Pennsylvaniaat the time of writing
| | - Daniel R Wolpaw
- D.R. Wolpaw was professor of medicine and humanities and senior consultant, Education Innovation, Regional Medical Campus, Penn State College of Medicine, Hershey, Pennsylvaniaat the time of writing. He has since retired
| | - Britta M Thompson
- B.M. Thompson is associate dean, Learner Assessment and Program Evaluation, Penn State College of Medicine, Hershey, PennsylvaniaORCID: https://orcid.org/0000-0002-1977-4896
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Leong SL, Gillespie C, Jones B, Fancher T, Coe CL, Dodson L, Hunsaker M, Thompson BM, Dempsey A, Pallay R, Crump W, Cangiarella J. Accelerated 3-Year MD Pathway Programs: Graduates' Perspectives on Education Quality, the Learning Environment, Residency Readiness, Debt, Burnout, and Career Plans. Acad Med 2022; 97:254-261. [PMID: 34380931 PMCID: PMC8781222 DOI: 10.1097/acm.0000000000004332] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To compare perception of accelerated and traditional medical students, with respect to satisfaction with education quality, and the learning environment, residency readiness, burnout, debt, and career plans. METHOD Customized 2017 and 2018 Medical School Graduation Questionnaires (GQs) were analyzed using independent samples t tests for means and chi-square tests for percentages, comparing responses of accelerated MD program graduates (accelerated pathway [AP] students) from 9 schools with those of non-AP graduates from the same 9 schools and non-AP graduates from all surveyed schools. RESULTS GQ completion rates for the 90 AP students, 2,573 non-AP students from AP schools, and 38,116 non-AP students from all schools in 2017 and 2018 were 74.4%, 82.3%, and 83.3%, respectively. AP students were as satisfied with the quality of their education and felt as prepared for residency as non-AP students. AP students reported a more positive learning climate than non-AP students from AP schools and from all schools as measured by the student-faculty interaction (15.9 vs 14.4 and 14.3, respectively; P < .001 for both pairwise comparisons) and emotional climate (10.7 vs 9.6 and 9.6, respectively; P = .004 and .003, respectively) scales. AP students had less debt than non-AP students (P < .001), and more planned to care for underserved populations and practice family medicine than non-AP students from AP schools (55.7% vs 33.9% and 37.7% vs 9.4%; P = .002 and < .001, respectively). Family expectations were a more common influence on career plans for AP students than for non-AP students from AP schools and from all schools (26.2% vs 11.3% and 11.7%, respectively; P < .001 for both pairwise comparisons). CONCLUSIONS These findings support accelerated programs as a potentially important intervention to address workforce shortages and rising student debt without negative impacts on student perception of burnout, education quality, or residency preparedness.
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Affiliation(s)
- Shou Ling Leong
- S.L. Leong is assistant dean, Pathways Innovation, and director, 3+ Accelerated Pathway, Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: http://orcid.org/0000-0003-2954-5381
| | - Colleen Gillespie
- C. Gillespie is director, Division of Education Quality, Institute for Innovations in Medical Education, New York University Grossman School of Medicine, New York, New York
| | - Betsy Jones
- B. Jones is chair, Department of Medical Education, and codirector, Family Medicine Accelerated Track, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Tonya Fancher
- T. Fancher is associate dean, Workforce Innovation and Community Engagement, University of California Davis School of Medicine, Sacramento, California
| | - Catherine L. Coe
- C.L. Coe is assistant professor of family medicine and director, Fully Integrated Readiness for Service Training (FIRST) Program, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Lisa Dodson
- L. Dodson is campus dean, Medical College of Wisconsin–Central Wisconsin, Wasau, Wisconsin
| | - Matthew Hunsaker
- M. Hunsaker is campus dean, Medical College of Wisconsin–Green Bay, Green Bay, Wisconsin
| | - Britta M. Thompson
- B.M. Thompson is associate dean, Assessment and Evaluation, Penn State College of Medicine, Hershey, Pennsylvania
| | - Angela Dempsey
- A. Dempsey is associate dean, Curriculum in the Clinical Sciences, Medical University of South Carolina College of Medicine, Charleston, South Carolina
| | - Robert Pallay
- R. Pallay is chair and program director, Family Medicine, Mercer University School of Medicine, Macon, Georgia
| | - William Crump
- W. Crump is associate dean, Trover Campus, University of Louisville School of Medicine, Madisonville, Kentucky
| | - Joan Cangiarella
- J. Cangiarella is associate dean, Education, Faculty and Academic Affairs, and director, Accelerated Three Year MD Pathway, New York University Grossman School of Medicine, New York, New York
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Noverati N, R. Naro G, J. Fischer R, M. Thompson B. Using Video and Virtual Patients in Problem-Based Learning: a Scoping Review. Med Sci Educ 2020; 30:1685-1691. [PMID: 34457832 PMCID: PMC8368294 DOI: 10.1007/s40670-020-01108-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 06/07/2023]
Abstract
Problem presentation in problem-based learning can include the use of videos and interactive virtual patients. This review scopes the literature for this variation and what benefits or pitfalls there may be to their use. Themes indicate that videos and virtual patients may better prepare students for future difficult clinical interactions, while also increasing authenticity and memorability of cases. Findings are more inconsistent in determining whether they lead to clear knowledge or critical thinking gains. Despite inconsistent data, in an age where the use of technology is inevitable, the findings of this scoping review can inform future practice and guide innovation.
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Affiliation(s)
| | - Gillian R. Naro
- Pennsylvania State University College of Medicine, Hershey, PA USA
| | - Ryan J. Fischer
- Pennsylvania State University College of Medicine, Hershey, PA USA
| | - Britta M. Thompson
- Department of Medicine and Woodward Center for Excellence in Health Sciences Education, Hershey, PA USA
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Abstract
Phenomenon: Medical education is better aligning with the needs of health systems. Health systems science competencies, such as high-value care, population health, and systems thinking, are increasingly being integrated into curricula, but not without challenges. One challenge is mixed receptivity by students, the underlying reasons of which have not been extensively explored. In this qualitative study, we explored the research question: "How do students perceive health systems science curricula across all four years, and how do such perceptions inform the reasons for mixed quality ratings?" Approach: Following large-scale health systems science curricular changes in their medical school, we used students' open-ended comments obtained from course evaluations related to 1st-, 2nd-, and 4th-year courses and performed a qualitative thematic analysis to explore students' perceptions. We identified themes, synthesized findings into a conceptual figure, and agreed upon results and quotations. Findings: Five themes were identified: (1) perceived importance and relevance of health systems science education, (2) tension between traditional and evolving health systems science-related professional identity, (3) dissatisfaction with redundancy of topics, (4) competition with basic and clinical science curricula, and, (5) preference for discrete, usable, testable facts over complexity and uncertainty. The relationship between themes is described along a continuum of competing agendas between students' traditional mindset (which focuses on basic/clinical science) and an emerging medical education approach (which focuses on basic, clinical, and health systems science). Insights: Health systems science education can be viewed by learners as peripheral to their future practice and not aligned with a professional identity that places emphasis on basic and clinical science topics. For some students, this traditional identity limits engagement in health systems science curricula. If health systems science is to achieve its full potential in medical education, further work is required to explore the adoption of new perspectives by students and create activities to accelerate the process.
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Affiliation(s)
- Jed D Gonzalo
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Christopher Davis
- Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Britta M Thompson
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Paul Haidet
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Halliday NL, Moon MB, O'Donoghue DL, Thompson BM, Crow SM. Transformation and Closure for Anatomical Donor Families that Meet Medical Students. Anat Sci Educ 2019; 12:399-406. [PMID: 31038285 DOI: 10.1002/ase.1888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 06/09/2023]
Abstract
The University of Oklahoma College of Medicine has conducted an annual Anatomical Donor Luncheon where families of the anatomical donors met anatomy dissection groups of medical students. The luncheon presented an opportunity for donor family members to share the life story of their loved one with the medical students prior to the start of the anatomy course. This study was designed to understand the impact of the Anatomical Donor Luncheon on families of the donors. Seven families in two different focus groups were included to explore the reactions and attitudes of the donor families to meeting the medical students. Conversations were digitally recorded and transcribed. Qualitative analysis of textual data were coded by three investigators using the Constant Comparative Method. To provide evidence of validity, a form of member checking was utilized. For further triangulation, an analyst not involved in conducting the focus groups or analyzing the data, re-coded all data. This analyst used categories and themes identified by the original analysts, ensuring validity of the themes and any negative cases (data not supporting or contradictory of the established categories and themes). One meta-theme and three sub-themes were identified. The meta-theme was Donor Family Participants Experience Transformation and Closure, and sub-themes were Motivators for Participation, Optimal Venue Factors, and Optimal Medical Student-Anatomical Donor Family Interactions. Study findings indicated the Anatomical Donor Luncheon facilitated closure on the death of their loved one, and transformed their apprehension about the luncheon and body donation into an attitude of gratitude and appreciation.
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Affiliation(s)
- Nancy L Halliday
- Department of Cell Biology, College of Medicine, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Mary B Moon
- Department of Cell Biology, College of Medicine, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Daniel L O'Donoghue
- Department of Cell Biology, College of Medicine, The University of Oklahoma, Oklahoma City, Oklahoma
- Department of Family and Preventive Medicine, College of Medicine, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Britta M Thompson
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Sheila M Crow
- Educational Development Office, University of Miami Miller School of Medicine, Miami, Florida
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Volpe RL, Hopkins M, Van Scoy LJ, Wolpaw DR, Thompson BM. Does Pre-clerkship Medical Humanities Curriculum Support Professional Identity Formation? Early Insights from a Qualitative Study. Med Sci Educ 2019; 29:515-521. [PMID: 34457509 PMCID: PMC8368951 DOI: 10.1007/s40670-018-00682-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There is a lack of consensus about the outcomes of medical humanities training. In this qualitative study, the authors analyzed pre-clerkship small group discussions to assess the nature of learning in medical humanities. Twenty-two medical students (12 females and 10 males) in three humanities small groups consented to participate. The authors used inductive thematic analysis to qualitatively analyze the text from 13 weeks of curriculum. Findings indicate that students reflect about negotiating the clinician-patient relationship within the stressful environment characteristic of today's healthcare systems, that they worry about sacrificing their personal values in pursuit of honoring professional expectations, and that they encounter and commonly confront ambiguity. These themes were used to develop a descriptive framework of humanities small groups as a structure and safe space for the early development of professional identity.
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Affiliation(s)
- Rebecca L. Volpe
- Department of Humanities, Penn State College of Medicine, 500 University Drive, H134, Hershey, PA 17011 USA
| | - Margaret Hopkins
- Department of Humanities, Penn State College of Medicine, 500 University Drive, H134, Hershey, PA 17011 USA
| | - Lauren Jodi Van Scoy
- Pulmonary, Allergy and Critical Care Division, Penn State College of Medicine, Hershey, PA USA
| | - Daniel R. Wolpaw
- Department of Humanities and Medicine, Penn State College of Medicine, Hershey, PA USA
| | - Britta M. Thompson
- Department of Medicine and Woodward Center for Excellence in Health Sciences Education, Hershey, PA USA
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Gonzalo JD, Wolpaw D, Graaf D, Thompson BM. Educating patient-centered, systems-aware physicians: a qualitative analysis of medical student perceptions of value-added clinical systems learning roles. BMC Med Educ 2018; 18:248. [PMID: 30384850 PMCID: PMC6211412 DOI: 10.1186/s12909-018-1345-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/12/2018] [Indexed: 05/06/2023]
Abstract
BACKGROUND Medical schools have a critical need to develop roles for students that are "value-added," defined as "…experiential roles that can positively impact health outcomes while also enhancing student knowledge, attitudes, and skills in Clinical or Health Systems Science." Following implementation of value-added clinical systems learning roles for all first-year students, authors investigated student perceptions of the educational value from these patient-centered experiences. METHODS Between 2014 and 16, authors collected logs from students following their working with patients; authors also performed six, 1:1 student interviews, which were audio recorded and transcribed verbatim. Authors used thematic analysis to explore students' perceptions of the experience and educational benefits from these roles. Authors identified themes, and agreed upon results and quotations. RESULTS A total of 792 logs from 363 patients and six interviews were completed and analyzed. Students reported six educational benefits of performing value-added clinical systems learning roles in the health system, including enhanced understanding of and appreciation for a patient's perspective on health care and his/her health, barriers and social determinants of health, health care systems and delivery, interprofessional collaboration and teamwork, clinical medicine, and approach to communicating with patients. CONCLUSIONS Students' reported educational benefits from value-added clinical systems learning roles span several learning areas that align with clinical and Health Systems Science, i.e. the needs of future physicians. These roles have the potential to shift learning from the physician-centric identity to one more fully aligned with patient-centered, team-based providers, while also potentially improving health today.
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Affiliation(s)
- Jed D. Gonzalo
- Medicine and Public Health Sciences and Associate Dean for Health Systems Education, Penn State College of Medicine, Hershey, PA USA
- Division of General Internal Medicine, Penn State Hershey Medical Center – HO34, 500 University Drive Hershey, Hershey, PA 17033 USA
| | - Daniel Wolpaw
- Medicine and Humanities, Senior Consultant for Educational Innovation at the Regional Medical Campus, Penn State College of Medicine, Hershey, PA USA
| | - Deanna Graaf
- Office of Medical Education, Penn State College of Medicine, Hershey, PA USA
| | - Britta M. Thompson
- Medicine and Associate Dean for Learner Assessment and Program Evaluation, Penn State College of Medicine, Hershey, PA USA
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Gonzalo JD, Graaf D, Ahluwalia A, Wolpaw DR, Thompson BM. A practical guide for implementing and maintaining value-added clinical systems learning roles for medical students using a diffusion of innovations framework. Adv Health Sci Educ Theory Pract 2018; 23:699-720. [PMID: 29564583 DOI: 10.1007/s10459-018-9822-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 03/14/2018] [Indexed: 05/22/2023]
Abstract
After emphasizing biomedical and clinical sciences for over a century, US medical schools are expanding experiential roles that allow students to learn about health care delivery while also adding value to patient care. After developing a program where all 1st-year medical students are integrated into interprofessional care teams to contribute to patient care, authors use a diffusion of innovations framework to explore and identify barriers, facilitators, and best practices for implementing value-added clinical systems learning roles. In 2016, authors conducted 32 clinical-site observations, 29 1:1 interviews with mentors, and four student focus-group interviews. Data were transcribed verbatim, and a thematic analysis was used to identify themes. Authors discussed drafts of the categorization scheme, and agreed upon results and quotations. Of 36 sites implementing the program, 17 (47%) remained, 8 (22%) significantly modified, and 11 (31%) withdrew from the program. Identified strategies for implementing value-added roles included: student education, patient characteristics, patient selection methods, activities performed, and resources. Six themes influencing program implementation and maintenance included: (1) educational benefit, (2) value added to patient care from student work, (3) mentor time and site capacity, (4) student engagement, (5) working relationship between school, site, and students, and, (6) students' continuity at the site. Health systems science is an emerging focus for medical schools, and educators are challenged to design practice-based roles that enhance education and add value to patient care. Health professions' schools implementing value-added roles will need to invest resources and strategize about best-practice strategies to guide efforts.
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Affiliation(s)
- Jed D Gonzalo
- Medicine and Public Health Sciences, Health Systems Education, Penn State College of Medicine, Hershey, PA, USA.
- Division of General Internal Medicine, Penn State Hershey Medical Center - HO34, 500 University Drive, Hershey, PA, 17033, USA.
| | - Deanna Graaf
- Office of Medical Education, Penn State College of Medicine, Hershey, PA, USA
| | | | - Dan R Wolpaw
- Medicine and Humanities, Penn State College of Medicine, Hershey, PA, USA
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Joshi A, Haidet P, Wolpaw D, Thompson BM, Levine R. The Case for Transitioning to Pass/Fail Grading on Psychiatry Clerkships. Acad Psychiatry 2018; 42:396-398. [PMID: 29058225 DOI: 10.1007/s40596-017-0844-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/15/2017] [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
| | | | | | - Ruth Levine
- University of Texas Medical Branch, Galveston, TX, USA
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Levine RE, Borges NJ, Roman BJB, Carchedi LR, Townsend MH, Cluver JS, Frank J, Morey O, Haidet P, Thompson BM. High-Stakes Collaborative Testing: Why Not? Teach Learn Med 2018; 30:133-140. [PMID: 29220581 DOI: 10.1080/10401334.2017.1365719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Phenomenon: Studies of high-stakes collaborative testing remain sparse, especially in medical education. We explored high-stakes collaborative testing in medical education, looking specifically at the experiences of students in established and newly formed teams. APPROACH Third-year psychiatry students at 5 medical schools across 6 sites participated, with 4 participating as established team sites and 2 as comparison team sites. For the collaborative test, we used the National Board of Medical Examiners Psychiatry subject test, administering it via a 2-stage process. Students at all sites were randomly selected to participate in a focus group, with 8-10 students per site (N = 49). We also examined quantitative data for additional triangulation. FINDINGS Students described a range of heightened emotions around the collaborative test yet perceived it as valuable regardless if they were in established or newly formed teams. Students described learning about the subject matter, themselves, others, and interpersonal dynamics during collaborative testing. Triangulation of these results via quantitative data supported these themes. Insights: Despite student concerns, high-stakes collaborative tests may be both valuable and feasible. The data suggest that high-stakes tests (tests of learning or summative evaluation) could also become tests for learning or formative evaluation. The paucity of research into this methodology in medical education suggests more research is needed.
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Affiliation(s)
- Ruth E Levine
- a Office of Clinical Education and Department of Psychiatry and Behavioral Sciences , The University of Texas Medical Branch , Galveston , Texas , USA
| | - Nicole J Borges
- b Office of Academic Affairs, Wright State University Boonshoft School of Medicine , Dayton , Ohio , USA
| | - Brenda J B Roman
- c Office of Curriculum and Department of Psychiatry , Wright State University, Boonshoft School of Medicine , Dayton , Ohio , USA
| | - Lisa R Carchedi
- d Department of Psychiatry , University of Texas Southwestern Medical Center , Austin , Texas , USA
| | - Mark H Townsend
- e Department of Psychiatry , Louisiana State University Health Sciences Center , New Orleans , Louisiana , USA
| | - Jeffrey S Cluver
- f Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina , Charleston , South Carolina , USA
| | - Julia Frank
- g Department of Psychiatry , George Washington University School of Medicine and Health Sciences , Washington , DC , USA
| | - Oma Morey
- h Office of Educational Development, University of Texas Medical Branch , Galveston , Texas , USA
| | - Paul Haidet
- i Woodward Center for Excellence in Health Sciences Education, Pennsylvania State University College of Medicine , Hershey , Pennsylvania , USA
| | - Britta M Thompson
- i Woodward Center for Excellence in Health Sciences Education, Pennsylvania State University College of Medicine , Hershey , Pennsylvania , USA
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Matsumoto RAEK, Bresciani BH, Thompson BM, de Barros N. Encapsulated Papillary Breast Carcinoma: Anatomopathological and Clinicoradiological Aspects. Hong Kong J Radiol 2018. [DOI: 10.12809/hkjr1616816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Boufelli G, Mota BS, Franca FC, Doria MT, Maesaka JY, Ricci MD, Piato JRM, Rocha FBC, Giribela AHG, Gonçalves R, Masili-Oku S, Mano MS, Chala LF, Thompson BM, Baracat EC, Filassi JR. Abstract P2-12-11: Does conservative surgery treatment for locally advanced breast cancer safe after neoadjuvant treatment? Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-12-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND:
The aim of this study was to assess the oncological efficacy of breast conserving surgery (BCS) after neoadjuvant chemotherapy in patients with local advanced breast cancer.
PATIENTS AND METHODS:
A retrospective cohort study was conducted with locally advanced breast cancer invasive (Stage IIb to III) treated at ICESP, an oncologic referral center between 2008 and 2016. Endpoints were disease free survival (DFS), local disease free survival (LDFS) and overall survival (OS). Multivariable analyses were performed using Cox proportional hazards models.
RESULTS:
530 patients were included, 26% (138) were stage IIB, 41.9% (222) IIIA, 29.6% (157) IIIB and 2.5% (13) IIIA. 88.8% (470) were invasive ductal carcinoma. The mean age was 51.5(23-95). 95.5% and 4.5% were submitted Neoadjuvant Chemotherapy and Hormone therapy, respectively. The BCS were performed in 24.5% (130) patients versus 75.5% (400) of mastectomies. The mean follow up was 36.4(0.16-80.2) months. There were no differences in local disease free-survival 59 (95%CI 58-61) versus 60 (95%CI 57-60); p=0.4 and overall survival 56.2 (95%CI 52-60) versus 59.3(95%CI 53-65); p= 0.24 for mastectomy and BCS. The disease free survival was lower at mastectomy group 51.4 (95%CI 49-53) versus 56,8 (95%CI 53-59); p=0.01. Logistic regression models were significant only for cancer stage both patterns, although the results were better for masses, particularly when kinetic assessments were included (LR 12.8; p = 0.005)
CONCLUSION:
In our population, the BCS does not affect the overall and local disease-free survival rates, which seems to be safe to perform in patients who desire to conserve the breast after neoadjuvant treatment.
Citation Format: Boufelli G, Mota BS, Franca FC, Doria MT, Maesaka JY, Ricci MD, Piato JRM, Rocha FBC, Giribela AHG, Gonçalves R, Masili-Oku S, Mano MS, Chala LF, Thompson BM, Baracat EC, Filassi JR. Does conservative surgery treatment for locally advanced breast cancer safe after neoadjuvant treatment? [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-12-11.
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Affiliation(s)
- G Boufelli
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - BS Mota
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - FC Franca
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - MT Doria
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - JY Maesaka
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - MD Ricci
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - JRM Piato
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - FBC Rocha
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - AHG Giribela
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - R Gonçalves
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - S Masili-Oku
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - MS Mano
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - LF Chala
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - BM Thompson
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - EC Baracat
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - JR Filassi
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Gonzalo JD, Ahluwalia A, Hamilton M, Wolf H, Wolpaw DR, Thompson BM. Aligning Education With Health Care Transformation: Identifying a Shared Mental Model of "New" Faculty Competencies for Academic Faculty. Acad Med 2018; 93:256-264. [PMID: 28991850 DOI: 10.1097/acm.0000000000001895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE To develop a potential competency framework for faculty development programs aligned with the needs of faculty in academic health centers (AHCs). METHOD In 2014 and 2015, the authors interviewed 23 health system leaders and analyzed transcripts using constant comparative analysis and thematic analysis. They coded competencies and curricular concepts into subcategories. Lead investigators reviewed drafts of the categorization themes and subthemes related to gaps in faculty knowledge and skills, collapsed and combined competency domains, and resolved disagreements via discussion. RESULTS Through analysis, the authors identified four themes. The first was core functional competencies and curricular domains for conceptual learning, including patient-centered care, health care processes, clinical informatics, population and public health, policy and payment, value-based care, and health system improvement. The second was the need for foundational competency domains, including systems thinking, change agency/management, teaming, and leadership. The third theme was paradigm shifts in how academic faculty should approach health care, categorized into four areas: delivery, transformation, provider characteristics and skills, and education. The fourth theme was the need for faculty to be aware of challenges in the culture of AHCs as an influential context for change. CONCLUSIONS This broad competency framework for faculty development programs expands existing curricula by including a comprehensive scope of health systems science content and skills. AHC leaders can use these results to better align faculty education with the real-time needs of their health systems. Future work should focus on optimal prioritization and methods for teaching.
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Affiliation(s)
- Jed D Gonzalo
- J.D. Gonzalo is associate professor of medicine and public health sciences and associate dean, Health Systems Education, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: http://orcid.org/0000-0003-1253-2963. A. Ahluwalia is a third-year medical student, Penn State College of Medicine, Hershey, Pennsylvania. M. Hamilton is director, Quality Programs/Quality Academy, Penn State Health Milton S. Hershey Medical Center, and codirector, Health Systems Science Academy, Penn State College of Medicine, Hershey, Pennsylvania. H. Wolf is assistant professor of pediatrics and codirector, Health Systems Science Academy, Penn State College of Medicine, Hershey, Pennsylvania. D.R. Wolpaw is professor of medicine and humanities, senior consultant, Education Innovation, Regional Medical Campus, and director, Kienle Center for Humanistic Medicine, Penn State College of Medicine, Hershey, Pennsylvania. B.M. Thompson is associate dean, Learner Assessment and Program Evaluation, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: http://orcid.org/0000-0002-1977-4896
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Gonzalo JD, Thompson BM, Haidet P, Mann K, Wolpaw DR. A Constructive Reframing of Student Roles and Systems Learning in Medical Education Using a Communities of Practice Lens. Acad Med 2017. [PMID: 28640036 DOI: 10.1097/acm.0000000000001778] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Health systems are in the midst of a transformation that is being driven by a variety of forces. This has important implications for medical educators because clinical practice environments play a key role in learning and professional development, and evolving health systems are beginning to demand that providers have "systems-ready" knowledge, attitudes, and skills. Such implications provide a clear mandate for medical schools to modify their goals and prepare physicians to practice flexibly within teams and effectively contribute to the improvement of health care delivery. In this context, the concepts of value-added medical education, authentic student roles, and health systems science are emerging as increasingly important. In this Article, the authors use a lens informed by communities of practice theory to explore these three concepts, examining the implications that the communities of practice theory has in the constructive reframing of educational practices-particularly common student roles and experiences-and charting future directions for medical education that better align with the needs of the health care system. The authors apply several key features of the communities of practice theory to current experiential roles for students, then propose a new approach to students' clinical experiences-value-added clinical systems learning roles-that provides students with opportunities to make meaningful contributions to patient care while learning health systems science at the patient and population level. Finally, the authors discuss implications for professional role formation and anticipated challenges to the design and implementation of value-added clinical systems learning roles.
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Affiliation(s)
- Jed D Gonzalo
- J.D. Gonzalo is assistant professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: http://orcid.org/0000-0003-1253-2963. B.M. Thompson is professor of medicine and associate dean for learner assessment and program evaluation, Penn State College of Medicine, Hershey, Pennsylvania. P. Haidet is professor of medicine, humanities, and public health sciences and director of medical education research, Penn State College of Medicine, Hershey, Pennsylvania. K. Mann was professor emeritus, Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. D.R. Wolpaw is professor of medicine and humanities, senior consultant for education innovation, Regional Medical Campus, and director, Doctors Kienle Center for Humanistic Medicine, Penn State College of Medicine, Hershey, Pennsylvania
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Thompson BM, Bratzler DW, Fisher MJ, Torres A, Faculty EPIC, Sparks RA. Working together: Using a unique approach to evaluate an interactive and clinic-based longitudinal interprofessional education experience with 13 professions. J Interprof Care 2016; 30:754-761. [DOI: 10.1080/13561820.2016.1227962] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Landmann A, Havron WS, Patel A, Thompson BM, Lees JS. Medical student expectations from surgical education: A two-year institutional experience. Am J Surg 2016; 212:1265-1269. [PMID: 27889269 DOI: 10.1016/j.amjsurg.2016.09.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The third-year surgical rotation is the first exposure medical students have to the fundamentals of surgical education. It is known that medical students come to the surgical clerkship with preconceived ideas, many of them negative and based on prior student feedback and hearsay. METHODS An anonymous survey was conducted of third-year medical students while on the surgical clerkship. We sought to quantify student's experiences and expectations by assessing the students' confidence levels before and after the rotation. RESULTS Over a 26 month period from July 2013-August 2015, 250 surveys were conducted. In terms of confidence gained on the surgical rotation, students reported a statistically significant (p < 0.01) increase in confidence in fifteen different areas of interest. However, in terms of expectations, students reported discordance between anticipated experience and actual experience. Students' responses indicate that students felt confident with their knowledge of diseases; however, they desire more involvement in complex patient care and procedural skills. CONCLUSIONS The third-year clerkship is the first exposure to surgery for many medical students. Surgical educators are tasked with providing a foundation for clinical medicine; however, students have expressed an expectation to be more involved with complex patient care and management.
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Affiliation(s)
| | - William S Havron
- Orlando Regional Medical Center, Department of Surgical Education, USA
| | - Arpit Patel
- University of Oklahoma, College of Medicine, Department of Surgery, USA
| | - Britta M Thompson
- Penn State College of Medicine, Department of Medical Education, USA
| | - Jason S Lees
- University of Oklahoma, College of Medicine, Department of Surgery, USA
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Affiliation(s)
| | - Jed D Gonzalo
- PennState College of Medicine, Hershey, Pennsylvania, USA
| | - Ruth E Levine
- University of Texas Medical Branch, Galveston, Texas, USA
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Borges NJ, Thompson BM, Roman BJ, Townsend MH, Carchedi LR, Cluver JS, Frank JB, Haidet PM, Levine RE. Team Emotional Intelligence, Team Interactions, and Gender in Medical Students During a Psychiatry Clerkship. Acad Psychiatry 2015; 39:661-663. [PMID: 25700670 DOI: 10.1007/s40596-015-0282-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 01/13/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This study examined the relationship between team emotional intelligence, quality of team interactions, and gender. METHODS Psychiatry clerkship students participating in Team-Based Learning (TBL, n = 484) or no TBL (control, n = 265) completed the Workgroup Emotional Intelligence Profile (WEIP-S) and the Team Performance Scale (TPS). RESULTS Significant correlations (p < 0.01) existed between quality of team interactions (i.e., TPS) and team emotional intelligence (i.e., WEIP-S) subscales, but not gender. Control and TBL groups experienced significant increases in WEIP-S subscales pre to post (p < 0.01, η (2) = .08), with the TBL group experiencing significantly higher gains in three of four subscales. Control group scored higher on TPS. CONCLUSIONS A significant relationship exists between team emotional intelligence and quality of team interactions. Gender was unrelated to TPS or WEIP-S subscales. TBL group experienced higher gains in WEIP-S subscales while the control group experienced slightly higher TPS scores. Results suggest implications for medical educators who use TBL.
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Affiliation(s)
| | | | | | | | | | - Jeff S Cluver
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Paul M Haidet
- Pennsylvania State University, University Park, PA, USA
| | - Ruth E Levine
- The University of Texas Medical Branch, Galveston, TX, USA
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Thompson BM, Sparks RA, Seavey J, Wallace MD, Irvan J, Raines AR, McClure H, Nihira MA, Lees JS. Informed consent training improves surgery resident performance in simulated encounters with standardized patients. Am J Surg 2015; 210:578-84. [DOI: 10.1016/j.amjsurg.2014.12.044] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/17/2014] [Accepted: 12/22/2014] [Indexed: 01/16/2023]
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Thompson BM, Haidet P, Borges NJ, Carchedi LR, Roman BJB, Townsend MH, Butler AP, Swanson DB, Anderson MP, Levine RE. Team cohesiveness, team size and team performance in team-based learning teams. Med Educ 2015; 49:379-85. [PMID: 25800298 DOI: 10.1111/medu.12636] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 08/28/2013] [Accepted: 09/29/2014] [Indexed: 05/27/2023]
Abstract
OBJECTIVES The purpose of this study was to explore the relationships among variables associated with teams in team-based learning (TBL) settings and team outcomes. METHODS We administered the National Board of Medical Examiners (NBME) Psychiatry Subject Test first to individuals and then to teams of Year three students at four medical schools that used TBL in their psychiatry core clerkships. Team cohesion was analysed using the Team Performance Scale (TPS). Bivariate correlation and linear regression analysis were used to analyse the relationships among team-level variables (mean individual TPS scores for each team, mean individual NBME scores of teams, team size, rotation and gender make-up) and team NBME test scores. A hierarchical linear model was used to test the effects of individual TPS and individual NBME test scores within each team, as well as the effects of the team-level variables of team size, team rotation and gender on team NBME test scores. Individual NBME test and TPS scores were nested within teams and treated as subsampling units. RESULTS Individual NBME test scores and individual TPS scores were positively and statistically significantly (p < 0.01) associated with team NBME test scores, when team rotation, team size and gender make-up were controlled for. Higher team NBME test scores were associated with teams rotating later in the year and larger teams (p < 0.01). Gender make-up was not significantly associated. CONCLUSIONS The results of an NBME Psychiatry Subject Test administered to TBL teams at four medical schools suggest that larger teams on later rotations score higher on a team NBME test. Individual NBME test scores and team cohesion were positively and significantly associated with team NBME test scores. These results suggest the need for additional studies focusing on team outcomes, team cohesion, team size, rotation and other factors as they relate to the effective and efficient performance of TBL teams in health science education.
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Affiliation(s)
- Britta M Thompson
- Department of Paediatrics, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA; Office of Medical Education, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
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Thompson BM, Vannatta JB, Scobey LE, Fergeson M, Crow SM. Providing context for a medical school basic science curriculum: The importance of the humanities. Med Teach 2015; 38:82-87. [PMID: 25811322 DOI: 10.3109/0142159x.2015.1018878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION To increase students' understanding of what it means to be a physician and engage in the everyday practice of medicine, a humanities program was implemented into the preclinical curriculum of the medical school curriculum. The purpose of our study was to determine how medical students' views of being a doctor evolved after participating in a required humanities course. METHODS Medical students completing a 16-clock hour humanities course from 10 courses were asked to respond to an open-ended reflection question regarding changes, if any, of their views of being a doctor. The constant comparative method was used for coding; triangulation and a variety of techniques were used to provide evidence of validity of the analysis. RESULTS A majority of first- and second-year medical students (rr = 70%) replied, resulting in 100 pages of text. A meta-theme of Contextualizing the Purpose of Medicine and three subthemes: the importance of Treating Patients Rather than a Disease, Understanding Observation Skills are Important, and Recognizing that Doctors are Fallible emerged from the data. CONCLUSIONS Results suggest that requiring humanities as part of the required preclinical curriculum can have a positive influence on medical students and act as a bridge to contextualize the purpose of medicine.
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Affiliation(s)
| | | | | | | | - Sheila M Crow
- c University of Oklahoma School of Community Medicine , USA
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Chuter VH, de Jonge XAKJ, Thompson BM, Callister R. The efficacy of a supervised and a home-based core strengthening programme in adults with poor core stability: a three-arm randomised controlled trial. Br J Sports Med 2014; 49:395-9. [DOI: 10.1136/bjsports-2013-093262] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Ernst KD, Cline WL, Dannaway DC, Davis EM, Anderson MP, Atchley CB, Thompson BM. Weekly and consecutive day neonatal intubation training: comparable on a pediatrics clerkship. Acad Med 2014; 89:505-510. [PMID: 24448036 DOI: 10.1097/acm.0000000000000150] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To determine whether medical student intubation proficiency with a neonatal mannequin differs according to weekly or consecutive day practice sessions during a six-week pediatric clerkship. METHOD From July 2010 through June 2011, the authors prospectively randomized 110 third-year medical students into three neonatal intubation practice groups: standard (control; no practice sessions), weekly (practice once/week for four consecutive weeks), or consecutive day (practice once/day for four consecutive days). At baseline, students performed intubation during individual sessions using a neonatal mannequin (SimNewB). Two reviewers, blinded to practice group, viewed videotapes of intubations and independently scored students on equipment selection, procedural skill steps, length of intubation attempts (in seconds), and the number of attempts (up to three) needed for a successful intubation. Videotaped individual final assessment intubation sessions during week six were evaluated in the same manner. RESULTS Students in the weekly and consecutive day practice groups performed better at the final assessment on all variables than students in the standard group (P < .001), but over six weeks, the authors detected no differences between the two distributed practice formats for any outcomes of interest. CONCLUSIONS Practice improved all aspects of neonatal intubation performance, including choosing the correct equipment, properly performing the skill steps, length of time to successful intubation, and success rate, for novice health care providers in a simulation setting. Over six weeks, neither practice format proved superior, but it remains unclear whether one format is superior for learning and skill retention over the long term or in actual practice.
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Affiliation(s)
- Kimberly D Ernst
- Dr. Ernst is associate professor and director of medical education in newborn medicine, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Dr. Cline was, at the time of this study, neonatology fellow, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, and she is currently a clinical neonatologist in private practice, CoxHealth South, Springfield, Missouri. Dr. Dannaway is assistant professor and assistant director, Neonatal Fellowship Program, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Ms. Davis is a graduate student, Division of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Dr. Anderson is assistant professor and statistician, Division of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Dr. Atchley was, at the time of this study, neonatology fellow, and she is currently assistant professor, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Dr. Thompson is assistant dean for medical education and is affiliated with the Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Craig LB, Smith C, Crow SM, Driver W, Wallace M, Thompson BM. Obstetrics and gynecology clerkship for males and females: similar curriculum, different outcomes? Med Educ Online 2013; 18:21506. [PMID: 24300748 PMCID: PMC3849500 DOI: 10.3402/meo.v18i0.21506] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 08/26/2013] [Accepted: 10/09/2013] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To determine if performance differences exist between male and female students on a 6-week obstetrics and gynecology (Ob/Gyn) clerkship and to evaluate potential variables that might underlie any observed variations. STUDY DESIGN Final clerkship grades and component scores (clinical evaluations, objective structured clinical examination [OSCE], oral examination, and National Board of Medical Examiners [NBME] subject examination) from July 2007 to June 2010 were matched by student and analyzed by gender. Basic science grade point average (GPA) and initial United States Medical Licensing Exam (USMLE) Step 1 scores were used to establish students' baseline medical knowledge. On a post-clerkship questionnaire, a subset of students reported the numbers of procedures they performed during the clerkship; students also completed online pre- and post-clerkship questionnaires reflecting their self-assessed confidence in women's health clinical skills. RESULTS Scores were analyzed for 136 women and 220 men. Final clerkship grades were significantly higher for females than for males (89.05 vs. 87.34, p=0.0004, η(2)=0.08). Specifically, females outscored males on the OSCE, oral, and NBME subject examination portions of the clerkship but not clinical evaluations. Males reported completing fewer breast examinations (p=0.001, η(2)=0.14). Pre-clerkship, males were significantly less confident than females in women's health clinical skills (p<0.01) but reached similar levels upon completion of the clerkship. No gender differences were detected for basic science GPA and USMLE Step 1 scores. CONCLUSION Student gender is associated with final grades on an Ob/Gyn clerkship. Further research regarding these differences should be explored.
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Affiliation(s)
- LaTasha B Craig
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA;
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Morrison LJ, Thompson BM, Gill AC. A required third-year medical student palliative care curriculum impacts knowledge and attitudes. J Palliat Med 2012; 15:784-9. [PMID: 22686121 DOI: 10.1089/jpm.2011.0482] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite broad support for palliative and end-of-life care training in medical schools, required clinical palliative care and end-of-life experiences are rare. In this study, we assess the impact of a required palliative care educational intervention on medical students' palliative care pain knowledge and end-of-life attitudes. METHODS In this wait-list control crossover design, third-year medical students from two sequential classes (n=157) completed a palliative care workshop at the beginning of a required year-long course. Students then completed a patient experience, online pain management module, and reflective essay in either the first or second half of the course. Fifteen validated multiple choice palliative care pain management items and the Thanatophobia Scale (7 items) were administered to measure knowledge and attitudes for all students at baseline, 5.5 months, and 11 months. Multivariate repeated measures ANOVA was used to determine differences between groups and across time. RESULTS Analysis found statistically significant increases in knowledge and improvements in attitudes (p<0.001) across the time points as well as a statistically significant interaction effect between time and groups (p=0.006). These changes correspond to specific curricular intervention components in which attitudinal improvements are seen after the workshop, and knowledge increases are seen after the patient experience, online pain module, and reflective essay. CONCLUSION A modest, required palliative care curriculum can yield improvements in medical student knowledge and attitudes. However, expansion of the experiential component and palliative care skills training and assessment are needed for students to have more meaningful outcomes and to ultimately contribute to better patient outcomes.
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Affiliation(s)
- Laura J Morrison
- Department of Medicine, Section of Geriatrics, Baylor College of Medicine, Houston, TX 77030, USA.
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Abstract
BACKGROUND Human dissection commonly occurs early in the undergraduate medical school curriculum, thus presenting an immediate opportunity for educators to teach and encourage humanistic qualities of respect, empathy, and compassion. PURPOSE The purpose of this study was to measure the impact of the Donor Luncheon, a unique program in which medical students meet the families of the anatomical donor prior to dissection in the anatomy course at the University of Oklahoma College of Medicine. METHODS Students were randomized into groups of 8 to attend the luncheon and either met with family of the donor or attended the luncheon with no donor family present. A questionnaire measured students' attitudes at 2 weeks, 6 weeks, and at the conclusion of the anatomy course. RESULTS Factor analysis revealed 5 scales. Analysis revealed statistically significant differences across time for Donor as Person, Dissection Process, and Donor as Patient and statistically significant differences between groups for Donor as Person and Donor as Patient. CONCLUSIONS These results suggest that this program can provide students with the opportunity to maintain more humanistic attitudes at the beginning of their medical education career.
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Affiliation(s)
- Sheila M Crow
- Department of Pediatrics, University of Oklahoma Tulsa School of Community Medicine, Tulsa, Oklahoma 74135, USA.
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Thompson BM, Searle NS, Gruppen LD, Hatem CJ, Nelson EA. A national survey of medical education fellowships. Med Educ Online 2011; 16:10.3402/meo.v16i0.5642. [PMID: 21475643 PMCID: PMC3071874 DOI: 10.3402/meo.v16i0.5642] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 01/21/2011] [Accepted: 01/21/2011] [Indexed: 05/12/2023]
Abstract
PURPOSE The purpose of our study was to determine the prevalence, focus, time commitment, graduation requirements and programme evaluation methods of medical education fellowships throughout the United States. Medical education fellowships are defined as a single cohort of medical teaching faculty who participate in an extended faculty development programme. METHODS A 26-item online questionnaire was distributed to all US medical schools (n=127) in 2005 and 2006. The questionnaire asked each school if it had a medical education fellowship and the characteristics of the fellowship programme. RESULTS Almost half (n=55) of the participating schools (n=120, response rate 94.5 %) reported having fellowships. Duration (10-584 hours) and length (<1 month-48 months) varied; most focused on teaching skills, scholarly dissemination and curriculum design, and required the completion of a scholarly project. A majority collected participant satisfaction; few used other programme evaluation strategies. CONCLUSIONS The number of medical education fellowships increased rapidly during the 1990s and 2000s. Across the US, programmes are similar in participant characteristics and curricular focus but unique in completion requirements. Fellowships collect limited programme evaluation data, indicating a need for better outcome data. These results provide benchmark data for those implementing or revising existing medical education fellowships.
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Affiliation(s)
- Britta M Thompson
- Office of Educational Development and Support, University of Oklahoma College of Medicine, Oklahoma City, OK 73126-0901, USA.
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Hafler JP, Ownby AR, Thompson BM, Fasser CE, Grigsby K, Haidet P, Kahn MJ, Hafferty FW. Decoding the learning environment of medical education: a hidden curriculum perspective for faculty development. Acad Med 2011; 86:440-4. [PMID: 21346498 DOI: 10.1097/acm.0b013e31820df8e2] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Medical student literature has broadly established the importance of differentiating between formal-explicit and hidden-tacit dimensions of the physician education process. The hidden curriculum refers to cultural mores that are transmitted, but not openly acknowledged, through formal and informal educational endeavors. The authors extend the concept of the hidden curriculum from students to faculty, and in so doing, they frame the acquisition by faculty of knowledge, skills, and values as a more global process of identity formation. This process includes a subset of formal, formative activities labeled "faculty development programs" that target specific faculty skills such as teaching effectiveness or leadership; however, it also includes informal, tacit messages that faculty absorb. As faculty members are socialized into faculty life, they often encounter conflicting messages about their role. In this article, the authors examine how faculty development programs have functioned as a source of conflict, and they ask how these programs might be retooled to assist faculty in understanding the tacit institutional culture shaping effective socialization and in managing the inconsistencies that so often dominate faculty life.
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Affiliation(s)
- Janet P Hafler
- Yale School of Medicine, Yale University, New Haven, Connecticut 06510, USA.
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Thompson BM, Teal CR, Scott SM, Manning SN, Greenfield E, Shada R, Haidet P. Following the clues: teaching medical students to explore patients' contexts. Patient Educ Couns 2010; 80:345-50. [PMID: 20674240 PMCID: PMC3049898 DOI: 10.1016/j.pec.2010.06.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Revised: 06/24/2010] [Accepted: 06/25/2010] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Physicians often overlook important contextual clues that patients give during an encounter. The objective of our study was to increase medical students' knowledge and skills in identifying contextual issues. METHODS Six consecutive learning experiences, including a standardized patient (SP) encounter and activities designed to trigger reflection, were implemented within a first-year Introduction to Clinical Medicine course. Evaluation of the intervention was measured through self-confidence, attitudes, SP history checklist, and student and small group facilitator evaluations. RESULTS Standardized patient encounters, coupled with activities designed to trigger reflection, can help students identify patients' contextual clues. Students' confidence in eliciting patient clues significantly increased after the intervention. Our results suggest that some contextual clues were more difficult for students to elicit. CONCLUSION Multi-faceted approaches that include activities to trigger reflection are effective in teaching students to recognize and respond to contextual clues, however, more research is needed. PRACTICE IMPLICATIONS While students elicited most clues in this study, they struggled with identifying some clues. These results suggest the need for additional research and educational development in this area.
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Affiliation(s)
- Britta M Thompson
- Office of Educational Development and Support, The University of Oklahoma College of Medicine, Oklahoma City, OK 73104, United States.
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Thompson BM, Teal CR, Rogers JC, Paterniti DA, Haidet P. Ideals, activities, dissonance, and processing: a conceptual model to guide educators' efforts to stimulate student reflection. Acad Med 2010; 85:902-8. [PMID: 20520048 DOI: 10.1097/acm.0b013e3181d7423b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE Medical schools are increasingly incorporating opportunities for reflection into their curricula. However, little is known about the cognitive and/or emotional processes that occur when learners participate in activities designed to promote reflection. The purpose of this study was to identify and elucidate those processes. METHOD In 2008, the authors analyzed qualitative data from focus groups that were originally conducted to evaluate an educational activity designed to promote reflection. These data afforded the opportunity to explore the processes of reflection in detail. Transcripts (94 pages, single-spaced) from four focus groups were analyzed using a narrative framework. The authors spent approximately 40 hours in group and 240 hours in individual coding activities. RESULTS The authors developed a conceptual model of five major elements in students' reflective processes: the educational activity, the presence or absence of cognitive or emotional dissonance, and two methods of processing dissonance (preservation or reconciliation). The model also incorporates the relationship between the student's internal ideal of what a doctor is or does and the student's perception of the teacher's ideal of what a doctor is or does. The model further identifies points at which educators may be able to influence the processes of reflection and the development of professional ideals. CONCLUSIONS Students' cognitive and emotional processes have important effects on the success of educational activities intended to stimulate reflection. Although additional research is needed, this model-which incorporates ideals, activities, dissonance, and processing-can guide educators as they plan and implement such activities.
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Affiliation(s)
- Britta M Thompson
- Department of Pediatrics, College of Medicine Dean's Office, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma 73104, USA.
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Thompson BM, Haidet P, Casanova R, Vivo RP, Gomez AG, Brown AF, Richter RA, Crandall SJ. Medical students' perceptions of their teachers' and their own cultural competency: implications for education. J Gen Intern Med 2010; 25 Suppl 2:S91-4. [PMID: 20352500 PMCID: PMC2847104 DOI: 10.1007/s11606-009-1245-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Enhancing the cultural competency of students is emerging as a key issue in medical education; however, students may perceive that they are more able to function within cross-cultural situations than their teachers, reducing the effectiveness of cultural competency educational efforts. OBJECTIVE The purpose of our study was to compare medical students' perceptions of their residents, attendings, and their own cultural competency. DESIGN Cross-sectional study. MAIN MEASURES A questionnaire containing previously validated instruments was administered to end-of-third-year medical students at four institutions throughout the US. Repeated measures multivariate analysis was used to determine differences in student ratings. PARTICIPANTS Three hundred fifty-eight medical students from four schools participated, for an overall response rate of 65%. RESULTS Analysis indicated overall statistically significant differences in students' ratings (p < 0.001, eta(2) = 0.33). Students rated their own cultural competency as statistically significantly higher than their residents, but similar to their attendings. For reference, students rated the patient care competency of themselves, their residents, and their attendings; they rated their attendings' skills as statistically significantly higher than residents, and residents as statistically significantly higher than themselves. There were differences between cultural competency and patient care ratings. CONCLUSIONS Our results indicate that students perceive the cultural competency of their attendings and residents to be the same or lower than themselves. These findings indicate that this is an important area for future research and curricular reform, considering the vital role that attendings and residents play in the education of medical students.
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Affiliation(s)
- Britta M Thompson
- The University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA.
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Searle NS, Thompson BM, Friedland JA, Lomax JW, Drutz JE, Coburn M, Nelson EA. The prevalence and practice of academies of medical educators: a survey of U.S. medical schools. Acad Med 2010; 85:48-56. [PMID: 20042821 DOI: 10.1097/acm.0b013e3181c4846b] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Academies of medical educators can be defined as formal organizations of academic teaching faculty recognized for excellence in their contributions to their school's education mission and who, as a group, serve specific needs of the institution. The authors studied the characteristics of academies, including the processes for admission, selection, and retention of academy members; the types of faculty who are academy members; program goals; benefits offered by academies to the individual and to the institution; funding sources and amounts; and the rapid increase in academies since 2003. METHOD In 2008, the authors sent an online questionnaire to 127 U.S. medical schools. Responses were analyzed using descriptive statistics. To determine differences between groups, multivariate analysis of variance was performed. Correlation analysis (Pearson r) was used to identify association between variables. Effect size was determined using eta squared (eta2). RESULTS Thirty-six of the 122 responding schools (96% response rate) reported having academies; 21 schools had initiated academies since 2003, and 33 schools were planning or considering academies. There was a statistically significant difference between academies established before 2004 and in 2004 regarding benefits offered to individuals, membership terms and maintenance requirements, and goals. CONCLUSIONS Rogers' theory of the diffusion of innovation may explain the recent spread of academies. When beginning or reexamining existing academy programs, institutions should consider goals, application process, benefits offered to members as well as the institution, expendable resources, and means of support, because the final product depends on the choices made at the beginning.
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Affiliation(s)
- Nancy S Searle
- Department of Pediatrics, Academy of Distinguished Educators, Faculty Development and Recognition, Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, Texas 77030, USA.
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Sunde RA, Thompson KM, Evenson JK, Thompson BM. Blood glutathione peroxidase-1 mRNA levels can be used as molecular biomarkers to determine dietary selenium requirements in rats. Exp Biol Med (Maywood) 2009; 234:1271-9. [PMID: 19855070 DOI: 10.3181/0906-rm-182] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Transcript (mRNA) levels are increasingly being used in medicine as molecular biomarkers for disease and disease risk, including use of whole blood as a target tissue for analysis. Development of blood molecular biomarkers for nutritional status, too, has potential application that parallels opportunities in medicine, including providing solid data for individualized nutrition. We previously reported that blood glutathione peroxidase-1 (Gpx1) mRNA was expressed at levels comparable to major tissues in rats and humans. To determine the efficacy of using blood Gpx1 mRNA to assess selenium (Se) status and requirements, we fed graded levels of Se (0-0.3 microg Se/g as selenite) to weanling male rats. Se status was determined by liver Se concentration and selenoenzyme activity, and selenoprotein mRNA abundance in liver and blood was determined by ribonuclease protection analysis. Liver Se and plasma glutathione peroxidase-3 and liver Gpx1 activities indicated that minimal Se requirements were at 0.08 microg Se/g diet. When total RNA was isolated from whole blood, Gpx1 mRNA in Se-deficient rats decreased to 10% of levels in Se-adequate (0.2 microg Se/g diet) rats. With Se supplementation, blood Gpx1 mRNA levels increased sigmoidally to a plateau with a minimum Se requirement of 0.08 microg Se/g diet, whereas glutathione peroxidase-4 mRNA levels were unaffected. Similarly, Gpx1 mRNA in RNA isolated from fractionated red blood cells decreased in Se-deficient rats to 23% of Se-adequate levels, with a minimum Se requirement of 0.09 microg Se/g diet. Additional studies showed that the preponderance of whole blood Gpx1 mRNA arises from erythroid cells, most likely reticulocytes and young erythrocytes. In summary, whole blood selenoprotein mRNA levels can be used as molecular biomarkers for assessing Se requirements, illustrating that whole blood has potential as a target tissue in development of molecular biomarkers for use in nutrition as well as in medicine.
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Affiliation(s)
- Roger A Sunde
- Department of Nutritional Sciences, University of Wisconsin, 1415 Linden Drive, Madison, WI 53706, USA.
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Thompson BM, Levine RE, Kennedy F, Naik AD, Foldes CA, Coverdale JH, Kelly PA, Parmelee D, Richards BF, Haidet P. Evaluating the quality of learning-team processes in medical education: development and validation of a new measure. Acad Med 2009; 84:S124-S127. [PMID: 19907373 DOI: 10.1097/acm.0b013e3181b38b7a] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Measurement of the quality of team processes in medical education, particularly in classroom-based teaching settings, has been limited by a lack of measurement instruments. Therefore, the purpose of this study was to develop and test an instrument to measure the quality of team interactions. METHOD The authors created 30 items and reduced these to 18 items using factor analysis. They distributed the scale to 309 second-year medical students (RR = 95%) in a course that used teams and measured internal consistency, validity, and differences in scores between teams. RESULTS Cronbach's alpha for the scale was 0.97. Team ratings were variable, with a mean score of 95.7 (SD 8.5) out of 108. Team Performance Scale (TPS) scores correlated inversely with the spread of peer evaluation scores (r = -0.38, P = .003). Differences between teams were statistically significant (P < .001, eta = 0.33). CONCLUSIONS The TPS was short, had evidence of reliability and validity, and exhibited the capacity to distinguish between teams. This instrument can provide a measure of the quality of team interactions. More work is needed to provide further evidence of validity and generalizability.
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Thompson BM, Levine RE, Kennedy F, Naik AD, Foldes CA, Coverdale JH, Kelly PA, Parmelee D, Richards BF, Haidet P. Evaluating the quality of learning-team processes in medical education: development and validation of a new measure. Acad Med 2009; 84:157-8. [PMID: 19907373 DOI: 10.1097/acm.0b013e318193ae85] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Measurement of the quality of team processes in medical education, particularly in classroom-based teaching settings, has been limited by a lack of measurement instruments. Therefore, the purpose of this study was to develop and test an instrument to measure the quality of team interactions. METHOD The authors created 30 items and reduced these to 18 items using factor analysis. They distributed the scale to 309 second-year medical students (RR = 95%) in a course that used teams and measured internal consistency, validity, and differences in scores between teams. RESULTS Cronbach's alpha for the scale was 0.97. Team ratings were variable, with a mean score of 95.7 (SD 8.5) out of 108. Team Performance Scale (TPS) scores correlated inversely with the spread of peer evaluation scores (r = -0.38, P = .003). Differences between teams were statistically significant (P < .001, eta = 0.33). CONCLUSIONS The TPS was short, had evidence of reliability and validity, and exhibited the capacity to distinguish between teams. This instrument can provide a measure of the quality of team interactions. More work is needed to provide further evidence of validity and generalizability.
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Abstract
BACKGROUND Learning is a complex process that follows predictable patterns. The authors explored whether students' self-assessment of competencies could be used as a measure of learning within medical school. METHOD Medical students (all grade levels) rated their achievement of competencies at the beginning and end of an academic year. Repeated-measures ANOVA and [eta]2 were used to determine differences. RESULTS Five hundred thirty-three students participated (response rate = 79.3%). Self-assessment ratings between four grade levels were significant (P < .001, [eta]2 = 0.33), with the steepest difference between MS2 and MS3; professionalism ratings remained relatively stable. The largest percent increase within an academic year occurred between MS1 and MS2, with little increase within MS3 and MS4. CONCLUSIONS Medical students' self-assessment ratings of competencies indicated differences between grade levels and during an academic year, following a sigmoidal curve. These results have implications for medical education and indicate the need to develop longitudinal measures to track changes in learning.
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Dewey CM, Coverdale JH, Ismail NJ, Culberson JW, Thompson BM, Patton CS, Friedland JA. Residents-as-teachers programs in psychiatry: a systematic review. Can J Psychiatry 2008; 53:77-84. [PMID: 18357925 DOI: 10.1177/070674370805300202] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Because psychiatry residents have important roles as teachers and significant opportunities to contribute to medical student education, we set out to: identify all randomized control trials (RCT) for residents' teaching skills programs in psychiatry and to identify the efficacy of those interventions for improving teaching skills; identify the strengths and weaknesses of the available studies across medical disciplines; and identify currently available methods for enhancing residents' teaching skills for residents training in psychiatry. METHODS The published English-language literature was searched using PubMed, Social Sciences Index, and PsycINFO databases, with key search words including: residents, teaching skills, residents as teachers, psychiatry, and assessments. Both RCT and controlled, nonrandomized trials of residents' teaching programs directed to enhance residents' teaching skills were selected and critically appraised. RESULTS Of 13 trials identified and reviewed, most included residents in internal medicine. Only one included psychiatry residents and assessed their ability to teach interviewing skills to medical students. Along with other studies, this study demonstrated improvement in residents' teaching skills. Overall, interventions and outcome measures were heterogeneous while the quality of methodologies varied. Five studies were of higher quality, representing examples of quality educational research. Several described group differences, blinding, good follow-up, and use of valid, reliable tools. CONCLUSIONS Only one trial exists that incorporated psychiatry residents. Significant opportunity to advance educational research in this field exists. Psychiatry residency program directors should incorporate high-quality methodologies and can benefit from the findings of trials in other disciplines.
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Affiliation(s)
- Charlene M Dewey
- Vanderbilt University School of Medicine, Office of Teaching and Learning in Medicine, Nashville, TN 37232-0432, USA.
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Thompson BM, Schneider VF, Haidet P, Perkowski LC, Richards BF. Factors influencing implementation of team-based learning in health sciences education. Acad Med 2007; 82:S53-6. [PMID: 17895691 DOI: 10.1097/acm.0b013e3181405f15] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Limited studies have looked at factors that lead to successful implementation of team-based learning (TBL). The purpose of this study was to identify contextual factors associated with implementation of TBL with a larger pool of individuals. METHOD The authors administered a questionnaire who had implemented TBL via the Web to participants who attended TBL workshops; 297 of 594 responded. We used the constant comparative method to analyze responses. RESULTS Analysis revealed five factors important to successful implementation of TBL: buy-in, expertise, resources, time, and course characteristics, with 60%, 38%, 37%, 36%, and 16% of respondents identifying each factor, respectively. CONCLUSIONS When health science faculty and administrators implement TBL or other educational innovations, they must have buy-in, ensure adequate time and resources, develop needed expertise, and determine best fit within a course. Although these results are specific to TBL, they are consistent with models of dissemination and have implications for other educational innovations.
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Affiliation(s)
- Britta M Thompson
- Office of Curriculum, M301, Baylor College of Medicine, Houston, TX 77030, USA.
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Thompson BM, Schneider VF, Haidet P, Levine RE, McMahon KK, Perkowski LC, Richards BF. Team-based learning at ten medical schools: two years later. Med Educ 2007; 41:250-7. [PMID: 17316209 DOI: 10.1111/j.1365-2929.2006.02684.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE In 2003, we described initial use of team-based learning (TBL) at 10 medical schools. The purpose of the present study was to review progress and understand factors affecting the use of TBL at these schools during the subsequent 2 years. METHODS Representatives from 10 schools evaluated in 2003 were again evaluated in 2005. They were interviewed by members of the Team Based Learning Collaborative using a semistructured interview process. Data were analysed by 2 researchers using the constant comparative method and were triangulated through sharing results with other interviewers at regular intervals to verify conclusions and form consensus. RESULTS TBL continued to be used in all but 1 school. At the 9 remaining schools, TBL was added to 18 courses, continued to be used in 19 and was discontinued in 13 courses. At some schools, it was discontinued in single courses in lieu of new, longitudinal integration courses in which TBL was a main instructional strategy. Faculty, student, course and institutional factors were associated with changes in TBL use. CONCLUSION Faculty, administration/curriculum, students and characteristics of specific courses influence ongoing utilisation of TBL. Those who desire to implement TBL would do well to take these factors into account as they plan implementation efforts at their schools.
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Abstract
BACKGROUND Interns experience tremendous challenges on the transition from student to new physician. There is limited literature describing curriculum that enhances medical students' preparation for internship. DESCRIPTION To prepare graduating medical students at our institution for the new responsibilities and stressors that they will face as interns, an elective course, Integrative Clinical Experience, was implemented. Over a 2-week period, participating medical students rotate through 1 to 3-hr modules that cover four major domains: managing acutely ill patients, teaching, communicating, and coping with stressors. EVALUATION Participants evaluated the course qualitatively and quantitatively through verbal and written feedback. Students found the course useful and educationally valuable. They also had a statistically significant increase in perceived preparedness for internship upon completion of the course. CONCLUSIONS A 2-week, concentrated course is a feasible and effective method for raising students' perceived preparedness for internship.
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Affiliation(s)
- Joslyn W Fisher
- Department of Medicine, Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas 77030, USA.
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Abstract
Longitudinal programs to enhance the educational skills of medical school faculty are present in many medical schools and academic health centers. Multiinstitutional programs are less common. Three health professions schools, Baylor College of Medicine, The University of Texas Medical School at Houston, and The University of Texas Dental Branch have jointly sponsored the Educational Scholars Fellowship Program (ESFP) since 2003. The evolution of this program, from one that addressed the faculty educator development needs of one medical school in the mid-1990s to a more flexible model that includes faculty and fellows from three institutions, reflects the changing needs of faculty as well as those of other health professions schools. The ESFP's strengths lie in the effective use of resources across three schools; the opportunity for an interinstitutional and interdisciplinary collaborative network; the flexibility of the curriculum offerings; and the positive impact on fellows' knowledge, skills and leadership in medical and dental education. The evolution of this program represents a cost-effective and educationally sound response to the changing needs of faculty educators.
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Affiliation(s)
- Nancy S Searle
- Office of Curriculum, Baylor College of Medicine, Houston, Texas 77030, USA.
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Thompson BM, Knight SL. The Effect of a Multicomponent Professional Development Training on the Beliefs and Behaviors of Community Health Educators Concerning Food Irradiation. Health Educ Behav 2006; 33:703-13. [PMID: 16840794 DOI: 10.1177/1090198105285784] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Beliefs have a significant effect on the health behaviors of individuals and educators; however, they can be difficult to change. The purpose of this study was to determine if exposing community health educators, specifically family and consumer sciences county extension educators, to a multicomponentprofessional development training on food irradiation could change their beliefs and behaviors. This study compared the food irradiation beliefs and educational programmingof educators who participated in a professional development training with thosewhodidnot.Results indicatedthat the trainingsignificantlyimproved the foodirradiationbeliefs ofparticipants. In addition, the number of participants who provided food irradiation education significantly improved compared with educators who had not attended the training. These results suggest that this type of professional development training format can significantly affect beliefs and could increase the amount of food irradiation information available to consumers through community health educators.
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Affiliation(s)
- Britta M Thompson
- Baylor College of Medicine, One Baylor Plaza, Room M301, Houston, TX 77030-3498, USA.
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Thompson BM, Knight SL. Determining the food irradiation beliefs of community nutrition educators: do beliefs influence educational outreach? J Nutr Educ Behav 2006; 38:50-5. [PMID: 16595278 DOI: 10.1016/j.jneb.2005.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To develop an instrument to measure the food irradiation beliefs of community nutrition educators and to determine the influence of those beliefs on food irradiation educational outreach. DESIGN Survey development, cross-sectional telephone survey. SETTING Cooperative Extension Program. PARTICIPANTS All Family and Consumer Sciences (FCS) county extension agents serving in the most populated counties in Texas (n = 134, response rate = 99%). These participants may not be representative of all FCS extension agents. VARIABLES MEASURED Food irradiation beliefs and educational outreach as well as selected demographic variables. ANALYSIS To determine validity and reliability of the instrument, factor analysis and Cronbach's alpha were conducted, respectively. To determine if food irradiation beliefs influenced food irradiation educational outreach, logistic and multiple regression analyses were conducted, with significance set at P < .05. RESULTS The instrument had adequate reliability; two belief scales were identified through factor analysis, referred to as Safety Beliefs and Understanding Beliefs. Additionally, regression analysis suggested that educators' beliefs about food irradiation influenced the amount of food irradiation education they provided. CONCLUSIONS AND IMPLICATIONS Results suggest that educators' beliefs about the safety and their understanding of food irradiation are predictors of the educational outreach they provide about it, indicating the potential value of professional development regarding food irradiation.
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Affiliation(s)
- Britta M Thompson
- Office of Curriculum, Baylor College of Medicine, Houston, Texas 77030-3498, USA.
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Thompson BM, Andrews SR. An historical commentary on the physiological effects of music: Tomatis, Mozart and neuropsychology. Integr Physiol Behav Sci 2000; 35:174-88. [PMID: 11286370 DOI: 10.1007/bf02688778] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article provides an overview of the theoretical underpinnings of the Tomatis Method, along with a commentary on other forms of sound/music training and the need for research. A public debate was sparked over the "Mozart Effect." This debate has turned out to be unfortunate because the real story is being missed. The real story starts with Alfred Tomatis, M.D., scientist and innovator. Dr. Tomatis was the first to develop a technique using modified music to stimulate the rich interconnections between the ear and the nervous system to integrate aspects of human development and behavior. The originating theories behind the Tomatis Method are reviewed to describe the ear's clear connection to the brain and the nervous system. The "neuropsychology of sound training" describes how and what the Tomatis Method effects. Since Dr. Tomatis opened this field in the mid 20th century, no fewer than a dozen offshoot and related systems of training have been developed. Though each new system of treatment makes claims of effectiveness, no research exists to substantiate their claims. Rather, each simplified system bases its "right to exist and advertise" on the claimed relationship to Tomatis and his complex Method. Research is desperately needed in this area. The 50 years of clinical experience and anecdotal evidence amassed by Tomatis show that sound stimulation can provide a valuable remediation and developmental training tool for people of all ages. Offshoot systems have watered down the Tomatis Method without research to guide the decisions of simplifying the techniques and equipment.
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Affiliation(s)
- B M Thompson
- Sound Listening & Learning Center, Phoenix, AZ 85012, USA.
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Abstract
OBJECTIVES The Society for Academic Emergency Medicine (SAEM) commissioned an emergency medicine (EM) faculty salary and benefits survey for all 1998 residency review committee (RRC)-EM-accredited programs using the SAEM fourth-generation survey instrument. Responses were collected by SAEM and blinded from the investigators. METHODS Blinded program and individual faculty data were entered into a customized version of FileMaker Pro, a relational database program with a built-in statistical package. Salary data were sorted by program region, faculty title, American Board of Emergency Medicine (ABEM) certification, academic rank, years postresidency, program size, and whether data were reported to the American Association of Medical Colleges (AAMC). Demographic data were analyzed with regard to numerous criteria, including department staffing levels, ED volumes, ED length of stay, department income sources, salary incentive components, and specific type and value of fringe benefits offered. Data were compared with those from previous SAEM studies. RESULTS Seventy-three of 120 (61%) accredited programs responded, yielding usable data for 70 programs and 965 full-time faculty among the four AAMC regions. Mean salaries were reported as follows: all faculty, $167,478; first-year faculty, $140,616; programs reporting data to the AAMC, $161,794; programs not reporting data to the AAMC, $165,724. Mean salaries as reported by AAMC region: northeast, $167,876; south, $160,586; midwest, $190,957; west, $148,977. CONCLUSIONS Reported salaries for full-time EM residency faculty continue to rise. Significant regional differences in salaries have been present in all four SAEM surveys. Nonclinical hours are compensated at approximately one-half the rate paid for clinical hours. The demographic data indicate that EM residency faculty are working at the upper extremes of numbers of patient encounters per physician, patient acuity levels, and department lengths of stay.
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Kristal SL, Marx JA, Randall-Kristal KA, Thompson BM. Academic emergency department funding sources and incentives: Results from the 1998–1999 SAEM emergency medicine faculty salary survey. Ann Emerg Med 1999. [DOI: 10.1016/s0196-0644(99)80469-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- B M Thompson
- Sound Listening and Learning Center, Phoenix, AZ, USA.
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Abstract
OBJECTIVE The Society for Academic Emergency Medicine (SAEM) commissioned an emergency medicine (EM) faculty salary and benefit survey for all 1995 Residency Review Committee in Emergency Medicine (RRC-EM)-accredited programs using the SAEM third-generation survey instrument. Responses were collected by SAEM and blinded from the investigators. POPULATION Seventy-six of 112 (68%) accredited programs responded, yielding data for 1,032 full-time faculty among the four Association of American Medical Colleges (AAMC) regions. METHODS Blinded program and individual faculty data were entered into a customized version of Filemaker Pro, a relational database program with a built-in statistical package. Salary data were sorted by 115 separate criteria such as program regions, faculty title, American Board of Emergency Medicine (ABEM) certification, academic rank, years postresidency, program size, and whether data were reported to AAMC. Demographic data from 132 categories were analyzed and included number of staff and residents per shift, number of intensive care unit (ICU) beds, obstacles to hiring new staff, and specific type and value of fringe benefits offered. Data were compared with those from the 1990 and 1992 SAEM and the 1995-96 AAMC studies. RESULTS Mean salaries were reported as follows: all faculty, $158,100; first-year faculty, $131,074; programs reporting data to AAMC, $152,198; programs not reporting data to AAMC, $169,251. Mean salaries as reported by AAMC region: northeast, $155,909; south, $155,403; midwest, $172,260; west, $139,930. Mean salaries as reported by program financial source: community, $175,599; university, $152,878; municipal, $141,566. CONCLUSIONS Reported salaries for full-time EM residency faculty continue to rise. Salaries in programs reporting data to the AAMC are considerably lower than those not reporting. The gap between ABEM-certified and non-ABEM-certified faculty continues to widen. Residency-trained faculty are now shown to earn more than non-residency-trained faculty. Significant regional differences in salaries have been present in all three SAEM surveys.
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Affiliation(s)
- S L Kristal
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI 48202, USA.
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