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Rhee DW, Reinstein I, Jrada M, Pendse J, Cocks P, Stern DT, Sartori DJ. Mapping hospital data to characterize residents' educational experiences. BMC Med Educ 2022; 22:496. [PMID: 35752814 PMCID: PMC9233374 DOI: 10.1186/s12909-022-03561-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/04/2022] [Accepted: 06/06/2022] [Indexed: 06/04/2023]
Abstract
BACKGROUND Experiential learning through patient care is fundamental to graduate medical education. Despite this, the actual content to which trainees are exposed in clinical practice is difficult to quantify and is poorly characterized. There remains an unmet need to define precisely how residents' patient care activities inform their educational experience. METHODS: Using a recently-described crosswalk tool, we mapped principal ICD-10 discharge diagnosis codes to American Board of Internal Medicine (ABIM) content at four training hospitals of a single Internal Medicine (IM) Residency Program over one academic year to characterize and compare residents' clinical educational experiences. Frequencies of broad content categories and more specific condition categories were compared across sites to profile residents' aggregate inpatient clinical experiences and drive curricular change. RESULTS There were 18,604 discharges from inpatient resident teams during the study period. The crosswalk captured > 95% of discharges at each site. Infectious Disease (ranging 17.4 to 39.5% of total discharges) and Cardiovascular Disease (15.8 to 38.2%) represented the most common content categories at each site. Several content areas (Allergy/Immunology, Dermatology, Obstetrics/Gynecology, Ophthalmology, Otolaryngology/Dental Medicine) were notably underrepresented (≤ 1% at each site). There were significant differences in the frequencies of conditions within most content categories, suggesting that residents experience distinct site-specific clinical content during their inpatient training. CONCLUSIONS There were substantial differences in the clinical content experienced by our residents across hospital sites, prompting several important programmatic and curricular changes to enrich our residents' hospital-based educational experiences.
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Affiliation(s)
- David W Rhee
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Ilan Reinstein
- Institute for Innovations in Medical Education, NYU Langone Health, New York, NY, USA
| | - Morris Jrada
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Jay Pendse
- Division of Endocrinology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Patrick Cocks
- Internal Medicine Residency Program, Department of Medicine, NYU Grossman School of Medicine, NYU Langone Hospital - Brooklyn, New York, USA
| | - David T Stern
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
- VA NY Harbor Health, New York, NY, USA
| | - Daniel J Sartori
- Internal Medicine Residency Program, Department of Medicine, NYU Grossman School of Medicine, NYU Langone Hospital - Brooklyn, New York, USA.
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Rhee DW, Chun JW, Stern DT, Sartori DJ. Experience and Education in Residency Training: Capturing the Resident Experience by Mapping Clinical Data. Acad Med 2022; 97:228-232. [PMID: 33983144 DOI: 10.1097/acm.0000000000004162] [Citation(s) in RCA: 2] [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: 06/12/2023]
Abstract
PROBLEM Internal medicine training programs operate under the assumption that the 3-year residency training period is sufficient for trainees to achieve the depth and breadth of clinical experience necessary for independent practice; however, the medical conditions to which residents are exposed in clinical practice are not easily measured. As a result, residents' clinical educational experiences are poorly understood. APPROACH A crosswalk tool (a repository of International Classification of Diseases [ICD]-10 codes linked to medical content areas) was developed to query routinely collected inpatient principal diagnosis codes and translate them into an educationally meaningful taxonomy. This tool provides a robust characterization of residents' inpatient clinical experiences. OUTCOMES This pilot study has provided proof of principle that the crosswalk tool can effectively map 1 year of resident-attributed diagnosis codes to both the broad content category level (e.g., "cardiovascular disease") and to the more specific condition category level (e.g., "myocardial disease"). The authors uncovered content areas in their training program that are overrepresented and some that are underrepresented relative to material on the American Board of Internal Medicine (ABIM) Certification Exam. NEXT STEPS The crosswalk tool introduced here translated residents' patient care activities into discrete, measurable educational content and enabled 1 internal medicine residency program to characterize residents' inpatient educational experience with a high degree of resolution. Leaders of other programs seeking to profile the clinical exposure of their trainees may adopt this strategy. Such clinical content mapping drives innovation in the experiential curriculum, enables comparison across practice sites, and lays the groundwork to test associations between individual clinical exposure and competency-based outcomes, which, in turn, will allow medical educators to draw conclusions regarding how clinical experience reflects clinical competency.
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Affiliation(s)
- David W Rhee
- D.W. Rhee is a fellow, the Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Jonathan W Chun
- J.W. Chun is clinical assistant professor, Department of Medicine, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, and an affiliate, Stanford University School of Medicine, Stanford, California
| | - David T Stern
- D.T. Stern is chief of medicine, Veterans Affairs NY Harbor Healthcare System, and professor of medicine and vice chair, Education and Faculty Affairs, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Daniel J Sartori
- D.J. Sartori is assistant professor and associate program director, Internal Medicine Residency Program, Department of Medicine, NYU Grossman School of Medicine, New York, New York ORCID: https://orcid.org/0000-0003-3138-7183
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3
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Rhee DW, Pendse J, Chan H, Stern DT, Sartori DJ. Mapping the Clinical Experience of a New York City Residency Program During the COVID-19 Pandemic. J Hosp Med 2021; 16:353-356. [PMID: 34129487 PMCID: PMC8191765 DOI: 10.12788/jhm.3623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/24/2021] [Indexed: 11/20/2022]
Abstract
The COVID-19 pandemic has dramatically disrupted the educational experience of medical trainees. However, a detailed characterization of exactly how trainees' clinical experiences have been affected is lacking. Here, we profile residents' inpatient clinical experiences across the four training hospitals of NYU's Internal Medicine Residency Program during the pandemic's first wave. We mined ICD-10 principal diagnosis codes attributed to residents from February 1, 2020, to May 31, 2020. We translated these codes into discrete medical content areas using a newly developed "crosswalk tool." Residents' clinical exposure was enriched in infectious diseases (ID) and cardiovascular disease content at baseline. During the pandemic's surge, ID became the dominant content area. Exposure to other content was dramatically reduced, with clinical diversity repopulating only toward the end of the study period. Such characterization can be leveraged to provide effective practice habits feedback, guide didactic and self-directed learning, and potentially predict competency-based outcomes for trainees in the COVID era.
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Affiliation(s)
- David W Rhee
- Leon H Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Jay Pendse
- VA NY Harbor Healthcare, New York, New York
- Division of Endocrinology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Hing Chan
- Bellevue Hospital Center, New York, New York
| | - David T Stern
- VA NY Harbor Healthcare, New York, New York
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Daniel J Sartori
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
- Corresponding Author: Daniel J Sartori, MD; ; Telephone: 718-630-6337; Twitter: @sartori_dj
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Schaye VE, Reich JA, Bosworth BP, Stern DT, Volpicelli F, Shapiro NM, Hauck KD, Fagan IM, Villagomez SM, Uppal A, Sauthoff H, LoCurcio M, Cocks PM, Bails DB. Collaborating Across Private, Public, Community, and Federal Hospital Systems: Lessons Learned from the Covid-19 Pandemic Response in NYC. NEJM Catalyst 2020. [PMCID: PMC7577524 DOI: 10.1056/cat.20.0343] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In the spring of 2020, New York City became the epicenter of the Covid-19 pandemic in the United States. During the peak from March 10 to May 1, the hospitals of the Department of Medicine at New York University Grossman School of Medicine — including an academic, private hospital in a community setting, a private hospital, an affiliated public hospital, and an affiliated Veterans Affairs federal hospital — cared for more than 5,000 hospitalized patients with Covid-19. Each hospital encountered unique challenges based on its own resources, affiliations, size, and patient populations. However, with ongoing collaboration, leadership developed protocols applicable across sites. Despite these four hospitals being distinct, these collaborations resulted in many strategies that can be applied to a wide variety of medical centers that must rapidly respond to the unprecedented challenges created by the Covid-19 pandemic. In this article, the authors describe strategies for communication, surge planning, clinical care, and staff wellness.
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Affiliation(s)
- Verity E. Schaye
- Director of Inpatient Medicine, NYC Health + Hospitals/Bellevue, New York, New York, USA
- Assistant Professor, NYU Grossman School of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York, USA
| | - Jenna A. Reich
- Medical Student, NYU Grossnman School of Medicine, New York, New York, USA
| | - Brian P. Bosworth
- Chief of Medicine, NYU Langone Medical Center, New York, New York, USA
- Professor of Medicine, NYU Grossman School of Medicine, Division of Gastroenterology, New York, New York, USA
| | - David T. Stern
- Chief of Medicine, Veterans Affairs New York Harbor Healthcare, New York, New York, USA
- Vice Chair of Education, NYU Grossman School of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York, USA
| | - Frank Volpicelli
- Chief of Medicine and Associate Chief Medical Officer, NYU Langone Hospital Brooklyn, Brooklyn, New York, USA
- Assistant Professor, NYU Grossman School of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York, USA
| | - Neil M. Shapiro
- Associate Chief of Medicine, Veterans Affairs New York Harbor Healthcare System, New York, New York, USA
- Associate Professor, NYU Grossman School of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York, USA
| | - Kevin D. Hauck
- Associate Director Inpatient Medicine, NYU Langone Health, New York, New York, USA
- Assistant Professor, NYU Grossman School of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York, USA
| | - Ian M. Fagan
- Associate Director of Inpatient Medicine, NYC Health + Hospitals/Bellevue, New York, New York, USA
- Assistant Professor, NYU Grossman School of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York, USA
| | - Seagram M. Villagomez
- Chief of Hospital Medicine, Veterans Affairs New York Harbor Healthcare System, New York, New York, USA
- Assistant Professor, NYU Grossman School of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York, USA
| | - Amit Uppal
- Director of Critical Care, NYC Health + Hospitals/Bellevue, New York, New York, USA
- Assistant Professor, NYU Grossman School of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, New York, New York, USA
| | - Harald Sauthoff
- Director, Medical Intensive Care Unit, Veterans Affairs New York Harbor Healthcare System, New York, New York, USA
- Associate Professor, NYU Grossman School of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, New York, New York, USA
| | - Michael LoCurcio
- Associate Professor, NYC Health + Hospitals/Bellevue, New York, New York, USA
- Associate Chair for Education, NYU Grossman School of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York, USA
| | - Patrick M. Cocks
- Director, Internal Medicine Residency Program, NYU Grossman School of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York, USA
| | - Douglas B. Bails
- Chief of Medicine, NYC Health + Hospitals/Bellevue, New York, New York, USA
- Associate Professor, NYU Grossman School of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York, USA
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Abstract
Introduction: Educators have theorized that interventions grounded in dual process theory (DPT) and script theory (ST) may improve the diagnostic reasoning process of physicians but little empirical evidence exists. Methods: In this quasi-experimental study, we assessed the impact of a clinical reasoning (CR) curriculum grounded in DPT and ST on medicine residents participating in one of three groups during a 6-month period: no, partial, or full intervention. Residents completed the diagnostic thinking inventory (DTI) at baseline and 6 months. At 6 months, participants also completed a post-survey assessing application of concepts to cases. Results: There was a significant difference between groups in application of concepts (no intervention 1.6 (0.65) compared to partial 2.3 (0.81) and full 2.2 (0.91), p = 0.05), as well as describing cases in problem representation format (no intervention 1.2 (0.38) and partial 1.5 (0.55) compared to full 2.1 (0.93), p = 0.004). There was no significant difference in change in DTI scores (no intervention 7.0 (16.3), partial 8.8 (9.8), full 7.8 (12.0)). Conclusions: Residents who participated in a CR curriculum grounded in DPT and ST were effective in applying principles of CR in cases from their practice. To our knowledge, this is the first workplace-based CR educational intervention study showing differences in the reasoning process residents apply to patients.
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Affiliation(s)
- Verity Schaye
- New York University School of Medicine , New York , NY , USA
- Department of Medicine, NYC Health and Hospitals Bellevue , New York , NY , USA
| | - Kinga L Eliasz
- New York University School of Medicine , New York , NY , USA
- NYU Langone Health , New York , NY , USA
| | - Michael Janjigian
- New York University School of Medicine , New York , NY , USA
- Department of Medicine, NYC Health and Hospitals Bellevue , New York , NY , USA
| | - David T Stern
- New York University School of Medicine , New York , NY , USA
- VA New York Harbor Healthcare System , New York , NY , USA
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Moroz A, Horlick M, Mandalaywala N, Stern DT. Faculty feedback that begins with resident self-assessment: motivation is the key to success. Med Educ 2018; 52:314-323. [PMID: 29205433 DOI: 10.1111/medu.13484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/18/2017] [Accepted: 09/25/2017] [Indexed: 05/12/2023]
Abstract
CONTEXT The seeking and incorporating of feedback are necessary for continuous performance improvement in medicine. We know that beginning feedback conversations with resident self-assessment may reduce some of the tensions experienced by faculty staff. However, we do not fully understand how residents experience feedback that begins with self-assessment, and whether any existing theoretical frameworks can explain their experiences. METHODS We conducted a constructivist grounded theory study exploring physical medicine and rehabilitation residents' experiences as they engaged in a structured self-assessment and faculty staff feedback programme. Utilising purposive sampling, we conducted 15 individual interviews and analysed verbatim transcripts iteratively. We implemented several procedures to enhance the credibility of the findings and the protection of participants during recruitment, data collection and data analysis. After defining the themes, we reviewed a variety of existing frameworks to determine if any fitted the data. RESULTS Residents valued self-assessment followed by feedback (SAFF) and had clear ideas of what makes the process useful. Time pressures and poor feedback quality could lead to a process of 'just going through the motions'. Motivation coloured residents' experiences, with more internalised motivation related to a more positive experience. There were no gender- or year of training-related patterns. CONCLUSIONS Self-determination theory provided the clearest lens for framing our findings and fitted into a conceptual model linking the quality of the SAFF experience and residents' motivational loci. We identified several study limitations including time in the field, evolving characteristics of the SAFF programme and the absence of faculty voices. We believe that by better understanding residents' experiences of SAFF, educators may be able to tailor the feedback process, enhance clinical performance and ultimately improve patient care.
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Affiliation(s)
- Alex Moroz
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, New York, USA
| | - Margaret Horlick
- Veterans' Affairs New York Harbor Healthcare System and Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Neil Mandalaywala
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, New York, USA
| | - David T Stern
- Veterans' Affairs New York Harbor Healthcare System and Department of Medicine, New York University School of Medicine, New York, New York, USA
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7
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Abstract
BACKGROUND Communication and courtesy are important elements of consultations, but there is limited published data about the quality of trainee consults. OBJECTIVES This study assessed residents' views on consult interactions, evaluated the impact of the consult interactions on patient care, and developed and implemented a pocket card and training on trainee consults. METHODS We surveyed resident and fellow physicians at Mount Sinai Hospital to assess perceptions, created a CONSULT card that uses a mnemonic for key elements, and developed a training session for how to call consults. We also conducted a consult training session using the CONSULT card as part of orientation in 2011 for all interns. We assessed the acceptability, feasibility, and sustainability of this intervention. RESULTS Of 1001 trainees, 403 (40%) responded. Respondents reported that the most important components of calling consults included giving patient name, medical record number, and location (91%), and giving a clear question/reason (89%). Respondents also reported that these behaviors are done consistently for only 64%, and 10% of consults, respectively. Trainees reported that consult interactions affect the timeliness of treatment (62%), timeliness of tests performed (57%), appropriateness of diagnosis (56%), and discharge planning (49%). Approximately 300 interns attended the consult training session, and their feedback demonstrated acceptability and utility of the session. CONCLUSIONS Trainees believe that consult interactions impact patient care, but important components of the consult call are often missing. Our training and CONSULT card is an acceptable, feasible, and novel training intervention. Once developed, the training session and CONSULT card require minimal faculty time to deliver.
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Shea JA, Stern DT, Klotman PE, Clayton CP, O'Hara JL, Feldman MD, Griendling KK, Moss M, Straus SE, Jagsi R. Career development of physician scientists: a survey of leaders in academic medicine. Am J Med 2011; 124:779-87. [PMID: 21640329 DOI: 10.1016/j.amjmed.2011.04.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 04/02/2011] [Indexed: 10/18/2022]
Affiliation(s)
- Judy A Shea
- University of Pennsylvania School of Medicine, Philadelphia, USA.
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Stern DT, Podolsky AH, Klotman P. Follow the leader. Educ Health (Abingdon) 2011; 24:615. [PMID: 21710426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Moyer CA, Arnold L, Quaintance J, Braddock C, Spickard A, Wilson D, Rominski S, Stern DT. What factors create a humanistic doctor? A nationwide survey of fourth-year medical students. Acad Med 2010; 85:1800-7. [PMID: 20881828 DOI: 10.1097/acm.0b013e3181f526af] [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] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE The authors sought to develop a conceptual framework of the factors that most influence medical students' development of humanism and to explore students' opinions regarding the role these factors play in developing or inhibiting humanism. METHOD In 2006-2007, the authors conducted 16 focus groups with fourth-year students and first-year residents at four universities to design a conceptual framework. They used the framework to develop a survey, which they administered to fourth-year medical students at 20 U.S. medical schools in 2007-2008. RESULTS Data from 80 focus-group participants suggested that the key influences on students' development of humanism were their authentic, unique, and participatory experiences before and during medical school, and the opportunity to process these experiences. Students who completed the survey (N = 1,170) reported that experiences of greatest intensity (e.g., being involved in a case where the patient dies), participatory learning experiences (e.g., volunteer work, international clinical rotations), and positive role models had the greatest effect on their development of humanism, whereas stressful conditions, such as a busy workload or being tired or postcall, inhibited their humanism. Women and students going into primary care placed significantly greater importance on experiences promoting humanism than did men and those not going into primary care. In addition, students with lower debt burdens viewed such experiences as more important than did those with higher debt burdens. CONCLUSIONS Students viewed a variety of factors as influencing their development of humanism. This research provides a starting point for enhancing curricula to promote humanism.
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Affiliation(s)
- Cheryl A Moyer
- Department of Medical Education, Global REACH, University of Michigan Medical School, Ann Arbor, Michigan, USA.
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Guo Y, Sippola E, Feng X, Dong Z, Wang D, Moyer CA, Stern DT. International medical school faculty development: the results of a needs assessment survey among medical educators in China. Adv Health Sci Educ Theory Pract 2009; 14:91-102. [PMID: 18274879 DOI: 10.1007/s10459-007-9093-z] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 11/22/2007] [Indexed: 05/22/2023]
Abstract
To explore the need for faculty development among Chinese medical educators. Leaders at each medical school in China were asked to complete a 123-item survey to identify interest in various topics and barriers and perceived benefits of participating in faculty development programs. Interest levels were high for all topics. Experience with Hospital Management and Research positively correlated with interest in learning more (p < 0.001). Ninety-two percent believe that international experiences are very or extremely important to medical educators' career advancement. Chinese medical education faculty members have a strong interest in faculty development programs.
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Affiliation(s)
- Yan Guo
- Peking University Health Science Center, Beijing, People's Republic of China.
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12
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Ackerman A, Graham M, Schmidt H, Stern DT, Miller SZ. Critical events in the lives of interns. J Gen Intern Med 2009; 24:27-32. [PMID: 18972091 PMCID: PMC2607494 DOI: 10.1007/s11606-008-0769-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 04/16/2008] [Accepted: 08/14/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early residency is a crucial time in the professional development of physicians. As interns assume primary care for their patients, they take on new responsibilities. The events they find memorable during this time could provide us with insight into their developing professional identities. OBJECTIVE To evaluate the most critical events in the lives of interns. PARTICIPANTS Forty-one internal medicine residents at one program participated in a two-day retreat in the fall of their first year. Each resident provided a written description of a recent high point, low point, and patient conflict. MEASUREMENTS We used a variant of grounded theory to analyze these critical incidents and determine the underlying themes of early internship. Independent inter-rater agreement of >90% was achieved for the coding of excerpts. MAIN RESULTS The 123 critical incidents were clustered into 23 categories. The categories were further organized into six themes: confidence, life balance, connections, emotional responses, managing expectations, and facilitating teamwork. High points were primarily in the themes of confidence and connections. Low points were dispersed more generally throughout the conceptual framework. Conflicts with patients were about negotiating the expectations inherent in the physician-patient relationship. CONCLUSION The high points, low points, and conflicts reported by early residents provide us with a glimpse into the lives of interns. The themes we have identified reflect critical challenges interns face the development of their professional identity. Program directors could use this process and conceptual framework to guide the development and promotion of residents' emerging professional identities.
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Affiliation(s)
- Alexandra Ackerman
- Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA.
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13
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Moyer CA, Ekpo G, Calhoun CL, Greene J, Naik S, Sippola E, Stern DT, Adanu RM, Koranteng IO, Kwawukume EY, Anderson FJ. Quality of life, optimism/pessimism, and knowledge and attitudes toward HIV Screening among pregnant women in Ghana. Womens Health Issues 2008; 18:301-9. [PMID: 18485737 DOI: 10.1016/j.whi.2008.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 01/25/2008] [Accepted: 02/06/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We sought to explore optimism/pessimism, knowledge of HIV, and attitudes toward HIV screening and treatment among Ghanaian pregnant women. METHOD Pregnant women in Accra, Ghana, completed a self-administered questionnaire including the Life Orientation Test-Revised (LOT-R, an optimism/pessimism measure), an HIV knowledge and screening attitudes questionnaire, the Short Form 12 (SF-12, a measure of health-related quality of life [HRQOL]), and a demographic questionnaire. Data were analyzed using t-tests, ANOVA, correlations, and the chi2 test. RESULTS There were 101 participants; 28% were nulliparous. Mean age was 29.7 years, and mean week of gestation was 31.8. All women had heard of AIDS, 27.7% had been tested for HIV before this pregnancy, 46.5% had been tested during this pregnancy, and 59.4% of the sample had ever been tested for HIV. Of those not tested during this pregnancy, 64.2% were willing to be tested. Of all respondents, 89% said they would get tested if antiretroviral drugs (ARVs) were readily available and might prevent maternal-to-child transmission. Neither optimism/pessimism nor HRQOL was associated with attitudes toward HIV screening. Optimism was negatively correlated with HIV knowledge (p = .001) and was positively correlated with having never been tested before this pregnancy (p = .007). CONCLUSION The relationship between optimism/pessimism and HIV knowledge and screening behavior is worthy of further study using larger samples and objective measures of testing beyond self-report.
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Affiliation(s)
- Cheryl A Moyer
- Global REACH, Department of Medical Education, University of Michigan Medical School, Ann Arbor, Michigan 48104, USA.
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14
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Abstract
As the "passion that animates authentic professionalism," humanism must be infused into medical education and clinical care as a central feature of medicine's professionalism movement. In this article, we discuss a current definition of humanism in medicine. We will also provide detailed descriptions of educational programs intended to promote humanism at a number of medical schools in the United States (and beyond) and identify the key factors that make these programs effective. Common elements of programs that effectively teach humanism include: (1) opportunities for students to gain perspective in the lives of patients; (2) structured time for reflection on those experiences; and (3) focused mentoring to ensure that these events convert to positive, formative learning experiences. By describing educational experiences that both promote and sustain humanism in doctors, we hope to stimulate the thinking of other medical educators and to disseminate the impact of these innovative educational programs to help the profession meet its obligation to provide the public with humanistic physicians.
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Affiliation(s)
- David T Stern
- Division of General Medicine, University of Michigan Medical School, and the VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
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15
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Arnold L, Shue CK, Kalishman S, Prislin M, Pohl C, Pohl H, Stern DT. Can there be a single system for peer assessment of professionalism among medical students? A multi-institutional study. Acad Med 2007; 82:578-86. [PMID: 17525545 DOI: 10.1097/acm.0b013e3180555d4e] [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: 05/12/2023]
Abstract
PURPOSE Peer assessment is a valuable source of information about medical students' professionalism. How best to facilitate peer assessment of students' professional behavior remains to be answered, however. This report extends previous research through a multi-institutional study of students' perspectives about system characteristics for peer assessment of professionalism. It examines whether students from different schools and year levels prefer different characteristics of peer assessment to assess each other candidly, or whether a single system can be designed. It then identifies the characteristics of the resulting preferred system(s). METHOD At the beginning of academic year 2004-2005, students (1,661 of 2,115; 78%) in years one through four at four schools replied to a survey about which peer assessment characteristics - related to, for example, who receives the assessment, its anonymity, and timing - would prevent or encourage their participation. Multivariate analysis of variance was used to detect differences among institutions and students from each year level. RESULTS Students across year levels and schools generally agreed about the characteristics of peer assessment. They prefer a system that is 100% anonymous, provides immediate feedback, focuses on both unprofessional and professional behaviors, and uses peer assessment formatively while rewarding exemplary behavior and addressing serious repetitive professional lapses. The system, they emphasize, must be embedded in a supportive environment. CONCLUSIONS Students' agreement about peer-assessment characteristics suggests that one system can be created to meet the majority of students' preferences. Once implemented, the system should be monitored for student acceptability to maximize participation and to determine the formative and summative value of the process.
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Affiliation(s)
- Louise Arnold
- Office of Medical Education and Research, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri 64108, USA.
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Abstract
BACKGROUND Although it may take up relatively little time, hospitalized patients' interactions with their physicians are important elements of their hospital experience. PURPOSE We conducted a qualitative study to explore what is important to patients about bedside interactions with their physician teams. METHODS We interviewed medical inpatients and used grounded theory methodology to analyze interview transcripts. RESULTS We recruited 17 patients from an academic medical center including a university hospital and a Veterans Administration (VA) hospital. We found that important aspects of patient-team interactions included the exchange of information, evidence of caring from their team, involvement in teaching, knowing the team members, and bedside manner. Patients also described team characteristics that were important to them such as team attributes and intrateam collaboration. CONCLUSIONS This model clarifies the aspects of bedside interactions that patients value and will allow physicians to focus their limited time to the benefit of their patients.
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Affiliation(s)
- Kathlyn E Fletcher
- Robert Wood Johnson Clinical Scholars Program, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
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Affiliation(s)
- David T Stern
- Department of Internal Medicine, University of Michigan Medical School and the Veterans Affairs Ann Arbor Healthcare System, Ann Arbor 48109, USA.
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Abstract
Training in ethics and professionalism is a fundamental component of residency education, yet there is little empirical information to guide curricula. The objective of this study is to describe empirically derived ethics objectives for ethics and professionalism training for multiple specialties. Study design is a thematic analysis of documents, semi-structured interviews, and focus groups conducted in a setting of an academic medical center, Veterans Administration, and community hospital training more than 1000 residents. Participants were 84 informants in 13 specialties including residents, program directors, faculty, practicing physicians, and ethics committees. Thematic analysis identified commonalities across informants and specialties. Resident and nonresident informants identified consent, interprofessional relationships, family interactions, communication skills, and end-of-life care as essential components of training. Nonresidents also emphasized formal ethics instruction, resource allocation, and self-monitoring, whereas residents emphasized the learning environment and resident-attending interactions. Conclusions are that empirically derived learning needs for ethics and professionalism included many topics, such as informed consent and resource allocation, relevant for most specialties, providing opportunities for shared curricula and resources.
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Abstract
BACKGROUND To establish international standards for medical schools, an appropriate panel of experts must decide on performance standards. A pilot test of such standards was set in the context of a multidimensional (multiple-choice question examination, objective structured clinical examination, faculty observation) examination at 8 leading schools in China. METHODS A group of 16 medical education leaders from a broad array of countries met over a 3-day period. These individuals considered competency domains, examination items, and the percentage of students who could fall below a cut-off score if the school was still to be considered as meeting competencies. This 2-step process started with a discussion of the borderline school and the relative difficulty of a borderline school in achieving acceptable standards in a given competency domain. Committee members then estimated the percentage of students falling below the standard that is tolerable at a borderline school and were allowed to revise their ratings after viewing pilot data. RESULTS Tolerable failure rates ranged from 10% to 26% across competency domains and examination types. As with other standard-setting exercises, standard deviations from initial to final estimates of the tolerable failure rates fell, but the cut-off scores did not change significantly. Final, but not initial cut-off scores were correlated with student failure rates (r = 0.59, P = 0.03). DISCUSSION This paper describes a method to set school-level outcome standards at an international level based on prior established standard-setting methods. Further refinement of this process and validation using other examinations in other countries will be needed to achieve accurate international standards.
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Affiliation(s)
- David T Stern
- Department of Internal Medicine , University of Michigan Medical School, Ann Arbor, Michigan, USA.
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Papadakis MA, Teherani A, Banach MA, Knettler TR, Rattner SL, Stern DT, Veloski JJ, Hodgson CS. Disciplinary action by medical boards and prior behavior in medical school. N Engl J Med 2005; 353:2673-82. [PMID: 16371633 DOI: 10.1056/nejmsa052596] [Citation(s) in RCA: 437] [Impact Index Per Article: 23.0] [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: 11/19/2022]
Abstract
BACKGROUND Evidence supporting professionalism as a critical measure of competence in medical education is limited. In this case-control study, we investigated the association of disciplinary action against practicing physicians with prior unprofessional behavior in medical school. We also examined the specific types of behavior that are most predictive of disciplinary action against practicing physicians with unprofessional behavior in medical school. METHODS The study included 235 graduates of three medical schools who were disciplined by one of 40 state medical boards between 1990 and 2003 (case physicians). The 469 control physicians were matched with the case physicians according to medical school and graduation year. Predictor variables from medical school included the presence or absence of narratives describing unprofessional behavior, grades, standardized-test scores, and demographic characteristics. Narratives were assigned an overall rating for unprofessional behavior. Those that met the threshold for unprofessional behavior were further classified among eight types of behavior and assigned a severity rating (moderate to severe). RESULTS Disciplinary action by a medical board was strongly associated with prior unprofessional behavior in medical school (odds ratio, 3.0; 95 percent confidence interval, 1.9 to 4.8), for a population attributable risk of disciplinary action of 26 percent. The types of unprofessional behavior most strongly linked with disciplinary action were severe irresponsibility (odds ratio, 8.5; 95 percent confidence interval, 1.8 to 40.1) and severely diminished capacity for self-improvement (odds ratio, 3.1; 95 percent confidence interval, 1.2 to 8.2). Disciplinary action by a medical board was also associated with low scores on the Medical College Admission Test and poor grades in the first two years of medical school (1 percent and 7 percent population attributable risk, respectively), but the association with these variables was less strong than that with unprofessional behavior. CONCLUSIONS In this case-control study, disciplinary action among practicing physicians by medical boards was strongly associated with unprofessional behavior in medical school. Students with the strongest association were those who were described as irresponsible or as having diminished ability to improve their behavior. Professionalism should have a central role in medical academics and throughout one's medical career.
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Affiliation(s)
- Maxine A Papadakis
- School of Medicine, University of California, San Francisco, San Francisco, USA.
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Abstract
BACKGROUND Medical students have unique information about peers' professionalism but are reluctant to share it through peer assessment. METHOD Students (231 of 375; 62%) in one school replied to a survey about whether various characteristics of peer assessment (e.g., who receives the assessment, its anonymity, implications for the classmate) would prevent or encourage their participation. RESULTS Sixty-six percent of the students agreed that there should be peer assessment of professionalism as long as the assessment reflected their preferences for how the assessment should take place. Some of their preferences included reporting unprofessional behavior to an impartial counselor, a 100% anonymous process, and having the classmate receive corrective instruction. Students across year levels generally agreed about the characteristics of peer assessment. Men and women disagreed about some characteristics. CONCLUSION Most students are willing to participate in peer assessment as long as their preferences are taken into consideration.
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Affiliation(s)
- Carolyn K Shue
- University of Missouri-Kansas City School of Medicine, 2411 Holmes, Kansas City, MO 64108, USA
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Abstract
BACKGROUND Although peer assessment holds promise for assessing professionalism, reluctance and refusal to participate have been noted among learners and practicing physicians. Understanding the perspectives of potential participants may therefore be important in designing and implementing effective peer assessment. OBJECTIVE To identify factors that, according to students themselves, will encourage or discourage participation in peer assessment. DESIGN A qualitative study using grounded theory to interpret views shared during 16 focus groups that were conducted by leaders using a semi-structured guide. PARTICIPANTS Sixty-one students in Years 1, 3, and 4 in 2 mid-western public medical schools. RESULTS Three themes students say would promote or discourage peer assessment emerged: personal struggles with peer assessment, characteristics of the assessment system itself, and the environment in which the system operates. Students struggle with reporting an unprofessional peer lest they bring harm to the peer, themselves, or their clinic team or work group. Who receives the assessment and gives the peer feedback and whether it is formative or summative and anonymous, signed, or confidential are important system characteristics. Students' views of characteristics promoting peer assessment were not unanimous. Receptivity to peer reports and close positive relationships among students and between students and faculty mark an environment conducive to peer assessment, students say. CONCLUSIONS The study lays a foundation for creating acceptable peer assessment systems among students by soliciting their views. Merely introducing an assessment tool will not result in students' willingness to assess each other.
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Affiliation(s)
- Louise Arnold
- University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA.
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Abstract
Objectives Over time, quarantine has become a classic public health intervention and has been used repeatedly when newly emerging infectious diseases have threatened to spread throughout a population. Here, we weigh the economic costs and benefits associated with implementing widespread quarantine in Toronto during the SARS outbreaks of 2003. Methods We compared the costs of two outbreak scenarios: in Scenario A, SARS is able to transmit itself throughout a population without any significant public health interventions. In Scenario B, quarantine is implemented early on in an attempt to contain the virus. By evaluating these situations, we can investigate whether or not the use of quarantine is justified by being either cost-saving, life saving, or both. Results Our results indicate that quarantine is effective in containing newly emerging infectious diseases, and also cost saving when compared to not implementing a widespread containment mechanism. Conclusions This paper illustrates that it is not only in our humanitarian interest for public health and healthcare officials to remain aggressive in their response to newly emerging infections, but also in our collective economic interest. Despite somewhat daunting initial costs, quarantine saves both lives and money.
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Affiliation(s)
- Anu G. Gupta
- Global REACH, University of Michigan Medical School, 7C 06 NIB, P.O. Box 0429, Ann Arbor, MI 48109-0429, USA
| | - Cheryl A. Moyer
- Global REACH, University of Michigan Medical School, 7C 06 NIB, P.O. Box 0429, Ann Arbor, MI 48109-0429, USA
- Corresponding author. Tel.: +1-734-998-6827; fax: +1-734-998-6105.
| | - David T. Stern
- Global REACH, University of Michigan Medical School, 7C 06 NIB, P.O. Box 0429, Ann Arbor, MI 48109-0429, USA
- Departments of Medicine and Medical Education, University of Michigan Medical School, Ann Arbor, MI, USA
- Ann Arbor Veterans Affairs Hospital, Ann Arbor, MI, USA
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Gauger PG, Gruppen LD, Minter RM, Colletti LM, Stern DT. Initial use of a novel instrument to measure professionalism in surgical residents. Am J Surg 2005; 189:479-87. [PMID: 15820466 DOI: 10.1016/j.amjsurg.2004.09.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Revised: 09/16/2004] [Accepted: 09/16/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND No universally accepted method to measure professionalism exists. We developed an instrument to measure specific aspects of professionalism in surgical residents. METHODS Professionalism was deconstructed into 15 domains. Behavioral descriptors were determined for extreme and selected intermediate anchors. It became evident that residents could "go too far" in some professional behaviors. Therefore, although a 7-point continuous ordinal scale forms the framework, a score of 7 does not necessarily indicate the ideal. This characteristic minimizes the problem of inflated ratings. RESULTS The instrument was utilized by attending faculty to evaluate residents and also by residents as a self-evaluation. Calculated from ordinal values, mean (SD) of the ratings across domains for faculty evaluations of residents was 4.95 (0.38) while mean for self-evaluations was 4.95 (0.39). Reliability was high (coefficient alpha 0.85). CONCLUSIONS This instrument provides a means to measure professional behaviors during surgical residency. Repeated use will be required to thoroughly establish validity and reliability.
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Affiliation(s)
- Paul G Gauger
- Department of Surgery, Division of Endocrine Surgery, 1500 E. Medical Center Dr., Taubman Center TC2920H, Ann Arbor, MI 48109-0331, USA.
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Stern DT, Ben-David MF, De Champlain A, Hodges B, Wojtczak A, Schwarz MR. Ensuring global standards for medical graduates: a pilot study of international standard-setting. Med Teach 2005; 27:207-13. [PMID: 16011943 DOI: 10.1080/01421590500129571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Increasing physician and patient mobility has led to a move toward internationalization of standards for physician competence. The Institute for International Medical Education proposed a set of outcome-based standards for student performance, which were then measured using three assessment tools in eight leading schools in China: a 150-item multiple-choice examination, a 15-station OSCE and a 16-item faculty observation form. The purpose of this study was to empanel a group of experts to determine whether international student-level performance standards could be set. The IIME convened an international panel of experts in student education with specialty and geographic diversity. The group was split into two, with each sub-group establishing standards independently. After a discussion of the borderline student, the sub-groups established minimally acceptable cut-off scores for performance on the multiple-choice examination (Angoff and Hofstee methods), the OSCE station and global rating performance (modified Angoff method and holistic criterion reference), and faculty observation domains (holistic criterion reference). Panelists within each group set very similar standards for performance. In addition, the two independent parallel panels generated nearly identical performance standards. Cut-off scores changed little before and after being shown pilot data but standard deviations diminished. International experts agreed on a minimum set of competences for medical student performance. In addition, they were able to set consistent performance standards with multiple examination types. This provides an initial basis against which to compare physician performance internationally.
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Affiliation(s)
- David T Stern
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, USA.
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Abstract
OBJECTIVE The purpose of this study was to establish outcome measures for professionalism in medical students and to identify predictors of these outcomes. DESIGN Retrospective cohort study. SETTING A US medical school. PARTICIPANTS All students entering in 1995 and graduating within 5 years. MEASURES Outcome measures included review board identification of professionalism problems and clerkship evaluations for items pertaining to professionalism. Pre-clinical predictor variables included material from the admissions application, completion of required course evaluations, students' self-reporting of immunisation compliance, students' performance on standardised patient (SP) exercises, and students' self-assessed performance on SP exercises. RESULTS The outcome measures of clerkship professionalism scores were found to be highly reliable (alpha 0.88-0.96). No data from the admissions material was found to be predictive of professional behaviour in the clinical years. Using multivariate regression, failing to complete required course evaluations (B = 0.23) and failing to report immunisation compliance (B = 0.29) were significant predictors of unprofessional behaviour found by the review board in subsequent years. Immunisation non-compliance predicted low overall clerkship professional evaluation scores (B = - 0.34). Student self-assessment accuracy (SP score minus self-assessed score) (B = 0.03) and immunisation non-compliance (B = 0.54) predicted the internal medicine clerkship professionalism score. CONCLUSIONS This study identifies a set of reliable, context-bound outcome measures in professionalism. Although we searched for predictors of behaviour in the admissions application and other domains commonly felt to be predictive of professionalism, we found significant predictors only in domains where students had had opportunities to demonstrate conscientious behaviour or humility in self-assessment.
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Affiliation(s)
- David T Stern
- VA Ann Arbor Healthcare System, Division of General Medicine, Department of Internal Medicine, University of Michigan, Michigan, USA.
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Abstract
OBJECTIVE To assess the importance to patients of various aspects of bedside interactions with physician teams. DESIGN Cross-sectional survey. SETTING VA hospital. PATIENTS Ninety-seven medical inpatients. INTERVENTION Survey of 44 questions including short answer, multiple choice, and Likert-type questions. MEASUREMENTS AND MAIN RESULTS Data analysis included descriptive statistics. The sample was predominantly male, with a mean age of 62. Overall satisfaction with the hospital experience and with the team of doctors were both high (95% and 96% reported being very or mostly satisfied, respectively). Patients reported learning about several issues during their interactions with the teams; the 3 most highly rated areas were new problems, tests that will be done, and treatments that will be done. Most patients (76%) felt that their teams cared about them very much. Patients were made comfortable when the team showed that they cared, listened, and appeared relaxed (reported by 63%, 57%, and 54%, respectively). Patients were made uncomfortable by the team using language they did not understand (22%) and when several people examined them at once (13%). Many (58%) patients felt personally involved in teaching. The majority of patients liked having medical students and residents involved in their care (69% and 64%, respectively). CONCLUSIONS Patients have much to teach about what is important about interacting with physician teams. Although patients' reactions to team interactions are generally positive, patients are different with respect to what makes them comfortable and uncomfortable. Taking their preferences into account could improve the experience of being in a teaching hospital.
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Abstract
The General Agreement on Trade in Services (GATS) is the result of an ongoing process of opening national markets to foreign health services within an international framework of trade agreements that prohibit discriminatory treatment of foreign suppliers. Developing markets are growing, as is demand for health care services, and most of this demand is being met by the private market. The globalization of health services requires the resources of the academic and corporate sectors of the developed world for equitable and sustainable growth. Health services trade should be seen as a tool for achieving these goals, rather than as an end in itself.
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Affiliation(s)
- lan S Mutchnick
- Neurosurgical Institute of Kentucky, University of Louisville School of Medicine, USA.
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Affiliation(s)
- Caroline C Wang
- School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA.
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White CB, Moyer CA, Stern DT, Katz SJ. A content analysis of e-mail communication between patients and their providers: patients get the message. J Am Med Inform Assoc 2004; 11:260-7. [PMID: 15064295 PMCID: PMC436072 DOI: 10.1197/jamia.m1445] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2003] [Accepted: 03/16/2004] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE E-mail use in the clinical setting has been slow to diffuse for several reasons, including providers' concerns about patients' inappropriate and inefficient use of the technology. This study examined the content of a random sample of patient-physician e-mail messages to determine the validity of those concerns. DESIGN A qualitative analysis of patient-physician e-mail messages was performed. MEASUREMENTS A total of 3,007 patient-physician e-mail messages were collected over 11 months as part of a randomized, controlled trial of a triage-based e-mail system in two primary care centers (including 98 physicians); 10% of messages were randomly selected for review. Messages were coded across such domains as message type, number of requests per e-mail, inclusion of sensitive content, necessity of a physician response, and message tone. RESULTS The majority (82.8%) of messages addressed a single issue. The most common message types included information updates to the physicians (41.4%), prescription renewals (24.2%), health questions (13.2%), questions about test results (10.9%), referrals (8.8%), "other" (including thank yous, apologies) (8.8%), appointments (5.4%), requests for non-health-related information (4.8%), and billing questions (0.3%). Overall, messages were concise, formal, and medically relevant. Very few (5.1%) included sensitive content, and none included urgent messages. Less than half (43.2%) required a physician response. CONCLUSION A triage-based e-mail system promoted e-mail exchanges appropriate for primary care. Most patients adhered to guidelines aimed at focusing content, limiting the number of requests per message, and avoiding urgent requests or highly sensitive content. Thus, physicians' concerns about the content of patients' e-mails may be unwarranted.
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Affiliation(s)
- Casey B White
- Office of Medical Education, University of Michigan Medical School, Learning Resource Center, 3960 Taubman Medical Library, 1135 East Catherine Street, Ann Arbor, MI 48109-0726, USA.
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Stern DT. Future Challenges from the U.S. Perspective: Trust as the Key to Clinical Research. The Journal of Clinical Ethics 2004. [DOI: 10.1086/jce200415114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Schwarz MR, Stern DT. Introductory Comments. The Journal of Clinical Ethics 2004. [DOI: 10.1086/jce200415102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Stern DT. Future challenges from the U.S. perspective: trust as the key to clinical research. J Clin Ethics 2004; 15:87-92. [PMID: 15202362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- David T Stern
- University of Michigan Medical School, Detroit, USA.
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Fletcher KE, Stern DT, White C, Gruppen LD, Oh MS, Cimmino VM. The physical examination of patients with abdominal pain: the long-term effect of adding standardized patients and small-group feedback to a lecture presentation. Teach Learn Med 2004; 16:171-4. [PMID: 15276894 DOI: 10.1207/s15328015tlm1602_9] [Citation(s) in RCA: 5] [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: 05/12/2023]
Abstract
BACKGROUND One of the most effective methods for teaching physical diagnosis may be standardized patient instructors. PURPOSE To determine if a lecture plus standardized patient instructors with small-group sessions is more effective than a lecture alone for teaching the evaluation of patients with abdominal pain. METHODS Control (class of 2001) and intervention (class of 2002) groups both attended a lecture on the abdominal examination. The intervention group then underwent an exercise with standardized patient instructors and a review session with surgical faculty. An evaluation 18 months later used standardized patient instructors to complete evaluations assessing history-taking and physical examination skills. RESULTS The intervention group performed significantly better than the control group on both the history and the physical examination subscales. CONCLUSION It is possible to have an important, measurable, and lasting effect on physical examination skills by adding standardized patient instructors and small-group discussion to a lecture presentation.
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Affiliation(s)
- David T Stern
- University of Michigan in the Division of General Medicine
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Abstract
Using an international network of experts in medical education, the Institute for International Medical Education (IIME) developed the Global Minimum Essential Requirements (GMER) as a set of competence-based outcomes for graduating students. To establish a set of tools to evaluate these competences, the IIME then convened a Task Force of international experts on assessment that reviewed the GMER. After screening 75 potential assessment tools, they identified three that could be used most effectively. Of the 60 competences envisaged in the GMER, 36 can be assessed using a 150-item multiple-choice question (MCQ) examination, 15 by using a 15-station objective structured clinical examination (OSCE), and 17 by using a 15-item faculty observation form. In cooperation with eight leading medical schools in China, the MCQ, OSCE and Faculty Observation Form were developed to be used in an assessment program that is scheduled to be given to all seven-year students in October 2003.
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Affiliation(s)
- David T Stern
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Abstract
PROBLEM STATEMENT AND BACKGROUND Cross-cultural experiences are in increasing demand by both graduate and undergraduate medical students, yet the benefits of these experiences are not clearly established. METHOD A review of the literature was conducted to identify articles on the outcomes of cross-cultural experiences. Themes were identified and categorized into domains. RESULTS Forty-two studies were found; 27 articles used qualitative methods, nine used quantitative methods, and six used both. Most (24) were from the nursing literature, 18 were from the medical literature. All studies reported positive outcomes along four domains: students' professional development, students' personal development, medical school benefits, and host population benefits. CONCLUSIONS Studies reviewed were primarily case controlled or case series. Future research is needed that more clearly defines outcome measures and uses more rigorous methods. Although results suggest positive outcomes in all domains, additional research is needed before cross-cultural rotations can be supported based on evidence.
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Katz SJ, Moyer CA, Cox DT, Stern DT. Effect of a triage-based E-mail system on clinic resource use and patient and physician satisfaction in primary care: a randomized controlled trial. J Gen Intern Med 2003; 18:736-44. [PMID: 12950483 PMCID: PMC1494914 DOI: 10.1046/j.1525-1497.2003.20756.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.6] [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: 11/20/2022]
Abstract
OBJECTIVES E-mail communication between patients and their providers has diffused slowly in clinical practice. To address concerns about the use of this technology, we performed a randomized controlled trial of a triage-based e-mail system in primary care. DESIGN AND PATIENTS/PARTICIPANTS: Physicians in 2 university-affiliated primary care centers were randomized to a triage-based e-mail system promoted to their patients. E-mails from patients of intervention physicians were routed to a central account and parsed to the appropriate staff for response. Control group physicians and their patients did not have access to the system. We collected information on patient e-mail use, phone calls, and visit distribution by physician over the 10 months and performed physician and patient surveys to examine attitudes about communication. RESULTS E-mail volume was greater for intervention versus control physicians (46 weekly e-mails per 100 scheduled visits vs 9 in the control group at the study midpoint; P <.01) but there were no between-group differences in phone volume (67 weekly phone calls per 100 scheduled visits vs 55 in the control group; P =.45) or rates of patient no-shows (5% in both groups; P =.77). Intervention physicians reported more favorable attitudes toward electronic communication than did control physicians but there were no differences in attitudes toward patient or staff communication in general. There were few between-group differences in patient attitudes toward electronic communication or communication in general. CONCLUSIONS E-mail generated through a triage-based system did not appear to substitute for phone communication or to reduce visit no-shows in a primary care setting. Physicians' attitudes toward electronic communication were improved, but physicians' and patients' attitudes toward general communication did not change. Growth of e-mail communication in primary care settings may not improve the efficiency of clinical care.
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Affiliation(s)
- Steven J Katz
- Veterans Affairs Ann Arbor Healthcare System and the Department of Health Management and Policy, School of Public Health, University of Michigan, 300 N. Ingalls, Suite 7E12, Box 0429, Ann Arbor, MI 48109-0429, USA.
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Affiliation(s)
- Monica L Lypson
- University of Michigan, Division of General Medicine, Department of Internal Medicine, 300 North Ingalls, Ann Arbor, MI 48109-0429, USA.
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Moyer CA, Stern DT, Dobias KS, Cox DT, Katz SJ. Bridging the electronic divide: patient and provider perspectives on e-mail communication in primary care. Am J Manag Care 2002; 8:427-33. [PMID: 12019595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To determine e-mail utilization patterns and attitudes toward e-mail use among primary care physicians and their ambulatory outpatient clinic patients. STUDY DESIGN Cross-sectional baseline survey. PARTICIPANTS AND METHODS Participants included 476 consecutive outpatient clinic patients, 126 general medical and family practice physicians, and 16 clinical and office staff from 2 large primary care centers within an academic teaching system. They completed a survey about e-mail usage patterns and their attitudes toward using e-mail for patient-provider communication. RESULTS More than half of patients (52.1%) were self-defined e-mail users, yet only 10.5% of those users had ever used e-mail to communicate with their doctors. Seventy percent of all patients said they would be willing to use e-mail to communicate with their doctors. Overall, patients were concerned about logistics, such as whether the message would get to the right person and how long it would take to get a response. Physicians and staff were more optimistic than patients about the potential for e-mail to improve the doctor-patient relationship. Patient e-mail users, patient e-mail nonusers, physicians, and staff reported low levels of concern about the security and privacy of e-mail. CONCLUSIONS Patient-provider e-mail may diffuse slowly into the primary care clinical practice setting because of patient concerns about efficiency and effectiveness and whether e-mail use will improve their relationship with providers. Managed care organizations that plan to build e-mail and Web-based patient portals will need to promote these technologies in a way that educates both patient and providers about their appropriate use.
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Affiliation(s)
- Cheryl A Moyer
- Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies, University of Michigan School of Medicine, Ann Arbor 48109-0409, USA
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Abstract
OBJECTIVE Today's medical school graduates have significant deficits in physical examination skills. Medical educators have been searching for methods to effectively teach and maintain these skills in students. The objective of this study was to determine if an auscultation curriculum centered on a portable multimedia CD-ROM was effective in producing and maintaining significant gains in cardiac auscultatory skills. DESIGN Controlled cohort study. PARTICIPANTS All 168 third-year medical students at 1 medical school in an academic medical center. INTERVENTIONS Students were tested before and after exposure to 1 or more elements of the auscultation curriculum: teaching on ward/clinic rotations, CD-ROM comprehensive cases with follow-up seminars, and a CD-ROM 20-case miniseries. The primary outcome measures were student performance on a 10-item test of auscultation skill (listening and identifying heart sound characteristics) and a 30-item test of auscultation knowledge (factual questions about auscultation). A subset of students was tested for attenuation effects 9 or 12 months after the intervention. RESULTS Compared with the control group (1 month clinical rotation alone), students who were also exposed to the CD-ROM 20-case miniseries had significant improvements in auscultation skills scores (P < .05), but not knowledge. Additional months of clerkship, comprehensive CD-ROM cases, and follow-up seminars increased auscultation knowledge beyond the miniseries alone (P < .05), but did not further improve auscultation skills. Students' auscultation knowledge diminished one year after the intervention, but auscultation skills did not. CONCLUSION In addition to the standard curriculum of ward and conference teaching, portable multimedia tools may help improve quality of physical examination skills.
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Affiliation(s)
- D T Stern
- Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Mich., USA.
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Abstract
OBJECTIVE The One-Minute Preceptor (OMP) model of faculty development is used widely to improve teaching, but its effect on teaching behavior has not been assessed. We aim to evaluate the effect of this intervention on residents' teaching skills. DESIGN Randomized controlled trial. SETTING Inpatient teaching services at both a tertiary care hospital and a Veterans Administration Medical Center affiliated with a University Medical Center. PARTICIPANTS Participants included 57 second- and third-year internal medicine residents that were randomized to the intervention group (n = 28) or to the control group (n = 29). INTERVENTION The intervention was a 1-hour session incorporating lecture, group discussion, and role-play. MEASUREMENTS AND MAIN RESULTS Primary outcome measures were resident self-report and learner ratings of resident performance of the OMP teaching behaviors. Residents assigned to the intervention group reported statistically significant changes in all behaviors (P <.05). Eighty-seven percent of residents rated the intervention as "useful or very useful" on a 1-5 point scale with a mean of 4.28. Student ratings of teacher performance showed improvements in all skills except "Teaching General Rules." Learners of the residents in the intervention group reported increased motivation to do outside reading when compared to learners of the control residents. Ratings of overall teaching effectiveness were not significantly different between the 2 groups. CONCLUSIONS The OMP model is a brief and easy-to-administer intervention that provides modest improvements in residents' teaching skills.
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Affiliation(s)
- S L Furney
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich, USA.
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Affiliation(s)
- D T Stern
- Division of General Medicine, Ann Arbor VA Medical Center, MI 48105, USA
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Abstract
Recognizing and rewarding teaching faculty are increasingly important to medical schools and are often hampered by low perceived reliability and validity of measures of teaching ability. The purpose of this study was to cross-validate two independently generated measures of teaching from medical students and residents. A total of 2,318 medical student and 4,425 resident scores for single-item measures of teaching ability for 129 teaching faculty members of a department of internal medicine over a 6-year period were compared. Results showed that average teaching scores were higher for medical students than residents. Rank order of faculty were within 2 quintiles for the two groups for over 90% of faculty. Highly discordant evaluations were seen for only 8% of faculty. The authors conclude the general concordance of two independent measures of teaching ability adds evidence to the existing literature of the validity of single-item measures of teaching ability from two different types of learners.
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Affiliation(s)
- B C Williams
- Ann Arbor VA Medical Center and University of Michigan Medical Center, USA
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Stern DT, Williams BC, Gill A, Gruppen LD, Woolliscroft JO, Grum CM. Is there a relationship between attending physicians' and residents' teaching skills and students' examination scores? Acad Med 2000; 75:1144-1146. [PMID: 11078678 DOI: 10.1097/00001888-200011000-00024] [Citation(s) in RCA: 36] [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: 05/23/2023]
Abstract
PURPOSE Faculty development programs and faculty incentive systems have heightened the need to validate a connection between the quality of teaching and students' learning. This study was designed to determine the association between attending physicians' and residents' teacher ratings and their students' examination scores. METHOD From a database of 362 students, 138 faculty, and 107 residents in internal medicine, student-faculty (n = 476) and student-resident (n = 474) pairs were identified. All students were in their third year, rotating on inpatient general medicine and cardiology services, July 1994 through June 1996, at a single institution. The outcome measure for students' knowledge was the NBME Subject Examination in internal medicine. To control for students' baseline knowledge, the predictors were scores on the USMLE Step 1 and a sequential examination (a clinically-based pre- and post-clerkship examination). Teaching abilities of faculty and residents were rated by a global item on the post-clerkship evaluation. Faculty's ratings used only scores from prior to the study period; residents' ratings included those scores students gave during the study period. RESULTS Multivariate analyses showed faculty's teaching ratings were a small but significant predictor of the increase in students' knowledge. Residents' teaching ratings did not predict an increase in students' knowledge. CONCLUSION Attending faculty's clinical teaching ability has a positive and significant effect on medical students' learning.
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Affiliation(s)
- D T Stern
- Department of Internal Medicine, VA Ann Arbor Healthcare System, Michigan, USA.
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Stern DT. The development of professional character in medical students. Hastings Cent Rep 2000; 30:S26-9. [PMID: 11658239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Stern DT. The development of professional character in medical students. Hastings Cent Rep 2000; 30:S26-9. [PMID: 10971901] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- D T Stern
- University of Michigan, Ann Arbor, USA
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