The Interdisciplinary Generalist Curriculum Project at the University of Vermont College of Medicine: The Vermont Generalist Curriculum (VGC) Experience

The University of Vermont College of Medicine received its Vermont Generalist Curriculum (VGC) subcontract as one of the second-cycle Interdisciplinary Generalist Curriculum (IGC) Project schools from 1995 to 1998. The Vermont program was jointly codirected by the chairs of family practice and pediatrics and the program director for internal medicine on a rotating basis and was overseen by a multidisciplinary steering committee that included generalists, basic scientists, specialists, and students. This committee provided guidance and support in recruitment of preceptors, continuous assessment and improvement of the courses, development of a clinical correlation manual for students in clinical offices, and cooperation around a jointly sponsored annual primary care meeting that included a joint scientific program, a research forum, and a faculty development workshop. The VGC has provided a pilot for many innovative curricular changes that have served as models for the school-wide curriculum redesign process currently under way at VERMONT: While the funding for this project ended in 1998, the changes, innovations, and collaboration born out of the project are valuable enough for the dean's office to maintain the VGC's funding and its steering committee for the future.

Weaving women's health across clinical clerkships

Clerkship directors have an opportunity to develop consensus on learning objectives for women's health issues and to develop curricula that cross disciplinary boundaries. A collaborative interdisciplinary approach assures proper sequencing of knowledge and skill acquisition, conserves educational resources, and reflects the values of connectedness and patient-centeredness that are central to women's health. The informal networks and the institutional structures that bring clerkship directors together for discussion of a variety of educational issues promote such collaboration. The authors describe three approaches to designing and implementing women's health curricula and discuss how each might be applied to the topic of domestic violence: adding free-standing courses to existing curricula, often as electives; delegating pieces of the women's health curriculum to existing courses; and creating new interdisciplinary curricula that then are integrated into the general curriculum. Each has advantages and disadvantages. Ideally, models for curriculum design will reflect the collaborative patient-centered models upon which the field of women's health is based. Such models enhance program effectiveness by taking advantage of discipline-based expertise while allowing for the sharing of both educational responsibilities and educational resources.

A vertical curriculum to teach the knowledge, skills, and attitudes of medical informatics

It is becoming increasingly apparent that medical schools must begin teaching the knowledge, skills and attitudes of information literacy and applied medical informatics as core competencies in undergraduate medical education. The University of Vermont College of Medicine recognized that these core competencies were lacking in its curriculum, and in 1992 it implemented a four year, integrated program to give students the information habits essential to twenty-first century practice. The first graduates of the program are now in residencies and feedback has enabled the College to refine the program to better meet the informatics education needs of the next generation of physicians. The result of these efforts is the Vertical Curriculum in Information Literacy and Applied Medical Informatics; its process of development, the product of the process, and its outcomes are discussed.

Student doctors and women in labor: attitudes and expectations

OBJECTIVE

To compare the attitudes and expectations that obstetric patients and medical students bring to the student-patient relationship in intrapartum care.

METHODS

Written questionnaires were distributed to obstetric patients who had students assist in their labor and delivery care and to medical students who had completed their clinical clerkship year. Responses of 222 patients and 67 students were analyzed for differences in expectations of student participation and assessment of skills.

RESULTS

Responses of medical students and patients were significantly different in all attitudes and expectations studied. One hundred thirty-six (61%) patients compared with 27 (40%) students identified the patients' wish to contribute to the education of students as the most important reason for agreeing to student participation. All patients felt that student participation should be requested rather than assigned, with 194 (87%) patients but only 30 (45%) students wishing to have the student absent from the room at the time of the request. Mean ratings of different student skills tended to be higher from patients (1.3-1.8 on a seven-point Likert scale) than from the students themselves (range 1.6-2.4). Although students' expectations of participation in patient care were high, patients indicated expectations of fairly low levels of student involvement in communication, examination, labor support, and procedures.

CONCLUSION

Students have high expectations for their active involvement in intrapartum care and tend to under-estimate the sense of altruism that motivates patients to allow student participation. Patients have low expectations of levels of student participation in their care, but are overall quite satisfied with the skills of the students. These differences highlight the need for the development of educational objectives that clarify student roles in clinical clerkships and the process of informed consent for student participation.

Psychiatry clerkship directors: who they are, what they do, and what they think

We mailed questionnaires to ascertain biographic, academic and attitudinal data about psychiatry clerkship directors in the U.S. The average director is 46 years old, has been in academic medicine for 13 years, and has directed the clerkship for 5.9 years. Most are associate or full professors and hold one or more additional administrative positions, most often director of medical student education in psychiatry. Most view their role as fulfilling and want to direct the clerkship for the rest of their careers. However, most also perceive that their medical school does not provide enough support, that faculty don't teach enough, and that the current economic climate impedes learning. Unless medical student education is supported under managed care, the quality of clerkships and job satisfaction for clerkship directors will decline.

Obstetric patients who select and those who refuse medical students' participation in their care

PURPOSE

To assess attitudes and expectations of obstetric patients toward the involvement of medical students in their care.

METHOD

At the Medical Center Hospital of Vermont in 1991, questionnaire responses were collected from 222 obstetric patients who had been assisted by clerkship students from the University of Vermont College of Medicine and 78 patients who had refused the participation of students. The responses were analyzed for differences in demographic backgrounds, prior hospital experiences, and general expectations of student involvement, using chi-square, two-tailed t-tests and analysis of variance.

RESULTS

Both groups of respondents consisted primarily of young, well-educated, married women, who appear to have made their decisions about student participation by balancing their personal needs and their sense of altruism. For example, 61% of those who had refused the participation of students ranked the desire for privacy as their primary reason, whereas 73% of those who had accepted student participation ranked as their primary reason the desire to contribute to a student's education. Although both groups of patients expected the students to perform few clinical procedures, the patients who had refused student participation expected the students to be more involved in patient care than did the patients who had allowed participation. Of the 25% of the patients who had had students involved in prior pregnancy care, those who had currently refused student participation had less positive views of prior student care.

CONCLUSION

Patients' needs for privacy, past experiences with student care, and expectations of student performance should be considered to ensure the respectful incorporation of student involvement in obstetric care.