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ABSTRACT: The Cognitive Behavior Survey (CBS) assesses learner behavior in healthcare-related fields.
The study aims were to evaluate the factorial validity of the CBS, which purports to measure three dimensions of learner behavior--conceptualization, reflection, and memorization--and propose and test an alternative model including its time invariance.
The CBS was administered to 3 cohorts of medical students upon matriculation and at the end of their 1st and 2nd year.
Confirmatory factor analysis (CFA) did not support the original CBS model. Exploratory factor analysis (EFA) with an independent sample provided a new model. Retesting the EFA model using CFA with the original sample yielded a model with improved fit and time invariance.
This study provides evidence for the original CBS 3-factor structure but requires alternative scoring for a time-invariant model.
Teaching and Learning in Medicine 04/2012; 24(2):133-9. · 0.75 Impact Factor
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ABSTRACT: Growing data support interprofessional teams as an important part of medical education. This study describes attitudes, barriers, and practices regarding interprofessional education (IPE) in internal medicine (IM) clerkships in the United States and Canada.
In 2009, a section on IPE was included on the Clerkship Directors in Internal Medicine annual survey. This section contained 23 multiple-choice questions exploring both core and subinternship experiences. Data were analyzed using descriptive statistics and Rasch analysis.
Sixty-nine of 107 institutional members responded to the survey (64% response rate). Approximately 68% of responding clerkship directors believed that IPE is important to the practice of IM. However, only 57% believed that it should become a part of the undergraduate clinical curriculum. The three most significant barriers to IPE in the IM clerkship were scheduling alignment, time in the existing curriculum, and resources in time and money. Although more than half of respondents felt IPE should be included in the clinical curriculum, 81% indicated that there was no formal curriculum on IPE in their core IM clerkship, and 84% indicated that there was no formal curriculum during IM subinternship rotations at their institution.
There is limited penetration of IPE into one of the foundational clinical training episodes for medical students in Liaison Committee for Medical Education-accredited schools. This may be related to misperceptions of the relative value of these experiences and limitations of curricular time. Learning in and from successful models of interprofessional teams in clinical practice may help overcome these barriers.
Academic medicine: journal of the Association of American Medical Colleges 05/2011; 86(7):872-6. · 2.34 Impact Factor
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ABSTRACT: Medical students use several strategies for United States Medical Licensing Examination (USMLE) Step 1 preparation. At Ohio State University College of Medicine, a yearlong, peer-designed and -led Step 1 review course is a new option for our second-year students. This study aims to ascertain the value of the peer-designed and -led Step 1 review course, to assess the difference in Step 1 scores between participants and nonparticipants, and to understand the course's role in improving preparation for Step 1 among participants.
Eligible students completed a confidential survey. Scores between participants and nonparticipants were compared, controlling for preexisting differences between groups.
Course participants had a higher average Step 1 score than nonparticipants (P = .005). The majority of participants felt the course was a valuable use of time and would recommend it to future students.
A Step 1 review course designed and led by near-peer senior medical students, those who had successfully completed the USMLE Step 1 exam within the previous year, was shown to be valuable to second-year medical students and improved Step 1 score outcomes.
Academic medicine: journal of the Association of American Medical Colleges 10/2010; 85(10 Suppl):S45-8. · 2.34 Impact Factor
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ABSTRACT: Multiple publications describe short- term and intermediate outcomes of premedical postbaccalaureate programs (PBPs). However, the authors could find no control group studies reporting the service provided by graduates of PBPs to patients who are medically indigent (e.g., on Medicaid or uninsured) and/or poor. The authors explored the relationship between successful completion of a midwestern PBP and providing care for the underserved.
In 2008, the authors surveyed 1996-2002 graduates of The Ohio State University College of Medicine who had been in practice for at least one year about their current practice population. The authors compared two groups: (1) physicians who completed the PBP and (2) a stratified random control group of physicians who graduated from the same medical school, in the same graduating classes, but did not participate in the PBP.
The survey return rate was 70.9% (73/103). Findings suggest that PBP graduates were more likely to be practicing medicine in a federally designated underserved area (29.4% versus 5.1%, P < .009) or providing service where 40% or more of the patients were medically indigent or poor (67.6% versus 33.3%, P < .003). PBP graduates were also more likely to be volunteering their services to patients who were indigent (47.1% versus 10.3%, P < .001).
This is likely the first control group study demonstrating the increased likelihood of graduates of a PBP providing health care to patients who are medically indigent and/or poor.
Academic medicine: journal of the Association of American Medical Colleges 01/2010; 85(1):36-40. · 2.34 Impact Factor
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ABSTRACT: The purpose of this article is to share the procedures used to strengthen the Medical Pathways (MEDPATH) premedical postbaccalaureate program (PBP) to increase the chances of its students successfully graduating from medical school in four years.
Subjects included students who matriculated into medical school between 1991-1999 (N = 72) following successful completion of the 12-month MEDPATH premedical PBP. Students who had passed the USMLE Step 1 on the first attempt were defined as successful and were compared to those who did not pass on their first attempt. Programmatic changes were implemented based on these findings, and outcomes were evaluated.
There was a significant improvement in total MCAT scores between pre-2003 (PBP entry year) participants (Mn = 20.73, SD = 3.10, N = 117) and post-2003 (PBP entry year) participants (Mn = 25.27, SD = 2.96, N = 37) (t = 7.86, df = 152, p < 0.001). MEDPATH premedical PBP coursework grade-point averages improved from 3.48 to 3.67 over the same time intervals. Diversity of program participants was maintained.
The enhanced MEDPATH premedical PBP appears to be producing underrepresented minority and disadvantaged medical students who are better prepared to succeed in medical school.
Journal of the National Medical Association 09/2008; 100(9):1021-4. · 1.16 Impact Factor
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ABSTRACT: The most common 3rd-year surgery clerkship uses general surgery services while limiting the involvement of subspecialty services. A novel surgery clerkship in which students were assigned to either general surgery or subspecialty services for the entire clerkship was tried at a large Midwestern medical school. The purpose of this study was to investigate the outcomes of clerks from subspecialty services and compare them with clerks from general surgery services.
Outcome measures included scores on the National Board of Medical Examiners Surgery Content Examination, faculty evaluation scores, and residency match results. A multivariate analysis of covariance compared National Board of Medical Examiners test scores and faculty evaluation ratings across service groups. United States Medical Licensing Examination Step 1 scores served as a covariate.
Results showed significant differences between groups on faculty evaluation scores (F = 28.03; P <or= 0.001), while controlling for initial differences in academic performance. However, no differences were observed on examination score (F = 2.32, ns), or residency match results (chi(2) = 2.05, ns).
These findings inform surgical educators to consider a more prominent role of subspecialty surgery in teaching 3rd-year medical students. However, caution is advised to accommodate the difference in stringency observed between subspecialty and general surgery faculty in rating medical student performance. Faculty development in student evaluation for subspecialty surgical faculty is recommended.
Journal of Surgical Research 04/2008; 153(1):152-5. · 2.25 Impact Factor
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ABSTRACT: The purpose of this study was to determine whether four types of professionalism deficiencies in medical students identified during a first-year course on doctor-patient relationships might predict poor performance in third-year clerkships.
Preceptors identified students who had deficiencies in interviewing patients: extreme shyness, poor process skills, paternalism, or a negative attitude toward interviewing. Deficient students were matched by academic ability to a control group. Performance on third-year clerkships was compared.
Students with paternalistic behavior or negative attitudes had significantly lower third-year grades.
Professionalism deficiencies that result in the inability of the student to establish patient rapport are detectable early and predict problems in future clinical performance.
Academic Medicine 11/2004; 79(10 Suppl):S46-8. · 3.52 Impact Factor
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Academic Medicine 11/2002; 77(10 Suppl):S13-6. · 3.52 Impact Factor
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ABSTRACT: Learning experiences during the medical school clinical rotation are largely shaped by patient contacts in a variety of clinical settings. For this reason, it is important to learn as much as possible about whether learning goals are being met. The patient encounter log has been used as a program evaluation tool to track students' clinical experiences.
In the present study, we used a scannable pencil and paper form to compare clinical and demographic data from two primary care experiences in a multidisciplinary clerkship. Students manually recorded the encounter date, patient age and gender, the students' level of involvement with the patient, and involvement with procedures. Up to four diagnoses relevant to the encounter were also recorded. To document the clinical content of the encounters, International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9- CM) codes were used.
Differences in patient encounters were found in five of the most frequently logged ICD-9-CM categories and also the presence of multiple diagnostic categories. Fewer family medicine encounters could be categorized as observational than general internal medicine encounters, and students on the family medicine month conducted physical examinations more frequently. Lower patient age was recorded for family medicine patients seen. Patient gender was balanced and comparable for the two specialties. The majority of the most frequently logged ICD-9-CM categories were strikingly similar. The range of diagnoses logged was identical. Students also documented similar opportunities for first contact with patients, doing patient histories, and the lack of exposure to procedures.
Ambulatory family medicine and internal medicine experiences can be both reinforcing and complementary, resulting in a more complete view of primary care. Common exposures in some diagnoses, ie, hypertension, can illuminate subtle differences in how family physicians manage patients in contrast to general internists. Students benefit from "hearing it again" but also from seeing that different approaches can lead to beneficial effects for patients. Other diagnoses that students experience in family practice offices that differ from their internal medicine rotation and vice versa ensure that students experience both the breadth and depth of primary care.
Family medicine 35(7):499-503. · 1.33 Impact Factor
