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ABSTRACT: The development of patient-centred attitudes by health care providers is critical to improving health care quality. A prior study showed that medical students with more patient-centred attitudes scored higher in communication skills as judged by standardised patients (SPs) than students with less patient-centred attitudes. We designed this multicentre study to examine the relationships among students' demographic characteristics, patient-centredness and communication scores on an SP examination.
Early Year 4 medical students at three US schools completed a 12-item survey during an SP examination. Survey items addressed demographics (gender, ethnicity, primary childhood language) and patient-centredness. Factor analysis on the patient-centredness items defined specific patient-centred attitudes. We used multiple regression analysis incorporating demographic characteristics, school and patient-centredness items and examined the effect of these variables on the outcome variable of communication score.
A total of 351 students took the SP examination and 329 (94%) completed the patient-centredness questionnaire. Responses indicated generally high patient-centredness. Student ethnicity and medical school were significantly associated with communication scores; gender and primary childhood language were not. Two attitudinal factors were identified: patient perspective and impersonal attitude. Multiple regression analysis revealed that school and scores on the impersonal factor were associated with communication scores. The effect size was modest.
In a medical student SP examination, modest differences in communication scores based on ethnicity were observed and can be partially explained by student attitudes regarding patient-centredness. Curricular interventions to enhance clinical experiences, teaching and feedback are needed to address key elements of a patient-centred approach to care.
Medical Education 07/2010; 44(7):653-61. · 3.18 Impact Factor
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ABSTRACT: Medical schools continually evolve their curricula to keep students abreast of advances in basic, translational, and clinical sciences. To provide feedback to educators, critical evaluation of the effectiveness of these curricular changes is necessary. This article describes a method of curriculum evaluation, called "empowerment evaluation," that is new to medical education. It mirrors the increasingly collaborative culture of medical education and offers tools to enhance the faculty's teaching experience and students' learning environments. Empowerment evaluation provides a method for gathering, analyzing, and sharing data about a program and its outcomes and encourages faculty, students, and support personnel to actively participate in system changes. It assumes that the more closely stakeholders are involved in reflecting on evaluation findings, the more likely they are to take ownership of the results and to guide curricular decision making and reform. The steps of empowerment evaluation include collecting evaluation data, designating a "critical friend" to communicate areas of potential improvement, establishing a culture of evidence, encouraging a cycle of reflection and action, cultivating a community of learners, and developing reflective educational practitioners. This article illustrates how stakeholders used the principles of empowerment evaluation to facilitate yearly cycles of improvement at the Stanford University School of Medicine, which implemented a major curriculum reform in 2003-2004. The use of empowerment evaluation concepts and tools fostered greater institutional self-reflection, led to an evidence-based model of decision making, and expanded opportunities for students, faculty, and support staff to work collaboratively to improve and refine the medical school's curriculum.
Academic medicine: journal of the Association of American Medical Colleges 05/2010; 85(5):813-20. · 2.34 Impact Factor
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ABSTRACT: For more than 40 years, the faculties of Duke University School of Medicine (SOM) and Stanford University SOM have encouraged or required students to engage in scholarship as a way to broaden their education and attract them to careers in academic medicine. A dedicated period of research was first integrated into the Duke curriculum in 1959 to provide an opportunity for students to develop into physician leaders through a rigorous scholarly experience in biomedically related research. Originally designed to foster experience in laboratory-based basic research, the third-year program has evolved in response to the changing landscape of medicine and shifting needs and career interests of the medical student population. Stanford University SOM also has a long-standing commitment to biomedical research and currently requires each student to complete an in-depth, mentored "scholarly concentration." In contrast to Duke, where most of the scholarly research experiences take place in an immersive third year, the Stanford program encourages a longitudinal, multiyear exposure over all four (or five) years of medical school. Although the enduring effects of embedding a rigorous research program are not yet fully known, preliminary data suggest that these experiences instill an appreciation for research, impart research rigor and methodologies, and may motivate students to pursue careers in academic medicine. The authors discuss the histories, evolution, logistics, and ongoing challenges of the research programs at Duke University SOM and Stanford University SOM.
Academic medicine: journal of the Association of American Medical Colleges 03/2010; 85(3):419-28. · 2.34 Impact Factor
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Rika Maeshiro,
Ian Johnson,
Denise Koo,
Jean Parboosingh,
Jan K Carney, Neil Gesundheit,
Evelyn T Ho,
David Butler-Jones,
Denise Donovan,
Jonathan A Finkelstein,
Nancy M Bennett,
Barbie Shore,
Stephen A McCurdy,
Lloyd F Novick,
Lily Dow Velarde,
M Marie Dent,
Ann Banchoff,
Laurence Cohen
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ABSTRACT: Abraham Flexner's 1910 report is credited with promoting critical reforms in medical education. Because Flexner advocated scientific rigor and standardization in medical education, his report has been perceived to place little emphasis on the importance of public health in clinical education and training. However, a review of the report reveals that Flexner presciently identified at least three public-health-oriented principles that contributed to his arguments for medical education reform: (1) The training, quality, and quantity of physicians should meet the health needs of the public, (2) physicians have societal obligations to prevent disease and promote health, and medical training should include the breadth of knowledge necessary to meet these obligations, and (3) collaborations between the academic medicine and public health communities result in benefits to both parties. In this article, commemorating the Flexner Centenary, the authors review the progress of U.S. and Canadian medical schools in addressing these principles in the context of contemporary societal health needs, provide an update on recent efforts to address what has long been perceived as a deficit in medical education (inadequate grounding of medical students in public health), and provide new recommendations on how to create important linkages between medical education and public health. Contemporary health challenges that require a public health approach in addition to one-on-one clinical skills include containing epidemics of preventable chronic diseases, reforming the health care system to provide equitable high-quality care to populations, and responding to potential disasters in an increasingly interconnected world. The quantitative skills and contextual knowledge that will prepare physicians to address these and other population health problems constitute the basics of public health and should be included throughout the continuum of medical education.
Academic medicine: journal of the Association of American Medical Colleges 02/2010; 85(2):211-9. · 2.34 Impact Factor
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Neil Gesundheit
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ABSTRACT: Background: Web-based clinical cases (“virtual patients”, VPs) provide the potential for valid, cost-effective teaching and assessment of clinical skills, especially clinical reasoning skills, of medical students. However, medical students must embrace this teaching and assessment modality for it to be adopted widely. Method: We examined student acceptance of a web-based VP system, Web-SP, developed for teaching and assessment purposes, in a group of 15 second-year and 12 fourth-year medical students. Results: Student acceptance of this web-based method was high, with greater acceptance in pre-clinical (second-year) compared with clinical (fourth-year) medical students. Students rated VPs as realistic and appropriately challenging; they particularly liked the ability of VPs to show physical abnormalities (such as abnormal heart and lung sounds, skin lesions, and neurological findings), a feature that is absent in standardized patients. Conclusions: These results document high acceptance of web-based instruction and assessment by medical students. VPs of the complexity used in this study appear to be particularly well suited for learning and assessment purposes in early medical students who have not yet had significant clinical contact.
09/2009; 31(8):739-742.
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ABSTRACT: Web-based clinical cases ("virtual patients", VPs) provide the potential for valid, cost-effective teaching and assessment of clinical skills, especially clinical reasoning skills, of medical students. However, medical students must embrace this teaching and assessment modality for it to be adopted widely.
We examined student acceptance of a web-based VP system, Web-SP, developed for teaching and assessment purposes, in a group of 15 second-year and 12 fourth-year medical students.
Student acceptance of this web-based method was high, with greater acceptance in pre-clinical (second-year) compared with clinical (fourth-year) medical students. Students rated VPs as realistic and appropriately challenging; they particularly liked the ability of VPs to show physical abnormalities (such as abnormal heart and lung sounds, skin lesions, and neurological findings), a feature that is absent in standardized patients.
These results document high acceptance of web-based instruction and assessment by medical students. VPs of the complexity used in this study appear to be particularly well suited for learning and assessment purposes in early medical students who have not yet had significant clinical contact.
Medical Teacher 08/2009; 31(8):739-42. · 1.22 Impact Factor
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Journal of clinical gastroenterology 07/2008; 42(7):861-2. · 2.21 Impact Factor
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ABSTRACT: The authors describe the population health curriculum at the Stanford University School of Medicine from 2003 to 2007 that includes a requirement for first-year medical students to engage in community-based population health projects. The new curriculum in population health comprises classroom and experiential teaching methods. Population health projects, a key component of the curriculum, are described and classified by topic and topic area (e.g., health education; health services) and the intended outcome of the intervention (e.g., establishing new policies; advocacy). During the past four years, 344 students have entered the curriculum and have participated in 68 population health projects. The projects were determined both by students' interests and community needs, and they represented diverse topics: 51% of the 68 projects addressed topics in the area of disease prevention and health promotion; 28% addressed health care access; 15% addressed health services; 4% addressed emergency preparedness; and 1% addressed ethical issues in health. Each project had one of three targets for intervention: community capacity building, establishing policies and engaging in advocacy, and bringing about change or improvement in an aspect of the health care system. Projects represented diverse stages in the evolution of a community-campus partnership, from needs assessment to planning, implementation, and evaluation of project outcomes. Experience to date shows that classroom-based sessions and experiential learning in the area of population health can be successfully integrated in a medical school curriculum. When contextualized in a population health curriculum, population health projects can provide future physicians with an experiential counterpart to their classroom learning.
Academic Medicine 05/2008; 83(4):338-44. · 3.52 Impact Factor
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ABSTRACT: Good self-assessment abilities may be one of the most important skills for medical students to acquire, both for successful completion of highly demanding educational programs and to ensure continuing professional development in their future careers as physicians. Still, studies show that many students have difficulties accurately assessing themselves. This study investigates second-year medical students' (N=41) ability to accurately assess their performance on two types of case-based examinations for clinical problem-solving-a computer-based simulated patient exam (Case-Ex) and a standardized patient exam (SP). Four patient cases were used in each exam and were matched as to level of difficulty. The purpose was to investigate differences in students' self-assessment accuracy between the two examination methods. Results indicate that students self-assess inaccurately, and that this occurs more frequently among low performing students. In addition, we found a slight tendency for students to self-assess more accurately with the Case-Ex examination method.
World Conference on E-Learning in Corporate, Government, Healthcare, and Higher Education, Quebec City, Canada; 10/2007
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ABSTRACT: During the last few decades there has been a significant shift in teaching methods in higher education, from a focus on facts towards a focus on problem solving, deeper understanding of principles, and critical thinking [Laurillard 2002, Marton & Booth 1997]. Corresponding assessment methods need to be developed to measure learning outcomes [Roos 2005]. Previous work shows great potential in web-based cases for valid, cost-effective assessment of clinical reasoning skills of medical students [Brutlag et al, 2006]. This paper examines student acceptance of a web-based simulated patient system, Web-SP, for assessment in medical education. Initial results show that student acceptance of this web-based assessment method is high, with greater acceptance in pre-clinical versus clinical students.
World Conference on E-Learning in Corporate, Government, Healthcare, and Higher Education (ELEARN), Quebec City, Canada; 10/2007
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ABSTRACT: Achieving competence in 'practice-based learning' implies that doctors can accurately self- assess their clinical skills to identify behaviours that need improvement. This study examines the impact of receiving feedback via performance benchmarks on medical students' self-assessment after a clinical performance examination (CPX).
The authors developed a practice-based learning exercise at 3 institutions following a required 8-station CPX for medical students at the end of Year 3. Standardised patients (SPs) scored students after each station using checklists developed by experts. Students assessed their own performance immediately after the CPX (Phase 1). One month later, students watched their videotaped performance and reassessed (Phase 2). Some students received performance benchmarks (their scores, plus normative class data) before the video review. Pearson's correlations between self-ratings and SP ratings were calculated for overall performance and specific skill areas (history taking, physical examination, doctor-patient communication) for Phase 1 and Phase 2. The 2 correlations were then compared for each student group (i.e. those who received and those who did not receive feedback).
A total of 280 students completed both study phases. Mean CPX scores ranged from 51% to 71% of items correct overall and for each skill area. Phase 1 self-assessment correlated weakly with SP ratings of student performance (r = 0.01-0.16). Without feedback, Phase 2 correlations remained weak (r = 0.13-0.18; n = 109). With feedback, Phase 2 correlations improved significantly (r = 0.26-0.47; n = 171). Low-performing students showed the greatest improvement after receiving feedback.
The accuracy of student self-assessment was poor after a CPX, but improved significantly with performance feedback (scores and benchmarks). Videotape review alone (without feedback) did not improve self-assessment accuracy. Practice-based learning exercises that incorporate feedback to medical students hold promise to improve self-assessment skills.
Medical Education 10/2007; 41(9):857-65. · 3.18 Impact Factor
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ABSTRACT: Teaching methods have been shifting from an emphasis on facts to an emphasis on critical thinking. Assessment methods should be shifted accordingly, to avoid sending contradictory signals to students which may affect learning outcomes. The Case-Ex project aims to provide a new, validated method for assessment in medical education, using an online simulated patient case tool, Web-SP. The eventual goal is to create a library of validated Case-Ex cases. A pilot study has shown the potential for validated testing using Case-Ex, but more work needs to be done to refine the process of case authoring and Case-Ex exam scoring. This poster will outline our refinement process and results.
World Conference on E-Learning in Corporate, Government, Healthcare, and Higher Education, Honolulu, Hawaii, USA; 10/2006
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ABSTRACT: During the last few decades there has been a significant shift in teaching methods in higher education, from a focus on facts towards a focus on problem solving, deeper understanding of principles, and critical thinking [Laurillard 2002, Marton & Booth 1997]. Corresponding assessment methods need to be developed to measure learning outcomes [Roos 2005]. This study examines the potential of a web-based simulated patient system, Web-SP, for assessment in medical education. We compare student scores on the current gold standard for assessment in clinical education – the Standardized Patient (SP) – to their scores on a medically equivalent web-based case – Case-Ex. Initial results suggest that there is great potential in Case-Ex cases for valid, cost-effective assessment of clinical reasoning skills of medical students. In addition, student acceptance of this web-based modality appears to be high, supporting that it can become a useful tool in medical education.
World Conference on E-Learning in Corporate, Government, Healthcare, and Higher Education, Honolulu, Hawaii, USA; 10/2006
