Medical Education Online

Published by Co-Action Publishing
Online ISSN: 1087-2981
Publications
Article
Patient satisfaction with the health care provided by doctors is of great significance. Thus, it is important to identify weaknesses in systems to aid improvement through the patient's eyes. This may be done by utilizing the Patient Satisfaction Questionnaire Short Form (PSQ-18), a concise, validated tool that may be applied to various settings, as well as comparing interventions. (Published: 23 July 2013) Citation: Med Educ Online 2013, 18 : 21747 - http://dx.doi.org/10.3402/meo.v18i0.21747
 
Post-intervention PBL 2.0 student survey results.
Article
The purpose of this study was to test a new problem-based learning (PBL) method to see if it reinvigorated the learning experience. A new PBL format called PBL 2.0, which met for 90 min two times per week, was introduced in 2009 into an 11-week integrated neuroscience course. One hundred second-year medical students, divided into 10 groups of 10, who had completed their first year of medical school using a traditional PBL format, participated in PBL 2.0. Students were prohibited from using computers during the first session. Learning objectives were distributed at the end of the first day to the small groups, and students were assigned to pairs/trios responsible for leading an interactive discussion on specific learning objectives the following day. Student-led 'lectures' were prohibited. All students were responsible for learning all of the learning objectives so that they could participate in their discussions. One hundred and six students were surveyed and 98 submitted answers (92% response). The majority of groups adhered to the new PBL method. Students invested more time preparing the learning objectives. Students indicated that the level of interaction among students increased. The majority of students preferred the new PBL format. PBL 2.0 was effective in increasing student interaction and promoting increased learning.
 
New internal medicine fellowship programs July 2000 through June 2008 No. (%) new programs 
Number of university versus community internal medicine programs created before and after 2005 RRC regulation change. 
Number of community and university hospital programs by subspecialty in June 2007 No. (%) programs 
Article
Since 2002, market studies have predicted a physician shortage with an increasing need for future subspecialists. A Residency Review Committee (RRC) rule that restricted sponsorship of fellowships was eliminated in 2005, but the influence of this change on the number of fellowships is not known. We believed that the rules change might make it possible for community hospitals to offer fellowships. Our objectives were to determine the extent of change in the number of fellowships in university and community hospitals from 2000 through 2008, both before and after the RRC regulation change in 2005, and to determine whether community hospitals contributed substantially to the number of new fellowships available to internal medicine graduates. We used archived Accreditation Council for Graduate Medical Education (ACGME) data from July 2000 through June 2008. The community hospital category included multispecialty clinics, community programs, and municipal hospitals. Of the 94 newly approved internal medicine subspecialty fellowships in this time period, 59 (63%) were community sponsored. As of 6/02/08, all were in good standing. Thirteen programs were started as a department of medicine solo fellowship since 2005. The number of new programs approved between 2005 and 2008 was roughly three times the number approved between 2000 and 2004. The number of subspecialty fellowship programs and approved positions has increased dramatically in the last 8 years. Many of the new programs were at community hospitals. The change in RRC rules has been associated with increased availability of fellowship programs in the university and community hospital setting for subspecialty training.
 
Update from key pediatric medical education articles from 2010 
Article
While most would agree that utilizing the literature to enhance individual educational practice and/or institutional success is the ideal method for improving medical education, methods to focus attention on the most relevant and valuable information have been heretofore lacking in the pediatric medical education literature. We performed a review of the medical education literature for the year 2010. Utilizing a similar strategy employed by others in Internal Medicine, we selected 12 high-yield education journals and manually reviewed the table of contents to select titles that would have grassroots applicability for medical educators. A broad search through PubMed was then completed using search terms adopted from prior studies, and titles from this search were similarly selected. The abstracts of selected titles (n=147) were each reviewed by two of the authors, then all authors reached consensus on articles for full review (n=34). The articles were then discussed and scored to achieve consensus for the 11 articles for inclusion in this paper. Several themes emerged from reviewing these publications. We did not select topics or sections of interest a priori. The themes, grouped into four areas: supervision and leadership, hand-off communication, core competencies: teaching and assessment, and educational potpourri, reflect our community's current concerns, challenges, and engagement in addressing these topics. Each article is summarized below and begins with a brief statement of what the study adds to the practice of pediatric medical education. This review highlights multiple 'articles of value' for all medical educators. We believe the value of these articles and the information they contain for improving the methods used to educate medical students, residents, and fellows are significant. The organically derived thematic areas of the representative articles offer a view of the landscape of medical education research in pediatrics in 2010. Readers can use these individual articles as both tools to improve their practice, as well as inspiration for future areas of research.
 
Proposed levels in modern e-learning 
Correct answers in pre-tests and post-tests 
Between-level comparisons in test result improve- ments 
Article
Background and aims: The fast development of e-learning and social forums demands us to update our understanding of e-learning and peer learning. We aimed to investigate if higher, pre-defined levels of e-learning or social interaction in web forums improved students' learning ability. Methods: One hundred and twenty Danish medical students were randomized to six groups all with 20 students (eCases level 1, eCases level 2, eCases level 2+, eTextbook level 1, eTextbook level 2, and eTextbook level 2+). All students participated in a pre-test, Group 1 participated in an interactive case-based e-learning program, while Group 2 was presented with textbook material electronically. The 2+ groups were able to discuss the material between themselves in a web forum. The subject was head injury and associated treatment and observation guidelines in the emergency room. Following the e-learning, all students completed a post-test. Pre- and post-tests both consisted of 25 questions randomly chosen from a pool of 50 different questions. Results: All students concluded the study with comparable pre-test results. Students at Level 2 (in both groups) improved statistically significant compared to students at level 1 (p>0.05). There was no statistically significant difference between level 2 and level 2+. However, level 2+ was associated with statistically significant greater student's satisfaction than the rest of the students (p>0.05). Conclusions: This study applies a new way of comparing different types of e-learning using a pre-defined level division and the possibility of peer learning. Our findings show that higher levels of e-learning does in fact provide better results when compared with the same type of e-learning at lower levels. While social interaction in web forums increase student satisfaction, learning ability does not seem to change. Both findings are relevant when designing new e-learning materials.
 
Demographic characteristics of the focus group participants 
Summary of main thematic findings 
Article
Improvement in child abuse and neglect education has been previously identified as a significant need among physicians. The purpose of this qualitative study was to better understand specific comparative educational needs regarding child abuse diagnosis and management among physicians from differing specialties and practice types. A total of 22 physicians participated in focus groups (one family practice (FP), one emergency medicine (EM), and one pediatrician group) facilitated by a professional moderator using a semi-structured interview guide. Five specific domains of child abuse education needs were identified from previously published literature. Child abuse education needs were explored across one general and five specific domains, including (1) general impressions of evaluating child abuse, (2) identification and management, (3) education/resource formats, (4) child/caregiver interviews, (5) medical evaluations, and (6) court testimony. Discussions were audiotaped and transcribed verbatim, then analyzed for common themes and differences among the three groups. Participants identified common areas of educational need but the specifics of those needs varied among the groups. Neglect, interviewing, court testimony, and subtle findings of abuse were educational needs for all groups. EM and FP physicians expressed a need for easily accessible education and management tools, with less support for intermittent lectures. All groups may benefit from specialty specific education regarding appropriate medical evaluations of potential cases of abuse/neglect. Significant educational needs exist regarding child abuse/neglect, and educational needs vary based on physician training and practice type. Educational program design may benefit from tailoring to specific physician specialty. Further studies are needed to more clearly identify and evaluate specialty specific educational needs and resources.
 
Basic characteristics of the study sample 1 
Article
Background: Individual variation of examination performance depends on many modifiable and non-modifiable factors, including pre-examination anxiety. Medical students' quality of life (QoL) and certain biochemical changes occurring while they are preparing for examinations has not been explored. Purpose: We hypothesize that these parameters would determine the examination performance among medical students. Methods: Fourth-year medical students (n=78) from the University of Ruhuna, Sri Lanka, were invited. Their pre- and post-exam status of QoL, using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, and the level of biochemical marker levels (i.e., serum levels of thyroid profile including thyroglobulin, cortisol and ferritin) were assessed. Differences between the scores of QoL and serum parameters were compared with their performance at the examination. Results: The mean QoL score was significantly lower at pre-exam (56.19±8.1) when compared with post-exam (61.7±7.1) levels (p<0.001). The median serum TSH level prior to the exam (0.9 mIU/L; interquartile range 0.74-1.4 mIU/L) was significantly lower (p=0.001) when compared with the level after the exam (median of 2.7 mIU/L; IQR 1.90-3.60). The mean±SD fT4 level was significantly higher before the exam (19.48±0.4 pmol/L at study entry vs. 17.43±0.3 pmol/L after the exam; p<0.001). Median serum ferritin (SF) level prior to the exam (43.15 (23.5-63.3) µg/L) was significantly lower (p≤0.001) when compared with after-exam status (72.36 (49.9-94.9) µg/L). However, there was no difference in mean serum cortisol levels (16.51±0.7 at pre-exam and 15.88±0.7 at post-exam, respectively; p=0.41). Conclusions: Students had higher fT4 and low ferritin levels on pre-exam biochemical assessment. It was evident that students who perform better at the examination had significantly higher QoL scores at each domain tested through the questionnaire (Physical health, Psychological, Social interaction and Environment). The higher the QoL scores, the better the grades were. It was also found that students who failed exhibited profound differences in the QoL score.
 
Article
In resident primary care continuity clinics, at the end of each academic year, continuity of care is disrupted when patients cared for by the graduating class are redistributed to other residents. Yet, despite the recent focus on the transfers of care between resident physicians in inpatient settings, there has been minimal attention given to patient care transfers in academic ambulatory clinics. We sought to elicit the views of pediatric residents regarding year-end patient handoffs in a pediatric resident continuity clinic. Residents assigned to a continuity clinic of a large pediatric residency program completed a questionnaire regarding year-end transfers of care. Thirty-one questionnaires were completed out of a total 45 eligible residents (69% response). Eighty seven percent of residents strongly or somewhat agreed that it would be useful to receive a written sign-out for patients with complex medical or social issues, but only 35% felt it would be useful for patients with no significant issues. Residents more frequently reported having access to adequate information regarding their new patients' medical summary (53%) and care plan (47%) than patients' functional abilities (30%), social history (17%), or use of community resources (17%). When rating the importance of receiving adequate sign-out in each those domains, residents gave most importance to the medical summary (87% of residents indicating very or somewhat important) and plan of care (84%). Residents gave less importance to receiving sign-out regarding their patients' functional abilities (71%) social history (58%), and community resources (58%). Residents indicated that lack of access to adequate patient information resulted in additional work (80%), delays or omissions in needed care (56%), and disruptions in continuity of care (58%). In a single-site study, residents perceive that they lack adequate information during year-end patient transfers, resulting in potential negative consequences for patient safety and medical education.
 
Distribution of number of CR visits 21 days before an exam. The distribution was derived from approximately 20 exam periods each for 408 first-year medical students across four cohorts from 2006 to 2010.
Average exam scores and CR visits by month of the academic year. Each point corresponds to the mean percentage exam score (in blue), and number of campus recreation (CR) visits (in red) for 408 first-year medical students for exams given in each month of the academic year. Number of CR visits was calculated as the number of times a student visited a CR facility in the 21-day period prior to an exam date.
Conditional means of CR visits and exam performance. An exam score of 60% represents the passing level for most exams. The data are based on approximately 20 exam sessions each for 408 first-year medical over 4 years. In (a), the number of CR visits is calculated as the number of times a student visited a CR facility in the 21-day period after an exam date. In (b), the number of CR visits is calculated as the number of times a student visited a CR facility in the 21-day period prior to an exam date. 
Predicted changes in CR use and academic performance from regression models. Graph (a) plots the average predicted values of D CR visits from the regression shown in Column 1 of Table 2. Graph (b) plots the average predicted values of D Exam Score from the regression shown in Column 2 of Table 2. 
Article
Self-care activities, including exercise, may be neglected by medical students in response to increasing academic demands. Low levels of exercise among medical students may have ripple effects on patient care and counseling. This study investigates the reciprocal role of recreation use and academic performance among first-year medical students. We combined retrospective administrative data from four cohorts of first-year medical students at the University of Illinois at Urbana-Champaign from 2006 to 2010 (n=408). We estimated regression models to clarify the role of changes in recreation use before examinations on changes in academic performance, and vice versa. The use of recreation facilities by first-year medical students was highly skewed. We found that changes in recreation use before an exam were positively associated with changes in exam performance, and vice versa. Students who make large decreases in their recreation use are likely to decrease their exam scores, rather than increase them. Students who make decreases in their recreation, on average, are likely to decrease their exam scores. These findings suggest that medical students may be able to boost their achievement through wellness interventions, even if they are struggling with exams. We find no evidence that decreasing wellness activities will help improve exam performance.
 
Logistic regression analysis of academic underper- formance a among undergraduate medical students (n0458) 
Article
Background Despite medical school admission committees’ best efforts, a handful of seemingly capable students invariably struggle during their first year of study. Yet, even as entrance criteria continue to broaden beyond cognitive qualifications, attention inevitably reverts back to such factors when seeking to understand these phenomena. Using a host of applicant, admission, and post-admission variables, the purpose of this inductive study, then, was to identify a constellation of student characteristics that, taken collectively, would be predictive of students at-risk of underperforming during the first year of medical school. In it, we hypothesize that a wider range of factors than previously recognized could conceivably play roles in understanding why students experience academic problems early in the medical educational continuum. Methods The study sample consisted of the five most recent matriculant cohorts from a large, southeastern medical school (n=537). Independent variables reflected: 1) the personal demographics of applicants (e.g., age, gender); 2) academic criteria (e.g., undergraduate grade point averages [GPA], medical college admission test); 3) selection processes (e.g., entrance track, interview scores, committee votes); and 4) other indicators of personality and professionalism (e.g., Mayer-Salovey-Caruso Emotional Intelligence Test™ emotional intelligence scores, NEO PI-R™ personality profiles, and appearances before the Professional Code Committee [PCC]). The dependent variable, first-year underperformance, was defined as ANY action (repeat, conditionally advance, or dismiss) by the college's Student Progress and Promotions Committee (SPPC) in response to predefined academic criteria. This study protocol was approved by the local medical institutional review board (IRB). Results Of the 537 students comprising the study sample, 61 (11.4%) met the specified criterion for academic underperformance. Significantly increased academic risks were identified among students who 1) had lower mean undergraduate science GPAs (OR=0.24, p=0.001); 2) entered medical school via an accelerated BS/MD track (OR=16.15, p=0.002); 3) were 31 years of age or older (OR=14.76, p=0.005); and 4) were non-unanimous admission committee admits (OR=0.53, p=0.042). Two dimensions of the NEO PI-R™ personality inventory, openness (+) and conscientiousness (−), were modestly but significantly correlated with academic underperformance. Only for the latter, however, were mean scores found to differ significantly between academic performers and underperformers. Finally, appearing before the college's PCC (OR=4.21, p=0.056) fell just short of statistical significance. Conclusions Our review of various correlates across the matriculation process highlights the heterogeneity of factors underlying students’ underperformance during the first year of medical school and challenges medical educators to understand the complexity of predicting who, among admitted matriculants, may be at future academic risk.
 
Difference between professional degrees and research degrees in medical sciences
Multipath to acquire multilevel of medical degrees.
Article
Context The Chinese government launched a comprehensive healthcare reform to tackle challenges to health equities. Medical education will become the key for successful healthcare reform. Purpose We describe the current status of the Chinese medical degree system and its evolution over the last 80 years. Content Progress has been uneven, historically punctuated most dramatically by the Cultural Revolution. There is a great regional disparity. Doctors with limited tertiary education may be licensed to practice, whereas medical graduates with advanced doctorates may have limited clinical skills. There are undefined relationships between competing tertiary training streams, the academic professional degree, and the clinical residency training programme (RTP). The perceived quality of training in both streams varies widely across China. As the degrees of master or doctor of academic medicine is seen as instrumental in career advancement, including employability in urban hospitals, attainment of this degree is sought after, yet is often unrelated to a role in health care, or is seen as superior to clinical experience. Meanwhile, the practical experience gained in some prestigious academic institutions is deprecated by the RTP and must be repeated before accreditation for clinical practice. This complexity is confusing both for students seeking the most appropriate training, and also for clinics, hospitals and universities seeking to recruit the most appropriate applicants. Conclusion The future education reforms might include: 1) a domestic system of ‘credits’ that gives weight to quality clinical experience vs. academic publications in career advancement, enhanced harmonisation between the competing streams of the professional degree and the RTP, and promotion of mobility of staff between areas of excellence and areas of need; 2) International – a mutual professional and academic recognition between China and other countries by reference to the Bologna Accord, setting up a system of easily comparable and well-understood medical degrees.
 
PISCES mission statement and core principles 
Sample student schedule 
Article
In 2005, medical educators at the University of California, San Francisco (UCSF), began developing the Parnassus Integrated Student Clinical Experiences (PISCES) program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants' career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.
 
Members of the Academy of Health Science Education for the years 2005Á13 according to Health Science Institution and primary degree related to professional field
Logo of the University of Texas Academy of Health Science Education depicting a temple of scholarship bolstered by the six pillars representing the guiding principles of the Academy.
Article
Background: The academy movement developed in the United States as an important approach to enhance the educational mission and facilitate the recognition and work of educators at medical schools and health science institutions. Objectives: Academies initially formed at individual medical schools. Educators and leaders in The University of Texas System (the UT System, UTS) recognized the academy movement as a means both to address special challenges and pursue opportunities for advancing the educational mission of academic health sciences institutions. Methods: The UTS academy process was started by the appointment of a Chancellor's Health Fellow for Education in 2004. Subsequently, the University of Texas Academy of Health Science Education (UTAHSE) was formed by bringing together esteemed faculty educators from the six UTS health science institutions. Results: Currently, the UTAHSE has 132 voting members who were selected through a rigorous, system-wide peer review and who represent multiple professional backgrounds and all six campuses. With support from the UTS, the UTAHSE has developed and sustained an annual Innovations in Health Science Education conference, a small grants program and an Innovations in Health Science Education Award, among other UTS health science educational activities. The UTAHSE represents one university system's innovative approach to enhancing its educational mission through multi- and interdisciplinary as well as inter-institutional collaboration. Conclusions: The UTAHSE is presented as a model for the development of other consortia-type academies that could involve several components of a university system or coalitions of several institutions.
 
(Continued) 
(Continued) 
Patients' reactions regarding medical students observing procedures done for them, performing procedures on them and presenting in operation theatres in teaching hospitals; Kuwait, April 2011 (n0932) a 
Article
Worldwide, patients are the cornerstone of bedside teaching of medical students. In this study, the authors aimed to assess patients' acceptability toward medical students in teaching hospitals of the Faculty of Medicine of Kuwait University. Ninehundred and ninety five patients were approached in 14 teaching hospitals; 932 patients agreed to participate (refusal rate is 6.3%). A self-administered questionnaire was used to collect data. In general, higher acceptance of students by patients was found when there is no direct contact between the patient and the student (e.g., reading patients' files, presenting in outpatient clinic, observing doctors performing examination or procedures) compared to other situations (e.g., performing physical examination or procedures). Pediatrics patients showed higher acceptance of students compared to patients in other specialties, while Obstetrics/Gynecology patients showed the highest refusal of students. Gender of patients (especially females) and students appeared to affect the degree of acceptance of medical students by patients. Majority of the patients (436; 46.8%) believed that the presence of medical students in hospitals improves the quality of health care. Patients are an important factor of bedside teaching. Clinical tutors must take advantage of patients who accept medical students. Clinical tutors and medical students should master essential communication skills to convince patients in accepting students, thus improving bedside teaching. Also, using simulation and standardization should be considered to address scenarios that most patients are unwilling to allow students to participate.
 
Fictional Clinical Vignette. 
Frequency of Scores Pre and Post-tutorial 
Correctly completed death certificate. 
Article
Death certificates are an invaluable source of statistical and medical information, as well as important legal documents. However, few physicians receive formal training on how to accurately complete them. To determine if a simple intervention can improve the accuracy of death certificate completion by medical students. Participants included all third year medical students undergoing their core Internal Medicine rotation at Mercer University School of Medicine at the Medical Center of Central Georgia. Participation was voluntary and participants completed an approved informed consent. Students were presented a tutorial from the National Association of Medical Examiners website. They were asked to complete a death certificate both before and after the tutorial along with subjective questionnaires. The primary outcome measurement was the difference in scores pre- and post-tutorial. The mean score before the tutorial was 11.75 (+/-3.20) and the mean score post-tutorial was 18.85 (+/-2.56), indicating an increase in scores. The mean difference in pre- and post-tutorial scores was significant (t = 20.39, p < 0.0001). We found that using a tutorial to teach students how to correctly complete a death certificate was effective.
 
The architectural plan of the classroom.
The students’ preferred seating positions and mean seating positions in the X (a) and Y (b) orientations.
Distribution of the students based on their final exam scores and either their mean seating positions (a) or the standard deviations of their seating positions (b) in the Y orientation.
Distribution of the students based on their number of absences and either their mean seating positions in the Y orientation (a) or their final exam scores (b).
Article
The seat selection and classroom dynamics may have mutual influence on the student performance and participation in both assigned and random seating arrangement. The aim of the study was to understand the influence of seat selection on educational achievement. The seating positions of the medical students were recorded on an architectural plan during each class session and the means and standard deviations of the students' locations were calculated in X and Y orientations. The locations of the students in the class were analyzed based on three architectural classifications: interactional zone, distance from the board, and access to the aisles. Final exam scores were used to measure the students' educational achievement. Our results demonstrate that there is a statistically significant relationship between the student's locations in the class and their attendance and educational achievements. two factors may effect on educational achievement: student seating in the high interactional zone and minimal changes in seating location. Seating in the high interaction zone was directly associated with higher performance and inversely correlated with the percentage of absences. This observation is consistent with the view that students in the front of the classroom are likely more motivated and interact with the lecturer more than their classmates.
 
Article
The Dreyfus model describes how individuals progress through various levels in their acquisition of skills and subsumes ideas with regard to how individuals learn. Such a model is being accepted almost without debate from physicians to explain the 'acquisition' of clinical skills. This paper reviews such a model, discusses several controversial points, clarifies what kind of knowledge the model is about, and examines its coherence in terms of problem-solving skills. Dreyfus' main idea that intuition is a major aspect of expertise is also discussed in some detail. Relevant scientific evidence from cognitive science, psychology, and neuroscience is reviewed to accomplish these aims. Although the Dreyfus model may partially explain the 'acquisition' of some skills, it is debatable if it can explain the acquisition of clinical skills. The complex nature of clinical problem-solving skills and the rich interplay between the implicit and explicit forms of knowledge must be taken into consideration when we want to explain 'acquisition' of clinical skills. The idea that experts work from intuition, not from reason, should be evaluated carefully.
 
Article
A computer-based learning experience was developed using cognitive flexibility theory to overcome the pitfalls often encountered in existing medical education. An earlier study (not published) showed significant pretest-posttest increase in scores, as well as a significant positive correlation between choosing to complete the module individually or in pairs. This experience was presented as part of a second-year course in medical school with randomized assignment for students to complete the program as pairs or individuals. Sixty-six scores of 101 medical students (31 from students working as singles and 35 from 70 working in pairs) were analyzed. Out of 47 possible points, the mean pretest score was 15.1 (SD = 6.4, range 13.7-15.9). The mean posttest score was 22.9 (SD = 5.2, range 21.1-24.2). Posttest scores were statistically significantly higher than pretest scores (p<.001, Cohen's d = 1.17, average gain 7.8 points). Both pairs and singles showed pre-to-post test score gains, but the score gains of pairs and singles were not significantly different. This learning module served as an effective instructional intervention. However, the effect of collaboration, measured by score gains for pairs, was not significantly different from score gains of students completing the assignment individually.
 
‘Learning curve’ for medical student ETI.
Results of multivariable mixed-effects model: odds ratio for cumulative ETI encounter reflects odds of success for each additional ETI patient encounter
Article
During the course of their training, medical students may receive introductory experience with advanced resuscitation skills. Endotracheal intubation (ETI--the insertion of a breathing tube into the trachea) is an example of an important advanced resuscitation intervention. Only limited data characterize clinical ETI skill acquisition by medical students. We sought to characterize medical student acquisition of ETI procedural skill. The study included third-year medical students participating in a required anesthesiology clerkship. Students performed ETI on operating room patients under the supervision of attending anesthesiologists. Students reported clinical details of each ETI effort, including patient age, sex, Mallampati score, number of direct laryngoscopies and ETI success. Using mixed-effects regression, we characterized the adjusted association between ETI success and cumulative ETI experience. ETI was attempted by 178 students on 1,646 patients (range 1-23 patients per student; median 9 patients per student, IQR 6-12). Overall ETI success was 75.0% (95% CI 72.9-77.1%). Adjusted for patient age, sex, Mallampati score and number of laryngoscopies, the odds of ETI success improved with cumulative ETI encounters (odds ratio 1.09 per additional ETI encounter; 95% CI 1.04-1.14). Students required at least 17 ETI encounters to achieve 90% predicted ETI success. In this series medical student ETI proficiency was associated with cumulative clinical procedural experience. Clinical experience may provide a viable strategy for fostering medical student procedural skills.
 
Article
Healthcare in the United States (US) is burdened with enormous healthcare disparities associated with a variety of factors including insurance status, income, and race. Highly vulnerable populations, classified as those with complex medical problems and/or social needs, are one of the fastest growing segments within the US. Over a decade ago, the US Surgeon General publically challenged the nation to realize the importance of oral health and its relationship to general health and well-being, yet oral health disparities continue to plague the US healthcare system. Interprofessional education and teamwork has been demonstrated to improve patient outcomes and provide benefits to participating health professionals. We propose the implementation of interprofessional education and teamwork as a solution to meet the increasing oral and systemic healthcare demands of highly vulnerable US populations.
 
Article
Background The U.S. Supreme Court has recently heard another affirmative action case, and similar programs to promote equitable representation in higher education are being debated and enacted around the world. Understanding the empirical and quantitative research conducted over the last 50 years is important in designing effective and fair initiatives related to affirmative action in medical education. Unfortunately, the quantitative measurement research relevant to affirmative action is poorly documented in the scholarly journals that serve medical education. Methods This research organizes and documents the measurement literature relevant to enacting affirmative action within the medical school environment, and should be valuable for informing future actions. It provides summaries of those areas where the research evidence is strong and highlights areas where more research evidence is needed. To structure the presentation, 10 topic areas are identified in the form of research questions. Results Measurement evidence related to these questions is reviewed and summarized to provide evidence-based answers. Conclusions These answers should provide a useful foundation for making important decisions regarding the use of racial diversity initiatives in medical education.
 
Article
Among all of the industrialized countries, the United States has the highest infant mortality rate. Racial and ethnic disparities continue to plague the United States with a disproportionally high rate of infant death. Furthermore, racial disparities among infant and neonatal mortality rates remain a chronic health problem in the United States. These risks are based on the geographical variations in mortality and disparities among differences in maternal risk characteristics, low birth weights, and lack of access to health care.
 
Number of words (±standard error) written by current medical student interviewers (CMSI) and faculty interviewers (FI) in Overall evaluation, Interests, Communication skills, Personality, and Motivation sections of the medical school admissions interview evaluation form. **Statistically significant difference. Overall p<0.001, Interests p<0.001, Communication skills p<0.001, Personality p<0.001, Motivation p=0.002.
Number of examples (±standard error) written by current medical student interviewers (CMSI) and faculty interviewers (FI) in the Interests, Communication skills, Personality, Medical experiences, and Motivation sections of the medical school admissions interview evaluation form. **Statistically significant difference. Communication skills p=0.007, Motivation p=0.002. Other comparisons are not significant.
Article
There is evidence that the addition of current medical student interviewers (CMSI) to faculty interviewers (FI) is valuable to the medical school admissions process. This study provides objective data about the contribution of CMSI to the admissions process. Thirty-six applicants to a 4-year medical school program were interviewed by both CMSI and FI, and the evaluations completed by the two groups of interviewers were compared. Both FI and CMSI assessed each applicant's motivation, medical experiences, personality, communication skills, and interests outside of the medical field, and provided a numerical score for each applicant on an evaluation form. Both objective and subjective data were then extracted from the evaluation forms, and paired t-test and rank order tests were used for statistical analysis. When compared with FI, CMSI wrote two to three times more words on the applicants' motivation, personality, communication skills, interests, and overall evaluation sections (p<0.001) and provided about 60% more examples on the motivation section (p=0.0011) and communication skills section (p=0.0035). In contrast, FI and CMSI provided similar numbers of negative examples in these and in the personality section and equivalent overall numerical evaluation scores. These results indicate that when compared with FI, CMSI give equivalent overall evaluation scores to medical school candidates but provide additional potentially useful information particularly in the areas of motivation and communication skills to committees assigned the task of selecting students to be admitted to medical school.
 
Importance of procedural skills assessment by program directors’ responses. The values reflect responses to the survey question ‘In your opinion, how important is it for each of the following skills to be assessed?’ Values reflect the sum of responses to ‘important’ and ‘extremely important’. The skills are sorted in the descending order of importance rated by all program directors ( n 0 293). 
Type of assessment for procedural skills by program directors responses. The values reflect responses to the survey question ‘In your opinion, please mark whether the assessments should be summative (e.g., used for advancement purposes), formative (e.g., used for feedback and teaching purposes), both or neither.’ Procedural skills are presented in the descending order of responses to ‘Summative Assessment’ (%) by program directors ( n 0 293). 
Importance of advanced communication skills assessment by program directors’ responses. The values reflect responses to the survey question ‘In your opinion, how important is it for each of the following skills to be assessed?’ Values reflect the sum of responses to ‘important’ and ‘extremely important.’ The skills are sorted in the descending order of importance rated by all program directors ( n 0 284). 
Type of assessment for advanced communication skills by program directors’ responses. The values reflect responses to the survey question ‘In your opinion, please mark whether the assessments should be summative (e.g., used for advancement purposes), formative (e.g., used for feedback and teaching purposes), both or neither.’ Advanced communication skills are presented in the descending order of responses to ‘Summative Assessment’ (%) by program directors ( n 0 284). 
Article
High stakes medical licensing programs are planning to augment and adapt current examinations to be relevant for a two-decision point model for licensure: entry into supervised practice and entry into unsupervised practice. Therefore, identifying which skills should be assessed at each decision point is critical for informing examination development, and gathering input from residency program directors is important. Using data from previously developed surveys and expert panels, a web-delivered survey was distributed to 3,443 residency program directors. For each of the 28 procedural and 18 advanced communication skills, program directors were asked which clinical skills should be assessed, by whom, when, and how. Descriptive statistics were collected, and Intraclass Correlations (ICC) were conducted to determine consistency across different specialties. Among 347 respondents, program directors reported that all advanced communication and some procedural tasks are important to assess. The following procedures were considered 'important' or 'extremely important' to assess: sterile technique (93.8%), advanced cardiovascular life support (ACLS) (91.1%), basic life support (BLS) (90.0%), interpretation of electrocardiogram (89.4%) and blood gas (88.7%). Program directors reported that most clinical skills should be assessed at the end of the first year of residency (or later) and not before graduation from medical school. A minority were considered important to assess prior to the start of residency training: demonstration of respectfulness (64%), sterile technique (67.2%), BLS (68.9%), ACLS (65.9%) and phlebotomy (63.5%). Results from this study support that assessing procedural skills such as cardiac resuscitation, sterile technique, and phlebotomy would be amenable to assessment at the end of medical school, but most procedural and advanced communications skills would be amenable to assessment at the end of the first year of residency training or later. Gathering data from residency program directors provides support for developing new assessment tools in high-stakes licensing examinations.
 
US medical school revenue by source ($ million/%) 
Article
This paper presents a narrative summary of an increasingly important trend in medical education by addressing the merits of community-based distributive medical education (CBDME). This is a relatively new and compelling model for teaching and training physicians in a manner that may better meet societal needs and expectations. Issues and trends regarding the growing shortage and imbalanced distribution of physicians in the USA are addressed, including the role of international medical graduates. A historical overview of costs and funding sources for medical education is presented, as well as initiatives to increase the training and placement of physicians cost-effectively through new and expanded medical schools, two- and four-year regional or branch campuses and CBDME. Our research confirms that although medical schools have responded to Association of American Medical Colleges calls for higher student enrollment and societal concerns about the distribution and placement of physicians, significant opportunities for improvement remain. Finally, the authors recommend further research be conducted to guide policy on incentives for physicians to locate in underserved communities, and determine the cost-effectiveness of the CBDME model in both the near and long terms.
 
Diagramatic flow of 5 career advising discussion topics.
The ecology of medical care.
Article
Background There are unique challenges to recruiting students into the specialty of family medicine within academic medical centers. Methods At Virginia Commonwealth University, we developed an advising framework to help students address institutional and personal obstacles to choosing family medicine as a career. Results The role of a faculty advisor is not to direct the student to a career choice but rather to foster a mentor relationship and help the student come to his or her own realizations regarding career choice. The faculty advisor/medical student interview is conceptualized as five discussion topics: self-knowledge, perception, organizational voice, cognitive dissonance, and anticipatory counseling. Conclusion This framework is intended to assist faculty in their efforts to encourage students to consider a career in family medicine.
 
Topics discussed between advisors and students, by class 
Ratings of overall satisfaction with advisor, and times met with advisor, by class 
Article
Purpose First-year students negotiate new professional culture with a certain amount of excitement and anxiety. There are different approaches for offering guidance. In this study, the authors present Weill Cornell Medical College's experience with an advising program for first- and second-year students. Methods Fifty faculty advisors were each assigned 1–3 first-year students who they would follow for 2 years. The responsibilities were outlined to both faculty and students. The program was evaluated using an anonymous questionnaire. Results For the two classes surveyed (2011 and 2012), most students met their advisors once. For both classes, the most frequently discussed issues were general adjustment to medical school, academic life, and the professional life of the advisor. Summer research and career opportunities were also discussed. Most students were satisfied with the advising program. Satisfaction increased with an increase in visits. Most students who did not meet their advisors established an advisor relationship on their own. Conclusions An advising program was established at Weill Cornell Medical College that satisfied most of the students. It is important to evaluate its format regularly, from both student and advisor perspectives, in order to ensure its continued success.
 
Future specialty choices of medical students in Kuwait University, academic year 2011/2012. 
Article
Background Choosing a medical specialty can be either a daunting and confusing experience for some medical students and junior doctors or a foregone conclusion to others. The aim of this study is to evaluate factors affecting future specialty choice among medical students in Kuwait University. Methods A self-administered questionnaire was used to collect data from medical students registered in Kuwait University during the academic year 2011/2012. Chi-square test and logistic regression were used to test the association between deciding a future specialty and students’ sociodemographic and academic factors. Results Of the 422 students approached, 387 (91.7%) decided to participate. A total of 144 (37.2%) students made a decision regarding their choice of future medical specialty. Pediatrics, general surgery, and cardiology were the most desired specialties – 18 (12.5%), 17 (11.8%), and 16 (11.1%) students requested these specialties, respectively. Only 61 (42.4%) of those who selected a future specialty received advice regarding their choice. Looking for a good treatment outcome for patients (66; 45.8%) and a challenging specialty (58; 40.3%) were the most influencing incentives when selecting a future specialty. Students in the clinical phase of their study were 3.014 (95% CI: 1.498–6.065) more likely to report on their decision regarding a future specialty compared to students in the basic medical sciences phase (p=0.002). Conclusion A variety of factors appeared to inspire medical students in Kuwait to choose a future medical specialty. When identified, these factors can be used by mentors of medical students and directors of residency training programs to motivate students to choose specialties that are limited in Kuwait.
 
Summary of guidelines proposed by Wiener and Rivera (17).
Summary of guidelines proposed by Wiener and Rivera (17).
Article
Despite the prevalence of medical interpreting in the clinical environment, few medical professionals receive training in best practices when using an interpreter. We designed and implemented an educational workshop on using interpreters as part of the cultural competency curriculum for second year medical students (MSIIs) at David Geffen School of Medicine at UCLA. The purpose of this study is two-fold: first, to evaluate the effectiveness of the workshop and second, if deficiencies are found, to investigate whether the deficiencies affected the quality of the patient encounter when using an interpreter. A total of 152 MSIIs completed the 3-hour workshop and a 1-station objective-structured clinical examination, 8 weeks later to assess skills. Descriptive statistics and independent sample t-tests were used to assess workshop effectiveness. Based on a passing score of 70%, 39.4% of the class failed. Two skills seemed particularly problematic: assuring confidentiality (missed by 50%) and positioning the interpreter (missed by 70%). While addressing confidentiality did not have a significant impact on standardized patient satisfaction, interpreter position did. Instructing the interpreter to sit behind the patient helps sustain eye contact between clinician and patient, while assuring confidentiality is a tenet of quality clinical encounters. Teaching students and faculty to emphasize both is warranted to improve cross-language clinical encounters.
 
Article
Changing undergraduate medical curricula to put more emphasis on teaching medical aspects of sports and exercise has been recommended for some years. This is partly because increasing evidence suggests an important role for physical activity and exercise in health promotion, and also because of the increasing number of sports-related injuries and diseases in which both general practitioners and other specialist physicians may be involved. In addition, students who have been exposed to sports and exercise medicine (SEM) education have the opportunity to direct their own learning goals and focus on their areas of interest in SEM. A study in Britain reported that the majority of general practitioners were inadequately trained to practise SEM and a majority of them would be interested in more training in this area. (Published: 15 February 2011) Citation: Medical Education Online 2011, 16 : 5962 - DOI: 10.3402/meo.v16i0.5962
 
FA and BLS curriculum timeline. 
Study flow-chart. 
First aid and basic life support test results; group scores. A) Boxplot of scores on first aid. Dotted lines represent minimum score to pass of 10 and maximum achievable score of 30. B) Boxplot of scores on basic life support. Dotted lines represent minimum score to pass of Á 1 and maximum achievable score of 10. 
Article
Background Undergraduate medical students follow a compulsory first aid (FA) and basic life support (BLS) course. Retention of BLS seems poor and only little information is provided on the retention of FA skills. This study aims at evaluating 1- and 2-year retention of FA and BLS training in undergraduate medical students. Methods One hundred and twenty students were randomly selected from first year (n=349) medical students who successfully followed a compulsory FA and BLS course. From these 120 students, 94 (78%) and 69 (58%) participated in retention tests of FA and BLS skills after 1 and 2 years, respectively. The assessment consisted of two FA stations and one BLS station. Results After 1 year, only 2% passed both FA and BLS stations and 68% failed both FA and BLS stations. After 2 years, 5% passed and 50% failed both FA and BLS stations. Despite the high failure rate at the stations, 90% adequately checked vital signs and started cardiopulmonary resuscitation appropriately. Conclusions The long-term retention of FA and BLS skills after a compulsory course in the first year is poor. Adequate check of vital signs and commencing cardiopulmonary resuscitation retained longer.
 
Flow of participants and study design.
Pre-tutorial and post-tutorial examination scores for the paper-based and the computer-assisted learning groups.
Post-tutorial examination scores for both paper-based and computer-based groups.
Article
To evaluate whether computer-based learning (CBL) improves newly acquired knowledge and is an effective strategy for teaching prenatal ultrasound diagnostic skills to third-year medical students when compared with instruction by traditional paper-based methods (PBM). We conducted a randomized, prospective study involving volunteer junior (3(rd) year) medical students consecutively rotating through the Obstetrics and Gynecology clerkship during six months of the 2005-2006 academic year. The students were randomly assigned to permuted blocks and divided into two groups. Half of the participants received instruction in prenatal ultrasound diagnostics using an interactive CBL program; the other half received instruction using equivalent material by the traditional PBM. Outcomes were evaluated by comparing changes in pre-tutorial and post instruction examination scores. All 36 potential participants (100%) completed the study curriculum. Students were divided equally between the CBL (n = 18) and PBM (n = 18) groups. Pre-tutorial exam scores (mean+/-s.d.) were 44%+/-11.1% for the CBL group and 44%+/-10.8% for the PBL cohort, indicating no statistically significant differences (p>0.05) between the two groups. After instruction, post-tutorial exam scores (mean+/-s.d.) were increased from the pre-tutorial scores, 74%+/-11% and 67%+/-12%, for students in the CBL and the PBM groups, respectively. The improvement in post-tutorial exam scores from the pre-test scores was considered significant (p<0.05). When post-test scores for the tutorial groups were compared, the CBL subjects achieved a score that was, on average, 7 percentage points higher than their PBM counterparts, a statistically significant difference (p < 0.05). Instruction by either CBL or PBM strategies is associated with improvements in newly acquired knowledge as reflected by increased post-tutorial examination scores. Students that received CBL had significantlyhigher post-tutorial exam scores than those in the PBM group, indicating that CBL is an effective instruction strategy in this setting.
 
Mobile barcode generated using tec-it (http:// barcode.tec-it.com/). This barcode links to a web address where a PowerPoint presentation describing the technique of generating and embedding barcodes into presentations can be accessed. 
Article
The PowerPoint presentation is the primary medium for medical education. Everyone involved in medical education has experienced the sinking feeling of watching a presentation and thinking ‘This is important information! I really could use a copy.’ We describe a novel mobile device strategy which allows the dissemination of PowerPoint presentations at the time of delivery. (Published: 21 December 2011) Citation: Medical Education Online 2011, 16 : 11743 - DOI: 10.3402/meo.v16i0.11743
 
Post-test median scores by type of instruction.
Median post-test scores with interquartile range and range of values for students who participated in the simulation session (with or without lecture or small group case-based sessions), students in the traditional curriculum (in lecture or small group case-based sessions only), and students who did not attend any sessions.
Article
Introduction Simulation-based medical education (SBME) is increasingly being utilized for teaching clinical skills in undergraduate medical education. Studies have evaluated the impact of adding SBME to third- and fourth-year curriculum; however, very little research has assessed its efficacy for teaching clinical skills in pre-clerkship coursework. To measure the impact of a simulation exercise during a pre-clinical curriculum, a simulation session was added to a pre-clerkship course at our medical school where the clinical approach to altered mental status (AMS) is traditionally taught using a lecture and an interactive case-based session in a small group format. The objective was to measure simulation's impact on students’ knowledge acquisition, comfort, and perceived competence with regards to the AMS patient. Methods AMS simulation exercises were added to the lecture and small group case sessions in June 2010 and 2011. Simulation sessions consisted of two clinical cases using a high-fidelity full-body simulator followed by a faculty debriefing after each case. Student participation in a simulation session was voluntary. Students who did and did not participate in a simulation session completed a post-test to assess knowledge and a survey to understand comfort and perceived competence in their approach to AMS. Results A total of 154 students completed the post-test and survey and 65 (42%) attended a simulation session. Post-test scores were higher in students who attended a simulation session compared to those who did not (p<0.001). Students who participated in a simulation session were more comfortable in their overall approach to treating AMS patients (p=0.05). They were also more likely to state that they could articulate a differential diagnosis (p=0.03), know what initial diagnostic tests are needed (p=0.01), and understand what interventions are useful in the first few minutes (p=0.003). Students who participated in a simulation session were more likely to find the overall AMS curriculum useful (p<0.001). Conclusion Students who participated in a simulation exercise performed better on a knowledge-based test and reported increased comfort and perceived competence in their clinical approach to AMS. SBME shows significant promise for teaching clinical skills to medical students during pre-clinical curriculum.
 
Article
Background In India, cardiothoracic (CT) surgery training follows a 3+3-year model, where 3 years of general surgery residency with certification (MS/DNB) is required for entering 3 years of thoracic surgery residency (MCh/DNB). There are two certifying boards at the national level. One being the Medical Council of India (MCI), which oversees the major accreditation process involving the undergraduate and postgraduate medical education in India, and the other being the National Board of Examinations (NBE), which was formed for the purpose of establishing a uniform standard of postgraduate medical education. Recently, the latter body has come up with an alternative model for thoracic surgery residency in India. This model includes an integrated 6-year residency, with lesser emphasis on general surgical skills and greater exposure to CT surgery. Conclusions Changes to the current model of training for CT surgery is the need of the hour and should be initiated very soon by the MCI to meet the future demand for CT surgeons in India. An integrated training program is essential to create a new generation of cardiovascular specialists. Future directions to achieve this goal must include modifications to the undergraduate programs so as to infuse interest for CT surgery in the young minds of medical students.
 
Focus Group Participants by Year and Gender University of California, Irvine School of Medicine
Question Route for CAM Focus Groups University of California, Irvine School of Medicine
Theoretical Model Generated by Focus Group Findings University of California, Irvine, School of Medicine
Article
Background: Student views of new curricula can shape training outcomes. This qualitative study elicited student opinions of CAM instruction to examine and distill best strategies. Methods: 49 second, third and fourth year students participated in focus groups using a predefined question route. Interviews were audio taped and transcribed. Results: Students successfully differentiated CAM curricula from other academic content and were supportive of a longitudinal integrated approach. They had positive disposition toward CAM use for themselves but this did not necessarily translate into patient recommendations. They agreed that goals of the CAM curriculum should center on awareness of patient use and evidence and information relevant to clinical practice. They advocated a case-based, hands-on, experiential strategy vs lectures. Students proposed greater institutional commitment to strengthen curricular effectiveness. The majority did not intend to practice CAM modalities but valued skills to assess them. Patient-centeredness was recognized. As training progressed, students exhibited a growing tendency to evaluate CAM efficacy, and therefore value, exclusively according to evidence. Conclusions: In-depth student input allowed examination of the effectiveness of a CAM curriculum, permitting improvement and assessment of program effectiveness.
 
Example of a survey question.
Article
Although medical programmes are often thoroughly evaluated, these evaluations more seldom include workplace points of view. The present study focuses on how well a Swedish medical programme was judged to prepare students for work as a physician. Thirty-two competences in physicians' work were identified through interviews. A subsequent questionnaire was completed by 123 programme alumni who had worked for 1-2(1/2) years in different parts of the country. Alumni were asked to rate the importance of each competence, their self-assessed competence as well as how these competences were addressed during their medical training. The subsequent analysis identified areas where their training programme, according to the alumni, failed to prepare them satisfactorily. Problem areas included competences in clinical skills, handling stressful situations and in applied rather than foundational knowledge about common symptoms and diseases. Despite extensive practical training, medical education still faces some problems in the transition from education to work.
 
Article
Background: The dying patient is a reality of medicine. Medical students, however, feel unprepared to effectively manage the complex end-of-life (EOL) management issues of the dying patient and want increased experiential learning in Palliative Care. Aims: To address the need for more formal curriculum in EOL care, we developed and implemented an online virtual patient (VP) clinical case in Palliative Care into the 2010-2011 Year Three Family Medicine Clerkship rotation curriculum. Methods: A mixed-method design was used to measure the change in knowledge and perceived preparedness level in EOL care before and after completing the online VP case. A survey collected qualitative descriptions of the students' educational experience of using this case. Results: Ninety five percent (130/137) of the students voluntarily consented to have their results analyzed. The group knowledge score (n=127) increased significantly from a pre-course average of 7.69/16±2.27, to a post-course average of 10.02/16±2.39 (p<0.001). The students' self-assessed comfort level increased significantly with all aspects of EOL management from pre-course to post-course (p<0.001). Nearly, 91.1% of the students rated the VP realism as 'Good to Excellent', 86% rated the case as educationally beneficial. Nearly 59.3% of students felt emotionally engaged with the VP. Qualitative feedback found that the case content was very useful and realistic, but that the interface was sometimes awkward to navigate. Conclusions: The online VP case in Palliative Care is a useful teaching tool that may help to address the need for increased formal Palliative Care experience in medical school training programs.
 
Predictive graphic nomogram for the probability of passing the American Board of Internal Medicine (ABIM) exam.
Baseline graduates characteristics
Screenshot of nomogram Web site. 
Article
Background: Although the American Board of Internal Medicine (ABIM) certification is valued as a reflection of physicians' experience, education, and expertise, limited methods exist to predict performance in the examination. Purpose: The objective of this study was to develop and validate a predictive tool based on variables common to all residency programs, regarding the probability of an internal medicine graduate passing the ABIM certification examination. Methods: The development cohort was obtained from the files of the Cleveland Clinic internal medicine residents who began training between 2004 and 2008. A multivariable logistic regression model was built to predict the ABIM passing rate. The model was represented as a nomogram, which was internally validated with bootstrap resamples. The external validation was done retrospectively on a cohort of residents who graduated from two other independent internal medicine residency programs between 2007 and 2011. Results: Of the 194 Cleveland Clinic graduates used for the nomogram development, 175 (90.2%) successfully passed the ABIM certification examination. The final nomogram included four predictors: In-Training Examination (ITE) scores in postgraduate year (PGY) 1, 2, and 3, and the number of months of overnight calls in the last 6 months of residency. The nomogram achieved a concordance index (CI) of 0.98 after correcting for over-fitting bias and allowed for the determination of an estimated probability of passing the ABIM exam. Of the 126 graduates from two other residency programs used for external validation, 116 (92.1%) passed the ABIM examination. The nomogram CI in the external validation cohort was 0.94, suggesting outstanding discrimination. Conclusions: A simple user-friendly predictive tool, based on readily available data, was developed to predict the probability of passing the ABIM exam for internal medicine residents. This may guide program directors' decision-making related to program curriculum and advice given to individual residents regarding board preparation.
 
Summary of Data Collection Methodology 
Demographic Characteristics of Pediatrics Residents Participating in ''eBoard Review'' (N 090) 
Correlations of ABP Standard Board Scores with Board Style Questions (N 071) 
Article
To investigate the impact of a weekly email based board review course on individual resident performance on the American Board of Pediatrics (ABP) General Pediatrics Certifying Examination for pediatric residents and, specifically, residents with low ABP In-training Examination (ITE) scores. Weekly board-type questions were emailed to all pediatric residents from 2004-2007. Responses to board-type questions were tracked, recorded, and correlated with ITE scores and ABP General Pediatrics Certifying Examination Scores. With regard to total number of questions answered, only total number of questions answered correctly had a significant positive correlation with standard board scores (n = 71, r = 0.24, p = 0.047). For "at risk" residents with ITE scores <or= 200 (n = 21), number of questions answered in PL 3 year (r = 0.51, p = 0.018) and number of questions answered correctly for all PL years (r = 0.59, p = 0.005) had significant positive correlations with standard board scores. Participating regularly in the email-based board review course, answering board style questions, and answering correctly to board style questions were associated with higher standard board scores. This benefit existed for all but was especially prominent among those with poor in-training examination scores.
 
Article
Ultrasound (USS) or ultrasonic imaging is now a mature technology having a well-established place in clinical practice and accounting for about one in four of all imaging procedures worldwide (1). More recently, USS has become the latest noninvasive method of morphological study to aid or supplement the teaching of gross human anatomy in some medical school curricula (26). Indeed, an expanding use of the technology whether correct or incorrect, or by the trained or untrained has caused the field of radiology to relax its hold on USS (7). (Published: 7 June 2013) Citation: Med Educ Online 2013, 18 : 20888 - http://dx.doi.org/10.3402/meo.v18i0.20888
 
Article
The present study was undertaken to identify the perceptions of students about their educational environment in a newly restructured curriculum. The Turkish version of the DREEM questionnaire (total score: 200) was used to diagnose the strengths and weaknesses of the curriculum which is known to be a major determinant of educational environment. Five hundred fifty three students (years 1, 3, 5) voluntarily replied to the questionnaire. The mean DREEM score was found to be 117.63 (58.8%). The mean scores for the whole DREEM questionnaire and the five essential domains were found to be significantly different in different phases of medical education. The scores were found to be highest (123.65) for year 3 students and lowest (109.39) for year 5 students. The results are the first data of a curriculum reform obtained from the students about the educational environment and give important feedback to curriculum planners and change managers of the faculty for necessary improvement.
 
Student satisfaction as indicated on institutional self-review. Student satisfaction with the overall experiences (A); the educational program (B); and the educational guidance (C) at our institution, as assessed by the five-point Likert scale. Percentages indicate percent of all student responders.
Satisfaction with student educational support and guidance by class. The breakdown of student satisfaction with the educational guidance and support at our institution by academic year, as assessed by the five-point Likert scale. In the Class of 2008, significantly fewer students were very satisfied and significantly more were dissatisfied.
The ‘Iceberg’ of medical information. Depiction of the concept of the ‘iceberg’ of medical information in which students are provided with vast quantities of information and must determine a method for drawing a ‘water line.’ Developing the ability to draw this line is an important part of medical education, as it helps to differentiate between higher- and lower-yield information.
Results of seminar series survey. Results from the post-course survey depicting student attendance (A); overall helpfullness of the course in terms of guidance and support (B); and projected student anxiety without the course (C). Scores were assessed with a five-point Likert scale, with 74% of students responding.
Article
Standardized examinations are the key components of medical education. The USMLE Step 1 is the first of these important milestones. Success on this examination requires both content competency and efficient strategies for study and review. Students employ a wide variety of techniques in studying for this examination, with heavy reliance on personal study habits and advice from other students. Nevertheless, few medical curricula formally address these strategies. In response to student-generated critique at our institution, a five-part seminar series on process-oriented preparation was developed and implemented to address such concerns. The series focused on early guidance and preparation strategies for Step 1 and the many other important challenges in medical school. Emphasis was placed on facilitating conversation and mentorship opportunities between students. A profoundly positive experience was reported by our medical students that included a decreased anxiety level for the Step 1 examination.
 
Article
Students take three approaches to learning and studying: deep, surface and strategic, influenced by the learning environment. Following the General Medical Council's report "Tomorrow's Doctors," a deep approach was cultivated in Years 1 and 2 of a university undergraduate medical programme by introducing explicit written learning objectives constructed according to Biggs' SOLO taxonomy, problem-based learning and constructively aligned in-course assignments and examinations. The effect of these changes was measured with the Approaches to Study Skills Inventory for Students (ASSIST). Scores were highest for a deep approach and lowest for a surface approach and showed relatively little change during the degree programme, apart from a slight fall in the scores for a surface approach, particularly for students undertaking an intercalated science degree. Possible explanations include: students' approaches may be established prior to university entry; deep scores were already high at the beginning of the programme and may be difficult to increase further; the changes in learning environment may not be strong enough to alter approaches which students perceive as having been successful.
 
Article
The implicit "hidden curriculum" strongly influences medical students' perceptions of the importance of patient-centeredness. A new instrument, the Communication, Curriculum, and Culture Survey (C3), already used to assess this hard-to- access part of the curriculum in the US, has potential for use in cross-cultural comparisons. To use the C3 to perform a pilot cross-cultural comparison of the patient-centeredness of the hidden curriculum between a Saudi medical school and 9 U.S. medical schools. Senior Saudi medical students completed the C3 and a second instrument, the Patient-Provider Orientation Scale (PPOS), which measured their attitudes toward patient-centered behavior. Senior Saudi medical students. 139/256 (54%) Saudis completed the C3; 122/256(48%) completed the PPOS. Means for 2 out of 3 of the C3's domains (0-100 scale) were lower for the Saudis than those for the Americans (95% confidence intervals in parentheses): 47 (45, 50) vs. 55 (53, 58); 54 (50, 58) vs. 68 (67, 70); they overlapped in the third: 60 (57, 63) vs. 62 (60, 63). The mean Saudi PPOS score was 4.0 (3.9, 4.1); for the American medical schools, 4.8 (4.8-4.8) (1-6, least to most patient-centered). In this preliminary study the data suggest that the patient-centeredness of the hidden curriculum differs in Saudi and US medical schools in 2 out of 3 domains. Cross-cultural use of instruments such as the C3 can highlight such important differences and help educators evaluate their curriculum from an international, as well as a local perspective. Use of instruments across borders is a growing trend and an indicator of the increasing globalization of medical education.
 
Characteristics of the study population (n 053)
Rating of the value of specific educational resources (n=45).
Rating of the value of specific educational resources with respect to the trainees' acquisition of knowledge at baseline and at the end of the study period (mean values). The comparison between baseline survey and post-intervention survey was available for 45 residents.
Article
The acquisition of new knowledge is a primary goal of residency training. Retrieving and retaining influential primary and secondary medical literature can be challenging for house officers. We set out to investigate the effect of a Universal Serial Bus (USB) drive loaded with landmark scientific articles on housestaff education in a pilot study. We created a USB syllabus that contains 187 primary scientific research articles. The electronic syllabus had links to the full-text articles and was organized using an html webpage with a table of contents according to medical subspecialties. We performed a prospective cohort study of 53 house officers in the internal medicine residency program who received the USB syllabus. We evaluated the impact of the USB syllabus on resident education with surveys at the beginning and conclusion of the nine-month study period. All 50 respondents (100%) reported to have used the USB syllabus. The self-reported number of original articles read each month was higher at the end of the nine-month study period compared to baseline. Housestaff rated original articles as being a more valuable educational resource after the intervention. An electronic syllabus with landmark scientific articles placed on a USB drive was widely utilized by housestaff, increased the self-reported reading of original scientific articles and seemed to have positively influenced residents' attitude toward original medical literature.
 
Article
The Medical School at Bristol University is noted for offering, and in some instances requiring, its students to work creatively with medical themes. Students, artists, educationalists and a web designer have worked to create an on-line exhibition of the resulting creative output. This can be viewed at www.outofourheads.net. This site is a themed repository of poetry, prose, drawings, paintings, cartoons, films, music, dance and rap. Most works come with commentaries that can be as illuminating as the works they describe. The site invites comment and welcomes new postings from anyone connected to medicine. As an alternative to the conventional pedagogical report, and in keeping with the subject matter, in this paper we tell the story of this unique educational enterprise through the narratives of four of its principle architects. The 'Teacher's Tale', the 'Designer's Tale', the 'Curator's Tale' and the 'Artist's Tale' offer different, personal, tellings of how the site came to be. Each tale contains hypertext links to notable works on the site some of which have become teaching resources within the institution. This paper is of relevance to anyone who seeks to explore and champion the human insights of this privileged community.
 
Questionnaire items and sub-categories 
Breakdown of the stratified random sample 
Article
Faculty development in medical education is crucial for maintaining academic vitality. The authors conducted a needs assessment survey in Singapore to determine the educational needs and priorities of clinical faculty. This study implemented a questionnaire-based, anonymous, multi-institutional survey with stratified random sampling. Each question was anchored with two statements on a 9-point scale. Respondents were asked to determine their current knowledge and the knowledge they would need in future. The response rate was 81.9%. Overall, the participants' current knowledge was rated either "modest" (scale 4-6) or "substantial" (scale 7-9), irrespective of teaching experience. Participants reported higher knowledge in areas related to teaching and modest knowledge in educational concepts and assessment. They reported a need for higher knowledge in most areas to function well as a teacher. The need for faculty development is universal and independent of teaching experience in this group. Teaching faculty from the institutes studied understood the need for improved knowledge in pedagogical knowledge.
 
Article
Introduction: We report about the direct short-term effects of a Clinical Epidemiology and Evidence-based Medicine (CE-EBM) module on the knowledge, attitude, and behavior of students in the University Medical Center Utrecht (UMCU), Universitas Indonesia (UI), and University of Malaya (UM). Methods: We used an adapted version of a 26-item validated questionnaire, including four subscales: knowledge, attitude, behavior, and future use of evidence-based practice (EBP). The four components were compared among the students in the three medical schools before the module using one-way ANOVA. At the end of the module, we measured only knowledge and attitudes. We computed Cronbach's α to assess the reliability of the responses in our population. To assess the change in knowledge and attitudes, we used the paired t-test in the comparison of scores before and after the module. Results: In total, 526 students (224 UI, 202 UM, and 100 UMCU) completed the questionnaires. In the three medical schools, Cronbach's α for the pre-module total score and the four subscale scores always exceeded 0.62. UMCU students achieved the highest pre-module scores in all subscales compared to UI and UM with the comparison of average (SD) score as the following: knowledge 5.04 (0.4) vs. 4.73 (0.69) and 4.24 (0.74), p<0.001; attitude 4.52 (0.64) vs. 3.85 (0.68) and 3.55 (0.63), p<0.001; behavior 2.62 (0.55) vs. 2.35 (0.71) and 2.39 (0.92), p=0.016; and future use of EBP 4.32 (0.59) vs. 4.08 (0.62) and 3.7 (0.71), p<0.01. The CE-EBM module increased the knowledge of the UMCU (from average 5.04±0.4 to 5.35±0.51; p<0.001) and UM students (from average 4.24±0.74 to 4.53±0.72; p<0.001) but not UI. The post-module scores for attitude did not change in the three medical schools. Conclusion: EBP teaching had direct short-term effects on knowledge, not on attitude. Differences in pre-module scores are most likely related to differences in the system and infrastructure of both medical schools and their curriculum.
 
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Peggy S Odegard
  • University of Washington Seattle
Hongbin Wu
  • Peking University
Vernon R Curran
  • Memorial University of Newfoundland
Carole Orchard
  • The University of Western Ontario
Maisie de Wolf
  • King's College London