Medical Education Online

Published by Taylor & Francis

Online ISSN: 1087-2981


The Patient Satisfaction Questionnaire Short Form (PSQ-18) as an adaptable, reliable, and validated tool for use in various settings
  • Article
  • Full-text available

July 2013


9,180 Reads


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 -

Post-intervention PBL 2.0 student survey results.
PBL 2.0: Enhancing problem-based learning through increased student participation

June 2012


585 Reads

Daniel Wiznia


Robert Korom


Peter Marzuk




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.

Table 1 . New internal medicine fellowship programs July 2000 through June 2008 No. (%) new programs 
Figure 1. Number of university versus community internal medicine programs created before and after 2005 RRC regulation change. 
Table 2 . Number of community and university hospital programs by subspecialty in June 2007 No. (%) programs 
Sponsorship of Internal Medicine Subspecialty Fellowships Since 2000: Trends and Community Hospital Involvement

June 2009


143 Reads

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.

Table 1 . Update from key pediatric medical education articles from 2010 
Update in medical education for pediatrics: Insights and directions from the 2010 literature
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.

Table 1 . Proposed levels in modern e-learning 
Table 2 . Correct answers in pre-tests and post-tests 
Table 3 . Between-level comparisons in test result improve- ments 
Does peer learning or higher levels of e-learning improve learning abilities? A randomized controlled trial

November 2013


135 Reads

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.

Table 1 . Demographic characteristics of the focus group participants 
Table 2 . Summary of main thematic findings 
Comparative needs in child abuse education and resources: perceptions from three medical specialties

July 2010


95 Reads

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.

Fig. 1. 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.
Fig. 2. 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.
Fig. 3. 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. 
Fig. 4. 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. 
The relationship between academic performance and recreation use among first-year medical students

March 2015


2,966 Reads

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) 
A holistic review of the medical school admission process: Examining correlates of academic underperformance

April 2014


142 Reads

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.

Table 1 . Difference between professional degrees and research degrees in medical sciences
Multipath to acquire multilevel of medical degrees.
Development of a medical academic degree system in China

January 2014


1,048 Reads

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.

Improving year-end transfers of care in academic ambulatory clinics: A survey of pediatric resident physician perceptions

May 2012


36 Reads

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.

Table 1 . Basic characteristics of the study sample 1 
How does the quality of life and the underlying biochemical indicators correlate with the performance in academic examinations in a group of medical students of Sri Lanka?

January 2014


146 Reads

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

Table 1 . PISCES mission statement and core principles 
Table 2 . Sample student schedule 
Development of a longitudinal integrated clerkship at an academic medical center

April 2011


680 Reads

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.

Table 1 . 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.
A university system's approach to enhancing the educational mission of health science schools and institutions: The University of Texas Academy of Health Science Education

March 2013


92 Reads

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.

Table 5 (Continued) 
Table 6 (Continued) 
Table 6 . 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 
Are medical students accepted by patients in teaching Hospitals?

April 2012


598 Reads

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.

Figure 1. Fictional Clinical Vignette. 
Table 1 . Frequency of Scores Pre and Post-tutorial 
Figure 2. Correctly completed death certificate. 
The Effect of Student Training on Accuracy of Completion of Death Certificates

September 2009


492 Reads

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).
The effect of seating preferences of the medical students on educational achievement

May 2012


668 Reads

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.

Evidence of Knowledge Acquisition in a Cognitive Flexibility-Based Computer Learning Environment

June 2008


306 Reads

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.

The Dreyfus model of clinical problem-solving skills acquisition: a critical perspective
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.

‘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
Endotracheal intubation skill acquisition by medical students

August 2011


496 Reads

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.

A measurement perspective on affirmative action in U.S. medical education

April 2013


111 Reads

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.

Infant Mortality: A call to action overcoming health disparities in the United States

September 2013


121 Reads

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.

Health disparities among highly vulnerable populations in the United States: A call to action for medical and oral health care

March 2013


372 Reads

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.

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.
Current medical student interviewers add data to the evaluation of medical school applicants

June 2010


58 Reads

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.

Fig. 1. 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). 
Fig. 2. 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). 
Fig. 3. 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). 
Fig. 4. 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). 
Clinical skills assessment of procedural and advanced communication skills: performance expectations of residency program directors

July 2012


678 Reads

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.

Table 4 . US medical school revenue by source ($ million/%) 
Community-based distributive medical education: Advantaging Society

February 2012


479 Reads

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.

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