Teaching and Learning in Medicine

Published by Taylor & Francis (Routledge)
Online ISSN: 1532-8015
Print ISSN: 1040-1334
Publications
Despite numerous initiatives, medical educators have failed to effect a sustainable increase in the number of underrepresented minority students at medical colleges in the United States. This study reviewed the recent literature regarding the admission process to specifically examine and determine if current policies are helping facilitate the proper representation of minority students. Papers were selected on the basis of their relevance to the topic of underrepresented minority students and medical school admission policies and were limited to the years between 1987 and 1998. Each paper was individually evaluated on the basis of its study design and soundness of its contribution to the field. The articles are organized under 4 major themes: Cognitive factors (mostly Medical College Admission Test scores and grade point average), noncognitive factors (e.g., leadership ability, interpersonal skills, motivation), the admission interview, and enrichment programs. Table 1 briefly summarizes these constituent articles. It was found that the body of literature is inadequately small and heterogeneous with regard to study design and results. A concerted effort must be made across medical education to correct the deficiencies in this particular area.
 
The appropriateness of U.S. physician workforce size and the proportion of generalists versus specialists have long been debated. Difficulty collecting reliable data and varying methodologies complicate clear analysis of workforce questions. This work examines the rate at which internists subspecialized during the 1990s. It also compares two approaches for estimating subspecialization rates: (a) following resident classes longitudinally ("cohort" approach), and (b) comparing 1st year fellowship (F-1) class size to the previous year's 3rd-year resident (R-3) class size (F-1/R-3). Data were collected through the American Board of Internal Medicine's tracking program. Physicians completing their R-3 year in 1992 through 1998 were the participants. The proportion of each R-3 group that eventually entered subspecialty training was examined. Demographic data for those entering subspecialty training and those who did not were compared. Subspecialization rate estimates for the cohort and F-1/R-3 approaches were also compared. The number of internists increased, whereas the number entering subspecialty training declined. Men were more likely to enter a subspecialty than women. International medical school graduates were more likely to enter a subspecialty than U.S. medical school graduates. University-based residency program trainees were more likely to enter a subspecialty than community hospital program trainees. Those entering subspecialty training tended to be younger and score higher on the internal medicine certification examination than those who did not. Almost identical estimates where produced by the cohort and F-1/R-3 approaches. There was a downward trend in the rate at which internists entered subspecialty training during the 1990s. The two methodologies examined produced similar results.
 
As domestic violence (DV) is frequently unrecognized by physicians, efforts to improve education on the topic have been undertaken. To assess changes in medical education about DV. Incoming residents from 1995 (N = 52) and 2001 (N = 43) were surveyed regarding education and attitudes about DV. The resident-reported emphasis on DV education increased significantly from 1995 to 2001. Hours devoted to the subject experienced no significant change. The likelihood they would ask female patients about DV and their competence in dealing with DV-specific situations experienced no significant improvement-both were rated below average. Although emphasis on medical education about DV has improved from 1995 to 2001, likelihood of screening and competence at dealing with DV has not improved. The content of undergraduate medical education about DV should be strengthened, and the educational process should continue during residency training.
 
Abstracts presented at meetings may be a reflection of the meeting's quality. The goal is to determine purpose, content areas, research design, and subsequent publication rates of abstracts presented at Clerkship Directors in Internal Medicine's annual meetings. Abstracts presented in 1995-2005 were analyzed. A total of 201 abstracts were analyzed and coded. The purpose of the majority of the studies was description (155, 77%), 44 (22%) were justification studies, and 2 (1%) were clarification studies. In all, 109 (54%) assessed the relationship between teaching and student performance. Seven (4%) were studies about how students learn, study, solve problems, obtain medical knowledge, and think critically. Nineteen (10%) were studies about students' noncognitive skills, professionalism, interpersonal skills, and well-being studies. In all, 29 (14%) were measurement studies assessing reliability or validity of assessments. Twenty (10%) focused on career or faculty development pertaining to either faculty or residents. Research design of most studies was descriptive or pre-experimental (175, 87%), some were quasi-experimental (13, 7%), and two thirds (135, 66%) were not published as full articles in peer-reviewed journals. and there was an upward trend in publication rates. These findings may serve as an indicator of the quality of the educational meeting. It may further stimulate efforts to develop programs to help program attendees achieve scholarly publications for work presented and serve as a benchmark against which future meetings may be judged.
 
Background: Further dissemination of medical education work presented at national meetings is limited. Purposes: The purpose of this study was to explore dissemination outcomes of scholarly work in pediatric medical education. Methods: Council on Medical Student Education in Pediatrics (COMSEP) members who presented at COMSEP national meetings from 1998 to 2008 received a questionnaire about scholarly dissemination outcomes. Descriptive statistics and chi-square analysis explored variables related to dissemination. Qualitative analysis of free text comments explored barriers to dissemination. Results: Outcomes were determined for 81% of presentations (138/171). The dissemination rate was 67% (92/138 presentations), with 47 publications (34%). Dissemination rates did not vary by presentation type (poster vs. oral) or project type. There was no relationship between presentation type, project type, and dissemination method. Barriers included perceived inadequate time, mentorship, and methodological skills for scholarly work. Conclusions: Most projects were further disseminated. Additional resources including mentoring and protected time for scholarly work are needed by educators to optimize dissemination.
 
Outcome themes from service-learning in medical education
Phenomenon: In the United States, the Affordable Care Act has increased the need for community-centered pedagogy for medical education such as service-learning, wherein students connect academic curriculum and reflections to address a community need. Yet heterogeneity among service-learning programs suggests the need for a framework to understand variations among service-learning programs in medical education. A qualitative systematic review of literature on service-learning and medical education was conducted for the period between 1998 and 2012. A two-stage inclusion criteria process resulted in articles (n = 32) on service-learning and Doctor of Medicine or Doctor of Osteopathic Medicine being included for both coding and analysis. Focused and selective coding were employed to identify recurring themes and subthemes from the literature. The findings of the qualitative thematic analysis of service-learning variation in medical education identified a total of seven themes with subthemes. The themes identified from the analysis were (a) geographic location and setting, (b) program design, (c) funding, (d) participation, (e) program implementation, (f) assessment, and (g) student outcomes. Insights: This systematic review of literature confirmed the existence of program heterogeneity among service-learning program in medical education. However, the findings of this study provide key insights into the nature of service-learning in medical education building a framework for which to organize differences among service-learning programs. A list of recommendations for future areas of inquiry is provided to guide future research.
 
Medical societies in emergency medicine (EM) have recommended teaching EM topics in the preclinical years of medical school. However, the magnitude of integrating an EM curriculum into the 1st and 2nd year of medical school is unknown. The purpose of this survey was to determine the extent and type of exposure to EM in the 1st and 2nd years of medical schools in the United States. The deans of all allopathic and osteopathic medical schools in the country were surveyed by mail. The survey took the form of a questionnaire and had seven questions that included type of exposure, number of students, length of the exposure, learning objectives, lectures, laboratory, textbook, evaluation process and grades, departmental status, board certification, emergency department volume, and size of the medical school class. The data were analyzed with SPSS software. The survey was returned by 84 of the 125 (67.2%) medical schools in the country. The average class size was 129.0 students. As many as 63.9% of the medical schools responding provided EM exposure in the 1st year and 54.3% in the 2nd year. The 1st-year exposure most frequently used more than one type of teaching activity (47.4%), observation (12.3%), cardiopulmonary resuscitation training (15.8%), universal precautions (7.0%), and other (17.5%). None taught physical diagnosis. The various teaching activities lasted anywhere from hours (27.5%), to days (25.3%) or weeks (52.5%), with a mean of 2.25 weeks. Second-year exposure most frequently included multiple activities (49.0%), observation (16.3%), or other activities (14.3%); a few taught physical diagnosis (8.2%), cardiopulmonary resuscitation training (6.1%), or universal precautions (6.1%). These teaching activities lasted from hours (20.6%), to days (14.7%) or weeks (64.7%), with a mean of 2.44 weeks. Most U.S. medical schools provide EM exposure in the first 2 years of medical school, lasting slightly more than 2 weeks in length most frequently covering multiple topics.
 
Many studies have supported the use of standardized patients (SPs) to evaluate medical students and residents in the context of an objective structured clinical examination (OSCE). However, the psychometric impact of using students as patients and raters has been studied very little, and not at all in pharmacy. The study investigated the quantitative impact of using 1st-year pharmacy students as SPs. The psychometric properties of an OSCE for senior pharmacy students were compared when 1st-year students versus SPs were used to portray the cases. The reliability and validity of faculty and patient ratings were largely unaffected by the use of 1st-year students rather than SPs to perform the patient roles. Using 1st-year students is psychometrically feasible and may provide learning benefits to the student participants
 
of visit satisfaction, time during the visit, and perceived quality of visit for patients seen with or without a 1st/2nd-year student 
Background: Medical student education has shifted to earlier clinical experiences and increased use of ambulatory settings. Little is known about patient perceptions of having 1st- and 2nd-year medical students involved in their care. Purposes: The purpose of this article is to study patient perceptions of having 1st- and 2nd-year medical students involved in their care in an ambulatory setting. Methods: In 2011 we surveyed 314 patients seen in 2 primary care clinics who saw 1st- or 2nd-year medical students. The survey included questions regarding patient visit satisfaction and perception of overall quality of the visit, adequacy of visit time, benefit of having a student involved in their care, and willingness to see a student in clinic again. Comparisons were made for patients who saw a student and a preceptor (n = 201) and patients who saw only the preceptor (n = 113). Results: Overall visit satisfaction was very high for patients who saw students (83% very satisfied) and patients who saw only the preceptor (91% very satisfied). More than 95% of patients were satisfied with the visit time, and all patients rated the overall quality of their visit as good or excellent. Eighty-five percent of patients would want to see a student again or had no preference. Forty-three percent of patients felt the presence of a student added value to their visit. White patients were more likely than non-White patients to be very satisfied with their visit and rated the overall quality of the visit as excellent. There were no differences based on student gender or year of training. Conclusions: Our results suggest that 1st- and 2nd-year students can be successfully integrated into clinical settings while maintaining patient satisfaction and perceived value of the care they receive.
 
The residency recruitment and selection process is a critical one for residency programs and medical students. In 1999, internal medicine programs conducted the residency match on the Web for the first time using the Electronic Residency Application Service (ERAS). The authors wished to study the impact of this change on house staff recruitment and quality of match. A Web-based survey with e-mail, paper, and fax reminders was sent to all 407 internal medicine residency programs after the 1999 match. Eighty-six percent of reporting programs found the screening of applicants easier. The overall number of applicants varied greatly (48% of programs reported more applicants; 32% reported fewer). The quality of final match was rated the same as previous years by 47%, better by 38%, and worse by 15%. The transition to ERAS was successful in internal medicine. However, there are several areas that were identified that will improve the ERAS process as it evolves.
 
Residents' perceptions about evidence-based clinical decision making remain largely unexplored. To understand how residents perceive and use evidence-based medicine in clinical decision making. Qualitative study using a semistructured questionnaire and focus group in a postgraduate training program in internal medicine at an academic U.S. medical center. Seventeen 1st-year internal medicine residents in their 1st postgraduate year were interviewed. Six additional 1st-year residents formed a validation group. The interplay of time and expertise modified how physicians-in-training incorporate evidence into clinical decision making. When time was available, the residents preferred to answer their questions by searching and critically appraising the literature. This "self-acquired" expertise empowered them to help patients by using participatory decision-making styles. When time was limited, the residents turned to experts. Residents assumed that experts practiced evidence-based medicine. This "borrowed" expertise was thought to be the most efficient way of integrating evidence and clinical expertise, but it led to the use of a parental style when answers were taken back to the bedside. The practice of evidence-based medicine empowers 1st-year residents and appears to affect their choice of decision-making style. Further research is needed to better understand the link between decision-making style and evidence-based medicine.
 
Input from both basic science and clinical faculty members is needed to promote further integration of medical curricula. To assess current views of clerkship directors about the role and relationship of the basic sciences to clinical years in medical education. As part of the 2002 Annual CDIM Survey, questions regarding basic science curriculum were included; 89 of 123 CDIM members responded (72%). Overall, respondents felt participation from both basic science and clinical faculty members is necessary to define basic science course content. Nearly 89% of clerkship directors indicated curricular review should be collaborative and interdepartmental; 93% felt that this review effort should occur frequently. Supporting the growing philosophy that the structure of the preclinical years should involve increased clinically relevant integration, 58% favored an integrated organ system approach rather than the traditional departmental structure (18%). In addition, in order of ranking, respondents felt that small group (M = 2.0 +/- 0.9) and problem-based learning (M = 2.1 +/- 1.1) are better approaches than the standard lecture format (M = 2.8 +/- 1.2). Although clerkship directors recognized the need for increased clinical input in the preclinical years, many reported a lack of knowledge regarding the amount of clinical exposure students received in the basic science years (33%), frequency of peer review of the basic science courses (20%), and who performed peer review of the basic science courses at their institution (36%). Medical clerkship directors believe that basic science education should be developed collaboratively, organized by organ system, and presented in small groups.
 
The Medicare Prescription Drug Modernization and Improvement Act of 2003 (MMA) will undoubtedly influence health care delivery and affect how physicians practice medicine in the United States. To evaluate the extent to which medical students, medicine residents, and physicians are informed about key provisions of the MMA. Eighty-four attending physicians, 104 medicine residents, and 115 fourth-year medical students at the University of Pennsylvania were surveyed over a 2-week period in February-March 2004. The brief survey instrument consisted of 10 multiple choice questions: 9 questions assessing how well-informed respondents were about the MMA and 1 question assessing their knowledge of general current events. Most respondents (77.8%) either "strongly disagreed" or "disagreed" that they were adequately informed about the MMA. While more than half of all respondents correctly answered the two questions about drug importation from Canada and general current events, a majority did not provide the correct answer to each of the other questions. No significant differences appeared by training. Attending physicians, medicine residents, and medical students at the University of Pennsylvania were generally ill informed about the MMA. Physician ignorance about important health care legislation continues to be a significant problem. More effective means of educating and informing medical students and physicians at all levels of training about important health policy changes may be warranted.
 
Despite published consensus-based statements on assessment of ECG interpretation skills, studies and curricula regarding the training needed to obtain basic ECG interpretation skills are lacking. These consensus statements have focused on attaining competency in ECG interpretation during postgraduate training; however, recommendations regarding assessment of competency in the undergraduate curriculum are not discussed. The purpose is to describe the current methods of teaching and assessing ECG interpretation skills across institutions on the 3rd-year internal medicine (IM) clerkship. In 2005, the Clerkship Directors in Internal Medicine surveyed its institutional members. Twelve questions on the survey dealt with ECG interpretation. Descriptive statistics, chi-square, and Mann-Whitney U were used for analysis. Eighty-eight of 109 members (81%) responded to the survey. Overall, 89% of institutional respondents feel that ECG interpretation is an important clinical skill for medical students with 92% indicating that instruction occurs on the IM clerkship. Lectures (75%) and teaching rounds (44%) were the most cited methods of instruction. Most schools spend 1 to 6 hr during the IM clerkship on formal ECG instruction. Over 63% indicated that ECG interpretation skills are assessed during the clerkship. The most common assessment methods were written exam (40%) and OSCE (23%). Objective data regarding attainment and assessment of basic ECG interpretation competency in the undergraduate curriculum are lacking; our report provides preliminary descriptive data regarding ECG teaching and assessment on the 3rd-year IM clerkship. Further studies are needed to determine the ideal method of instruction and evaluation of this important clinical skill.
 
Despite published literature demonstrating deficiencies in chest radiograph (CXR)/basic radiology interpretation skills of 4th-year medical students, studies and subsequent curricula regarding the training needed to obtain these skills are lacking. Terms such as clinical exposure and radiology teaching have been used to describe the experience for these basic interpretive skills, but best practice methods of delivery, let alone common methods, have yet to be defined. The objective is to describe the current methods of teaching and assessing CXR/basic radiology interpretation skills across institutions on the 3rd-year internal medicine (IM) clerkship. In 2005, the Clerkship Directors in Internal Medicine (CDIM), an international organization representing U.S. and Canadian medical schools, surveyed its institutional members. Twelve questions on the survey dealt with X-ray interpretation. Eighty-eight of 109 members (81%) responded to the survey. Overall, 81% of respondents felt that CXR interpretation is an important clinical skill for medical students. Seventy-six percent indicated that instruction in these skills occurs on the IM clerkship. The most cited methods of instruction were lectures (56%) and teaching rounds (48%). Most schools spent on average of 2 to 4 hr during the IM clerkship on formal radiology instruction. Only 33% indicated that radiology interpretation skills are assessed during the clerkship. The most common assessment methods were written examination (19%) and OSCE (19%). Substantive data regarding attainment and assessment of CXR/basic radiology interpretation skills in the undergraduate curriculum are lacking. Our study provides preliminary descriptive data regarding CXR instruction and assessment on the 3rd-year IM clerkship.
 
This journal watch is sponsored by the Alliance for Clinical Education (ACE). The purpose of this article is to summarize medical education manuscripts from specialty journals that are important and relevant to educators across specialties. Specialties included in our review were cardiology, gastroenterology, general internal medicine, pulmonology, nephrology, hematology and oncology, endocrinology, rheumatology, infectious disease, and neurology. We are grateful to Teaching and Learning in Medicine and ACE for giving us the opportunity to publish this review. The Clerkship Directors in Internal Medicine Research Committee conducted this review. Included are English articles published from September 2006 through September 2007. PubMed was searched for peer-reviewed research publications reporting primary data on medical education. Medical subject heading terms included combinations of medical education, medical student, residency training, practice, undergraduate medical education, graduate medical education, internship and residency, and continuing medical education. We also reviewed the bibliographies of all articles found though our PubMed search to identify additional articles that may not have been included in PubMed's search engine. Furthermore, we discussed identified articles with content experts in each specialty to ensure that appropriate journals and articles were included from each subspecialty. The journals that we selected for review are not often read by the typical medical educator. We included articles from general and subspecialty journals of internal medicine excluding the following, which have a focus on medical education or cross-specialties: Academic Medicine, Advances in Health Science Education, Medical Education, Medical Teacher, Teaching and Learning in Medicine, Journal of the American Medical Association, and New England Journal of Medicine. Specialties included in our review were cardiology, gastroenterology, general internal medicine, pulmonology, nephrology, hematology and oncology, endocrinology, rheumatology, infectious disease, and neurology. We also reviewed the bibliographies of all articles found though our PubMed search to identify additional articles. Furthermore, we discussed identified articles with content experts in each specialty to ensure that appropriate journals and articles were included from each subspecialty. Authors rated each article based on relevance, rigor, importance, and generalizibility of findings. We also sought to include articles from each phase in the continuum of medical education: undergraduate, graduate, and continuing medical education as well as qualitative and quantitative studies. Articles were ranked by each author. We then held conference calls and had e-mail discussions to establish consensus on the articles included in this review. The following is a summary of each selected article grouped by theme.
 
Research in medical education is stymied by a variety of methodological, logistical, and institutional challenges. Multicenter collaboration may advance the current state of medical education research by increasing subject sample size, harnessing the power of collective expertise, and garnering visibility for issues of national importance. We convened the "Millennium Conference 2007: A Collaborative Approach to Educational Research" in May 2007 to consider the role of national initiatives in addressing challenges in educational research. We selected 9 medical schools through a competitive application process to participate as school teams. We led participants through structured discussions about the challenges of educational research and the opportunities offered through national collaboratives. School teams also met to refine their current local educational research initiatives. A group of committed stakeholders met to consider a national educational research agenda. The recommendations from this conference proceed from consensus reached by the participants.
 
Thirty-seven abstracts were selected for presentation at the 27th annual meeting of the Association for Surgical Education, held March 2007, in Washington, D.C. Based on common themes eight abstracts were chosen for publication under the auspices of the Alliance for Clinical Education. These abstracts have been modified to be self-contained and understandable to those who have not attended the meeting or are from non-surgical disciplines.The first two abstracts use the method of Cognitive-Task-Analysis, which translates an expert's knowledge of a procedure or skill into a basic outline of sequential steps and decision points. This outline in turn can be used to teach novices attempting to learn a skill or to provide guidance to the expert attempting to teach this skill. The first abstract used this method to teach decision making during tendon repair, while the second used the method to identify omission of relevant steps while teaching colonoscopy.The next group of abstracts explored surgical skills. The impact of a curriculum focused on error recognition did not improve acquisition of skills. The next abstract in this group examined the age-related decay of skills.Self-assessment was the focus of two abstracts. Both found a lack of correlation between faculty assessment and self-assessment of non-operative clinical skills, while in contrast there was a high correlation with respect to intra-operative skills.Use of emerging technology for enhancing education was a common theme in many of the works presented at the meeting. One technology-based abstract is presented in which the use of virtual patients was found to reduce anxiety and improve learning when teaching medical students sexual-history taking skills.The final abstract investigated the role of emotional intelligence, which has implications for individual training in the areas of interpersonal communication, and team leadership, both of which are essential to the competency of practice-based learning.
 
The 33rd Annual Meeting of the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) was held June 21 to 23, 2007, in Park City, Utah. Plenary sessions, workshops, and posters covered a wide range of educational topics, including Liaison Committee on Medical Education (LCME) issues, culture and stigma in medical education, and innovative media. Dr. Robert Eaglen, the interim secretary for the LCME, gave the keynote address: "Modern Medical Education through the LCME Lens," which highlighted clerkship directors' responsibilities in the accreditation process such as ensuring comparability and uniform criteria for student clinical experiences, equivalent cross-site evaluations, preparing residents for their instructional roles and providing timely mid- and final clerkship feedback. Dr. Ruth Lamdan, chair of the ADMSEP Task Force on LCME ED-2, presented "Results of ED-2 Adherence in 10 Medical Schools" and discussed the challenges of uniformity in data collection and remediation strategies for core topics. The group found that uniformity in collection efforts was limited because of different patient encounter documentation systems utilized and that remediation strategies vary greatly for students who had not encountered specified diagnoses, from case discussions and videos to team-based learning experiences to arranging an exposure at an additional clinical site. Hendry Ton, from University of California, Davis, presented a developmental approach to Cultural Competence, sharing strategies for addressing resistance to acknowledging bias and the impact of culture on health care in medical education. The six abstracts in these proceedings include a range of topics, such as mindfulness training, application of virtual technologies, preparing for the National Board of Medical Examiners subject exam, palliative care, and how students judge their communication skills in Objective Structured Clinical Examinations. These abstracts, representative of ADMSEP educational research, were chosen for their general interest to medical student educators.
 
Background: A specialties' lifestyle is known to be important for specialty selection, but how medical students define this concept is unknown. Purpose: The aim of this article is to determine how 4th-year medical students perceive lifestyle of specialties. Methods: All 4th-year U.S. medical students graduating in 2009 with a military service obligation were invited to participate in an electronic survey. Responses to an open-ended question, "When someone says 'That specialty has a good lifestyle,' what does that mean to you?" were classified into themes by a consensus of the authors and then compared to the students' selected specialty. Results: Response rate for the questionnaire was 46% (369 of 797). Four themes describing lifestyle emerged: "schedule control" (67% of students), "off time" (53%), "financial aspects" (48%), and "work life" (26%). Conclusions: Medical students' definition of a "good lifestyle" includes four themes, which should be used in future research of the lifestyle factor of specialty selection.
 
The Society of Teachers of Family Medicine (STFM; http://www.stfm.org) is a community of professionals devoted to teaching family medicine through undergraduate, graduate, and continuing medical education. This multidisciplinary group of physicians, educators, behavioral scientists, and researchers works to further STFM's mission of improving the health of all people through education, research, patient care, and advocacy. STFM holds an annual conference each spring and a predoctoral education conference each winter. STFM held its 34th Predoctoral Education Conference in Portland, Oregon, from January 24 to 27, 2008. The theme was "Igniting Students' Passion for Serving the Underserved." Christine Stabler, MD, Lancaster General Hospital, Lancaster, Pennsylvania, opened the conference with a plenary presentation on the passion for patient care, medical education, and advocacy that have defined her own career and continue to inspire medical trainees. Kenneth Ginsburg, MD, The Children's Hospital of Philadelphia and the University of Pennsylvania, continued the theme of igniting students' passion by exploring the ways in which socialization in medical education can teach students to suppress their feelings and humorously illustrated how accessing a full range of emotions can lead to satisfying lives and practices. Tanya Page, MD, a recent residency graduate practicing in a homeless clinic in Portland, Oregon, described her own passion for caring for the underserved. Participants shared ideas and learned new skills in more than 65 workshops, seminars, and discussions as well as 65 educational research and curriculum evaluation papers. The unifying theme was incorporating care of the underserved in medical education. From the educational research or curriculum evaluation papers presented at the conference, the STFM Education Committee selected 8 papers felt to be of interest to readers of Teaching and Learning in Medicine.
 
The 2003 Institute of Medicine's report "Health Professions Education: A Bridge to Quality" argued for the education of health professionals in patient safety. In response to this call, a number of organizations and institutions have developed frameworks and curricula that provide the educational foundation essential for learning about patient safety. However, there is limited guidance on strategies for implementation of training programs in patient safety. We convened the "Millennium Conference 2009: Patient Safety--Implications for Teaching in the 21st Century" to develop concrete approaches to teach patient safety in undergraduate and graduate medical education. We selected 9 medical schools through a competitive application process to participate as school teams. We led attendees through structured discussions on three topics: (a) promoting a culture of patient safety, (b) implementing patient safety content into preexisting curricula, and (c) providing faculty development. School teams also met to refine their current local initiatives in patient safety teaching. A group of committed stakeholders gathered to collectively consider strategies for the integration of patient safety education into undergraduate and graduate medical education. The recommendations from this conference proceed from consensus reached by the participants.
 
This Journal Watch is sponsored by the Alliance for Clinical Education (ACE) and is the first annual review of medical education articles on behalf of the Association of Professors of Gynecology and Obstetrics (APGO). The purpose of this series of articles is to identify and summarize medical education articles from subspecialty literature for educators from other specialty areas who do not routinely read these journals. The authors are representatives of the Undergraduate Medical Education Committee for APGO. Articles published during the years 2010 and 2011 are included. The PubMed database was searched using the subject terms medical education, undergraduate medical education, medical school, assessment, resident education, and teaching and then combined with the term obstetrics or gynecology. The search was limited to English language articles. The journals Obstetrics and Gynecology and the American Journal of Obstetrics and Gynecology were reviewed in their entirety. Articles from general medical education journals such as Academic Medicine, Medical Education, and Teaching and Learning in Medicine, and journals commonly read by all practitioners such as New England Journal of Medicine, Lancet, and Journal of the American Medial Association were excluded. Review articles and articles published in other surgical or simulation journals were also excluded. This search strategy identified 161 articles, from which the authors selected the following based on soundness of methodology and relevance/interest to medical educators within and outside the field of obstetrics and gynecology. This selection reflects the current trend and focus of topics in the ob-gyn education-based literature.
 
Twenty-four of 85 submitted abstracts were selected for podium presentation at the 31st annual meeting of the Association for Surgical Education, held in Boston, Massachusetts. Based on popular themes, 10 abstracts were chosen for publication under the auspices of the Alliance for Clinical Education. These abstracts have been modified to succinct, self-contained works that can be understood by those who have not attended the meeting or are from nonsurgical disciplines.
 
Background: Education in the ambulatory setting should be an integral part of undergraduate medical education. However, previous studies have shown education in this setting has been lacking in medical school. Ambulatory education occurs on some internal medicine clerkships. The extent of this education is unclear. Purpose: The purpose of this survey was to assess the structure, curriculum, assessment methods, and barriers to implementation of ambulatory education on the internal medicine clerkship. Methods: An annual survey of institutional members of the Clerkship Directors in Internal Medicine (CDIM) was done in April 2010. The data were anonymous and descriptive statistics were used to summarize responses. Free text results were analyzed using qualitative techniques. Results: The response rate was 75%. The majority of respondents had a required ambulatory component to the clerkship. Ambulatory experiences distinct from the inpatient internal medicine experience were common (46%). Integration with either the inpatient experiences or other departmental clerkships also occurred. The majority of ambulatory educational experiences were with generalists (74%) and/or subspecialists (45%). The most common assessment tool was the National Board of Medical Examiners (NBME) ambulatory shelf exam. Thematic analysis of the question about how practice based learning was taught elicited four major themes: Not taught; taught in the context of learning evidence based medicine; taught while learning chronic disease management with quality improvement; taught while learning about health care finance. Barriers to implementation included lack of faculty and financial resources. Conclusions: There have been significant increases in the amount of time dedicated to ambulatory internal medicine. The numbers of medical schools with ambulatory internal medicine education has increased. Integration of the ambulatory experiences with other clerkships such as family medicine occurs. Curriculum was varied but difficulties with dissemination and assessment in these disparate settings was noted. Overall, the results of this study demonstrate increased implementation and recognition of the importance of ambulatory education in internal medicine.
 
The mission of Clerkship Directors in Internal Medicine (CDIM) is to promote excellence in medical student internal medicine education. The organization represents course directors, site directors, and program administrators. CDIM is a member of the Alliance for Academic Internal Medicine, a consortium of five academically focused specialty organizations representing departments of internal medicine, at medical schools and teaching hospitals in the United States and Canada. At Academic Internal Medicine Week 2011 in Anaheim, California, CDIM held its annual meeting at which oral abstracts and posters were presented. Selected by the CDIM Research Committee, the abstracts highlight CDIM members? innovation and careful appraisal of the medical student experience. Three abstracts address the changing climate in medical education by clarifying medical students? clerkship experiences with hospitalists, assessing their role at medical emergencies, and presenting evidence that the physical examination is receiving less attention. Two abstracts address improving evaluation and feedback skills of the faculty and residents responsible for student teaching. Additional selected abstracts highlight curricular innovations including the use of game theory to teach students about cost, geriatrics home visits, and enhancement of the sub-internship. A novel clerkship was created to allow students? exposure to continuity of care. Finally, clerkship administrators share an effective approach to enhance collaboration. s were identified by CDIM as the highest quality and most relevant for medical student educators and the readership of Teaching and Learning in Medicine.
 
Purpose: Critical thinking is central to the function of health care professionals. However, this topic is not explicitly taught or assessed within current programs, yet the need is greater than ever, in an era of information explosion, spiraling health care costs, and increased understanding about metacognition. To address the importance of teaching critical thinking in health professions education, the Shapiro Institute for Education and Research and the Josiah Macy Jr. Foundation jointly sponsored the Millennium Conference 2011 on Critical Thinking. Summary: Teams of physician and nurse educators were selected through an application process. Attendees proposed strategies for integrating principles of critical thinking more explicitly into health professions curricula. Working in interprofessional, multi-institutional groups, participants tackled questions about teaching, assessment, and faculty development. Deliberations were summarized into consensus statements. Conclusions: Educational leaders participated in a structured dialogue about the enhancement of critical thinking in health professions education and recommend strategies to teach critical thinking.
 
Twenty-six of 89 submitted abstracts were selected for podium presentation at the 32nd annual meeting of the Association for Surgical Education, held in San Diego, California. Based on popular themes, 10 abstracts were chosen for publication under the auspices of the Alliance for Clinical Education. These abstracts have been modified to succinct, self-contained works that can be understood by those who have not attended the meeting or are from non-surgical disciplines. The first 4 abstracts involve learning about and teaching nontechnical skills in the operating room. First is an ethnographic study exploring surgeons? responses to intraoperative challenge. The second is an ASE Paper of Distinction, reporting a needs assessment for teaching conflict resolution in the operating room. The third abstract regards the theme of motivating learners in the operating room, and the final abstract in this group, another ASE Paper of Distinction, provides recommendations for training assessors of nontechnical skills. The concept of risk taking and risk management in surgery is explored in the fifth abstract. The next 3 abstracts involve facets of focused simulated-skills training. A novel simulation model for casting is presented, and the link between focused skills training and patient outcome is examined via meticulous video analysis of microsurgical technique. The efficacy of a large-scale, telesimulation program for teaching laparoscopic skills was demonstrated. The final 2 abstracts examine teaching methods on the surgery clerkship. A method for eliciting and exploring issues of professionalism is presented, and the rationale for multimedia slide design receives further support.
 
The mission of Clerkship Directors in Internal Medicine (CDIM) is to promote excellence in medical student internal medicine education. The organization represents course directors, site directors, and program administrators. CDIM is a member of the Alliance of Academic Internal Medicine, a consortium of 5 academically focused specialty organizations representing departments of internal medicine and medical schools and teaching hospitals in the United States and Canada. At Academic Internal Medicine Week 2012 in Phoenix, Arizona, CDIM held its annual meeting at which oral abstracts and posters selected by the CDIM Research committee were presented. In these proceedings we share with you selected abstracts from the meeting that highlight CDIM members' innovation and careful appraisal of the medical student experience. Three abstracts address quality improvement and/or patient safety, including the description of a longitudinal quality improvement curriculum, an observed structured clinical examination to teach transitions of care, and teaching handoffs with simulation. Additional abstracts focus on teaching students about the evolving landscape of medicine, including education about cost-conscious care, the effect of duty hour restrictions on the subinternship, and student readiness for the meaningful use of electronic health records. One abstract surveys students' extracurricular reading habits and another demonstrates the effects of postdischarge phone calls on both patients and medical students. CDIM is pleased to present these abstracts, which were identified as the highest quality and most relevant for medical student educators and the readership of Teaching and Learning in Medicine.
 
The mission of the Association of Professors of Gynecology and Obstetrics (APGO) is to promote excellence in women's health care by providing optimal resources and support to educators who inspire, instruct, develop, and empower women's health care providers of tomorrow. Each year, APGO holds a joint meeting with the Council on Resident Education in Obstetrics and Gynecology, which focuses on improving medical education for students and residents studying women's health. The 2012 meeting entitled "Embracing Transitions in Healthcare: Educating for Tomorrow, Today" was held March 7 to 10, 2012, in Orlando, Florida, and exhibited a wide variety of abstracts and breakout sessions, including the first annual Film Festival featuring videos for learners related to teaching procedural, clinical, and educational skills. The main plenary sessions included David Irby, PhD, from UCSF School of Medicine, whose address "Rethinking How We Educate Physicians Across the Continuum" focused on the sweeping changes occurring as a result of the 2010 Carnegie report, and Valerie Arkoosh, MD, PhD, President of the National Physicians Alliance, whose lecture "Educating for Tomorrow: The Future of Health Care and Education Under the Patient Protection and Affordable Care Act (PPACA)" addressed the impact the changes brought about by the PPACA will have on medical education. The following oral abstracts, as selected by representatives from both organizations, address several topics including the impact new innovations and curricula have on learners' experiences, issues related to residency training including the balance between service and education and the impact of duty hour restrictions.
 
The Society of Teachers of Family Medicine (STFM; http://www.stfm.org ) is a community of professionals devoted to teaching family medicine through undergraduate, graduate, and continuing medical education. This multidisciplinary group of physicians, educators, behavioral scientists, and researchers works to further STFM's mission of improving the health of all people through education, research, patient care, and advocacy. The STFM held its 38th Conference on Medical Student Education in Long Beach, California, from February 2 to 5, 2012. The unifying theme of the conference was meeting the demands of high-quality education in a changing health care delivery environment. Kevin Grumbach, MD, from the University of California-San Francisco opened the conference with a plenary presentation emphasizing the importance of educating leaders and followers for health system improvement. Throughout the conference, participants shared ideas and learned new skills in more than 70 workshops, seminars, and discussions as well as 90 educational research and curriculum evaluation papers. Finally, Jeffrey Brenner, MD, from Camden Coalition of Healthcare Providers, New Jersey concluded the conference with a plenary session discussing how a citywide coalition can improve the quality, capacity, and accessibility of healthcare for one of America's poorest cities, all while reducing overall health care costs. The STFM Education Committee selected 9 papers from the educational research and curriculum evaluation papers, felt to be of interest to readers of Teaching and Learning in Medicine. One of the papers deals with preclerkship education, three with 3rd- and 4th-year education, two with longitudinal experiences across all years of medical school, and three with assessment.
 
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