Do Good Medical Students Make Good Doctors?

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fourth_year This study looks at the relationship between the performance of students in their last year of undergraduate medical school and in their first roles as junior doctors. Data (grade point average, last year Emergency Medicine attachment exam, and 6th year written examination) were collected from 200 students in their final year (6th year) of their Australian medical education.  In addition, results of each student’s performance in their initial clinical assignments post graduation were obtained.  These are measured by the Junior Doctor Assessment Tool, which evaluates newly-graduated doctors’ clinical management skills, communication skills, and professional behavior throughout the first two postgraduate years.  No single undergraduate assessment reliably predicted the performance of the students once they started clinical practice, however, taken as an aggregate, these scores correlated with their achievement as measured by the Junior Doctor Assessment Tool.  – Lee Ann Schein, Ph.D.

Relationships between academic performance of medical students and their workplace performance as junior doctors. Carr SE, Celenza A, Puddey I, Lake F
BMC Medical Education [BMC Med Educ] 2014 Jul 30; Vol. 14 (1), pp. 157.

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Fostering Communication Skills

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communication   A comparative study was conducted assessing the communication skills of first and second year medical students.  Students were observed interacting with simulated patients in a clinical scenario.  Their communication skills were observed and assessed by simulated patients, communication skills faculty and health care faculty not trained in communication skills.  Due to a curriculum change, one cohort of students had no formal training in communication skills (2nd year students), while the cohort of first year students had communication skills as part of their medical school curriculum.  As expected, all three groups of reviewers rated the communication skills of the first year students with the formal training in communication higher than those of second year students.  An interesting finding was that there was no significant difference between the rating scores given to both groups of students by the simulated patients and by the communication skills faculty.  The ratings, however scored by the non-communication skills faculty were significantly higher than the other two assessor groups for the same student interactions.  Simulated patients, who worked with the students in these exercises, were more in sync with the faculty who were actively involved in teaching communication skills than health care faculty who were not.  This underscores the need to have appropriate facilitators for gauging student exercises.  – Lee Ann Schein, Ph.D.

Assessors For Communication Skills: Sps Or Healthcare Professionals?
Liew, Siaw. Medical Teacher Volume: 36 Issue: 7 (2014-01-01) p. 626 – 631. ISSN: 1466-187X

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E-Journal Articles Encourage Critical Thinking

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eJournal  Educators at Rutgers Robert Wood Johnson Medical School used guided reviews of online e-journals as a tool to promote collaborative learning among first year medical students.   After reading medical journal articles posted online, students, either individually or in groups, answered on-line questions about the articles.  Students needed to integrate the basic science knowledge they received from class lectures to correctly answer the questions.  Answers were posted either individually or in groups of four, encouraging peer teaching and collaboration.  Greater than 90% of the students responded well to factoid-based questions as well as questions which required a higher level of reasoning, as judged by faculty reviewers.  In addition, based on the students’ evaluations, the students found the exercise useful as a tool to foster critical analysis of medical journal articles as well as a good way to review the basic science material taught in class.  – Lee Ann Schein, Ph.D.

Abali EE, Phadtare S, Galt J, Brodsky B.,An online guided e-journal exercise in pre-clerkship years: oxidative phosphorylation in brown adipose tissue., Biochem Mol Biol Educ. 2014 May-Jun;42(3):259-69.

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Tackling the challenge of bedside teaching: give feedback for students to self-correct

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feedback   Feedback is often conceptualized as a process that occurs after an event. But when it comes to bedside rounds, effective teaching occurs when feedback takes place during the event. In a video ethnographic study of 12 bedside teaching encounters, Rizan et al use conversation analysis to identify effective feedback strategies that promote learning. Some examples include avoiding highly explicit (no, that is wrong) or implicit (well, we shall see…) correction techniques, and judicious use of self-correction strategies such as clarifying the question, providing hints, and even a 2-second pause before responding to the student’s incorrect answer. The goal of bedside rounds should be to guide the student to discover the correct answer. Use of these self-correction strategies can be “face-saving” for the student, establishing a supportive learning environment while minimizing exposure of student error to patients. –Sarang Kim, MD

Rizan C, Elsey C, Lemon T, Grant A, Monrouxe LV., Feedback in action within bedside teaching encounters: a video ethnographic study.,Med Educ. 2014 Sep;48(9):902-20.

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Finding Time and Money for Ultrasound Education

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   ultrasound

A survey of medical school curricular administrators (with a 61% response rate) found that although 62% reported that there was some required or elective exposure to ultrasound in their curriculum, only a very small minority reported that they trained students to obtain ultrasound scans.  Seventy-nine percent felt that ultrasound instruction should be part of the undergraduate medical curriculum, but many found that a lack of time in the curriculum and lack of financial resources were major barriers to providing this instruction. — Laura Willett, MD

Bahner DP, Goldman E, Way D, Royall NA, Liu YT.,The State of Ultrasound Education in U.S. Medical Schools: Results of a National Survey., Acad Med. 2014 Aug 5.

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How Do Humanistic Physicians Stay That Way?

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humanistic physician   In a thoughtful qualitative interview study, investigators asked internal medicine residents at the University of Pennsylvania to nominate attendings who were excellent role models for humanistic care.  The top 16 physicians were mostly academic clinicians and clinician-educators; 75% taught in both the inpatient and outpatient setting.  Among the sustaining factors mentioned by more than half of these physicians were: humility, curiosity, self-reflection, and connecting with the patient as a human being.  A majority felt that humanism helps the physician as well as the patient, and that other people in the environment (e.g. colleagues, nurses, chaplains, learners) helped to sustain their humanism. — Laura Willett, MD

Chou CM, Kellom K, Shea JA. Attitudes and Habits of Highly Humanistic Physicians. Acad Med. 2014 Jul 8.

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Improving Quality Improvement (QI) Education

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quality_improvement  Two small studies in this month’s Academic Medicine describe the results of QI education at their institutions. Residents, faculty, and staff at the White River Junction (VT) VA hospital were interviewed, and critical care fellows at Mayo Clinic were serially surveyed regarding their programs. Both groups of learners had overall positive responses to the programs, and both studies report marked improvements in care delivery metrics such as vaccination rates, delivery of embolism prophylaxis, smoking-cessation interventions, compliance with an intubation safety checklist, compliance with sedation interruption guidelines, and decreased inappropriate bladder catheterization. In contrast to a recently-reviewed article from UC-San Francisco, learners were not directly rewarded for the achievement of quality goals; however it is clear that these programs require resources, namely protected faculty time and the services of a research assistant or data analyst. In the VA study, residents also mentioned the importance of a resident room with a white board to track QI project progress. Attitudinal resources are required as well: the expectation that this is part of everyone’s medical education; the ability to incorporate QI teaching and projects into regular workdays; the involvement of multiple levels and types of learners in the projects; and the ability to “hand-off” QI projects from one group of learners to another as learners go to various rotations. — Laura Willett, MD

Educational System Factors That Engage Resident Physicians in an Integrated Quality Improvement Curriculum at a VA Hospital: A Realist Evaluation. Ogrinc G, Ercolano E, Cohen ES, Harwood B, Baum K, van Aalst R, Jones AC, Davies L. Acad Med. 2014 Jun 20. [Epub ahead of print]

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Quality Improvement Education Incorporated as an Integral Part of Critical Care Fellows Training at the Mayo Clinic. Kashani KB, Ramar K, Farmer JC, Lim KG, Moreno-Franco P, Morgenthaler TI, Dankbar GC, Hale CW.Acad Med. 2014 Jul 1. [Epub ahead of print]

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Medical Students Start Using Hand-Held Ultrasound Starting in Year One

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ultrasound  Educators and students from University of California, Irvine, describe their intensive involvement with ultrasound as an adjunct to physical diagnosis.  Pre-clerkship students engage in weekly practice sessions precepted primarily by fourth-year students.  Ultrasound exposure continues throughout the curriculum.  It is unclear whether patient outcomes or educational outcomes other than ultrasound proficiency have been affected by this program. — Laura Willett, MD

Fox JC, Schlang JR, Maldonado G, Lotfipour S, Clayman RV., Proactive Medicine: The “UCI 30,” an Ultrasound-Based Clinical Initiative From the University of California, Irvine. Academic Medicine, 2014 May 13 [epub ahead of Print]

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First-Year Medical Students Changed Resources They Cite in Response to Curricular Changes

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PBL 2  First-year students writing weekly “learning issue” essays in a problem-based learning curriculum cited the sources of their information.  The type of references cited changed after changes in the curriculum including earlier delineation of “high-quality” resources, instruction on efficient search strategies, a hands-on computer searching workshop, and peer collaboration and feedback.  From 2006-2009, before and after these curricular changes, the percentage of “highest quality” references (peer-reviewed primary reports, systematic reviews, and guidelines) increased from 20% to 31%, while the percentage of references to lay or discouraged sources decreased from 24% to 6%.  The authors do not mention whether these essays and the type of literature cited contributed to the student’s grade for the course. — Laura Willett, MD

Krasne S, Stevens CD, Wilkerson L., Improving Medical Literature Sourcing by First-Year Medical Students in Problem-Based Learning: Outcomes of Early Interventions. Academic Medicine 2014 May 13 [epub ahead of print]

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What Should a July Intern Know? EPAs Proposed for Medical Students

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EPA  EPAs (entrustable professional activities))are just rolling out this year for residency programs with the new accreditation system.  The Association of American Medical Colleges (AAMC) has now drafted a set of 13 EPAs for graduating medical students.  They range from the crucial (recognize an emergency and seek help), to the mundane (able to perform a history and physical), to the ineffable (contribute to a culture of safety and improvement).  Overall, they seem a reasonable way to standardize expectations upon graduation, but implementing them will be difficult. — Laura Willett, MD

ten Cate 0, Trusting Graduates to Enter Residency: What Does It Take?. Journal of Graduate Medical Education: March 2014, Vol. 6, No. 1, pp. 7-10.

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