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Gupta A, Villegas CV, Watkins AC, Foglia C, Rucinski J, Winchell RJ, Barie PS, Narayan M. General Surgery Residents' Perception of Feedback: We Can Do Better. JOURNAL OF SURGICAL EDUCATION 2020; 77:527-533. [PMID: 32151513 DOI: 10.1016/j.jsurg.2019.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/14/2019] [Accepted: 12/15/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Feedback (FB) regarding perioperative care is essential in general surgery residents' (GSRs) training. We hypothesized that FB would be distributed unevenly across preoperative (PrO), intraoperative (IO), and postoperative (PO) continuum of the perioperative period. We aimed to compare results between university- and community-hospital settings planning to institute structured, formalized FB in a large health care system operating multiple surgery residency programs in departments that are linked strategically. METHODS Quantitative, cross-sectional, Likert scale anonymous surveys were distributed to all GSRs (categorical and preliminary; university: community 1:2). Twenty-five questions considered frequency and perceived quality of FB in PrO, IO, and PO settings. Data were tabulated using REDCap and analyzed in Microsoft Excel using the Mann-Whitney U test, with α = 0.05. Comparisons were made between university- and community-hospital settings, between junior (Post-Graduate Year (PGY) 1-3) and senior (PGY 4-5) GSRs, and by gender. RESULTS Among 115 GSRs surveyed, 83 (72%) responded. Whereas 93% reported receiving some FB within the past year, 46% reported receiving FB ≤ 20% of the time. A majority (58%) found FB to be helpful ≥ 80% of the time. Among GSRs, 77%, 24%, and 64% reported receiving PrO, IO, or PO FB ≤ 20% of the time, respectively, but 52% also believed that FB was lacking in all 3 areas. Most GSRs wanted designated time for PrO planning FB (82%) and PO FB (87%), respectively. Thirty-six percent of GSRs reported that senior/chief (i.e., PGY-4/PGY-5 GSRs) took them through cases ≥40% of the time; notably,78% reported that FB from senior/chief GSRs was equally or more valuable than FB from attending surgeons. A majority (78%) reported that attending surgeons stated explicitly when they were providing FB only ≤20% of the time. GSRs at the community hospital campuses reported receiving a higher likelihood of "any" FB, IO FB, and PO FB (p < 0.05). Most GSRs surveyed preferred a structured format and designated times for debriefing and evaluation of performance. Subanalyses of gender and GSR level of training showed no differences. CONCLUSIONS FB during GSR training varies across the perioperative continuum of care. Community programs seem to do better than University Programs. More work need to be done to elucidate why differences exist between the frequency of FB at University and Community programs. Further, data show particularly low FB outside of the operating room. Ideally, according to respondents, FB would be provided in a structured format and at designated times for debriefing and evaluation of performance, which poses a challenge considering the temporal dynamism of general surgery services.
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Affiliation(s)
- Aakanksha Gupta
- Department of Surgery, Division of Trauma, Burns, Acute and Critical Care, Weill Cornell Medicine, New York, New York
| | - Cassandra V Villegas
- Department of Surgery, Division of Trauma, Burns, Acute and Critical Care, Weill Cornell Medicine, New York, New York
| | - Anthony C Watkins
- Department of Surgery, Division of Trauma, Burns, Acute and Critical Care, Weill Cornell Medicine, New York, New York; Department of Surgery, NewYork Presbyterian-Weill Cornell Medical Center, New York, New York
| | | | - James Rucinski
- Department of Surgery, NewYork Presbyterian-Brooklyn Methodist, Brooklyn, New York
| | - Robert J Winchell
- Department of Surgery, Division of Trauma, Burns, Acute and Critical Care, Weill Cornell Medicine, New York, New York; Department of Surgery, NewYork Presbyterian-Weill Cornell Medical Center, New York, New York
| | - Philip S Barie
- Department of Surgery, Division of Trauma, Burns, Acute and Critical Care, Weill Cornell Medicine, New York, New York; Department of Medicine, Division of Medical Ethics, Weill Cornell Medicine, New York, New York; Department of Surgery, NewYork Presbyterian-Weill Cornell Medical Center, New York, New York
| | - Mayur Narayan
- Department of Surgery, Division of Trauma, Burns, Acute and Critical Care, Weill Cornell Medicine, New York, New York; Department of Surgery, NewYork Presbyterian-Weill Cornell Medical Center, New York, New York.
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Paul CR, Vercio C, Tenney-Soeiro R, Peltier C, Ryan MS, Van Opstal ER, Alerte A, Christy C, Kantor JL, Mills WA, Patterson PB, Petershack J, Wai A, Beck Dallaghan GL. The Decline in Community Preceptor Teaching Activity: Exploring the Perspectives of Pediatricians Who No Longer Teach Medical Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:301-309. [PMID: 31425181 DOI: 10.1097/acm.0000000000002947] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Difficulty in recruiting and retaining community preceptors for medical student education has been described in the literature. Yet little, if any, information is known about community outpatient preceptors who have stopped or decreased teaching time with students. This study aimed to examine these preceptors' perspectives about this phenomenon. METHOD Using a phenomenology framework, this multi-institutional qualitative study used semistructured interviews with community pediatric preceptors who had stopped or reduced teaching time with medical students. Interviews were conducted between October 2017 and January 2018 and transcribed verbatim. Interviews explored factors for engaging in teaching, or decreasing or ceasing teaching, that would enable future teaching. An initial code book was developed and refined as data were analyzed to generate themes. RESULTS Twenty-seven community pediatricians affiliated with 10 institutions participated. Thirty-seven codes resulted in 4 organizing themes: evolution of health care, personal barriers, educational system, and ideal situations to recruit and retain preceptors, each with subthemes. CONCLUSIONS From the viewpoints of physicians who had decreased or stopped teaching students, this study more deeply explores previously described reasons contributing to the decline of community preceptors, adds newly described barriers, and offers strategies to help counter this phenomenon based on preceptors' perceptions. These findings appear to be manifestations of deeper issues including the professional identify of clinical educators. Understanding the barriers and strategies and how they relate to preceptors themselves should better inform education leaders to more effectively halt the decline of community precepting and enhance the clinical precepting environment for medical students.
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Affiliation(s)
- Caroline R Paul
- C.R. Paul is associate professor of pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. C. Vercio is assistant professor of pediatrics, Loma Linda University School of Medicine, Loma Linda, California. R. Tenney-Soeiro is associate professor of clinical pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. C. Peltier is associate professor of clinical pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio. M.S. Ryan is associate professor of pediatrics and assistant dean for clinical medical education, Virginia Commonwealth University School of Medicine, Richmond, Virginia. E.R. Van Opstal is assistant professor of pediatrics and internal medicine, Rush Medical College, Chicago, Illinois. A. Alerte is professor of pediatrics, University of Connecticut Health Center, Hartford, Connecticut. C. Christy is professor of pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York. J.L. Kantor is associate clerkship director, International University College of Medicine, Miami, Florida. W.A. Mills Jr is associate professor of pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina. P.B. Patterson is assistant professor of pediatrics, Tufts University School of Medicine, Boston, Massachusetts, and Maine Medical Center, Portland, Maine. J. Petershack is professor of pediatrics, The Long School of Medicine at UT Health San Antonio, San Antonio, Texas. A. Wai is assistant professor of pediatrics and internal medicine, Loma Linda University School of Medicine, Loma Linda, California. G.L. Beck Dallaghan is director of educational scholarship, University of North Carolina School of Medicine, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0002-8539-6969
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Christner JG, Beck Dallaghan G, Briscoe G, Graziano S, Mylona E, Wood S, Power DV. To Pay or Not to Pay Community Preceptors? That Is a Question …. TEACHING AND LEARNING IN MEDICINE 2019; 31:279-287. [PMID: 30596274 DOI: 10.1080/10401334.2018.1528156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Phenomenon: Pairing medical students with community-based preceptors has provided unique medical education advantages. However, due to an increase in the number of M.D.-granting medical schools and medical school class sizes, academic medical institutions have struggled to recruit community preceptors to teach their students. This task has been made more difficult due to rising pressures upon institutions and clinicians-for example, increased productivity demands, greater volume and oversight of electronic health record documentation, and competition for community preceptors from both D.O. and non-U.S.-based medical schools. Although academic institutions have historically relied largely on altruistic motives and intrinsic rewards to actively engage and retain community-based preceptors, alternative models have arisen, chiefly those in which community-based preceptors are explicitly compensated for teaching. Approach: To study this phenomenon, representatives of the Alliance for Clinical Education developed and deployed a 31-item survey accompanied with a subset of free text questions to the collective membership of its 8-member constituent organizations. Survey questions explored if community preceptors were compensated indirectly or directly and what types of compensation were provided, if any. There were 188 surveys analyzed, with an estimated response rate of 18.2%. Findings: Twenty-six percent of respondents indicated they compensate community preceptors directly and/or indirectly. Respondents discussed their motivations for payment (or nonpayment), mechanisms for paying, aspirations to pay, and expectations of the recipient. No statistically significant association was found when comparing responses of paid versus not paid by region. Free text responses provided additional insight regarding payment considerations, institutional competition, recruitment/retention, recognition, and education issues. Insights: Increasingly, medical schools are finding it necessary to provide funding for community preceptors in order to retain them. New creative forms of compensation to community preceptors may prove important in the future for this vital aspect of medical student education.
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Affiliation(s)
| | - Gary Beck Dallaghan
- b Department of Pediatrics , University of North Carolina School of Medicine , Chapel Hill , North Carolina , USA
| | - Greg Briscoe
- c Psychiatry , Eastern Virginia Medical School , Norfolk , Virginia , USA
| | - Scott Graziano
- d Department of Obstetrics and Gynecology , Loyola University Chicago, Stritch School of Medicine , Chicago , Illinois , USA
| | - Elza Mylona
- e Faculty Affairs and Professional Development , Eastern Virginia Medical School , Norfolk , Virginia , USA
| | - Sarah Wood
- f Medical Education , Charles E. Schmidt College of Medicine at Florida Atlantic University , Boca Raton , Florida , USA
| | - David V Power
- g Department of Family Medicine , University of Minnesota Medical School , Minneapolis , Minnesota , USA
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Ryan MS, Leggio LE, Peltier CB, Chatterjee A, Arenberg S, Byerley JS, Belkowitz JL, Rabalais GP, Barone MA. Recruitment and Retention of Community Preceptors. Pediatrics 2018; 142:peds.2018-0673. [PMID: 30115732 DOI: 10.1542/peds.2018-0673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Recruiting and retaining community-based pediatricians for teaching medical students has been explored through the lens of preceptors and educational leaders. The purpose of this study was to explore the perspective of pediatric department chairs, a key stakeholder group charged with maintaining teaching capacity among a faculty. METHODS In 2015, members of the Association of Medical School Pediatric Department Chairs and Council on Medical Student Education in Pediatrics joint task force disseminated a 20-item survey to pediatric department chairs in the United States and Canada. Topics included demographics, incentives offered to community pediatricians, and the perceived value and feasibility of such incentives. Data were analyzed using descriptive statistics and χ2 to compare categorical variables. RESULTS Pediatric department chairs from 92 of 145 (63% response rate) medical schools returned the survey. Sixty-seven percent reported difficulty recruiting or retaining preceptors, and 51% reported high-reliance on preceptors for the ambulatory portion of the pediatrics clerkship. Almost all (92%) cited competition from other programs for the services of community preceptors. The provision of incentives was correlated with perceived feasibility (R2 = 0.65) but not their perceived value (R2 = 0.12). Few (21%) chairs reported providing financial compensation to preceptors. The provision of compensation was not related to reliance but did vary significantly by geographical region (P < .001). CONCLUSIONS Pediatric departments rely heavily on community-based pediatricians but face competition from internal and external training programs. The perspective of department chairs is valuable in weighing interventions to facilitate continued recruitment and retention of community preceptors.
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Affiliation(s)
- Michael S Ryan
- Department of Pediatrics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia;
| | - Lisa E Leggio
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Christopher B Peltier
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Archana Chatterjee
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota
| | - Steven Arenberg
- Marketing and Communications, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Julie S Byerley
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Julia L Belkowitz
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida; and
| | - Gerard P Rabalais
- Department of Pediatrics, School of Medicine, University of Louisville, Louisville, Kentucky
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Christner JG, Dallaghan GB, Briscoe G, Casey P, Fincher RME, Manfred LM, Margo KI, Muscarella P, Richardson JE, Safdieh J, Steiner BD. The Community Preceptor Crisis: Recruiting and Retaining Community-Based Faculty to Teach Medical Students-A Shared Perspective From the Alliance for Clinical Education. TEACHING AND LEARNING IN MEDICINE 2016; 28:329-36. [PMID: 27092852 DOI: 10.1080/10401334.2016.1152899] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
ISSUE Community-based instruction is invaluable to medical students, as it provides "real-world" opportunities for observing and following patients over time while refining history taking, physical examination, differential diagnosis, and patient management skills. Community-based ambulatory settings can be more conducive to practicing these skills than highly specialized, academically based practice sites. The Association of American Medical Colleges and other national medical education organizations have expressed concern about recruitment and retention of preceptors to provide high-quality educational experiences in community-based practice sites. These concerns stem from constraints imposed by documentation in electronic health records; perceptions that student mentoring is burdensome resulting in decreased clinical productivity; and competition between allopathic, osteopathic, and international medical schools for finite resources for medical student experiences. EVIDENCE In this Alliance for Clinical Education position statement, we provide a consensus summary of representatives from national medical education organizations in 8 specialties that offer clinical clerkships. We describe the current challenges in providing medical students with adequate community-based instruction and propose potential solutions. IMPLICATIONS Our recommendations are designed to assist clerkship directors and medical school leaders overcome current challenges and ensure high-quality, community-based clinical learning opportunities for all students. They include suggesting ways to orient community clinic sites for students, explaining how students can add value to the preceptor's practice, focusing on educator skills development, recognizing preceptors who excel in their role as educators, and suggesting forms of compensation.
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Affiliation(s)
| | - Gary Beck Dallaghan
- b Office of Medical Education, University of Nebraska Medical Center , Omaha , Nebraska , USA
| | - Gregory Briscoe
- c Department of Psychiatry , Eastern Virginia Medical School , Norfolk , Virginia , USA
| | - Petra Casey
- d Department of Obstetrics and Gynecology , Mayo Clinic , Rochester , Minnesota , USA
| | - Ruth Marie E Fincher
- e Academic Affairs, Medical College of Georgia Augusta , Augusta , Georgia , USA
| | - Lynn M Manfred
- f Departments of Pediatrics and Medicine , Medical University of South Carolina , Charleston , South Carolina , USA
| | - Katherine I Margo
- g Department of Family Medicine and Community Health , Perelman School of Medicine , Philadelphia , Pennsylvania , USA
| | - Peter Muscarella
- h Department of Surgery , Montefiore Medical Center , Bronx , New York , USA
| | - Joshua E Richardson
- i Health Informatics, Weill Cornell Graduate School of Medical Sciences , New York , New York , USA
| | - Joseph Safdieh
- j Department of Neurology , Weill Cornell Medical College , New York , New York , USA
| | - Beat D Steiner
- k Department of Family Medicine , University of North Carolina , Chapel Hill , North Carolina , USA
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Ojano Sheehan O, Brannan G, Dogbey G. Osteopathic medical students' perception of teaching effectiveness of their primary care clinical preceptors. INT J OSTEOPATH MED 2016. [DOI: 10.1016/j.ijosm.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Stein R, Johnston I, Bannister S. Students completing a pediatric clinical clerkship in a regional center perform as well as their peers training at a university teaching hospital ... and they liked it better? TEACHING AND LEARNING IN MEDICINE 2009; 21:225-228. [PMID: 20183342 DOI: 10.1080/10401330903018500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Medical school size in Ontario is increasing. As some institutions cannot accommodate all medical students in the university-affiliated hospital, some students are completing the majority of their clinical rotations in a regional setting. PURPOSE To determine whether the regional experience is equivalent to the more traditional tertiary care experience. METHODS Students' examination results and rotation evaluation forms were collected after completing a pediatrics rotation. Results from students completing most of the rotation in a regional setting were compared to those who remained in a tertiary care setting. RESULTS There was no difference between the two groups on their final examination. Students in the rural setting rated the rotation higher than the students in the university setting. CONCLUSION A regional rotation eases the challenges of an increasing medical class size and provides an educationally appropriate rotation for a clinical clerk.
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Affiliation(s)
- Robert Stein
- Department of Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada.
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Mohsin R. Performance of clinical clerks doing paediatric rotations in a community hospital versus a university hospital. Paediatr Child Health 2008; 12:761-4. [PMID: 19030461 DOI: 10.1093/pch/12.9.761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2007] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Most clinical clerks (third-year medical students) do their paediatric rotation at the IWK Health Centre, the Dalhousie University-affiliated tertiary care paediatric institution in Halifax, Nova Scotia. Due to limited space, some clerks are sent to community hospitals in the provinces of New Brunswick and Prince Edward Island. These community hospitals are different in terms of the academic environment and the availability of paediatric subspecialty services. OBJECTIVE To compare performance of clinical clerks doing paediatric rotations in community hospitals (group I) with those in a university hospital (group II). METHODS The end-of-rotation test scores on the 45 single correct answer multiple choice questions and the three 15 min objective structured clinical examinations in group I (n=54) and group II (n=124) for two consecutive academic years were studied. The end-of-rotation comments by the clerks in group I were examined to assess the quality of their experience. RESULTS For the two academic years, the cumulative mean +/- SD scores for multiple choice questions and objective structured clinical examinations were 82.82+/-7.47 and 70.82+/-11.37, respectively, in group I compared with 83.03+/-7.74 and 69.02+/-11.23 in group II. There were no significant differences in the results between the two groups. No difference in results was seen when the scores were analyzed separately for each of the academic years. The clerks in group I rated their experience as positive. CONCLUSIONS Clerks doing paediatric rotations in community hospitals perform as well and receive similar educational benefits as those at university hospitals. Community hospitals can provide a quality experience for paediatric clerkship training.
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Affiliation(s)
- Rashid Mohsin
- Department of Paediatrics, Undergraduate Medical Education, Dalhousie University, Halifax, Nova Scotia
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Fuentealba C, Mason RV, Johnston SD. Community-based clinical veterinary education at Western University of Health Sciences. JOURNAL OF VETERINARY MEDICAL EDUCATION 2008; 35:34-42. [PMID: 18339954 DOI: 10.3138/jvme.35.1.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This article describes a distributed model clinical curriculum developed by the College of Veterinary Medicine, Western University of Health Sciences (CVMWU), and presents outcome data for the 2005/2006 academic year. Extramural clinical education requires close institutional involvement, including planning, formulation of learning objectives, selection of partner sites with numbers compatible with teaching needs, training of clinical preceptors, faculty commitment, administrative support, and ongoing assessment. Extramural delivery of the CVMWU clinical curriculum is facilitated by its geographical location in close proximity to participating sites and by an admissions process designed to select students judged likely to succeed in a student-centered learning environment. Outcome data collected from students and clinical preceptors supports the conclusion that year 3 of the curriculum was successfully delivered.
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Beck GL, Matache MT, Riha C, Kerber K, McCurdy FA. Clinical experience and examination performance: is there a correlation? MEDICAL EDUCATION 2007; 41:550-5. [PMID: 17518834 DOI: 10.1111/j.1365-2923.2007.02764.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
CONTEXT The Liaison Committee on Medical Education (LCME) requires there to be: '...comparable educational experiences and equivalent methods of evaluation across all alternative instructional sites within a given discipline'. It is an LCME accreditation requirement that students encounter similar numbers of patients with similar diagnoses. However, previous empirical studies have not shown a correlation between the numbers of patients seen by students and performance on multiple-choice examinations. OBJECTIVE This study examined whether student exposure to patients with specific diagnoses predicts performance on multiple-choice examination questions pertaining to those diagnoses. METHODS The Department of Pediatrics at the University of Nebraska Medical Center has collected patient logbooks from clerks since 1994. These contain information on patient demographics and students' roles in patient care. During week 7 of an 8-week course, students took an examination intended to help them prepare for their final examination. Logbooks and pre-examination questions were coded using standard ICD-9 codes. Data were analysed using Minitab statistical software to determine dependence between patient encounters and test scores. Subjects comprised a convenience sample of students who completed the clerkship during 1997-2000. RESULTS Our analysis indicates that performance on a multiple-choice examination is independent of the number of patients seen. CONCLUSIONS Our data suggest knowledge-based examination performance cannot be predicted by the volume of patients seen. Therefore, too much emphasis on examination performance in clinical courses should be carefully weighed against clinical performance to determine the successful completion of clerkships.
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Affiliation(s)
- Gary L Beck
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE 68198-2184, USA.
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Li STT, Smith S, Gigante J. A national survey of pediatric clerkship directors' approaches to meeting the LCME ED-2 requirement for quantified patient criteria for medical students. TEACHING AND LEARNING IN MEDICINE 2007; 19:352-356. [PMID: 17935464 DOI: 10.1080/10401330701542594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND The Liaison Committee on Medical Education (LCME) recently reinterpreted ED-2, their quantified patient criteria requirement. PURPOSE The purpose is to describe pediatric clerkship directors' response to ED-2. METHOD We used a survey of U.S. and Canadian pediatric clerkship directors. RESULTS Survey response rate was 76% (108/142). The most frequent categories that clerkship directors used to describe quantified patient criteria were age group (77%), organ systems (65%), or symptoms (61%). Computer simulations were the alternative patient experience in 83% of clerkships. Patient logs (90%) and checklists (31%) tracked student completion of ED-2. Thirty-two respondents had an LCME visit since ED-2 was reinterpreted, and 69% reported that LCME had concerns about their clerkships' fulfillment of ED-2. There was no difference in method of ED-2 implementation between schools who were cited by LCME and those who were not. CONCLUSIONS Clerkship directors have used a variety of approaches to specify and monitor quantified patient criteria.
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Affiliation(s)
- Su-Ting T Li
- Department of Pediatrics, University of California Davis, Sacramento, California 95817, USA.
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White CB, Thomas AM. Students assigned to community practices for their pediatric clerkship perform as well or better on written examinations as students assigned to academic medical centers. TEACHING AND LEARNING IN MEDICINE 2004; 16:250-254. [PMID: 15388380 DOI: 10.1207/s15328015tlm1603_5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Medical schools are increasingly using community practice sites (CPS) for clerkship training. PURPOSES We compared the test performance of all students assigned to CPS with all students trained at an academic medical center (AMC) for their pediatric clerkship for the past 5 years. METHODS Baseline comparability of both groups was established by the group mean scores on 1st and 2nd year medical school grade point average (GPA) and the United States Medical Licensing Examination (USMLE) Step 1 and Step 2. Performance outcome was compared by group mean scores on a written clerkship exam and the National Board of Medical Examiners Pediatric Subject Examination. RESULTS There was no statistical difference between the two groups with regard to GPA or USMLE scores. Standardized test performance results: [table: see text] CONCLUSION The CPS-trained students performed as well or better on standardized written tests compared with AMC-trained students. Community pediatric practices can provide a quality clerkship experience for junior medical students.
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Affiliation(s)
- Christopher B White
- Department of Pediatrics, Medical College of Georgia, Augusta, Georgia, USA.
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McCurdy FA, Sell DM, Beck GL, Kerber K, Larzelere RE, Evans JH. A comparison of clinical pediatric patient encounters in university medical center and community private practice settings. AMBULATORY PEDIATRICS : THE OFFICIAL JOURNAL OF THE AMBULATORY PEDIATRIC ASSOCIATION 2003; 3:12-5. [PMID: 12540247 DOI: 10.1367/1539-4409(2003)003<0012:acocpp>2.0.co;2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Growing numbers of medical students complete clerkships in community private practice (CPP) settings instead of the more traditional university-based clinics, yet few empirical studies have evaluated how setting type impacts clinical experiences, skill development, and student satisfaction. OBJECTIVE This study compared the pediatric patient encounters seen by third-year medical students in university medical center (UMC) and CPP settings. METHODS Third-year medical students were required to keep a log of all patients seen during their 8-week pediatric clerkship. Logbook entries were coded and then analyzed for differences in the number and distribution of the primary diagnostic categories between settings. RESULTS CPP students reported, on the average, seeing over 3 times more patients than UMC students. The case mix distribution also differed significantly by setting. In general, CPP students reported seeing proportionately more routine illnesses, whereas UMC students reported seeing proportionately more uncommon disorders. Because CPP students saw more patients overall, they averaged more cases in almost all diagnostic categories. CONCLUSION CPP students received more clinical patient exposure than UMC students, except for patients in a few diagnostic categories.
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Affiliation(s)
- Fredrick A McCurdy
- Department of Pediatrics, University of Nebraska College of Medicine, Omaha 68198, USA.
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Abstract
Knowledge of graduate student's impressions and attitudes toward pediatrics is important for planning strategies to stimulate their interest in pursuing a career in pediatrics. The clinical pediatric experience may influence many of their misconceptions and apprehension. This study was designed to examine this hypothesis. Rotating interns who were starting pediatric rotations between January 8, 1998 and January 4, 2001 were included prospectively. A structured 2-part, 28-item questionnaire examining their impressions and attitudes toward pediatrics was completed on the first week and at the end of the 8-week rotation. One hundred eighty-eight interns (53.5% males) aged 23 to 30 years (mean 24.8, SD 1.3) were included. One hundred two pre- and 86 post-rotation questionnaires were completed. Selecting pediatrics as the first future career choice did not change significantly at the end of the rotation, from 19.5% to 26% post-rotation. Females were 3.4 times more likely to select pediatrics (95% CI 1.6-7.8, p = 0.001). Several impressions about the specialty were significantly changed at the end of the rotation including worry about inflicting pain (28% vs 12%, p = 0.01), concerns about difficulties in the examination and cooperation of children (22% vs 8%, p = 0.01), and difficulties with intravenous access (43% vs 17%, p = 0.0003). Most interns (76%) felt that their pediatric rotation was better than anticipated. To conclude, although the rotation experience did not increase the likelihood of selecting pediatrics as the first future career choice, many impressions and concerns were positively influenced. The majority reported a better than anticipated experience.
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Affiliation(s)
- Manal A al-Asnag
- Department of Pediatrics, King Abdulaziz University Hospital, College of Medicine and Allied Health Sciences, Jeddah, Kingdom of Saudi Arabia
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Bowen JL, Irby DM. Assessing quality and costs of education in the ambulatory setting: a review of the literature. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2002; 77:621-680. [PMID: 12114139 DOI: 10.1097/00001888-200207000-00006] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Time-pressured interactions with little direct observation or feedback characterize teaching in ambulatory settings. The authors report findings from the literature on teaching and learning in the ambulatory setting and propose opportunities for further research that addresses these barriers. METHOD The authors searched 1995-1999 databases for all empirical studies that focused on research conducted in ambulatory settings. Publications were reviewed for evidence of inclusion criteria. Findings were sorted into categories previously described for defining and evaluating quality of ambulatory care educational programs. RESULTS Most studies were conducted in departments of internal medicine (40%), focused on medical students (43%), and took place in a single program (77%), making generalizations difficult. Students and residents are learning in ambulatory environments, and the types of patients they encounter are likely to prepare them for practice. Patient care outcomes have emerged as a measure of learning. Teachers may be the single most important factor, yet they lack self-confidence as teachers. Community-based preceptors teach because of enjoyment of teaching and the opportunity to stay current. However, none of the studies addressed the impact of the Medicare documentation requirements on satisfaction with teaching. Teaching settings cost about one third more than non-teaching settings to operate. CONCLUSION This review identifies many gaps in our knowledge of effective clinical teaching practices, and of learning environments in which that teaching takes place. The predominance of single-institution studies limits generalizability of current findings. A prioritized research agenda should be established and funded, focusing on improving the efficiency and effectiveness of teaching and learning in ambulatory settings.
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Affiliation(s)
- Judith L Bowen
- Department of Medicine, Oregon Health & Science University, Portland, Oregon 97201-3098, USA.
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