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Lin HJ, Wu JH, Lin WH, Nien KW, Wang HT, Tsai PJ, Chen CY. Using ACGME milestones as a formative assessment for the internal medicine clerkship: a consecutive two-year outcome and follow-up after graduation. BMC Med Educ 2024; 24:238. [PMID: 38443912 PMCID: PMC10916194 DOI: 10.1186/s12909-024-05108-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/29/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND This study evaluated the utility of using Accreditation Council for Graduate Medical Education (ACGME) Milestones as a formative assessment tool for the fifth- and sixth-grade medical students' performance in their internal medicine (IM) clerkship and the same students' performance in their post-graduate year (PGY) IM training. METHODS Retrospective data were collected from 65 medical students completing the two-year IM clerkship in the academic years 2019 and 2020 and 26 of the above students completing their PGY-1 training at the same university hospital in the academic year 2021. Data included the assessment results of 7 of the ACGME IM Milestones, information on admitted patients assigned to the students, and surveys of the students' satisfaction. RESULTS The analysis included 390 assessment results during the IM clerkship and 78 assessment results during the PGY-1 training. Clinical teachers commonly rated level 3 to medical students in the IM clerkship, with PC-2 subcompetency receiving the lowest rating among seven subcompetencies. The levels of most subcompetencies showed stationary in the two-year IM clerkship. Significant improvement was observed in all subcompetencies during the PGY-1 training. The medical students in the second-year IM clerkship expressed higher satisfaction with implementing Milestones than in their first-year IM clerkship and perceived Milestones assessments' usefulness as learning feedback. CONCLUSIONS Using ACGME Milestones as a formative assessment tool in the IM clerkship yielded promising outcomes. Longitudinal follow-up of subcompetencies facilitated tracking students' development and providing constructive feedback.
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Affiliation(s)
- Hsiao-Ju Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jhong-Han Wu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Hung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Wen Nien
- Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huei-Ting Wang
- Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Jen Tsai
- Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chiung-Yu Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Signor E, Gerstenberger J, Cotton J, Colbert-Getz J, Lappé K. Integrating a self-directed ultrasound curriculum for the internal medicine clerkship. Ultrasound J 2024; 16:19. [PMID: 38443723 PMCID: PMC10914648 DOI: 10.1186/s13089-024-00367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Incorporating ultrasound into the clinical curriculum of undergraduate medical education has been limited by a need for faculty support. Without integration into the clinical learning environment, ultrasound skills become a stand-alone skill and may decline by the time of matriculation into residency. A less time intensive ultrasound curriculum is needed to preserve skills acquired in preclinical years. We aimed to create a self-directed ultrasound curriculum to support and assess students' ability to acquire ultrasound images and to utilize ultrasound to inform clinical decision-making. METHODS Third year students completed the self-directed ultrasound curriculum during their required internal medicine clerkship. Students used Butterfly iQ+ portable ultrasound probes. The curriculum included online modules that focused on clinical application of ultrasound as well as image acquisition technique. Students were graded on image acquisition quality and setting, a patient write-up focused on clinical decision-making, and a multiple-choice quiz. Student feedback was gathered with an end-of-course survey. Faculty time was tracked. RESULTS One hundred and ten students participated. Students averaged 1.79 (scale 0-2; SD = 0.21) on image acquisition, 78% (SD = 15%) on the quiz, and all students passed the patient write-up. Most reported the curriculum improved their clinical reasoning (72%), learning of pathophysiology (69%), and patient care (55%). Faculty time to create the curriculum was approximately 45 h. Faculty time to grade student assignments was 38.5 h per year. CONCLUSIONS Students were able to demonstrate adequate image acquisition, use of ultrasound to aid in clinical decision-making, and interpretation of ultrasound pathology with no in-person faculty instruction. Additionally, students reported improved learning of pathophysiology, clinical reasoning, and rapport with patients. The self-directed curriculum required less faculty time than prior descriptions of ultrasound curricula in the clinical years and could be considered at institutions that have limited faculty support.
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Affiliation(s)
- Emily Signor
- Department of Internal Medicine, University of Utah School of Medicine, 30 N Mario Cappechi Dr., Salt Lake City, United States
| | - John Gerstenberger
- Department of Internal Medicine, University of Utah School of Medicine, 30 N Mario Cappechi Dr., Salt Lake City, United States
| | - Jennifer Cotton
- Department of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jorie Colbert-Getz
- Department of Internal Medicine, University of Utah School of Medicine, 30 N Mario Cappechi Dr., Salt Lake City, United States
| | - Katie Lappé
- Department of Internal Medicine, University of Utah School of Medicine, 30 N Mario Cappechi Dr., Salt Lake City, United States.
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Kang YJ, Lin Y, Rho J, Ihm J, Kim DH. The hidden hurdles of clinical clerkship: unraveling the types and distribution of professionalism dilemmas among South Korean medical students. BMC Med Educ 2024; 24:150. [PMID: 38360613 PMCID: PMC10870601 DOI: 10.1186/s12909-024-05115-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND To improve the medical professionalism of medical students, it is essential to understand the dilemmas they face in various situations. This study explored the types and distribution of dilemmas Korean medical students encounter during their clinical clerkships. It then compared these with previous dilemma frameworks and identified the types and distribution of "complexity dilemmas," wherein two dilemma themes emerge in a single clinical situation. METHODS The researchers organized and recorded a group discussion with 106 third-year medical students who had completed their clinical clerkships. These students participated in the discussion as part of an assignment, focusing on the dilemmas they encountered during their clerkships. For data analysis and visualization, the researchers employed the MAXQDA software program and utilized the template analysis method, a qualitative research methodology. RESULTS A total of seven dilemma themes and sixteen sub-themes were identified. The identity-related dilemma concerning student-doctors had the highest frequency. The themes "mismatch" and "Nun-chi" emerged as new additions not found in previous dilemma frameworks. The complexity dilemmas appeared in the sequence of "identity-dignity," "identity-abuse," and "identity-consent". CONCLUSIONS To navigate the unique dilemmas present within South Korea's clinical culture, several key issues need consideration: elevating the role of student-doctors, balancing the primary emphasis of educational hospitals on delivering medical services, and understanding interpersonal strategies, such as "Nun-chi".
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Affiliation(s)
- Ye Ji Kang
- Department of Medical Education, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, 04763, Seoul, Republic of Korea
| | - Yanyan Lin
- Department of Medical Education, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, 04763, Seoul, Republic of Korea
| | - Jaehee Rho
- Department of Education, College of Educational Sciences, Yonsei University, 50 Yonsei-ro Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Jungjoon Ihm
- Dental Research Institute, School of Dentistry, Seoul National University, 1, Gwanak- ro, Gwanak-gu, 08826, Seoul, Republic of Korea.
| | - Do-Hwan Kim
- Department of Medical Education, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, 04763, Seoul, Republic of Korea.
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Ladowski JM, Howell TC, Nash A, Rhodin K, Tracy E, Migaly J, Bloom D, Vatsaas CJ. Surgical Residents as Clerkship Scholars May Improve Student Perception of the Surgery Clerkship. J Surg Res 2024; 294:37-44. [PMID: 37857141 DOI: 10.1016/j.jss.2023.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION The surgical clerkship is a formative experience in the medical school curriculum and can leave a lasting impression on students' perception of surgery. Given the historical negative stereotypes of surgeons, the clerkship represents an opportunity to impact students in a meaningful way. METHODS Our institution developed a program in which research residents can serve as junior clerkship coordinators and educators; working closely with medical students on their surgery clerkship. At the end of their clerkship, students were administered a survey with Likert-scale and free text responses regarding satisfaction with the rotation, lectures, feedback, and value of the clerkship. Student survey results were compared before (2015-2016) and after (2017-2019) the implementation of the scholar program with nonparametric statistical analysis and qualitative text analysis. RESULTS A total of 413 students responded to the survey with no significant difference in response rate by term (P = 0.88). We found no statistical difference with respect to overall course perception (92.3% versus 91.2%, P = 0.84), but a statistically significant difference was noted for the clarity of the provided written clerkship materials (80.3% versus 91.3%, P = 0.02) and usefulness of the feedback (57.5% versus 78.7%, P = 0.01). Qualitative analysis demonstrated an overall positive shift in perception of the clerkship, improvement in the course materials, and organization. CONCLUSIONS The scholar program was overall well received by the students with improvements in certain aspects of the clerkship: organization, feedback, and course materials. This program represents a potential strategy to improve certain portions of the medical school clerkship experience.
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Affiliation(s)
- Joseph M Ladowski
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
| | - T Clark Howell
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Amanda Nash
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Kristen Rhodin
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Elisabeth Tracy
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - John Migaly
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Diane Bloom
- Department of Health Policy and Management, Gillings School of Global Public Health University, University of North Carolina, Chapel Hill, North Carolina
| | - Cory J Vatsaas
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
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Subramanian S, Parikh P, Kra JA, Maldjian PD, Walther S, Kim S, DeNunzio NJ, Abrams MJ, Braunstein SE, Gunther JR, Mattes MD. Evaluation of a Radiation Oncology Micro clerkship as a Component of Medical Student Education. J Cancer Educ 2023; 38:1861-1864. [PMID: 37468769 DOI: 10.1007/s13187-023-02342-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
Compared to most oncologic subspecialties, radiation oncology (RO) lacks a natural pathway for incorporation into the clinical clerkships, and few students ever complete a formal rotation in RO. The feasibility, and perceived value, of a 1-day "microclerkship" exposure in RO during other related clerkships was evaluated in this study. At a single institution, the RO clerkship director partnered with clerkship directors in medical oncology, palliative care, and radiology so that every 3rd or 4th year student would spend 1 day in RO during those clerkships. Afterwards, students completed an electronic survey containing multiple choice and 5-point Likert-type questions describing their experience. Descriptive statistics are reported. Ninety-seven students completed the RO microclerkship over 2 years, and 81 completed the survey (response rate 84%). Only 8 students (10%) had ever been in a RO department previously. During the microclerkship, 73 students (90%) saw at least one new patient consultation; 77 (95%) were involved in contouring or treatment planning; 76 (94%) saw treatment delivery; and 38 (47%) saw a brachytherapy procedure. Seventy-nine students (98%) felt that the microclerkship was at least moderately valuable (mean Likert-type rating 4.01, SD 0.73). Forty students (49%) were either somewhat or much more interested in participating in a longer (2-4 week) rotation in radiation oncology (mean Likert-type rating 3.59, SD 0.83). This study demonstrated the feasibility of incorporating a 1-day RO microclerkship into other related elective clerkships. Students viewed the experience favorably and found it valuable in their education.
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Affiliation(s)
| | | | - Joshua A Kra
- Division of Hematology/Oncology, Rutgers New Jersey Medical School, Rutgers Cancer Institute of New Jersey at University Hospital, Newark, NJ, USA
| | - Pierre D Maldjian
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Susanne Walther
- Department of Medicine, University Hospital, Newark, NJ, USA
| | - Sung Kim
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Nicholas J DeNunzio
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Matthew J Abrams
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA, USA
| | - Jillian R Gunther
- Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA.
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Moll-Jongerius A, Langeveld K, Helmich E, Masud T, Kramer AWM, Achterberg WP. Becoming a physician for older patients: exploring the professional identity formation of medical students during a nursing home clerkship. A qualitative study. BMC Med Educ 2023; 23:845. [PMID: 37936183 PMCID: PMC10631180 DOI: 10.1186/s12909-023-04835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 11/01/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND To prepare medical students for the growing population of older patients, an appropriate professional identity formation is desirable. The community of practice of medical school is primarily hospital-based and disease-oriented which will lead to the development of a physician who is mainly focused on cure. This focus alone however is not always appropriate for older persons' health care. The aim of this study is to explore the influence of participating in a nursing home community of practice on the professional identity formation of medical students. METHODS A qualitative study based on a constructivist research paradigm was conducted, using individual semi-structured, in-depth interviews and a visual narrative method (drawing) as a prompt. Thematic analysis was applied to structure and interpret the data. The study population consisted of fifth-year medical students participating in a six-week nursing home clerkship. Thirteen participants were purposefully sampled. The clerkship took place in nursing homes in the South-West of the Netherlands. RESULTS The medical students described the nursing home as the living environment of the patients. Actively participating in the patients' care and experiencing the daily life of the patients was meaningful for the physician the students want to become in five ways: (1) a physician with a complete picture; (2) a physician who is close; (3) a physician who is in dialogue; (4) a physician who is able to let go and (5) a physican who collaborates. CONCLUSIONS Caring for older patients in the nursing home influences the professional identity formation of medical students. Patient-centeredness, personal, holistic and tailored care, approachability and collaboration are important characteristics in becoming a physician for older persons' health care. The context of this care provides relevant learning experiences for this development and the becoming of a physician in general.
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Affiliation(s)
- Annemarie Moll-Jongerius
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, The Netherlands.
| | - Kirsten Langeveld
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, The Netherlands
| | - Esther Helmich
- Amsta Health Care Organization, Amsterdam, The Netherlands
| | - Tahir Masud
- Department of Health Care for Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, The Netherlands
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Wang A, Karunungan KL, Story JD, Shlobin NA, Woo J, Ha EL, Hauer KE, Braddock CH. Reimagining a pass/fail clinical core clerkship: a US residency program director survey and meta-analysis. BMC Med Educ 2023; 23:788. [PMID: 37875929 PMCID: PMC10598945 DOI: 10.1186/s12909-023-04770-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023]
Abstract
Pass/fail (P/F) grading has emerged as an alternative to tiered clerkship grading. Systematically evaluating existing literature and surveying program directors (PD) perspectives on these consequential changes can guide educators in addressing inequalities in academia and students aiming to improve their residency applications. In our survey, a total of 1578 unique PD responses (63.1%) were obtained across 29 medical specialties. With the changes to United States Medical Licensure Examination (USMLE), responses showed increased importance of core clerkships with the implementation of Step 2CK cutoffs. PDs believed core clerkship performance was a reliable representation of an applicant's preparedness for residency, particularly in Accreditation Council for Graduate Medical Education's (ACGME)Medical Knowledge and Patient Care and Procedural Skills. PDs disagreed with P/F core clerkships because it more difficult to objectively compare applicants. No statistically significant differences in responses were found in PD preferential selection when comparing applicants from tiered and P/F core clerkship grading systems. If core clerkships adopted P/F scoring, PDs would further increase emphasis on narrative assessment, sub-internship evaluation, reference letters, academic awards, professional development and medical school prestige. In the meta-analysis, of 6 studies from 2,118 participants, adjusted scaled scores with mean difference from an equal variance model from PDs showed residents from tiered clerkship grading systems overall performance, learning ability, work habits, personal evaluations, residency selection and educational evaluation were not statistically significantly different than from residents from P/F systems. Overall, our dual study suggests that while PDs do not favor P/F core clerkships, PDs do not have a selection preference and do not report a difference in performance between applicants from P/F vs. tiered grading core clerkship systems, thus providing fertile grounds for institutions to examine the feasibility of adopting P/F grading for core clerkships.
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Affiliation(s)
- Andrew Wang
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
| | - Krystal L Karunungan
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Jacob D Story
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Nathan A Shlobin
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jiyun Woo
- Crean Lutheran High School, Irvine, CA, USA
| | - Edward L Ha
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Karen E Hauer
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Clarence H Braddock
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
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Sims DA, Cilliers FJ. Clinician educators' conceptions of assessment in medical education. Adv Health Sci Educ Theory Pract 2023; 28:1053-1077. [PMID: 36662334 PMCID: PMC10624725 DOI: 10.1007/s10459-022-10197-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
In pursuing assessment excellence, clinician-educators who design and implement assessment are pivotal. The influence of their assessment practice in university-run licensure exams on student learning has direct implications for future patient care. While teaching practice has been shown to parallel conceptions of teaching, we know too little about conceptions of assessment in medical education to know if this is the case for assessment practice and conceptions of assessment. To explore clinician-educators' conceptions of assessment, a phenomenographic study was undertaken. Phenomenography explores conceptions, the qualitatively different ways of understanding a phenomenon. Data analysis identifies a range of hierarchically inclusive categories of understanding, from simple to more complex, and the dimensions that distinguish each category or conception. Thirty-one clerkship convenors in three diverse Southern settings were interviewed in three cycles of iterative data collection and analysis. Four conceptions of assessment were identified: passive operator, awakening enquirer, active owner and scholarly assessor. Six dimensions were elucidated to describe and distinguish each conception: purpose of assessment; temporal perspective; role and responsibility; accountability; reflexivity and emotional valence. Additionally, three characteristics that appeared to track the progressive nature of the conceptions were identified: professional identity, assessment literacy and self-efficacy. These conceptions encompass and extend previously described conceptions across different educational levels, disciplines and contexts, suggesting applicability to other settings. There is some evidence of a relationship between conceptions and practice, suggesting, together with the hierarchical nature of these conceptions, that targeting conceptions during faculty development may be an effective approach to enhance assessment practice.
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Affiliation(s)
- D A Sims
- University of the Western Cape, 14 Blanckenberg Street, Bellville, South Africa.
| | - F J Cilliers
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Corazza L, Shirkhani S, Berberat PO, Wijnen-Meijer M. Structured interviews on self-regulated learning strategies of medical students in the final year of medical school. BMC Med Educ 2023; 23:604. [PMID: 37620862 PMCID: PMC10464390 DOI: 10.1186/s12909-023-04607-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/23/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND In the final year of medical school, the educational focus is on experiences in the clinical environment. This is where students acquire most of their practical knowledge for their future career and need to optimise their Self-Regulated Learning (SRL) strategies. Hence, the current study aims to explore which SRL strategies medical students use during their clerkships in different learning settings. METHODS Structured interviews were conducted between May 2019 and December 2020 with 43 medical students during their final year in Munich, Germany. The students were surveyed about their SRL strategies. The transcribed data were thematically analysed using the measurements Strategy Use (SU) and Strategy Frequency (SF). RESULTS Interview data were organized into 11 SRL strategy categories. The most used SRL strategy in general was "seeking information in the internet in form of a text" (SU: 1; SF: 2.605), with an e-learning tool; followed by "seeking social assistance from doctors" (SU: 0.977; SF: 1.884), and "seeking information in books" (SU: 0.884; SF: 1.419). There were differences in the usage of SRL in different learning contexts between female and male students. For example, 95.3% of students are "seeking social assistance from doctors" when having difficulties on the ward, but only 55.8% when they need help with written tasks (e.g. medical letter). The results show a difference in SRL usage when preparing for oral-practical (79.1% books) and written (97.7% e-learning tool) exam. However, it also appears that some students do not have SRL strategies for certain situations, mostly due to a lack of time. CONCLUSION Medical students in the clinical phase are adapting their SRL strategy to the learning situation. To better support students´ SRL, it is necessary to ensure availability for their preferred resources: e-learning tool and experienced physicians as supervisors. Future research should focus on strategies to handle the limited time during clerkships.
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Affiliation(s)
- Laura Corazza
- Technical University of Munich (TUM), School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany
| | - Sepide Shirkhani
- Technical University of Munich (TUM), School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany
| | - Pascal O Berberat
- Technical University of Munich (TUM), School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany
| | - Marjo Wijnen-Meijer
- Technical University of Munich (TUM), School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany.
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Tran JH, Loebel E, Edouard M, Quehl T, Walsh E, Ginsburg R, Frempong T, Fredrick D, Stein LK, Fara MG, Farouk SS, Chadha N. Creating ophthalmology experiences in undergraduate medical education: pilot of a cased-based learning ophthalmology tool. BMC Med Educ 2023; 23:559. [PMID: 37559068 PMCID: PMC10410917 DOI: 10.1186/s12909-023-04514-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 07/17/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE To evaluate medical student perceptions of a novel ophthalmology resource delivered through facilitated workshops in the core clerkship curriculum. METHODS We created www.2020sim.com, a free case-based learning (CBL) ophthalmology tool, adapted from NephSIM (www.nephsim.com). The tool was first piloted with the internal medicine (IM) residents. After confirming a need, we focused on undergraduate medical education (UME) by expanding the 20/20 SIM content and partnering with the neurology (pilot academic year [AY] 2020-2021) and pediatric clerkships (pilot AY 2021-2022) to deliver a facilitated one-hour ophthalmology workshop within each clerkship's didactic curriculum. We evaluated the tool using pre- and post-surveys and knowledge assessments. RESULTS Of 80 IM residents, 33 (41.3%) completed the needs assessment. Of the 25 residents who attended the workshop, 23 (92.0%) completed the exit survey. IM residents reported discomfort in several ophthalmology domains (9 of 14 rated mean score < 3.0), confirming a need. Most (n = 21/23, 91.3%) rated the tool as good/excellent. Of 145 neurology clerkship students, 125 (86.2%) and at least 88 (60.7%) students completed the pre- and post-test/exit surveys, respectively. On average, participants highly rated the tool, perceiving 20/20 SIM to be relevant to their education [4.1 (0.8)]. Mean pre- to post-test knowledge scores increased from 7.5 to 8.5/10.0 points (p < 0.001). Of the 136 pediatric clerkship students, 67 (49.3%) and 51 (37.5%) completed the pre- and post-surveys, respectively. Respondents perceived increased comfort with ophthalmology topics after the facilitated workshop [3.8 (0.8)]. Mean pre- to post-test knowledge scores trended from 1.8 to 2.0/5.0 points (p = 0.30). Collectively, 20/139 (14.4%) of exit survey respondents visited www.2020sim.com within 1 month after the workshop. CONCLUSION After identifying areas of greatest need with residents, we partnered with core clerkships to deliver cross-disciplinary ophthalmology content in UME. We found high engagement with 20/20 SIM, with trends toward increased knowledge.
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Affiliation(s)
- Jessica H Tran
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye & Ear Infirmary, Eye and Vision Research Institute, New York, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Emma Loebel
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mark Edouard
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of General Preventative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Thomas Quehl
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye & Ear Infirmary, Eye and Vision Research Institute, New York, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Erin Walsh
- Department of Ophthalmology & Visual Science, Yale School of Medicine, New Haven, USA
| | - Robin Ginsburg
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye & Ear Infirmary, Eye and Vision Research Institute, New York, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tameisha Frempong
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye & Ear Infirmary, Eye and Vision Research Institute, New York, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Douglas Fredrick
- Kaiser Permanente Medical Group South San Francisco, San Francisco, USA
| | - Laura K Stein
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Michael G Fara
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Samira S Farouk
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Nisha Chadha
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye & Ear Infirmary, Eye and Vision Research Institute, New York, USA.
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA.
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11
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Villamar MF, Roth JL. The value of neurology clerkship rotations at non-tertiary hospitals. J Neurol Sci 2023; 451:120736. [PMID: 37478795 DOI: 10.1016/j.jns.2023.120736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/04/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Mauricio F Villamar
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neurology, Rhode Island Hospital, Providence, RI, USA; Department of Medicine, Kent Hospital, Warwick, RI, USA.
| | - Julie L Roth
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Neurology, Rhode Island Hospital, Providence, RI, USA
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12
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Kung D, Brewer W, Oyelami V, Hessel S, Bramlett L, Gill A. Interprofessional Education on the Neurology Clerkship for Physical Therapy and Medical Students. MedEdPORTAL 2023; 19:11316. [PMID: 37261329 PMCID: PMC10227187 DOI: 10.15766/mep_2374-8265.11316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/02/2023] [Indexed: 06/02/2023]
Abstract
Introduction Globally, neurological disorders make up the second most common cause of death and are the leading cause of years lived with disability. Because neurological patients often require multidisciplinary care and future professionals will encounter increasing demands for neurological care, it is important to emphasize education on the interaction between physical therapy (PT) and neurology. Yet there is a dearth of interprofessional education (IPE) learning activities that include neurology clerkship students and physical therapists. Methods We created a 4-hour IPE experience that incorporated hospitalized patients with neurological disorders who were examined at the bedside by pairs of second- and third-year PT students and second- and third-year medical students, followed by a debriefing. Participants completed the Self-Efficacy for Interprofessional Experiential Learning (SEIEL) survey before and after the session. Results Significant pre/post improvements were seen for SEIEL total and domain scores (n = 75, p < .001). Qualitative comments were analyzed; major themes that emerged included a greater appreciation for the other discipline. Students felt the IPE activity was a great learning opportunity to understand roles and responsibilities and communicate with the other discipline. Discussion Students noted significant increases in their ability to understand and explain the importance of interprofessional communication and in their capabilities as health care professionals to work together on an interprofessional collaborative team. This clinical IPE experience can be seamlessly incorporated into the workplace for medical and PT students. IPE activities like this should be encouraged and developed to reach more students and other health care providers.
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Affiliation(s)
- Doris Kung
- Associate Professor, Department of Neurology, and Assistant Dean of Clinical Curriculum, Baylor College of Medicine
| | - Wayne Brewer
- Associate Professor, School of Physical Therapy, Texas Woman's University
- Co-second author
| | - Victor Oyelami
- Doctor of Physical Therapy, MD Anderson Cancer Center, University of Texas
- Co-second author
| | - Stephanie Hessel
- Doctor of Physical Therapy, Harris Health System
- Co-second author
| | - Laurene Bramlett
- Doctor of Physical Therapy, Harris Health System
- Co-second author
| | - Anne Gill
- Professor, Department of Pediatrics and Center for Medical Ethics and Health Policy, and Assistant Dean of Interprofessional Education, Baylor College of Medicine
- Co-second author
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13
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Meyer EG, Cozza KL, West JC, Hamaoka D. The Effectiveness of Online Experiential Learning in a Psychiatry Clerkship. Acad Psychiatry 2023; 47:181-186. [PMID: 36808570 PMCID: PMC9937738 DOI: 10.1007/s40596-023-01755-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The Uniformed Services University of the Health Sciences 5-week psychiatry clerkship educates about 180 students a year at sites around the USA. In 2017, weekly in-person experiential learning sessions were implemented for local students and resulted in improved performance in several end-of-clerkship Objective Structured Clinical Examination (OSCE) skills as compared to distant learners who did not receive these sessions. The difference in performance (~ 10%) highlighted a need to provide comparable training for distant learners. Providing in-person, repeated simulated experiential training at multiple distant sites was not practical, requiring development of a novel online approach. METHODS Students at all four distant sites over 2 years (n = 180) participated in five weekly synchronous online experiential learning sessions, while local students (n = 180) received five weekly in-person experiential learning sessions. Tele-simulation used the same curriculum, centralized faculty, and standardized patients as the in-person iterations. Overall end-of-clerkship OSCE performance was compared for learners receiving online versus in-person experiential learning for non-inferiority. Specific skills were compared to receiving no experiential learning. RESULTS Overall OSCE performance was non-inferior for students who received synchronous online as compared to in-person experiential learning. Performance on each skill other than communication improved significantly when comparing students who received online versus no experiential learning (p < 0.05). CONCLUSIONS The use of weekly online experiential learning to enhance clinical skills is comparable to in-person efforts. Virtual, simulated, synchronous experiential learning provides a feasible and scalable platform for training complex clinical skills to clerkship students, a critical capability given the impact the pandemic has had on clinical training.
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Affiliation(s)
- Eric G Meyer
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Kelly L Cozza
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - James C West
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Derrick Hamaoka
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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14
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Luo P, Shen J, Yu T, Zhang X, Zheng B, Yang J. Formative objective structured clinical examination with immediate feedback improves surgical clerks' self-confidence and clinical competence. Med Teach 2023; 45:212-218. [PMID: 36151754 DOI: 10.1080/0142159x.2022.2126755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Clerkship is crucial for fourth-year medical students before entering the clinical environment. However, lack of confidence impairs clerks' performance during the clinical rotation. We assess the impact of formative Objective Structured Clinical Examination (OSCE) with immediate feedback on surgical clerks' self-confidence and clinical competence. METHODS This is a prospective randomized controlled study. Thirty-eight fourth-year medical students starting their surgical clerkship were randomly divided into the control group (n = 19) and the OSCE group (n = 19), where an extra 6-station formative OSCE was given prior to the surgical rotation with immediate feedback on the participant's performance. Self-confidence assessment (SCA) was collected from each participant before, right after the formative OSCE and one month later. Clinical competence was assessed using a mini-clinical evaluation exercise (mini-CEX) with a case of acute abdominal pain and direct observation of procedural skills (DOPS) with incision and suture one month later. RESULTS The SCAs were significantly improved in the OSCE group right after the training, and a month later, compared to the control group. The mini-CEX score was significantly higher in the OSCE group compared to the control group, but not the DOPS score of incision and suture. CONCLUSION The formative OSCE with immediate feedback could significantly enhance surgical clerks' self-confidence and their clinical competence when taking the history, performing the physical examination, and in clinical reasoning; however, the formative OSCE did not improve their dexterity in performing the procedural skills.
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Affiliation(s)
- Peng Luo
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiliang Shen
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tunan Yu
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaochen Zhang
- Department of Education Office, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Zheng
- Surgical Simulation Research Lab, University of Alberta Office, Edmonton, Alberta, Canada
| | - Jin Yang
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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15
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McAfee NW, Schumacher JA, Williams DC, Madson MB, Bagge CL, Konkle-Parker D, Paul IA, Houston LJ, Young KM. Multidimensional Evaluation of Screening Brief Intervention and Referral to Treatment Training for Medical Students. Acad Psychiatry 2023:10.1007/s40596-023-01752-2. [PMID: 36720777 DOI: 10.1007/s40596-023-01752-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach to identifying and addressing alcohol use in non-specialty settings. Many medical schools teach SBIRT, but most published evaluations of these efforts exclude rigorous skill assessments and teaching methods. METHODS During the 2017-2018 academic year, 146 third-year medical students received classroom-based learning on SBIRT and motivational interviewing (MI) and at least two SBIRT practices with feedback as part of a 4-week psychiatry clerkship. The objective of this curriculum was to improve SBIRT knowledge, attitudes, and confidence and enable learners to skillfully deliver SBIRT. Outcomes evaluated included satisfaction, knowledge, attitudes and confidence, and clinical skill in delivering SBIRT to a standardized patient (rated by the actor, as well as an expert). RESULTS Results indicated acceptable satisfaction at post-curriculum and significant improvements in attitudes and knowledge from pre- to post-curriculum. On the clinical skills exam, all students were rated as having mastered at least 80% of SBIRT elements by standardized patients and 91.8% were rated at this level by a faculty expert. Student attitudes and knowledge were unrelated to expert ratings, and standardized patient ratings had limited associations with expert ratings. CONCLUSIONS These results suggest curriculum objectives were achieved and provide unique contributions to the SBIRT curricular outcome research for healthcare trainees. Other findings included that trainee knowledge and confidence may not relate to skill, and standardized patient feedback provides different information on SBIRT and MI skill than expert ratings.
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Affiliation(s)
| | | | | | | | | | | | - Ian A Paul
- University of Mississippi Medical Center, Jackson, MS, USA
| | - L Joy Houston
- Southern Illinois University School of Medicine, Springfield, IL, USA
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16
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Vo A, Torti J, Haddara W, Sultan N. Exploring medical students' perspectives of physician leadership. BMC Med Educ 2023; 23:10. [PMID: 36604671 PMCID: PMC9817360 DOI: 10.1186/s12909-022-03971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Leadership has been recognized as an important competency in medicine. Nevertheless, leadership curricula for Canadian medical students lacks standardization and may not be informed by medical students' perspectives of physician leadership. The purpose of this study was to elicit these perspectives on physician leadership. METHODS The present study utilized semi-structured interviews to ascertain the views of medical student participants, including students in their first, second and third years of medical school, on physician leadership. Interview questions were based on 'the 3-C model' of physician leadership, which includes three aspects of leadership, namely character, competence and commitment. The interviews were audio-recorded, transcribed and then coded using thematic analysis. RESULTS The medical students of this study provided rich examples of resident and staff physicians demonstrating effective and ineffective leadership. The participants identified the importance of character to effective physician leadership, but some participants also described a feeling of disconnect with the relevance of character at their stage of training. When discussing physician competence, medical students described the importance of both medical expertise and transferable skills. Lastly, the leadership aspect of commitment was identified as being relevant, but medical students cautioned against the potential for physician burnout. The medical student participants' suggestions for improved leadership development included increased experiences with examples of physician leadership, opportunities to engage in leadership and participation in reflection exercises. CONCLUSIONS Overall, the study participants demonstrated an appreciation for three aspects of leadership; character, competence and commitment. Furthermore, they also provided recommendations for the future design of medical leadership curricula.
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Affiliation(s)
- Albert Vo
- Family Medicine, Western University, London, ON, Canada.
| | - Jacqueline Torti
- Centre for Education Research & Innovation, Western University, London, ON, Canada
| | - Wael Haddara
- Critical Care Medicine, London Health Sciences Centre, London, ON, Canada
| | - Nabil Sultan
- Division of Nephrology, London Health Sciences Centre, London, ON, Canada
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17
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Khanittanuphong P, Iamthanaporn K, Bvonpanttarananon J. The impact of the transition from flipped classroom to online lectures on learning outcomes and student satisfaction in a rehabilitation medicine clerkship during the COVID-19 pandemic. BMC Med Educ 2022; 22:885. [PMID: 36539732 PMCID: PMC9765370 DOI: 10.1186/s12909-022-03959-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The flipped classroom (FC) is a well-known active learning module that activates the prior knowledge of students and promotes their cognitive skills during in-class activities. However, most on-site teaching during the COVID-19 pandemic had to be conducted online. The FC in our rehabilitation medicine clerkship curriculum was also shifted to online asynchronous lectures (OLs), without real-time interactions. There is no previous comparison of effectiveness between these two methods. Therefore, this study aimed to compare learning outcomes and student satisfaction in both FC and OL models. METHODS The study design was a historically controlled study. A physical modality was chosen for the content. The FC group (n = 233), in the academic years 2018 and 2019, was assigned to perform a pre-class activity consisting of reading study materials. Thereafter, the in-class activity comprised a small-group case-based discussion. The OL group (n = 240) in the academic years 2020 and 2021 followed an online model during the COVID-19 lockdown. They were also asked to read the online materials and then watch a self-paced recorded lecture video on Learning Management Systems. The learning outcomes, including their multiple-choice questions (MCQs) scores, final exam scores, grade points, and letter grades, were evaluated. Their overall course satisfaction ratings were also collected. RESULTS The OL group had an overall higher MCQ score for the physical modality portion than the FC group (p = 0.047). The median (lower quartile, upper quartile) of the total 50-MCQ scores were 34 (31, 37) in the OL group and 33 (29, 36) in the FC group (p = 0.007). The median final exam scores of the OL and FC groups were 69.5 and 68.3, respectively (p = 0.026). The median grade points and the letter grades were not significantly different between the groups. The proportions of satisfaction were significantly higher in the FC group than in the OL group. CONCLUSIONS The OL group revealed significantly higher learning outcomes than the FC group. However, the FC group showed more satisfaction with interactivity than the OL group. The authors are of the view that a combination of both FC and OL methods will likely result in better outcomes.
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Affiliation(s)
- Phichamon Khanittanuphong
- Department of Rehabilitation Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
| | - Khanin Iamthanaporn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Jongdee Bvonpanttarananon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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18
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Andraous F, Amin GEAD, Allam MF. The "new normal" for medical education during and post-COVID-19. Educ Health (Abingdon) 2022; 35:67-68. [PMID: 36647934 DOI: 10.4103/efh.efh_412_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
After outbreaks in more than 110 countries, the World Health Organization declared COVID-19 a global pandemic on the March 11, 2020, heralding unprecedented challenges in medical education. Our aim is to provide a descriptive overview of the impact of COVID-19 on medical education worldwide and to assess its future repercussions. Worldwide, medical students were removed from clerkship training. Clinical skills and practical procedure training transitioned to being online, and in some cases, postponed. Medical educators scrambled to convert the curriculum into online formats. Access to Internet, technology, and computer education posed resource allocation challenges in developing countries and further widened the disparities in medical education. Even in countries where the framework and funding were available to support the online transition, debatably, this arrangement can lead to disparities in clinical skills, bedside manner, and field experience among pre- and post-COVID-19 medical graduates. Challenges extend beyond undergraduate medical education to include the medical licensing process of international and national postgraduates. The international community of medical educators needs to collaborate to drive the future of medical education, as the world adapts to the "new normal."
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Affiliation(s)
- Fady Andraous
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Mohamed Farouk Allam
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Cervantes J, Dudrey E, Baatar D, Lyn H, Sambalingam D, Wojciechowska J, Hernan LJ. Improving Integration of Basic Science into Clinical Medicine: Vertical Integration into Clinical Education (VICE) Activity. Med Sci Educ 2022; 32:47-50. [PMID: 35186430 PMCID: PMC8814280 DOI: 10.1007/s40670-021-01485-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
UNLABELLED The integration of basic science into clinical clerkships continues to be a challenge in medical curricula. We developed an integrated session for 3rd year medical students enrolled in OB-Gyn/Pediatric Block. The session focused on transplacental and perinatal infections, and consisted of a student-driven pedagogy activity in which students were required to explain the basic science principles behind the pathophysiology of the clinical presentations, the work-up, and the treatment of the infections. This approach helps students understand how basic science knowledge informs clinical practice and potential increase clerkship-level students' confidence as it makes them serve as leaders of active learning modules. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-021-01485-7.
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Affiliation(s)
- Jorge Cervantes
- Dept. Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX USA
| | - Ellen Dudrey
- Dept. Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX USA
| | - Dolgor Baatar
- Department of Biomedical Science, Kaiser Permanente. Bernard J. Tyson School of Medicine, Pasadena, CA USA
| | - Heidi Lyn
- Dept. Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX USA
| | - Devaraj Sambalingam
- Dept. Pediatrics, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX USA
| | - Joanna Wojciechowska
- Dept. Pediatrics, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX USA
| | - Lynn J. Hernan
- Dept. Pediatrics, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX USA
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20
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Wu JH, Du JK, Lee CY. Development and questionnaire-based evaluation of virtual dental clinic: a serious game for training dental students. Med Educ Online 2021; 26:1983927. [PMID: 34694980 PMCID: PMC8547877 DOI: 10.1080/10872981.2021.1983927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/24/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The volume of literature about serious gaming in dental education has increased, however, none of the previous studies have developed a serious game for closing the gap between preclinical and clinical training. OBJECTIVE Virtual Dental Clinic (VDC) is a serious game that was created to help develop clinical reasoning skills in dental students. This study aimed to evaluate VDC as an educational tool and its effectiveness on clinical skill and knowledge gain among clerkship dental students. METHODS The following three stages of VDC design and testing were addressed from 2016 to 2020: development, validation, and application. The VDC was developed using Unity game engine. In the validation stage, the content validity was reviewed by five visiting staff; construct validity and face validity were examined by 9 postgraduate-year dentists and 14 clerkship dental students. Concurrent validity and predictive validity were examined by 34 fifth-year dental students during their clerkship from September, 2018 to May, 2019, the associations between VDC experiences, clerkship performance, and the score on a national qualification test were explored. In the application stage, the VDC was set up as a self-learning tool in the Family Dentistry Department from August, 2019, quantitative and qualitative analyses were conducted using the 92 clerkship students' feedback. RESULTS The VDC showed good validity and a high potential for education in practice. Students who have used VDC received significantly higher scores on qualification test (p = 0.029); the VDC experiences significantly predicted higher performance score on periodontics (p = 0.037) and endodontics (p = 0.040). After the outbreak of COVID-19 pandemic, significantly higher proportion of students confirmed the value of VDC as an assistant tool for learning clinical reasoning (p = 0.019). CONCLUSIONS The VDC as an educational tool, and the effectiveness on clinical reasoning skills and knowledge gain among clerkship dental students has been validated and confirmed in this study.
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Affiliation(s)
- Ju-Hui Wu
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Je-Kang Du
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chen-Yi Lee
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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21
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Newman JR, Fink J, Clough LA, Johnston S. Internal Medicine Clerkship ID Curriculum Flip: Will They Prefer to Pre-learn? Med Sci Educ 2021; 31:1751-1755. [PMID: 34490068 PMCID: PMC8409700 DOI: 10.1007/s40670-021-01384-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 06/13/2023]
Abstract
Varying pedagogical approaches of undergraduate medical education are utilized in clerkships to supplement bedside teaching. The flipped classroom mode, in which self-paced study precedes the in-person session, is often used in pre-clinical education. This shift allows time with the instructor to focus on guided application of pre-learned concepts. At our institution, the Internal Medicine Clerkship Infectious Diseases lecture was substituted to a flipped classroom with two pre-learning videos. Student satisfaction scores were higher for the flipped classroom and comments were more negative for the traditional lecture. This suggests that senior medical students favor flipped classroom pedagogy despite pre-learning requirements.
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Affiliation(s)
- Jessica R. Newman
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas Health System, Mailstop 1028, Kansas City, KS 66160 USA
| | - Jennifer Fink
- Division of General and Geriatric Medicine, Department of Internal Medicine, University of Kansas Health System, Kansas City, USA
| | - Lisa A. Clough
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas Health System, Mailstop 1028, Kansas City, KS 66160 USA
| | - Shane Johnston
- Office of Medical Education, School of Medicine, University of Kansas, Kansas City, USA
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Bazaid K, Simas K, Bezzahou A. Stigma in Psychiatry: Impact of a Virtual and Traditional Psychiatry Clerkship on Medical Student Attitudes. Acad Psychiatry 2021; 45:738-741. [PMID: 34648168 PMCID: PMC8515783 DOI: 10.1007/s40596-021-01541-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/17/2021] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The objective of the study was to assess the change in medical students' attitudes towards psychiatry following a virtual clerkship experience compared to a traditional clerkship experience. METHOD Ninety-seven medical students from the University of Ottawa were assessed pre- and post-clerkship on the ATP-30 (Attitudes Towards Psychiatry-30) measure. Cohorts of students were categorized as pre-COVID or during-COVID depending on when and how they experienced their clerkship (traditional or virtual). The total student response rate was approximately 48%. A quasi-experimental design was implemented, and non-parametric statistics were used to analyze the data. RESULTS Medical students' overall attitudes towards psychiatry improved from pre- to post-clerkship, with the type of clerkship experience (traditional or virtual) having no significant impact on the magnitude to which attitudes improved. CONCLUSION Implementation of a virtual clerkship in psychiatry did not deteriorate medical student attitudes towards psychiatry as a specialty, with both the traditional and virtual clerkship program enhancing students' attitudes towards psychiatry favorably.
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Affiliation(s)
| | - Kevin Simas
- Carleton University, Ottawa, Ontario, Canada.
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Lai J, Tillman D. Curriculum to Develop Documentation Proficiency Among Medical Students in an Emergency Medicine Clerkship. MedEdPORTAL 2021; 17:11194. [PMID: 34820512 PMCID: PMC8590992 DOI: 10.15766/mep_2374-8265.11194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Documenting a clinical encounter is a core skill for entering residency, but medical students often receive scant dedicated documentation training, leading to a high rate of inadequate information. Utilizing adult experiential learning theory, we created and implemented an educational resource to train medical students on how to proficiently document an emergency department (ED) patient encounter. METHODS One hundred and five third- and fourth-year medical students participating in an emergency medicine clerkship took part in a brief orientation day documentation curriculum that included a group didactic, a review of reference materials, a standardized patient activity, a sample patient note writing assignment with individualized feedback, and supervising faculty physician feedback on real patient notes. Students were subsequently entrusted with primary documentation responsibility for all ED patients whose care they participated in. RESULTS After completing this curriculum, students' self-rated comfort with writing a high-quality note increased from 4.1 to 5.9 (p < .001) and knowledge about billing and coding increased from 2.9 to 5.5 (p < .001) on a 7-point scale. Among faculty physicians, 93% found student notes to always, usually, or frequently be clinically useful, and 86% reported that student notes always, usually, or frequently contained enough information for billing and coding. DISCUSSION This curriculum was effective at training medical students on proficient patient care documentation in emergency medicine. The relatively short amount of synchronous learning time required could aid in implementation, and the allowance of medical student notes to count for billing purposes could facilitate student and faculty buy-in.
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Affiliation(s)
- Jason Lai
- Clinical Assistant Professor, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health
| | - David Tillman
- Director of Medical Student Education, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health
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Morgenstern BZ, Roman BJB, DeWaay D, Golden WC, Malloy E, Reddy RM, Rutter AE, Salas R, Soni M, Starr S, Sutton J, Wald DA, Pangaro LN. Expectations of and for Clerkship Directors 2.0: A Collaborative Statement from the Alliance for Clinical Education. Teach Learn Med 2021; 33:343-354. [PMID: 34294018 DOI: 10.1080/10401334.2021.1929997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/27/2021] [Indexed: 06/13/2023]
Abstract
This article presents an update of the collaborative statement on clerkship directors (CDs), first published in 2003, from the national undergraduate medical education organizations that comprise the Alliance for Clinical Education (ACE). The clerkship director remains an essential leader in the education of medical students on core clinical rotations, and the role of the CD has and continues to evolve. The selection of a CD should be an explicit contract between the CD, their department, and the medical school, with each party fulfilling their obligations to ensure the success of the students, the clerkship and of the CD. Educational innovations and accreditation requirements have evolved in the last two decades and therefore this article updates the 2003 standards for what is expected of a CD and provides guidelines for the resources and support to be provided.In their roles as CDs, medical student educators engage in several critical activities: administration, education/teaching, coaching, advising, and mentoring, faculty development, compliance with accreditation standards, and scholarly activity. This article describes (a) the work products that are the primary responsibility of the CD; (b) the qualifications for the CD; (c) the support structure, resources, and personnel that are necessary for the CD to accomplish their responsibilities; (d) incentives and career development for the CD; and (e) the dedicated time that should be provided for the clerkship and the CD to succeed. Given all that should rightfully be expected of a CD, a minimum of 50% of a full-time equivalent is recognized as appropriate. The complexity and needs of the clerkship now require that at least one full-time clerkship administrator (CA) be a part of the CD's team.To better reflect the current circumstances, ACE has updated its recommendations for institutions and departments to have clear standards for what is expected of the director of a clinical clerkship and have correspondingly clear guidelines as to what should be expected for CDs in the support they are provided. This work has been endorsed by each of the eight ACE member organizations.
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Affiliation(s)
- Bruce Z Morgenstern
- Department of Pediatrics, Roseman University of Health Sciences College of Medicine, Las Vegas, Nevada, USA
| | - Brenda J B Roman
- Departments of Medical Education and Psychiatry, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Deborah DeWaay
- Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
| | - W Christopher Golden
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin Malloy
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Rishindra M Reddy
- Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ann E Rutter
- Department of Family and Community Medicine, Albany Medical College, Albany, New York, USA
| | - Rachel Salas
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Madhu Soni
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Stephanie Starr
- Department of Pediatrics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Jill Sutton
- Department of Obstetrics and Gynecology, Brody School of Medicine at East, Carolina University, Greenville, North Carolina, USA
| | - David A Wald
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Louis N Pangaro
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Egiz A, Storz MA. The COVID-19 pandemic: doom to international medical electives? Results from two German elective databases. BMC Res Notes 2021; 14:287. [PMID: 34311768 PMCID: PMC8312202 DOI: 10.1186/s13104-021-05708-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE International medical electives are an essential part of medical education and popular among medical students. During the COVID-19 pandemic, however, many students had assistantship placements postponed and electives cancelled. Educational institutions switched face-to-face campus-based teaching to virtual platforms. Although it is conceivable that international medical electives were particularly affected by this development, numerical data on this phenomenon is yet scarce. To investigate how the COVID-19 pandemic influenced the clinical elective behavior of German-speaking medical students, we systematically analyzed two large German online databases (Famulatur-Ranking and PJ-Ranking) cataloging medical elective experience testimonies. RESULTS The COVID-19 pandemic substantially reduced the number of German medical students undertaking abroad medical electives. Between 2018 and 2020, a total of 10,976 reports were uploaded to both databases. We observed a notable decline in abroad elective reports in 2020. Prior to the COVID-19 pandemic, almost 5% of reports uploaded to "PJ-ranking" covered an international medical elective. This number dropped to 1.68% in 2020. Analyzing "Famulaturranking", we observed a comparable phenomenon. While 4.74% of reports in 2019 covered an international elective, the number dropped to 2.02% in 2020. The long-term consequences of this phenomenon will be subject to future research.
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Affiliation(s)
- Abdullah Egiz
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Maximilian Andreas Storz
- Center for Complementary Medicine, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
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Pinilla S, Cantisani A, Klöppel S, Strik W, Nissen C, Huwendiek S. Introducing a Psychiatry Clerkship Curriculum Based on Entrustable Professional Activities: an Explorative Pilot Study. Acad Psychiatry 2021; 45:354-359. [PMID: 33598804 PMCID: PMC8116264 DOI: 10.1007/s40596-021-01417-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The authors evaluated a reformed psychiatry clerkship curriculum based on entrustable professional activities (EPAs). METHODS The authors conducted an exploratory pilot study of a reformed clerkship curriculum based on EPAs. A novel workplace-based assessment format including an entrustment-supervision scale and curricular adaptations were introduced. The Kirkpatrick model was used to evaluate outcomes of the reformed clerkship curriculum on three levels (1 = acceptance, 2 = learning, 3 = change of behavior). RESULTS The pilot student cohort (n = 10) completed a questionnaire, 180 self-assessments (18 per student) on need for supervision, and 63 workplace-based assessments (6.3 per student, in 4 weeks). Level 1: high overall satisfaction with the clerkship (five-point Likert item: average, 4.9; range: 4.0-5.0). Level 2: the overall significant decrease in self-assessed need for supervision before and after the clerkship was two supervision levels (direct to indirect supervision; p < 0.05). The most frequently documented admissions included schizophrenic disorders (n = 11; 28%), affective disorders (n = 10; 25%), substance abuse disorders (n = 5; 13%), and anxiety and stress-related disorders (n = 5; 13%). Level 3: clinical supervisors used history taking, assessing the mental status, and documentation and presentation for workplace-based assessments. According to supervisors' ratings, there was a decreasing need for supervision from the first to last week of the clerkship. CONCLUSIONS Students reacted positively to the reformed clerkship curriculum. The workplace-based assessments with entrustment ratings appeared to support achievement of competency-based learning objectives. Better understanding of how to cover assessment of all core EPAs in the psychiatry clerkship is needed.
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Affiliation(s)
- Severin Pinilla
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Institute for Medical Education, University of Bern, Bern, Switzerland.
| | - Andrea Cantisani
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Werner Strik
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Institute for Medical Education, University of Bern, Bern, Switzerland
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Qiu C, Girard A, Lopez CD, Yang R. Plastic Surgery Subinternships: Current Perspectives and Future Considerations. J Surg Educ 2021; 78:733-736. [PMID: 33097453 DOI: 10.1016/j.jsurg.2020.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/28/2020] [Accepted: 09/26/2020] [Indexed: 06/11/2023]
Abstract
Subinternships are an important feature of the integrated plastic and reconstructive surgery residency application process. In our experience, there exists institutional heterogeneity in how subinterns are evaluated, how they are given feedback, and how their performance is compared across institutions. In this report, we conducted standardized interviews with 9 past and present integrated plastic and reconstructive surgery residency program directors, eliciting their expert opinions on current limitations of subinternships as a method of medical student education and evaluation. There near-unanimous agreement that subinternships were an important tool for evaluating the intangible traits of subinterns, with emphasis on teamwork, work ethic, and preparation for cases. However, our respondents suggested that subinterns lack direct feedback about real-time subinternship performance, and that there is a lack of transparency to subinterns regarding the quality of letters of recommendation. In the current system of subinternship evaluation, the letter-writer's reputation possibly overshadows the subintern's actual performance, which can be unfair to the student. We encourage the academic plastic and reconstructive surgery community to work toward more consistent and equitable evaluation of subinterns to the benefit of both residency applicants and programs.
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Affiliation(s)
- Cecil Qiu
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Alisa Girard
- Rutgers - Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Christopher D Lopez
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Robin Yang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Pinilla S, Kyrou A, Klöppel S, Strik W, Nissen C, Huwendiek S. Workplace-based assessments of entrustable professional activities in a psychiatry core clerkship: an observational study. BMC Med Educ 2021; 21:223. [PMID: 33882926 PMCID: PMC8059233 DOI: 10.1186/s12909-021-02637-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/27/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Entrustable professional activities (EPAs) in competency-based, undergraduate medical education (UME) have led to new formative workplace-based assessments (WBA) using entrustment-supervision scales in clerkships. We conducted an observational, prospective cohort study to explore the usefulness of a WBA designed to assess core EPAs in a psychiatry clerkship. METHODS We analyzed changes in self-entrustment ratings of students and the supervisors' ratings per EPA. Timing and frequencies of learner-initiated WBAs based on a prospective entrustment-supervision scale and resultant narrative feedback were analyzed quantitatively and qualitatively. Predictors for indirect supervision levels were explored via regression analysis, and narrative feedback was coded using thematic content analysis. Students evaluated the WBA after each clerkship rotation. RESULTS EPA 1 ("Take a patient's history"), EPA 2 ("Assess physical & mental status") and EPA 8 ("Document & present a clinical encounter") were most frequently used for learner-initiated WBAs throughout the clerkship rotations in a sample of 83 students. Clinical residents signed off on the majority of the WBAs (71%). EPAs 1, 2, and 8 showed the largest increases in self-entrustment and received most of the indirect supervision level ratings. We found a moderate, positive correlation between self-entrusted supervision levels at the end of the clerkship and the number of documented entrustment-supervision ratings per EPA (p < 0.0001). The number of entrustment ratings explained 6.5% of the variance in the supervisors' ratings for EPA 1. Narrative feedback was documented for 79% (n = 214) of the WBAs. Most narratives addressed the Medical Expert role (77%, n = 208) and used reinforcement (59%, n = 161) as a feedback strategy. Students perceived the feedback as beneficial. CONCLUSIONS Using formative WBAs with an entrustment-supervision scale and prompts for written feedback facilitated targeted, high-quality feedback and effectively supported students' development toward self-entrusted, indirect supervision levels.
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Affiliation(s)
- Severin Pinilla
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland.
| | - Alexandra Kyrou
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Werner Strik
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
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Pedersen K, Moercke AM, Paltved C, Mors O, Ringsted C. Video cases as tricksters, in medical students´ transition to psychiatric clerkship. A liminal perspective. MedEdPublish (2016) 2021; 10:95. [PMID: 38486587 PMCID: PMC10939659 DOI: 10.15694/mep.2021.000095.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
This article was migrated. The article was marked as recommended. OBJECTIVE This study introduced a lens of liminal theory, drawn from anthropological classical ritual theory, to explore how a preparatory teaching format using video casesinfluenced medical students' patient approaches in their subsequent psychiatric clerkship. The video cases portrayed simulated patient-doctor encounters in diagnostic interview situations and were hypothesized to function as a liminal trickster. METHODS The study applied a qualitative explorative design using individual rich picture interviews. We asked the students to draw their experiences, which we investigated using a semi-structured interview guide designed to capture and unfold the students' perspectives. We explored how students navigated insights from the preparatory teaching in their clerkship using liminal theory concepts in a mixed inductive and deductive thematic analysis. RESULTS The results from 8 rich picture interviews demonstrated that students' ability to navigate insight gained from the video cases in their clerkship varied according to their roles in the clinical diagnostic interview situations. Students having active roles in the diagnostic interview situation adopted a patient-centred focus demonstrating empathic engagement and self-reflexivity related to their learning experiences with the video cases. Students with passive roles described a focus on how to adopt an appropriate appearance and copied the behaviour of the simulated doctors in the video cases. CONCLUSION The liminal ritual theory perspective to explore the influence of preparatory teaching was useful for demonstrating how video cases could affect students' patient-centred learning. Without guidance and active roles in clerkship, medical students' learning experiences may lead to a prolonged liminal phase and may not capitalise on the potentially positive effects of the preparatory teaching. Liminal theory may further inform our understanding of students' learning considering patient cases in educational technology arrangements as tricksters.
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Khan MA, Malviya M, English K, Forman R, Frisch S, Jordan K, Southern W, Raff A, Aksoy T. Medical Student Personality Traits and Clinical Grades in the Internal Medicine Clerkship. Med Sci Educ 2021; 31:637-645. [PMID: 34457916 PMCID: PMC8368116 DOI: 10.1007/s40670-021-01239-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 05/30/2023]
Abstract
BACKGROUND Third year clerkship grades include subjective evaluations. The purpose of this study is to identify if personality traits and self-esteem predispose students to better clerkship performance. METHODS Third-year medical students completed the OCEAN Five Factor Model Personality Test and Rosenberg Self-Esteem Scale. Clerkship grades were matched to survey results. Chi-squared and linear regression analyses assessed the correlation between students' clerkship grades, personality traits, and self-esteem. RESULTS There was no association between OCEAN personality domains and any component of clerkship grade. In secondary post hoc analysis, students who are "deep thinking" (OR 2.97, 95% CI 1.26-7.01, p = 0.01), "sophisticated" (OR 2.70, 95% CI 1.12-6.50, p = 0.03), and "outgoing" (OR 2.45, 95% CI 1.02-5.89, p = 0.04) were significantly more likely to get an overall clerkship grade of Honors. "Deep thinking" (OR 3.44, 95% CI 1.47-8.04, p = 0.004) and "efficient" (OR 2.87, 95% CI 1.12-7.36, p = 0.03) students scored better on shelf exams, while "shy" students scored worse (OR 0.30, 95% CI 0.13-0.69, p = 0.004); "aloof" students received worse clinical scores (OR 0.57, 95% CI 0.37-0.89, p = 0.03), and "rude" (OR 5.08, 95% CI 1.03-24.94, p = 0.03) and "sophisticated" (OR 2.47, 95% CI 1.02-6.00, p = 0.04) students received higher preceptor scores. There was no correlation between self-esteem and clerkship grades. CONCLUSION Students with certain personality traits may be predisposed to success during clerkships. Medical educators should be cognizant of biases favoring certain personalities and help students maximize success by recognizing their strengths and identifying gaps.
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Affiliation(s)
- Masrur A. Khan
- Albert Einstein College of Medicine, Bronx, NY USA
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - Monica Malviya
- Albert Einstein College of Medicine, Bronx, NY USA
- Department of Internal Medicine, New York University Winthrop Hospital, Mineola, NY USA
| | - Keara English
- Albert Einstein College of Medicine, Bronx, NY USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Rebecca Forman
- Albert Einstein College of Medicine, Bronx, NY USA
- Department of Internal Medicine, Yale Medical Center, New Haven, CT USA
| | - Stacey Frisch
- Albert Einstein College of Medicine, Bronx, NY USA
- Department of Emergency Medicine, State University of New York Downstate, Brooklyn, NY USA
| | - Kevin Jordan
- Albert Einstein College of Medicine, Bronx, NY USA
- Department of Medicine, Mt. Sinai Beth Israel, Icahn School of Medicine, New York, NY USA
| | - William Southern
- Albert Einstein College of Medicine, Bronx, NY USA
- Department of Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY USA
| | - Amanda Raff
- Albert Einstein College of Medicine, Bronx, NY USA
- Department of Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY USA
| | - Tulay Aksoy
- Albert Einstein College of Medicine, Bronx, NY USA
- Department of Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY USA
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Russo RA, Griffeth BT, Combs H, Dinsell V, Palka JM, Morreale MK, Borghesani PR, Harper BL, Hilty DM, Fore-Arcand L. Elements of an Excellent Psychiatry Clerkship Experience: A Survey Study of Graduating Medical Students. Acad Psychiatry 2021; 45:174-179. [PMID: 33409938 DOI: 10.1007/s40596-020-01373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE One possible factor associated with choosing psychiatry as a career is students rating their psychiatry clerkship as excellent. Although this suggests that an excellent clerkship may improve recruitment into psychiatry, to our knowledge there has never been a multi-site survey study of graduating medical students that identify what factors lead to an excellent clerkship rating. The purpose of this study was to determine factors that medical student find important for an excellent psychiatry clerkship experience. METHODS A total of 1457 graduating medical students at eight institutions were sent a 22-item Likert-type survey about what clinical and administrative factors they considered when rating their psychiatry clerkship via email in the fall of their last year. 357 (24.5%) responded and Z-test, t-tests, and multiple regression analyses were carried out. RESULTS The factors which students rated higher than the mean included planned application to psychiatry residency, clear expectations, a transparent grading process, feeling part of a team, timely feedback by faculty, and a competent clerkship coordinator and director. Lectures, active learning, and self-study were rated as less pertinent, and the overall clerkship rating did differ between students going into psychiatry versus other specialties. CONCLUSIONS Although the low response undermines the validity of findings, by improving the administration of the clerkship with clear expectations, grading, feedback, and by encouraging clinical teams to fully integrate students clerkship ratings might improve which could potentially improve recruitment. Future research could further quantify and qualify these parameters and compare psychiatric clerkships to other clerkships.
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Affiliation(s)
- Rachel A Russo
- VA North Texas Health Care System and University of Texas - Southwestern Medical Center, Dallas, TX, USA.
| | - Benjamin T Griffeth
- University of South Carolina School of Medicine-Greenville, Greenville, SC, USA
| | - Heidi Combs
- University of Washington School of Medicine, Seattle, WA, USA
| | - Victoria Dinsell
- New York University Grossman School of Medicine, New York, NY, USA
| | - Jayme M Palka
- VA North Texas Health Care System and University of Texas - Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | - Donald M Hilty
- VA Northern California Health Care System and University of California Davis School of Medicine, Davis, CA, USA
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Sukumar S, Zakaria A, Lai CJ, Sakumoto M, Khanna R, Choi N. Designing and Implementing a Novel Virtual Rounds Curriculum for Medical Students' Internal Medicine Clerkship During the COVID-19 Pandemic. MedEdPORTAL 2021; 17:11106. [PMID: 33768143 PMCID: PMC7970635 DOI: 10.15766/mep_2374-8265.11106] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/24/2020] [Indexed: 05/20/2023]
Abstract
INTRODUCTION During the COVID-19 pandemic, third-year medical students were temporarily unable to participate in onsite clinical activities. We identified the curricular components of an internal medicine (IM) clerkship that would be compromised if students learned solely from online didactics, case studies, and simulations (i.e., prerounding, oral presentations, diagnostic reasoning, and medical management discussions). Using these guiding principles, we created a virtual rounds (VR) curriculum to provide IM clerkship students with clinical exposure during a virtual learning period. METHODS Held three times a week for 2 weeks, VR consisted of three curricular components. First, clerkship students prerounded on an assigned hospitalized patient by remotely accessing the electronic health record and calling into hospital rounds. Second, each student prepared an oral presentation on their assigned patient. Third, using videoconferencing, students delivered these oral presentations to telemedicine VR small groups consisting of three to four students and three tele-instructors. Tele-instructors then provided feedback on oral presentations and taught clinical concepts. We assessed the effectiveness of VR by anonymously surveying students and tele-instructors. RESULTS Twenty-nine students and 34 volunteer tele-instructors participated in VR over four blocks. A majority of students felt VR improved their prerounding abilities (86%), oral presentation abilities (93%), and clinical reasoning skills (62%). All students found small group to be useful. DISCUSSION VR allowed students to practice rounding skills in a supportive team-based setting. The lessons learned from its implementation could facilitate education during future pandemics and could also supplement in-person clerkship education.
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Affiliation(s)
- Smrithi Sukumar
- Medical Student, University of California, San Francisco, School of Medicine
- Corresponding author:
| | - Adam Zakaria
- Medical Student, University of California, San Francisco, School of Medicine
| | - Cindy J. Lai
- Professor, Department of Medicine, and Director, Internal Medicine Clerkship, University of California, San Francisco, School of Medicine
| | - Matthew Sakumoto
- Assistant Professor–Volunteer, Department of Medicine, University of California, San Francisco, School of Medicine
| | - Raman Khanna
- Associate Professor, Department of Medicine, University of California, San Francisco, School of Medicine
| | - Nancy Choi
- Assistant Professor, Department of Medicine, and Assistant Site Director, Internal Medicine Clerkship, University of California, San Francisco, School of Medicine
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Shin TH, Klingler M, Han A, Mocsiran JL, Vilchez V, Naples R, French J, Lipman JM, Rosenblatt S. Efficacy of Virtual Case-Based General Surgery Clerkship Curriculum During COVID-19 Distancing. Med Sci Educ 2021; 31:101-108. [PMID: 33200037 PMCID: PMC7654350 DOI: 10.1007/s40670-020-01126-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The COVID-19 pandemic created a paradigm shift in medical education with a reliance upon alternative teaching methods to deliver meaningful surgery clerkship content. This study examines the efficacy of a novel, case-based virtual surgery clerkship curriculum to determine its impact on student experience during quarantine. STUDY DESIGN Sixteen third-year medical students enrolled in the General Surgery clerkship between April through June 2020 during COVID-19 distancing at a quaternary medical center (Cleveland Clinic, Cleveland, OH) participated in this study. Course surveys, including a 10-question curriculum-based multiple-choice assessment, were administered before and after the clerkship. Analyses include student self-perception of readiness to see a surgical consult independently, students' interest in pursuing a General Surgery residency, and improvement of surgical knowledge. RESULTS AND CONCLUSION On a 5-point Likert scale, students felt significantly more assured in their ability to independently assess a surgical consult by the end of the course. Five (31%) students reported an influence of the curriculum on their personal interest in a career in General Surgery. Mean scores on the curriculum-based knowledge assessment increased. These findings highlight that a virtual platform can be a reliable alternative adjunct that delivers surgical content and positively impacts student experience. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-020-01126-5.
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Affiliation(s)
- Thomas H. Shin
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Michael Klingler
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Amy Han
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Jennifer L. Mocsiran
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Valery Vilchez
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Robert Naples
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Judith French
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Jeremy M. Lipman
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Steven Rosenblatt
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
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Chai AL, Matsushima K, Strickland M, Sullivan ME, Inaba K, Demetriades D. A Nationwide Survey Study on Medical Student Experience in Acute Care Surgery. J Surg Res 2021; 261:146-51. [PMID: 33429223 DOI: 10.1016/j.jss.2020.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/28/2020] [Accepted: 12/08/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is little known about medical student education in acute care surgery (ACS)-how much and what type of exposure students receive in the specialty. The aim of this study was to investigate the current status of ACS education provided to students in U.S. medical schools. MATERIALS AND METHODS We created an online survey tool covering the surgical clerkship and ACS curriculum and distributed this survey to the official email list of the Association for Surgical Education Committee on Clerkship Directors. RESULTS A total of 57 of 294 (19.4%) responses were received. All respondents reported that at least some of their major teaching hospitals are affiliated with an ACS service and have a level 1 or 2 trauma center. Although almost two-thirds (61.8%) of respondents believe that medical students should have formal ACS education in the form of a clinical rotation, an ACS rotation is mandatory at only 16.4% of programs and is optional at 69.1% of programs as part of the surgical clerkship curriculum. The duration of ACS rotations ranges from 1 to 6 wk, and half of programs require students to take overnight call (most often 1-2 nights/wk). The most common pathologies that students see on ACS include appendicitis, biliary disease and cholecystitis, intestinal obstruction, and trauma. CONCLUSIONS Medical students across the nation have varying exposure to ACS during their clinical training. With the continued growth of the ACS specialty, further study is warranted to examine the impact of undergraduate ACS education on student career planning.
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Stites SD, Rodriguez S, Dudley C, Fiester A. Medical Students' Exposure to Ethics Conflicts in Clinical Training: Implications for Timing UME Bioethics Education. HEC Forum 2020; 32:85-97. [PMID: 32410016 DOI: 10.1007/s10730-020-09412-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
While there is significant consensus that undergraduate medical education (UME) should include bioethics training, there is widespread debate about how to teach bioethics to medical students. Educators disagree about course methods and approaches, the topics that should be covered, and the effectiveness and metrics for UME ethics training. One issue that has received scant attention is the timing of bioethics education during medical training. The existing literature suggests that most medical ethics education occurs in the pre-clinical years. Follow-up studies indicate that medical students in their clinical rotations have little recall or ability to apply ethics concepts that were learned in their pre-clinical training. Trainees also report a desire for medical ethics to be taught in the context of practical application, which would suggest that the timing of pre-clinical ethics education is flawed. However, moving bioethics training to the clinical years should not be assumed to be the solution to the problems of recall and theory application. We argue that the effectiveness of timing bioethics education will depend on when medical students witness or experience particular categories of ethical dilemmas during their training. Our overarching hypothesis is that ethics education will be most effective when the bioethics training on a particular topic correlates to experiential exposure to that ethical issue. The purpose of our current study was to describe medical students exposure to particular categories of ethical conflicts, dilemmas, or issues. Our results may help bioethics educators better strategize about the most effective timing of medical ethics training in UME.
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Affiliation(s)
- S D Stites
- University of Pennsylvania, 423 Guardian Dr., Blockley Hall Floor 14, Philadelphia, PA, 19104, USA
| | - S Rodriguez
- University of Pennsylvania, 423 Guardian Dr., Blockley Hall Floor 14, Philadelphia, PA, 19104, USA
| | - C Dudley
- University of Pennsylvania, 423 Guardian Dr., Blockley Hall Floor 14, Philadelphia, PA, 19104, USA
| | - A Fiester
- University of Pennsylvania, 423 Guardian Dr., Blockley Hall Floor 14, Philadelphia, PA, 19104, USA.
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Abstract
Clinical reasoning is crucial to good patient care, but both learning and applying clinical reasoning skills in the context of a complex working environment can be challenging. We sought to understand the perceived barriers to learning clinical reasoning, as experienced by internal medicine clerkship students at our institution. We invited internal medicine clerkship students to participate in focus groups to discuss their experiences with and barriers to learning clinical reasoning. A survey was administered to gather additional responses. Responses were reviewed, coded, and synthesized to identify key themes. Twenty-nine medicine clerkship students (male = 14, female = 15) participated in six 60-minute focus groups, and 121 (61% response rate) students responded to the barriers to clinical reasoning survey from March 2018 to May 2019. We identified three themes (clerkship acclimation, data access, and practice optimization) and ten subthemes as aspects of the clerkship environment that impacted students' ability to develop clinical reasoning skills. Students identified barriers to learning clinical reasoning during the internal medicine clerkship. The themes "clerkship acclimation" and "data access" were identified as prerequisites to clinical reasoning while the theme "practice optimization" described key components of the deliberate practice of clinical reasoning. Educators and health systems may improve the development of clinical reasoning by recognizing and overcoming these barriers within clinical learning environments.
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Affiliation(s)
- Nicholas Duca
- Department of Medicine, Penn State College of Medicine, 500 University Drive H034, Hershey, PA 17033 USA
| | - Nancy Adams
- Harrell Health Sciences Library, Penn State College of Medicine, Hershey, PA USA
| | - Susan Glod
- Department of Medicine, Penn State College of Medicine, 500 University Drive H034, Hershey, PA 17033 USA
| | - Paul Haidet
- Department of Medicine, Penn State College of Medicine, 500 University Drive H034, Hershey, PA 17033 USA
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Austin JP, Baskerville M, Bumsted T, Haedinger L, Nonas S, Pohoata E, Rogers M, Spickerman M, Thuillier P, Mitchell SH. Development and evaluation of a simulation-based transition to clerkship course. Perspect Med Educ 2020; 9:379-384. [PMID: 32458381 PMCID: PMC7718359 DOI: 10.1007/s40037-020-00590-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Transition to clerkship courses bridge the curricular gap between preclinical and clinical medical education. However, despite the use of simulation-based teaching techniques in other aspects of medical training, these techniques have not been adequately described in transition courses. We describe the development, structure and evaluation of a simulation-based transition to clerkship course. APPROACH Beginning in 2012, our institution embarked upon an extensive curricular transformation geared toward competency-based education. As part of this effort, a group of 12 educators designed, developed and implemented a simulation-based transition course. The course curriculum involved seven goals, centered around the 13 Association of American Medical Colleges Core Entrustable Professional Activities for entering residency. Instructional techniques included high-fidelity simulation, and small and large group didactics. Student competency was determined through a simulation-based inpatient-outpatient objective structured clinical examination, with real-time feedback and remediation. The effectiveness of the course was assessed through a mixed methods approach involving pre- and post-course surveys and a focus group. EVALUATION Of 166 students, 152 (91.6%) completed both pre- and post-course surveys, and nine students participated in the focus group. Students reported significant improvements in 21 out of 22 course objectives. Qualitative analysis revealed three key themes: learning environment, faculty engagement and collegiality. The main challenge to executing the course was procuring adequate faculty, material and facility resources. REFLECTION This simulation-based, resource-heavy transition course achieved its educational objectives and provided a safe, supportive learning environment for practicing and refining clinical skills.
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Affiliation(s)
- Jared P Austin
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.
| | - Mark Baskerville
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Tracy Bumsted
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Leslie Haedinger
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Stephanie Nonas
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Eugen Pohoata
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Meghan Rogers
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Megan Spickerman
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Philippe Thuillier
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Suzanne H Mitchell
- Departments of Behavioral Neuroscience, Psychiatry and the Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
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Coffey CS, MacDonald BV, Shahrvini B, Baxter SL, Lander L. Student Perspectives on Remote Medical Education in Clinical Core Clerkships During the COVID-19 Pandemic. Med Sci Educ 2020; 30:1577-1584. [PMID: 33078085 PMCID: PMC7556768 DOI: 10.1007/s40670-020-01114-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 05/17/2023]
Abstract
PURPOSE To assess student perceptions of remote learning curricula implemented by clinical clerkships at a single US medical school during the COVID-19 pandemic. METHOD Students enrolled in core clinical clerkships at the UC San Diego School of Medicine from March to April 2020 were sent an anonymous online survey, assessing components of remote learning curricula via quantitative rating and free-response questions. RESULTS Of 132 students enrolled, 96 (73%) completed the survey. Online question banks, remote progress reviews, and telehealth sessions were rated as the most valuable resources, while textbooks were rated least valuable. Most students felt that the number of resources was adequate (69/94, 74%), the quantity of required content was appropriate (77/93, 83%), and there was a good balance of rigidity versus flexibility in the schedule (81/94, 86%). Most students felt "prepared" or "somewhat prepared" for the shelf examination (61/91, 67%) and for the next year of medical training (73/94, 78%). In narrative reflections, students valued the flexibility afforded by remote curricula but desired some weekly structure. Students enjoyed expanded access to learning resources and participating in interactive remote sessions. Students expressed anxiety about the pandemic and uncertainty regarding medical education, but transparent communication from clerkship directors helped assuage these concerns. CONCLUSIONS Student participation in direct patient care is fundamental to medical school core clerkships and was negatively impacted by the COVID-19 pandemic. Strategic incorporation of select remote learning components into clinical clerkships may permit a favorable student experience even when opportunities for on-site participation are limited.
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Affiliation(s)
- Charles S. Coffey
- Department of Surgery, Division of Otolaryngology/Head and Neck Surgery, University of California San Diego Moores Cancer Center, 3855 Health Sciences Dr. #0987, La Jolla, CA 92093-0987 USA
| | | | - Bita Shahrvini
- University of California San Diego School of Medicine, La Jolla, CA USA
| | - Sally L. Baxter
- Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, CA USA
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA USA
| | - Lina Lander
- Innovation and Medical Education, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA USA
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Ndoja S, Chahine S, Saklofske DH, Lanting B. The erosion of ambiguity tolerance and sustainment of perfectionism in undergraduate medical training: results from multiple samplings of a single cohort. BMC Med Educ 2020; 20:417. [PMID: 33167964 PMCID: PMC7654157 DOI: 10.1186/s12909-020-02345-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 10/30/2020] [Indexed: 05/16/2023]
Abstract
BACKGROUND Medicine is a field that is simultaneously factual and ambiguous. Medical students have their first exposure to full time clinical practice during clerkship. While studies have examined medical trainees' tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with perfectionism is unknown. The aim of this study was to evaluate the effect of clerkship experience on TOA and perfectionism in medical students. METHODS This was a multiple sampling, single cohort study of students in their first year of clinical clerkship which is comprised of 6 core rotations. Consenting students completed an online anonymous survey assessing their tolerance of ambiguity (TOA) and perfectionism in their first (pre) and last (post) 12 weeks of their clinical clerkship year. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons of TOA and perfectionism were assessed via t-tests. RESULTS From a cohort of 174 clinical clerkship students, 51 students responded to pre-survey, 62 responded to post-survey. Clerkship was associated with a significant decrease in TOA (p < 0.00) with mean pre-TOA scores of 59.57 and post TOA of 43.8. Perfectionism scores were not significantly different over time (p > 0.05). There was a moderate inverse correlation between TOA and perfectionism before clerkship (r = 0.32) that increased slightly after clerkship (r = 0.39). Those preferring primary care specialties had significantly lower rigid and total perfectionism scores in pre-clerkship than those choosing other specialties, but this difference was not found post-clerkship. CONCLUSION Exposure to clerkship decreased TOA while perfectionism remained stable in medical students. These results were not expected as exposure has been previously shown to increase TOA. The frequency of rotation changes maintaining a cycle of anxiety may be an underlying factor accounting for these results. Overall these results require further investigation to better characterize the role of clinical exposure on TOA.
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Affiliation(s)
- Silvio Ndoja
- Schulich School of Medicine & Dentistry, University of Western Ontario, 1151 Richmond St, London, ON, N6A 5C1, Canada.
| | - Saad Chahine
- Faculty of Education, Queen's University, Duncan McArthur Hall, 511 Union St W, Kingston, ON, K7M 5R7, Canada
| | - Donald H Saklofske
- Department of Psychology, University of Western Ontario, 1151 Richmond St, London, ON, N6A 5C1, Canada
| | - Brent Lanting
- Schulich School of Medicine & Dentistry, University of Western Ontario, 1151 Richmond St, London, ON, N6A 5C1, Canada
- London Health Sciences, 339 Windermere Rd, London, ON, N6A 5A5, Canada
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Abbas M, Dhane M, Beniey M, Meloche-Dumas L, Eissa M, Guérard-Poirier N, El-Raheb M, Lebel-Guay F, Dubrowski A, Patocskai E. Repercussions of the COVID-19 pandemic on the well-being and training of medical clerks: a pan-Canadian survey. BMC Med Educ 2020; 20:385. [PMID: 33109168 PMCID: PMC7590563 DOI: 10.1186/s12909-020-02293-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/09/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND The COVID-19 pandemic has been an unprecedented and potentially stressful event that inserted itself into the 2019-2020 Canadian medical curriculum. However, its impact on stress and subsequent professional pathways is not well understood. This study aims to assess the impact of the COVID-19 pandemic on the mental well-being, training, and career choices of Canadian medical clerks within the first three months of the pandemic. It also aims to assess their use of university support systems and their appreciation of potential solutions to common academic stressors. METHODS An electronic survey composed of four sections: demographics, stressors experienced during the pandemic, World Health Organization (WHO) well-being index, and stress management and resources was distributed to Canadian clerks. RESULTS Clerks from 10 of the 17 Canadian medical faculties participated in this study (n = 627). Forty-five percent of clerks reported higher levels of stress than usual; 22% reconsidered their residency choice; and 19% reconsidered medicine as a career. The factors that were most stressful among clerks were: the means of return to rotations; decreased opportunities to be productive in view of residency match; and taking the national licensing exam after the beginning of residency. The mean WHO well-being index was 14.8/25 ± 4.5, indicating a poor level of well-being among a considerable proportion of students. Clerks who reconsidered their residency choice or medicine as a career had lower mean WHO well-being indices. Most clerks agreed with the following suggested solutions: training sessions on the clinical management of COVID-19 cases; being allowed to submit fewer reference letters when applying to residency; and having protected time to study for their licensing exam during residency. Overall, clerks were less concerned with being infected during their rotations than with the impact of the pandemic on their future career and residency match. CONCLUSION The COVID-19 pandemic had a considerable impact on the medical curriculum and well-being of clerks. A number of student-identified solutions were proposed to reduce stress. The implementation of these solutions throughout the Canadian medical training system should be considered.
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Affiliation(s)
- Myriam Abbas
- Simulation and Medical Education Research Group, Université de Montréal, Montréal, QC Canada
- Faculté de médecine, Université de Montréal, 2900 Blvd Edouard Montpetit, Montréal, Quebec H3T 1J4 Canada
| | - Malek Dhane
- Simulation and Medical Education Research Group, Université de Montréal, Montréal, QC Canada
- Faculté de médecine, Université de Montréal, 2900 Blvd Edouard Montpetit, Montréal, Quebec H3T 1J4 Canada
| | - Michèle Beniey
- Simulation and Medical Education Research Group, Université de Montréal, Montréal, QC Canada
- Faculté de médecine, Université de Montréal, 2900 Blvd Edouard Montpetit, Montréal, Quebec H3T 1J4 Canada
| | - Léamarie Meloche-Dumas
- Simulation and Medical Education Research Group, Université de Montréal, Montréal, QC Canada
- Faculté de médecine, Université de Montréal, 2900 Blvd Edouard Montpetit, Montréal, Quebec H3T 1J4 Canada
| | - Mohamed Eissa
- Faculty of Medicine, Dalhousie University, 6299 South Street, Halifax, Nova Scotia B3H 4R2 Canada
| | - Natasha Guérard-Poirier
- Simulation and Medical Education Research Group, Université de Montréal, Montréal, QC Canada
- Faculté de médecine, Université de Montréal, 2900 Blvd Edouard Montpetit, Montréal, Quebec H3T 1J4 Canada
| | - Myriam El-Raheb
- Simulation and Medical Education Research Group, Université de Montréal, Montréal, QC Canada
- Faculté de médecine, Université de Montréal, 2900 Blvd Edouard Montpetit, Montréal, Quebec H3T 1J4 Canada
| | - Florence Lebel-Guay
- Simulation and Medical Education Research Group, Université de Montréal, Montréal, QC Canada
- Faculté de médecine, Université de Montréal, 2900 Blvd Edouard Montpetit, Montréal, Quebec H3T 1J4 Canada
| | - Adam Dubrowski
- Ontario Tech University, 200 Simcoe Nord street, Oshawa, Ontario L1G 0C5 Canada
| | - Erica Patocskai
- Simulation and Medical Education Research Group, Université de Montréal, Montréal, QC Canada
- Department of Surgical Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), 1051 rue Sanguinet, Montréal, Quebec H2X 0C1 Canada
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McKinley SK, Cassidy DJ, Mansur A, Saillant N, Ghosh A, Evenson A, Askari R, Haynes A, Cho N, James BC, Olasky J, Rangel E, Petrusa E, Phitayakorn R. Identification of Specific Educational Targets to Improve the Student Surgical Clerkship Experience. J Surg Res 2020; 254:49-57. [PMID: 32408030 DOI: 10.1016/j.jss.2020.03.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/12/2020] [Accepted: 03/31/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study describes the relationship between medical student perception of surgery, frequency of positive surgery clerkship activities, and overall surgical clerkship experience. METHODS Medical students at four academic hospitals completed pre- and post-clerkship surveys assessing 1) surgery clerkship activities/experiences and 2) perceptions of surgery during the 2017-2018 academic year. RESULTS Ninety-one percent of students completed both a pre- and post-clerkship survey (n = 162 of 179). Student perception of surgery significantly improved across the clerkship overall (P < 0.0001) and for 7 of 21 specific items. Eighty-six percent of students agreed that the clerkship was a meaningful experience. Sixty-six percent agreed that the operating room was a positive learning environment. Multivariable logistic regression identified one-on-one mentoring from a resident (OR [95% CI] = 2.12 [1.11-4.04], P = 0.02) and establishing a meaningful relationship with a surgical patient (OR = 2.21 [1.12-4.37], P = 0.02) as activities predictive of student agreement that the surgical clerkship was meaningful. Making an incision (OR = 2.92 [1.54-5.56], P = 0.001) and assisting in dissection (OR = 1.67 [1.03-2.69], P = 0.035) were predictive of student agreement that the operating room was a positive learning environment. Positive student perception of surgery before the clerkship was associated with increased frequency of positive clerkship activities including operative involvement (r = 0.26, P = 0.001) and relationships with surgical attendings (r = 0.20, P = 0.01), residents (r = 0.41, P < 0.0001), and patients (r = 0.24, P = 0.003). CONCLUSIONS Interventions to improve surgery clerkship quality should target enhancing student relationships with residents and surgical patients as well as providing opportunity for student operative involvement beyond just suturing. In addition, fostering positive perceptions of surgery in the preclinical period may increase meaningfulness and experience with the later surgery clerkship.
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Affiliation(s)
- Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Douglas J Cassidy
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arian Mansur
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Amy Evenson
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Reza Askari
- Harvard Medical School, Boston, Massachusetts
| | - Alex Haynes
- Department of Surgery, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts
| | - Nancy Cho
- Harvard Medical School, Boston, Massachusetts
| | - Benjamin C James
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Jaisa Olasky
- Department of Surgery, Dell Medical School, University of Texas, Austin, Texas
| | | | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Bird A, Tomescu O, Oyola S, Houpy J, Anderson I, Pincavage A. A Curriculum to Teach Resilience Skills to Medical Students During Clinical Training. MedEdPORTAL 2020; 16:10975. [PMID: 33015355 PMCID: PMC7526502 DOI: 10.15766/mep_2374-8265.10975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/26/2020] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Burnout in medical students is extensive and a critical issue. It is associated with increased rates of depression, suicide, and poor perception of the educational environment. Enhancing resilience, the ability to adapt well in the face of adversity, is a potential tool to mitigate burnout and improve medical student wellness. METHODS Our resilience curriculum consisted of facilitated workshops to cultivate resilience in medical students during their core clerkship rotations. This curriculum served as an introduction to the concept of resilience and taught skills to cultivate resilience and promote wellness. The sessions allowed for identification of and reflection on stressors in the clinical learning environment, including straining team dynamics, disappointment, and uncertainty. Educational sessions included resilience skill-building exercises for managing expectations, letting go of negative emotions, dealing with setbacks, and finding meaning in daily work. Associated materials included lesson plans for small-group facilitators, learner pre- and postcurriculum surveys, and a social media activity guide. RESULTS This curriculum was delivered to 144 clerkship students at two academic institutions over the 2017-2018 academic year. Sessions were well received by medical students, with the majority of students stating that the sessions should continue. The majority of attendees found the sessions valuable and learned new ways to approach challenges. DISCUSSION Students valued connecting with peers and feeling less alone through their participation. A challenge was constructing a setting conducive to comfortable reflection for all learners. Not all students found these sessions necessary. Sessions may have improved resilience levels.
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Affiliation(s)
- Amber Bird
- Assistant Professor of Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania
- Corresponding Author:
| | - Oana Tomescu
- Associate Professor of Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania
| | - Sonia Oyola
- Assistant Professor, Department of Family Medicine, University of Chicago Pritzker School of Medicine
| | - Jennifer Houpy
- Internal Medicine Resident, Department of Medicine, University of Chicago Pritzker School of Medicine
| | - Irsk Anderson
- Assistant Professor, Department of Medicine, University of Chicago Pritzker School of Medicine
| | - Amber Pincavage
- Associate Professor, Department of Medicine, University of Chicago Pritzker School of Medicine
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Lee SJ, Park CS, Kim BJ, Lee CS, Cha B, Lee YJ, Kim SJ, Hahm JR, Seo JH, Lee D, Seo J, Choi JW. Psychological Development during Medical School Clerkship: Relationship to Resilience. Acad Psychiatry 2020; 44:418-422. [PMID: 32048174 DOI: 10.1007/s40596-020-01191-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The authors investigated changes in medical students' defenses during clerkship and examined the effects of these changes on students' resilience. METHODS Between 2012 and 2014, all year-2 preclinical students (N = 249) at Gyeongsang National University Medical School were asked to participate. Those who agreed to participate (N = 237) completed the Korean version of the Defense Style Questionnaire (K-DSQ) and the Connor-Davidson resilience scale-10 (CD-RISC-10). After clerkship, students who proceeded to year 4 in 2 years (n = 187 (93 females), aged 24-38 years (mean, 28.9 ± 2.8 years)) completed the K-DSQ, CD-RISC-10, and the Korean version of the Hospital Anxiety and Depression Scale (K-HADS) in September 2014, 2015, and 2016. RESULTS The use of adaptive (W = 11,603.5, p < 0.001, r = 0.39) and self-inhibiting (W = 10,901.5, p < 0.001, r = 0.32) styles increased significantly after clerkship. A multiple linear regression analysis showed that changes in adaptive defense styles (B = 1.336, SE = 0.386, β = 0.218, p = 0.001) during clerkship were significantly related to resilience after adjusting for age, sex, depression, and anxiety. CONCLUSIONS Both positive personality development and maladaptive changes in defenses were evident. An increase in the adaptive defense style score was related to resilience.
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Affiliation(s)
- So-Jin Lee
- Gyeongsang National University Hospital, Jinju, Republic of Korea
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Chul-Soo Park
- Gyeongsang National University Hospital, Jinju, Republic of Korea.
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
| | - Bong-Jo Kim
- Gyeongsang National University Hospital, Jinju, Republic of Korea
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Cheol-Soon Lee
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Boseok Cha
- Gyeongsang National University Hospital, Jinju, Republic of Korea
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Yu-Jin Lee
- Seoul National University Hospital, Seoul, Republic of Korea
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seog-Ju Kim
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Ryeal Hahm
- Gyeongsang National University Hospital, Jinju, Republic of Korea
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Ji-Hyun Seo
- Gyeongsang National University Hospital, Jinju, Republic of Korea
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Dongyun Lee
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jiyeong Seo
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jae-Won Choi
- Gyeongsang National University Hospital, Jinju, Republic of Korea
- Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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Johnston A, Barrick K, Jivraj F, Ram R. 'The Virtual Check-In': A tool to facilitate virtual patient interaction for early clinical learners in a longitudinal integrated clerkship. MedEdPublish (2016) 2020; 9:108. [PMID: 38073841 PMCID: PMC10702631 DOI: 10.15694/mep.2020.000108.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
This article was migrated. The article was marked as recommended. In response to restrictions on learner placements in clinical environments during the COVID-19 pandemic the authors developed a tool, 'The Virtual Check-In', for clinical clerks in the University of Calgary Longitudinal Integrated Clerkship. These learners, who had been pulled from their rural and remote communities because of the pandemic, used the tool to continue to develop their clinical skills while working with their preceptors and patients online. This paper describes the rapid development of the tool using Kern's principles for curriculum development and implementation, the format and uses of the final tool, and its potential use in other contexts.
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Keser Z, Rodriguez YA, Tremont J, Hsieh PH, McCullough LD, Sandrone S, Stimming EF. The role of residents in medical students' neurology education: current status and future perspectives. BMC Med Educ 2020; 20:115. [PMID: 32299428 PMCID: PMC7164350 DOI: 10.1186/s12909-020-02036-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/06/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND Neurophobia, a well-described fear of neurology, affects medical students worldwide and may be one of the factors contributing to a shortage of neurologists in the United States. Residents spend a considerable amount of time with medical students; therefore, we sought to understand better the impact neurology residents have on medical students during their neurology clerkship and their subsequent interest in neurology. We aimed to identify and implement strategies to decrease neurophobia and increase the number of students pursuing neurology as a career. METHODS Third-year medical students (n = 234) of UTHealth's McGovern Medical School rotating through their neurology core clerkship completed two surveys regarding their rotation experiences. Surveys were completed anonymously before and after the clerkship to measure their interest and confidence in neurology and the impact of their interactions with the neurology residents during the clerkship. In parallel, residents participated in a teaching workshop focused on small group teaching to improve their teaching effectiveness. Non-parametrical comparison and ordinal regression analyses were utilized for data analyses. RESULTS Medical students reported a statistically significant increase in their confidence in managing neurological conditions and interest in pursuing a neurology residency after their clerkship. There was a significant association between the medical students' overall rotation experience and the residents' teaching effectiveness. The overall clerkship experience correlated with the medical students' interest and confidence in neurology. There was a trend towards an increase in residents' teaching effectiveness and students' rotation experience after a resident teaching workshop. Additionally, of note, students who rotated on both and outpatient and inpatient sites during their clerkship reported an increased interest in neurology. CONCLUSION Our study supports that resident-led teaching efforts are important in improving medical students' neurologic education and their interest in neurology. Our data also supports that the interest in neurology increased for medical students after their neurology clerkship. We examined future strategies to implement "near-peer" teaching activities to enhance the medical students' neurologic educational experience. These strategies could potentially mitigate neurophobia and ultimately lead to a much-needed increase in future neurologists.
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Affiliation(s)
- Zafer Keser
- Neurology Department, UTHealth McGovern Medical School, 6431 Fannin Street, Suite 7.044, Houston, TX, 77030, USA.
| | - Yvo A Rodriguez
- Neurology Department, UTHealth McGovern Medical School, 6431 Fannin Street, Suite 7.044, Houston, TX, 77030, USA
| | - Jennifer Tremont
- Neurology Department, UTHealth McGovern Medical School, 6431 Fannin Street, Suite 7.044, Houston, TX, 77030, USA
| | - Peggy H Hsieh
- Internal Medicine Department, UTHealth McGovern Medical School, Houston, TX, 77030, USA
| | - Louise D McCullough
- Neurology Department, UTHealth McGovern Medical School, 6431 Fannin Street, Suite 7.044, Houston, TX, 77030, USA
| | - Stefano Sandrone
- Department of Brain Sciences, Imperial College London, London, UK
| | - Erin F Stimming
- Neurology Department, UTHealth McGovern Medical School, 6431 Fannin Street, Suite 7.044, Houston, TX, 77030, USA
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Hansen JR, Gefke M, Hemmingsen R, Fog-Petersen C, Høegh EB, Wang A, Arnfred SM. E-Library of Authentic Patient Videos Improves Medical Students' Mental Status Examination. Acad Psychiatry 2020; 44:192-195. [PMID: 31722086 PMCID: PMC7078136 DOI: 10.1007/s40596-019-01130-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 10/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE During psychiatric rotation, clerkship students must learn the clinical skill of recording an accurate Mental Status Examination (MSE). The authors built a video e-library consisting of 23 authentic patient videos that were accessible on a secure website during the rotation period, aimed at assisting students' acquisition of MSE skills. METHODS The authors conducted a prospective case comparison study investigating the impact of the video e-library as "add-on" intervention, on acquisition of MSE skills, as measured by a test consisting of three videos with adjoining forced choice questionnaires. Eighty-five clerkship students had instructions and access to the video e-library whereas 82 did not. A group of clinicians, unfamiliar with the video e-library, was also subjected to the new MSE skills test and they served as a reference group. Outcome was defined as scores of MSE skills measured by the purpose made MSE skills test and entailed evaluation questions on the students' use of the e-library. RESULTS The MSE skill test score differed between the three groups, and the clinicians scored higher than both student groups (clinicians mean score (M) 12.6; p < 0.001). However, the students with video access scored higher compared to students without access (M 10.7 versus M 9.9, p = 0.04). The e-library was appreciated by the students as helpful (83.6%) and they used it not only for practicing the MSE but also for observation of interviewing techniques. CONCLUSION The e-library with video vignettes of authentic patients strengthens MSE skills as "add-on" to the psychiatric rotation, and evaluations by the students were positive.
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Affiliation(s)
- Jessica R Hansen
- Psychiatry West, Slagelse, Region Zealand Mental Health Service, Slagelse, Denmark
| | - Maria Gefke
- Psychiatry West, Slagelse, Region Zealand Mental Health Service, Slagelse, Denmark
| | - Ralf Hemmingsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Cecilie Fog-Petersen
- Psychiatry West, Slagelse, Region Zealand Mental Health Service, Slagelse, Denmark
| | - Erica B Høegh
- Psychiatry West, Slagelse, Region Zealand Mental Health Service, Slagelse, Denmark
| | - August Wang
- Mental Health Center Amager, Capital Region Mental Health Services, Copenhagen, Denmark
| | - Sidse Marie Arnfred
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.
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Kirpalani A, Grimmer J, Peebles ER. A Blended Model of Case-Based Learning in a Paediatric Clerkship Program. Med Sci Educ 2020; 30:23-24. [PMID: 34457631 PMCID: PMC8368365 DOI: 10.1007/s40670-020-00922-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Education during the clinical clerkship years requires active learning. Students cannot be bystanders, but rather they must discover, apply, and integrate new information in a clinical context. We present a novel model of case-based learning that encourages active learning, focusing on problem-solving skills for the clinical environment.
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Affiliation(s)
- Amrit Kirpalani
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON Canada
| | - Joanne Grimmer
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON Canada
| | - Erin R. Peebles
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON Canada
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Sless RT, Hayward NE, Ryan PM, Kovacs-Litman A, Najeeb U. Lessons from across the pond: Student perspectives on the Internal Medicine clerkship experience at an Irish and Canadian medical school. MedEdPublish (2016) 2020; 9:16. [PMID: 38073846 PMCID: PMC10702639 DOI: 10.15694/mep.2020.000016.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
This article was migrated. The article was marked as recommended. There is an increasing number of Canadians studying medicine outside of Canada, with a large cohort studying in Ireland. Studying abroad often means different foci in medical training which may make transitioning to residency in a different system more challenging. Students often enter North American elective rotations with little knowledge of student roles and responsibilities. This paper provides insight into the differences in learning objectives and student experiences in an Internal Medicine clerkship at a medical school in Canada and Ireland. Learning objectives are similar between systems; but there is an experiential discordance. In Ireland, clerks see many different patients, gaining exposure to a breadth of topics and clinical signs, but medical student presentations rarely inform decisions around patient care. In Canada, clerks have more direct patient responsibilities, performing physical examinations, reviewing investigations, writing progress notes, and devising management plans as part of their professional development. Overall, the Irish system places emphasis on the mastery of core clinical skills and maximizing breadth of patient exposure whereas the Canadian clerkship is more focused on graduated responsibility and formulating management plans, at the expense of some breadth of exposure. Such discrepancies may not affect the quality of residents, but are important considerations for Canadians studying abroad when repatriating for electives and residencies.
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Pernar LIM, Askari R, Breen EM. Oral examinations in undergraduate medical education - What is the 'value added' to evaluation? Am J Surg 2020; 220:328-33. [PMID: 31918844 DOI: 10.1016/j.amjsurg.2019.12.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/19/2019] [Accepted: 12/30/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Given the long tradition of oral examinations in surgical training, surgical clerkships continue to use oral examinations to evaluate medical students even though the value of oral examination at the post-graduate level has been questioned. The key issue in the context of undergraduate surgical training then is to understand value of the oral examination in assessment. The goal of this study is to clarify what oral examinations do, or appear to, test and how this complements other methods of assessment. METHODS The study is a retrospective, qualitative study of comments provided by examiners on the oral examination score sheets evaluating performance of students completing their core surgery clerkship at an academic medical center. Through immersion in and initial familiarization with the data we develop a scheme of codes for labeling the data for subsequent synthesis. Using these inductive codes, all comments were reviewed and analyzed to determine what qualities examiners detect, or naturally comment on, when administering and scoring the oral examinations. RESULTS Thirteen substantive codes (Communication, Critical Thinking, Decisiveness, Demeanor, Differential Diagnosis, Focus, Knowledge, Management, Organization, Pace, Prompting, Thoroughness, and Work Up) and three valence codes (Negative, Neutral, and Positive) were developed and used to code the data. The most universal code was 'Knowledge', used by 43 (100%) of examiners; the most frequently used code was 'Work Up', applied to the comments 437 (21.1%) times. Overall, positive valence was attached to 1146 (55.2%) of codes and negative valence to 879 (42.3%) codes. The most discriminating codes in grading were 'Demeanor', 'Focus', and 'Organization'. CONCLUSIONS Oral examinations provide rich opportunity for testing qualities readily tested on other examinations but also many intangible qualities that are otherwise less well or not well tested. As such, the 'value-added' by oral examinations likely justifies their continued use in the evaluation of surgical trainees. The identification of testable qualities should aid in the development of a standardized scoring rubric, the use of which may aid in minimizing subjectivity and bias in what otherwise is a rich assessment tool.
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Lin YK, Lin CD, Lin BYJ, Chen DY. Medical students' resilience: a protective role on stress and quality of life in clerkship. BMC Med Educ 2019; 19:473. [PMID: 31881997 PMCID: PMC6935077 DOI: 10.1186/s12909-019-1912-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 12/19/2019] [Indexed: 05/13/2023]
Abstract
BACKGROUND Resilience refers to the ability to be flexible and adaptive in response to challenges. Medical students in clerkship who are transitioning from medical studies to clinical practice face a variety of workplace demands that can lead to negative learning experiences and poor quality of life. This study explored whether medical students' resilience plays a protective role against the stresses incurred during workplace training and on their professional quality of life during clerkships. METHODS This was a 1-year prospective web-based questionnaire study comprising one cohort of medical students in their fifth year who were working as clerks as part of their 6-year medical education programme at one medical school in Taiwan between September 2017 and July 2018. Web-based, validated, structured, self-administered questionnaires were used to measure the students' resilience at the beginning of the clerkship and their perceived training stress (i.e. physical and psychological demands) and professional quality of life (i.e. burnout and compassion satisfaction) at each specialty rotation. Ninety-three medical students who responded to our specialty rotation surveys at least three times in the clerkship were included and hierarchical regressions were performed. RESULTS This study verified the negative effects of medical students' perceived training stress on burnout and compassion satisfaction. However, although the buffering (protective) effects of resilience were observed for physical demands (one key risk factor related to medical students' professional quality of life), this was not the case for psychological demands (another key risk factor). In addition, through the changes in R square (∆R2) values of the hierarchical regression building, our study found that medical students' perceived training stresses played a critical role on explaining their burnout but their resilience on their compassion satisfaction. CONCLUSIONS Medical students' resilience demonstrated a buffering effect on the negative relationship between physical demands and professional quality of life during clerkships. Moreover, different mechanisms (predictive paths) leading to medical students' professional quality of life such as burnout and compassion satisfaction warrant additional studies.
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Affiliation(s)
- Yung Kai Lin
- Surgery Department, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan, Republic of China
- Division of Cardiovascular Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Chia-Der Lin
- School of Medicine, China Medical University, Taichung, Taiwan, Republic of China
- Department of Otolaryngology-Head & Neck Surgery, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Blossom Yen-Ju Lin
- Department of Medical Humanities and Social Sciences, School of Medicine, College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist, Taoyuan City, 33302 Taiwan, Republic of China
| | - Der-Yuan Chen
- Center of Rheumatology and Immunology, China Medical University Hospital, Taichung, Taiwan, Republic of China
- College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
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