Medical education research study quality instrument: an objective instrument susceptible to subjectivity

BACKGROUND

The medical education research study quality instrument (MERSQI) was designed to appraise medical education research quality based on study design criteria. As with many such tools, application of the results may have unintended consequences. This study applied the MERSQI to published medical education research identified in a bibliometric analysis.

METHODS

A bibliometric analysis identified highly cited articles in medical education that two authors independently evaluated using the MERSQI. After screening duplicate or non-research articles, the authors reviewed 21 articles with the quality instrument. Initially, five articles were reviewed independently and results were compared to ensure agreed upon understanding of the instrument items. The remainder of the articles were independently reviewed. Overall scores for the articles were analyzed with a paired samples t-test and individual item ratings were analyzed for inter-rater reliability.

RESULTS

There was a significant difference in mean MERSQI score between reviewers. Inter-rater reliability for MERSQI items labeled response rate, validity and outcomes were considered unacceptable.

CONCLUSIONS

Based on these results there is evidence that MERSQI items can be significantly influenced by interpretation, which lead to a difference in scoring. The MERSQI is a useful guide for identifying research methodologies. However, it should not be used to make judgments on the overall quality of medical education research methodology in its current format. The authors make specific recommendations for how the instrument could be revised for greater clarity and accuracy.

Promotion Criteria for Medical Educators: Are We Climbing a Ladder with Invisible Rungs?

OBJECTIVE

In 2006 the Association of American Medical Colleges recommended standardization of documentation of the contributions of medical educators and guidelines for their academic promotion. The authors characterized current United States (US) medical school promotion guidelines for medical educators.

METHODS

Authors collected publicly available data from medical school promotion websites from March through July 2022 after determining categories by traditional-set domains as well as peer-reviewed standards. Extracted data were analyzed using descriptive and inferential statistics, and frequencies were calculated for nominal and categorical data.

RESULTS

Of 155 medical schools identified, promotion criteria were publicly available for 143 (92%) schools. Ninety-one (64%) schools identified a distinct educator track. Of those with a defined educator track, 44 (48%) schools consider workshops or other media when evaluating candidates for promotion, and only 52 (57%) of schools with a specified educational track require additional documentation of teaching or education as part of their promotion process. Notably, 34 (37%) of the 91 schools with an educator track specifically require an Educational Portfolio, compared to 27 (52%) of the 52 schools that do not have a specific educator track for promotion.

CONCLUSION

This study describes the current lack of clarity and consistency of the promotion criteria for medical educators and indicates that the guidelines proposed by the Association of American Medical Colleges over 15 years ago have not been widely adopted. These data amplify previous calls for a more objective set of criteria for evaluating and recognizing the contributions of medical educators.

Correction to: Implementing a Blood Pressure Measurement Curriculum for First-Year Medical Students

[This corrects the article DOI: 10.1007/s40670-023-01825-9.].

Implementing a Blood Pressure Measurement Curriculum for First-Year Medical Students

A core clinical skill medical students need to learn is obtaining an accurate blood pressure (BP) reading. We developed a standardized BP curriculum for first-year medical students. Medical students completed online modules and a hands-on skills session to learn BP skills. Pre- and post-surveys and an observed structured clinical encounter (OSCE) assessed student confidence and ability to accurately measure BP. Student confidence and mean OSCE scores (pre = 2.63, post = 6.51; p < 0.001) improved upon completion of the curriculum. The curriculum was feasible, well received, and improved student's skills for taking an accurate BP.

A Twitter-facilitated professional learning community: online participation, connectedness, and satisfaction

BACKGROUND

Twitter has gained increasing popularity and attention as a professional learning environment to share knowledge, exchange information, make connections, and build networks. To evaluate the effectiveness of Twitter-facilitated online discussions, a community of inquiry framework could be used with the three key elements of online environments: cognitive presence, social presence, and teaching presence. This study aims to explore how medical educators participate in synchronous online discussions on Twitter using #MedEdChat, and how participants' perceptions toward the three presences, sense of connectedness and interactions influenced their online satisfaction.

METHODS

A survey invitation was emailed using the medical education email list DR-ED and was posted during the weekly Twitter conversations in December 2020, to solicit participants who have been involved in any kind of #MedEdChat activities (i.e., read transcripts or directly participate in discussions).

RESULTS

A total of 68 people responded. Through descriptive analysis and path analysis, we found that almost half of the survey respondents were lurkers on #MedEdChat who read others' tweets or transcripts. In addition, participants mainly used Twitter for resource sharing, collaborating with others, and networking. Participants rated teaching (i.e., moderator) presence the highest, followed by overall satisfaction, cognitive presence, sense of connectedness, social presence, and interactions. Among them, sense of connectedness and cognitive presence were significantly associated with participants' overall satisfaction.

CONCLUSIONS

This study provided significant implications for using Twitter as a professional learning community to conduct online discussion activities. Facilitators could think of ways to improve participation by providing tutorials on how to participate on Twitter discussions, introduce or ask new participants to introduce themselves, facilitate discussion with intriguing questions, and invite medical educators of different roles as well as medical students and residents to join to bring in diverse perspectives.

Can We Ensure That Workshops Are Effective in Their Goal? Impact of a National Education Workshop on Participants' Subsequent Scholarship

Medical education conferences offer practical workshops to facilitate physicians' lifelong learning. Little is known about integration of workshop material after conferences. We sought to evaluate the application of workshop content focused on scholarly publication preparation. We developed an email survey to examine participants' progress preparing a publication in 2019, administered 4, 9, and 15 months post-conference. The survey included scaled items and open-ended questions. Thirty-three participants attended the workshop. Participants continued to develop their projects, but noted time, adequate evaluations, and no writing partners as barriers. Following up with workshop participants offers insights into effective application of workshop content.

Assessing the Impact of Early Undergraduate Exposure to the Medical School Curriculum

BACKGROUND

Programs such as mini-medical school programs have been implemented to introduce students to the medical school curriculum through a series of lectures in foundational sciences and healthcare topics. Since 2013, the UNC School of Medicine (SOM) has offered the Introduction to Clinical Medicine for Undergraduates (ICMU) course as an opportunity for UNC undergraduate students to be introduced to the medical school curriculum and integrated into the introductory clinical skills curriculum. This study explored the relationship between experiences from taking this course, pursuit of further education in healthcare professions, and preparedness for future clinical courses.

METHODS

An anonymous survey was distributed to all students who took the ICMU course at UNC-Chapel Hill as an undergraduate from 2013 to present. The locally developed survey consisted of 13 scaled questions asking about their experiences in the course and decisions to pursue further healthcare professional education. Survey results were analyzed using descriptive and correlational statistics.

RESULTS

Respondents perceived the experience increased their confidence and preparedness for future clinical courses in the competency measures of taking a patient history, performing a physical examination, and developing a differential diagnosis. Inclusion of students in the clinical skills course was significantly associated with their confidence going into their health professions school of choice (p = .002). Additionally, exposure to UNC SOM students, faculty, and culture was found to play a role in students choosing to attend UNC SOM.

CONCLUSION

Integration of undergraduate students into the medical school curriculum has motivated continued pursuit of education in a healthcare profession.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01449-x.

Exploring Online Participation and Discussion in an Online Professional Learning Activity on Twitter

BACKGROUND

Twitter offers opportunities to share resources, engage in online discussions, and network with other professionals. In medical education, Twitter is also being used for professional development. Little is known about the level of engagement in topical chats related to medical education. This study explores how medical educators participated and engaged in Twitter-facilitated discussion activity using #MedEdChat.

METHODS

All twitter chat transcripts using the hashtag #MedEdChat from Thursday night synchronous discussions were collected between January and December 2019. A total of 37 discussion topics were included. To answer the first research question about the overall participation, descriptive statistics were used to analyze the number of participants, posts, retweets, and interactions for each week's discussion. To answer the second question about types of discussion participants engaged in during weekly chats, a combination of top-down and bottom-up coding strategy was adopted with three categories: functional, social, and content.

RESULTS

This study identified five themes from #MedEdChat discussions: curriculum, faculty development, scholarship, assessment, and general medical education topics. All discussions had an average of 26 participants, with an average of 145 total posts, including 37 original posts, 52 retweets, and 56 interactions (mentions or replies using @). In terms of types of discussion, content-related tweets were most frequently posted, followed by functional and social tweets.

CONCLUSION

By identifying the patterns of participation and content of discussions, preliminary findings suggest implications for future study to further explore the social interactions and knowledge building processes among online participants in the Twitter-facilitated medical education online community.

Student-led peer review of an online teaching file: perspectives after 2 years

PROBLEM

Opportunities for self-directed learning were missing from our medical school curriculum in general and on our radiology electives specifically. Our objective was to explore the feasibility and benefits of using medical students in the development of our student-created teaching files.

APPROACH

In 2018, a website was developed at our institution to support medical student radiology education and create a repository for the online publication of student-developed teaching cases. Students participating in radiology clerkships at our institution had an opportunity to submit case presentations for publication to our online teaching file following peer review. The medical students participated in the peer review process facilitated by the faculty director of radiology undergraduate medical education. The faculty member oversaw the training of new student editors and the development of a peer review guide.

OUTCOMES

The peer review guide included goals of the teaching file project and direction regarding the peer review process. Student editors were trained using the peer review guide in conjunction with individual meetings with the faculty mentor. At twenty-four months, 82 student-developed cases had been published to the online teaching file following medical student peer review. The teaching file had garnered 3884 page views.

NEXT STEPS

The medical student-led peer review process meets core competencies in self-directed learning. The authors plan to explore the application of peer-assisted learning theories to the editing and peer-review process.

Creating an Ultrasound Scholarly Concentration Program for Medical Students

INTRODUCTION

Point of care ultrasound (POCUS) is increasingly prevalent and standardized in undergraduate medical education (UME); however, roughly 25% of United States medical schools lack an ultrasound curriculum. One of the commonly cited barriers to ultrasound training in UME is faculty time resources. Here, we describe an ultrasound scholarly concentration program (SCP) designed to provide medical students with ultrasound opportunities in clinical and scholarly domains, while reducing the need for extensive faculty resources.

METHODS

SCPs at the University of North Carolina School of Medicine have 3 requirements: an elective course, a longitudinal portfolio, and a final scholarly project. Thus, the ultrasound SCP was designed to comprise an introductory clinical elective to ultrasound, development of a longitudinal scan portfolio, and a final scholarly project in ultrasound related research or educational innovation. A review of the literature and search of the top 50 US medical schools by US News & World Report was performed to assess the novelty of the ultrasound SCP.

RESULTS

To the best of our knowledge, the ultrasound SCP is the first scholarly concentration, track or pathway offered to medical students in the United States. It is the first description of a student designed and student led curriculum focused on providing meaningful ultrasound opportunities to students without necessitating unavailable faculty resources and educational infrastructure.

CONCLUSION

A novel ultrasound SCP is described which has clinical aims to expose students to clinical ultrasound as well as scholarly aims to facilitate ultrasound related research and educational innovation. It is designed to enable students to make ultrasound a defining characteristic of their medical school experience. The SCP relies on motivated student involvement and near-peer teaching in a way that is self-sustaining and self-improving.

Should Medical Educators Help Learners Reframe Imposterism?

Issue: Impostor syndrome, impostor phenomenon, or imposterism, is a very common, likely ubiquitous, psychological construct in the general population and certainly among health care providers. It has been the subject of many, mostly descriptive, articles and blogs in the medical literature as well as in the lay press and on social media. Evidence: Imposterism has been associated with, but not demonstrated to be causative of, psychological conditions including stress, shame, guilt, and burnout, and behaviors such as "hiding out," which impede career development. The authors argue that to avoid these more serious potential manifestations of imposterism, the approach to imposterism should be reframed, and medical students, residents, and physicians should be helped to view episodic feelings of imposterism as appropriate situational responses. Implications: As feelings of imposterism are virtually universal for those on the journey from medical/graduate student through practicing physician/scientist, handling them appropriately could hopefully channel them into positive responses that mitigate potential psychological and behavioral consequences and improve emotional health.

Planning for Happenstance: Helping Students Optimize Unexpected Career Developments

INTRODUCTION

Planning for and responding to happenstance is an important but rarely discussed part of the professional development of medical students. We noted this gap while conducting a study of career inflection points of 24 physicians who frequently mentioned how luck had shaped their unfolding careers. A review of the career counseling literature led us to a body of work known as Planned Happenstance Learning Theory (PHLT). PHLT focuses on the attitudes and skills to make happenstance a positive force in one's life. We found no reference to this work in the medical education literature and resolved to address this gap.

METHODS

We created resources for an interactive, 90-minute faculty development workshop. In the workshop, the facilitator used a PowerPoint presentation, vignettes of happenstance, a student testimonial, and a reflection worksheet. We presented and formally evaluated the workshop at three national meetings for health science educators.

RESULTS

Workshop participants, mostly faculty (N = 45), consistently expressed positive regard for the workshop content, organization, and instructional methods, especially the opportunity for guided reflection. A retrospective pre/postevaluation revealed a meaningful increase in knowledge about PHLT attitudes and skills, as well as a commitment to use these skills in promoting professional development.

DISCUSSION

The skills and attitudes of PHLT are relevant to students' career development. A workshop designed to introduce PHLT skills and attitudes to faculty advisors and mentors can help prepare faculty to promote students' awareness and use of these attitudes and skills.

Medical Student Leadership Development through a Business School Partnership Model: A Case Study and Implementation Strategy

BACKGROUND

There is an ongoing call for leadership development in academic health care and medical students desire more training in this area. Although many schools offer combined MD/MBA programs or leadership training in targeted areas, these programs do not often align with medical school leadership competencies and are limited in reaching a large number of students.

METHODS

The Leadership Initiative (LI) was a program created by a partnership between a School of Medicine (SOM) and Business School with a learning model that emphasized the progression from principles to practice, and the competencies of self-awareness, communication, and collaboration/teamwork. Through offerings across a medical school curriculum, the LI introduced leadership principles and provided an opportunity to apply them in an interactive activity or simulation. We utilized the existing SOM evaluation platform to collect data on program outcomes that included satisfaction, fidelity to the learning model, and impact.

RESULTS

From 2017 to 2020, over 70% of first-year medical students participated in LI course offerings while a smaller percentage of fourth-year students engaged in the curriculum. Most students had no prior awareness of LI course material and were equivocal about their ability to apply lessons learned to their medical school experience. Students reported that the LI offerings provided opportunities to practice the skills and competencies of self-awareness, communication, and collaboration/teamwork.

DISCUSSION

Adding new activities to an already crowded medical curriculum was the greatest logistical challenge. The LI was successful in introducing leadership principles but faced obstacles in having participants apply and practice these principles. Most students reported that the LI offerings were aligned with the foundational competencies.

Millennials in Psychiatry: Exploring Career Choice Factors in Generation Y Psychiatry Interns

OBJECTIVE

There is a national shortage of psychiatrists. To grow the workforce, educators must understand the factors that influence the choice of psychiatry as a specialty for medical students in the Generation Y cohort.

METHODS

Psychiatry residents born between 1981 and 2000 were recruited from six psychiatry training programs across the USA and were interviewed in the fall of their first year. The interviews were coded and analyzed qualitatively for themes. Career Construction Theory (CCT) was applied to relate the themes within the four domains of Career Adaptability (a focus of CCT): concern, control, curiosity, and confidence.

RESULTS

The majority of themes mapped onto the four domains. A fifth domain, "contribution," was created to capture additional themes. Themes associated with choosing psychiatry as a career included Practice Concerns and Economic/Lifestyle Concerns (concern), Changes in Stigma and Changes in Legitimacy (control), Exploring Humanity and Exposures to Psychiatry (curiosity), Abilities Called Upon by the Field, Recognized Qualities in the Participant, and Recognized Qualities in the Faculty/Residents (confidence), and Hoping to Make a Difference and Engaging in Research/Technology (contribution).

CONCLUSIONS

With the knowledge generated from this study, educators now have a guide for the kinds of learning experiences that may attract Generation Y students to the field, and can identify those with the background, values, or personality traits most likely to find a career in psychiatry to be attractive.

Learner perceptions of family-centred rounds

BACKGROUND

Family-centred rounds (FCRs) are common in paediatric inpatient medicine. FCRs lead to shorter hospital stays, improved communication, and improved patient and family satisfaction. Rounding structures can differ between institutions based on participants, the location of rounds and the role of trainees. The aim of our study was to compare walking hallway rounds with a new conference-room rounding style, as measured by learner perceptions of FCRs.

METHODS

All students participating in FCRs on two hospitalist teams were included in this study. In October 2017, a family-centred conference-room rounding model was developed. Team A adopted conference-room rounds whereas team B continued to use hallway rounds. Student and resident evaluations were constructed using a nine-point Likert scale (1, strongly disagree; 9, strongly agree). Evaluations assessed various perceived components of rounding.

RESULTS

There were statistically significant differences between the evaluation responses from student team A (n = 21) versus student team B (n = 32) regarding perceived comfort in presenting (A = 7.86, B = 6.56, t = 3.42, p ≤ 0.001), confidence talking to families about medical decision making (A = 7.19, B = 6.32, t = 2.57, p = 0.013), educational value of rounds (A = 8.05, B = 6.16, z = -4.39, p ≤ 0.0001), value as a team member (A = 7.38, B = 6.34, z = -2.22, p = 0.013) and preparedness to round (A = 7.76, B = 6.34, z = -3.67, p ≤ 0.0001). Among residents, there were statistically significant differences regarding the perceived efficiency of rounds (A = 6.69, B = 4.89, t = 2.09, p = 0.048) and family engagement (A = 7.81, B = 5.89, z = -2.67, p = 0.003).

DISCUSSION

Compared with hallway rounds, students and residents had improved learner perceptions of FCRs when participating in conference-room rounds. Some component of conference room rounding may be beneficial to learners while maintaining family-centered care.

Peak Performance: A Communications-Based Leadership and Teamwork Simulation for Fourth-Year Medical Students

BACKGROUND

Medical education has traditionally been rooted in the teaching of health and disease processes, with little attention to the development of teamwork and leadership competencies.

OBJECTIVE

In an era of value-based health care provided by high-functioning teams, new approaches are needed to develop communication, leadership, and teamwork skills for medical students.

DESIGN

We designed and piloted a simulation-based educational activity called Peak Performance that linked a workbook, which focused on self-reflection on communication and leadership skills, with professional coaching. The simulation scenario placed students in the role of an upper-level resident on an inpatient service, followed by a small group debrief with students, a clinical faculty member, and a professional executive coach. After the debriefing session, students were invited to complete a self-reflection workbook within 1 week of the initial simulation. The final element of the curriculum was an individualized session with an executive coach. Peak Performance was offered to all fourth-year medical students enrolled in the Social and Health Systems Science required course at the University of North Carolina School of Medicine.

RESULTS

Pre-/post-self-assessments of leadership competencies were completed by students. Pre-simulation self-assessment scores ranged from 3.72 to 4.33 on a 5-point scale. The lowest scores were in "Managing Conflict" and "Managing Others." The highest score was in "Self-Awareness." The post-simulation scores decreased in every competency, with "Managing Others" dropping significantly from 3.72 pre-simulation to 3.36 post-simulation (0.31, P < .05). Satisfaction with the curriculum was high, as reflected by a Net Promoter Score of 91% ("excellent" > 50%).

CONCLUSIONS

A novel simulation-based educational activity linked to professional coaching is a feasible and impactful strategy to develop leadership, communication, and teamwork skills in medical students. Student insight and self-awareness increased as evidenced by a decrease in competency self-assessment after guided reflection and individualized coaching.

To Pay or Not to Pay Community Preceptors? That Is a Question …

Phenomenon: Pairing medical students with community-based preceptors has provided unique medical education advantages. However, due to an increase in the number of M.D.-granting medical schools and medical school class sizes, academic medical institutions have struggled to recruit community preceptors to teach their students. This task has been made more difficult due to rising pressures upon institutions and clinicians-for example, increased productivity demands, greater volume and oversight of electronic health record documentation, and competition for community preceptors from both D.O. and non-U.S.-based medical schools. Although academic institutions have historically relied largely on altruistic motives and intrinsic rewards to actively engage and retain community-based preceptors, alternative models have arisen, chiefly those in which community-based preceptors are explicitly compensated for teaching. Approach: To study this phenomenon, representatives of the Alliance for Clinical Education developed and deployed a 31-item survey accompanied with a subset of free text questions to the collective membership of its 8-member constituent organizations. Survey questions explored if community preceptors were compensated indirectly or directly and what types of compensation were provided, if any. There were 188 surveys analyzed, with an estimated response rate of 18.2%. Findings: Twenty-six percent of respondents indicated they compensate community preceptors directly and/or indirectly. Respondents discussed their motivations for payment (or nonpayment), mechanisms for paying, aspirations to pay, and expectations of the recipient. No statistically significant association was found when comparing responses of paid versus not paid by region. Free text responses provided additional insight regarding payment considerations, institutional competition, recruitment/retention, recognition, and education issues. Insights: Increasingly, medical schools are finding it necessary to provide funding for community preceptors in order to retain them. New creative forms of compensation to community preceptors may prove important in the future for this vital aspect of medical student education.

Innovation to Dissemination Workshop: Selecting Outcome Measures to Translate Educational Innovations Into Scholarship

Introduction

Curricular innovations are invaluable to the improvement of medical education programs, and thus, their dissemination to broader audiences is imperative. However, medical educators often struggle to translate innovative ideas into scholarly pursuits due to a lack of experience or expertise in selecting outcome measures that demonstrate impact. A recent national call for increased focus on outcome measures for medical education research highlights the need for more training in this area.

Methods

We developed a 2-hour interactive workshop to improve educator ability to identify outcome measures for educational innovations. This workshop was delivered at a national pediatrics educational conference and at three local institutional faculty development sessions.

Results

Participants were diverse in terms of experience, expertise, and roles within their educational programs. Participants rated the workshop positively in each setting and identified next steps in developing their own products of educational scholarship.

Discussion

This workshop can provide faculty and faculty developers with a template for developing a skill set in identifying outcome measures and pairing them with educational innovations.

The 2016 Survey of the Association of Directors of Medical Student Education in Psychiatry

OBJECTIVE

The members of the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) had been last surveyed in 2010 to identify trends in medical student education in psychiatry, teaching methods, academic productivity, and administrative issues. With increasing requirements, ADMSEP members were surveyed in 2016 to characterize current expectations for and needs of medical student educators in psychiatry.

METHODS

A 53-item survey was sent to members of ADMSEP (n=260) and to clerkship directors nationwide. The current survey expanded past surveys with questions about current issues in medical education. Questions included categorical and scaled items (1 = strongly disagree to 5 = strongly agree). All ADMSEP members were invited to complete the survey, but half of the questions were for those who identified as clerkship directors. The survey was sent electronically with two reminders.

RESULTS

The survey had a response rate of 42.7%. Half identified themselves as clerkship directors (49.5%), with an average of 6 years as both a clerkship director and member of ADMSEP. Respondents noted that being involved in education (mean 4.1) and ADMSEP (mean 4.2) were a benefit to their career, and also reported that they had adequate access to faculty resources. Respondents also reported concerns with access to educational research consultants and personnel management.

CONCLUSION

Results of the 2016 ADMSEP survey echoed previous membership surveys. However, training in personnel management, diminishing faculty resources, and compensation for education time emerged in this survey. Conducting a membership survey continues to provide beneficial information regarding the administration and education that occurs within psychiatry clerkship. Additionally, topics meriting further details have been identified that will be investigated in future membership surveys.

Measuring Burnout Among Psychiatry Clerkship Directors

OBJECTIVE

The primary purpose of this study was to determine the prevalence of burnout among Psychiatry clerkship directors.

METHODS

Psychiatry clerkship directors were solicited via email to complete an electronic version of the Maslach Burnout Inventory-General Survey and the Respondent Information Form.

RESULTS

Fifty-four out of 110 surveys (49%) were completed. Fourteen percent of respondents scored in the "high exhaustion" category, 21.6% scored in the "low professional efficacy" category, 20.4% scored in the "high cynicism" category, and 15.1% of respondents met threshold for at least two of the three categories. Those who scored in the "low professional efficacy" category reported higher levels of salary support for research, while those who scored in the "high cynicism" category reported lower levels of salary support at a trend level. Those who scored in the "high cynicism" category were younger.

CONCLUSIONS

Approximately 14-22 percent of psychiatry clerkship directors reported some level of burnout depending on the subscale used. Future studies should aim to better identify those clerkship directors who are at greatest risk for becoming burned out by their educational role and to clarify the link between salary support for research, age, and burnout.

The Community Preceptor Crisis: Recruiting and Retaining Community-Based Faculty to Teach Medical Students-A Shared Perspective From the Alliance for Clinical Education

ISSUE

Community-based instruction is invaluable to medical students, as it provides "real-world" opportunities for observing and following patients over time while refining history taking, physical examination, differential diagnosis, and patient management skills. Community-based ambulatory settings can be more conducive to practicing these skills than highly specialized, academically based practice sites. The Association of American Medical Colleges and other national medical education organizations have expressed concern about recruitment and retention of preceptors to provide high-quality educational experiences in community-based practice sites. These concerns stem from constraints imposed by documentation in electronic health records; perceptions that student mentoring is burdensome resulting in decreased clinical productivity; and competition between allopathic, osteopathic, and international medical schools for finite resources for medical student experiences.

EVIDENCE

In this Alliance for Clinical Education position statement, we provide a consensus summary of representatives from national medical education organizations in 8 specialties that offer clinical clerkships. We describe the current challenges in providing medical students with adequate community-based instruction and propose potential solutions.

IMPLICATIONS

Our recommendations are designed to assist clerkship directors and medical school leaders overcome current challenges and ensure high-quality, community-based clinical learning opportunities for all students. They include suggesting ways to orient community clinic sites for students, explaining how students can add value to the preceptor's practice, focusing on educator skills development, recognizing preceptors who excel in their role as educators, and suggesting forms of compensation.

Does student performance on preclinical OSCEs relate to clerkship grades?

BACKGROUND

Objective structured clinical examinations (OSCEs) have been used to assess the clinical competence and interpersonal skills of healthcare professional students for decades. However, the relationship between preclinical (second year or M2) OSCE grades and clerkship performance had never been evaluated, until it was explored to provide information to educators at the University of Nebraska Medical Center (UNMC). In addition, the relationship between M2 OSCE communication scores (which is a portion of the total score) and third-year (M3) Internal Medicine (IM) clerkship OSCE scores was also explored. Lastly, conflicting evidence exists about the relationship between the amount of previous clinical experience and OSCE performance. Therefore, the relationship between M3 IM clerkship OSCE scores and the timing of the clerkship in the academic year was explored.

METHODS

Data from UNMC M2 OSCEs and M3 IM clerkship OSCEs were obtained for graduates of the 2013 and 2014 classes. Specifically, the following data points were collected: M2 fall OSCE total, M2 fall OSCE communication; M2 spring OSCE total, M2 spring OSCE communication; and M3 IM clerkship OSCE total percentages. Data were organized by class, M3 IM clerkship OSCE performance, and timing of the clerkship. Microsoft Excel and SPSS were used for data organization and analysis.

RESULTS

Of the 245 records, 229 (93.5%) had data points for all metrics of interest. Significant differences between the classes of 2013 and 2014 existed for average M2 spring total, M2 spring communication, and M3 IM clerkship OSCEs. Retrospectively, there were no differences in M2 OSCE performances based on how students scored on the M3 IM clerkship OSCE. M3 IM clerkship OSCE performance improved for those students who completed the clerkship last in the academic year.

CONCLUSIONS

There were inconsistencies in OSCE performances between the classes of 2013 and 2014, but more information is needed to determine if this is because of testing variability or heterogeneity from class to class. Although there were no differences in preclinical scores based on M3 IM clerkship OSCE scores, students would benefit from a longitudinal review of their OSCE performance over their medical training. Additionally, students may benefit from more reliable and valid forms of assessing communication. In general, students who take the IM clerkship last in the academic year performed better on the required OSCE. More information is needed to determine why this is seen only at the end of the year.