Clerkship For Third-year Medical Students Research Articles

Taking More Society for Academic Emergency Medicine Practice Tests Does Not Lead to Improved National EM-M4 Exam Scores

Emergency medicine (EM) is a required clerkship for third-year medical students, and an elective EM acting internship (AI) is available to fourth-year students at our institution. The Society for Academic Emergency Medicine's (SAEM) National Emergency Medicine M4 Examination (EM-M4) is administered to students at the end of the EM AI experience. To prepare for the exam, students gain access to 23 practice tests available from SAEM. In this study we investigate the correlation between the number of practice tests taken and EM-M4 performance. We collected data for EM-M4 and the US Medical Licensing Exam (USMLE) Step 2 Clinical Knowledge (CK) from students completing a MS4 EM clerkship in consecutive medical school classes from 2014-2017 at a private medical school. In addition, we collected data during the clerkship on the number of practice exams taken and whether a comprehensive practice exam was taken. We analyzed the study population three ways to determine whether the number of practice tests impacted final exam results: a binary distribution (1-11 or 12-23 tests taken); quaternary distribution (1-6, 7-12, 13-18, or 19-23 tests taken); and individual test variability (1,2,3,…22,23 tests taken). Complete data for 147 students was used for data analysis. The EM-M4 showed moderate (r = 0.49) correlations with USMLE Step 2 CK. There was no significant difference in EM-M4 performance in the binary analysis (P ≤ 0.09), the quaternary analysis (P ≤ 0.09), or the continuous variable analysis (P ≤ 0.52). Inclusion of a comprehensive practice test also did not correlate with EM-M4 performance (P ≤ 0.78). Degree of utilization of SAEM practice tests did not seem to correlate with performance on the EM-M4 examination at our institution. This could be due to many factors including that the question bank is composed of items that had poor item discrimination, possible inadequate coverage of EM curriculum, and/or use of alternative study methods. While further investigation is needed, if our conclusions prove generalizable, then using the SAEM practice tests is an extraneous cognitive load from a modality without proven benefit.

Surgery Clerkship Curriculum Changes at an Academic Institution during the COVID-19 Pandemic

ProblemThe COVID-19 pandemic has suspended the surgery clinical clerkship for third-year medical students at numerous institutions across the world. As a result, educators and students have adapted rapidly. There is a paucity of precedents regarding urgent and brusque formal curricular changes for medical students enrolled in surgical clinical rotations.ApproachThe University of California, San Francisco Department of Surgery created a surgically focused extended mastery learning rotation (EMLR). The surgery clerkship leadership designed a curriculum consisting of multiple learning strategies compatible with virtual learning environments. The primary aims of the newly developed EMLR were to help students consolidate their foundational science knowledge before their return to clinical medicine in an altered learning environment. The EMLR is currently underway, and further studies are necessary to evaluate its effectiveness.

Integrating Geriatrics Knowledge into a Medical Student Clerkship Using Twitter Poll.

A controlled, prospective, 2-year cohort observational study was conducted to test whether weekly geriatric questions delivered through Twitter Poll could improve geriatrics knowledge during an internal medicine clerkship for third-year medical students. Pre- and post-rotation test results used a modified University of California, Los Angeles geriatric knowledge test that included questions linked to 26 Association of American Medical Colleges geriatric competencies for medical students. Data were analyzed using a general linear model repeated-measure design and Student t-test. The primary outcome showed that Twitter Poll participants had more than twice the geriatrics knowledge (p = .002) than students who did not use Twitter Poll. Subset analysis showed different test performances according to sex (p = .03), training site (p = .002), and cohort (p = .003). This study is the first demonstration of Twitter Poll efficacy in medical education and raises questions about whether it could be even more effective if linked to spaced timing of didactic content or supported by annotated answers to geriatrics questions. J Am Geriatr Soc 66:2389-2393, 2018.

Surgeons have an opportunity to improve teaching quality through feedback provision

BackgroundMedical student evaluations of faculty are increasingly incorporated into promotion and tenure decisions, making it imperative to understand learner perceptions of quality teaching. Prior work has shown that students value faculty responsiveness in the form of feedback, but faculty and students differ in their perceptions of what constitutes sufficient feedback. The innovative minute feedback system (MFS) can quantify responsiveness to students' feedback requests. This study assessed how feedback provision via MFS impacts teaching quality scores. Materials and methodsThis retrospective observational study compared average faculty teaching quality scores with faculty's percentage response to student feedback requests via the MFS. The data were generated from the core surgical clerkship for third-year medical students at the University of Michigan Medical School. The relationship between average teaching quality scores and response percentage was assessed by weighted regression analysis. ResultsTwo hundred thirty-seven medical students requested feedback via MFS, and 104 faculty were evaluated on teaching quality. The mean faculty feedback response percentage was 55.78%. The mean teaching quality score was 4.27 on a scale of 1 to 5. Teaching quality score was significantly correlated with response percentage (P < 0.001); for every 10% increase in response percentage, average teaching quality score improved by 0.075. Average teaching quality score was not significantly associated with response time (P = 0.158), gender (P = 0.407), or surgical service (P = 0.498). ConclusionsMedical students consider responsiveness to feedback requests an important component of quality teaching. Furthermore, faculty development focused on efficient and practical feedback strategies may have the added benefit of improving their teaching quality.

Orientation to the Operating Room: An Introduction to the Surgery Clerkship for Third-Year Medical Students.

The operating room is a complex environment in which individual team members perform specific tasks according to their role. A simulation activity was created to introduce medical students on the surgery clerkship to issues relating to patient safety, infection control, and regulatory requirements. This activity takes place prior to general surgery rotation operative experiences, and addresses the need for students to practice roles they will perform while participating in patient care. The activity includes a simulated operation, an assessment, and a scripted debriefing. Among other tasks, students practice safe patient transfer and monitoring, donning sterile garb, preparing the surgical site, and being active participants in a sign-in and time-out. Students are assessed on assigned tasks, their ability to maintain sterility, and the degree to which they engage with their team. Students reported the simulation helped them better understand how they could become involved on their first day in the operating room. Students also reported they were more confident when in the operating room. This finding also extended to students who had previously been in the operating room during a prior OB/GYN rotation. Patient safety is paramount when in the operating room, and this simulation activity fills a current gap in student's practical knowledge as they prepare to enter their surgery clerkship. Giving medical students the information and skills needed to be safe and effective members of the operating team prior to entering the operating room is of benefit to the surgical team, students, and patients.

The Sex Difference in Basic Surgical Skills Learning: A Comparative Study

Very little is known of sex-related differences among medical students in the acquisition of basic surgical skills at an undergraduate level. The aim of this study was to investigate the sex differences in basic surgical skills learning and the possible explanations for sex disparities within basic surgical skills education. A didactic description of 10 surgical skills was performed, including knot tying, basic suture I, basic suture II, sterile technique, preoperative preparation, phlebotomy, debridement, laparotomy, cecectomy, and small bowel resection with hand-sewn anastomosis. The students were rated on a 100-point scale for each basic surgical skill. Later during the same semester all the students took the final theoretical examination. A total of 342 (male = 317 and female = 25) medical students participated in a single skills laboratory as part of their third-year medical student clerkship. The mean scores for each of the 10 surgical skills were higher in female group. The difference in sterile technique, preoperative preparation, cecectomy, and small bowel resection with hand-sewn anastomosis reached the significant level. Compared with male medical students, the mean theory examination score was significantly higher in female medical students. Approximately 76% of the (19 of 25) female students expressed their interest in pursuing a surgical career, whereas only 65.5% (207 of 317) male students wanted to be surgical professionals (p = 0.381). Female medical students completed basic surgical skills training more efficiently and passed the theoretical examination with significantly higher scores than male medical students. In the future, studies should be done in other classes in our institution and perhaps other schools to see if these findings are reliable or valid or just a reflection of this 1 sample.

A Covert Standardized Patient With Medication-Induced QT Prolongation

Abstract Introduction This is a covert simulation scenario that was implemented during a family medicine clerkship for third-year medical students at our regional medical school campus. It was deve...

Successful Implementation of a Longitudinal, Integrated Pathology Curriculum During the Third Year of Medical School

There are few published examples of pathology instruction during the clinical years of medical student training. This lack of exposure to pathology may lead to poor understanding of laboratory testing and the role of pathologists in patient care. To design, implement, and evaluate a pathology curriculum integrated into a longitudinal clerkship for third-year medical students. The curriculum includes an introductory session during the transition week course, pathologist participation in longitudinal student case conferences, and a pathology elective. The curriculum was evaluated by using surveys consisting of both multiple choice and written responses. A total of 55 students participated in the longitudinal curriculum during the 2009-2010 academic year and 8 students, only one of whom stated a career interest in pathology, participated in the elective. More than 80 pathology topics were discussed and, for the first time, pathologists received teaching awards from the third-year students. All elective students would recommend the elective to colleagues; feedback also suggested an improved understanding of pathology as a profession. At the end of the year, 31% of all students, compared to only 19% in the initial survey, knew that most of an anatomic pathologist's caseload consists of specimens from living patients (P = .13). In addition, elective student interaction with a pathology faculty member directly led to an improvement in test reporting. A novel longitudinal curriculum allowed for the creative integration of pathology into third-year students' clinical training and led to better student understanding of the role of pathologists in patient care.

Reflections on Psychosomatic Medicine as a Third-Year Medical Student Clerkship: An Integrated Experience That Demonstrates the Biopsychosocial Model

Reflections on Psychosomatic Medicine as a Third-Year Medical Student Clerkship: An Integrated Experience That Demonstrates the Biopsychosocial Model

Using Elements from an Acute Abdominal Pain Objective Structured Clinical Examination (OSCE) Leads to More Standardized Grading in the Surgical Clerkship for Third-Year Medical Students

There is poor reliability in the Likert-based assessments of patient interaction and general knowledge base for medical students in the surgical clerkship. The Objective Structured Clinical Examination (OSCE) can be used to assess these competencies. We hypothesize that using OSCE performance to replace the current Likert-based patient interaction and general knowledge base assessments will not affect the pass/fail rate for third-year medical students in the surgical clerkship. In this retrospective study, third-year medical student clerkship data from a three-station acute abdominal pain OSCE were collected from the 2009-2010 academic year. New patient interaction and general knowledge base assessments were derived from the performance data and substituted for original assessments to generate new clerkship scores and ordinal grades. Two-sided nonparametric statistics were used for comparative analyses, using an α = 0.05. Seventy third-year medical students (50.0% female) were evaluated. A sign test showed a difference in the original (4.45/5) and the new (4.20/5) median patient interaction scores (p < 0.01). A sign test did not show a difference in the original (4.00/5) and the new (4.11/5) median general knowledge base scores (p = 0.28). Nine clerkship grades changed between these different grading schemes (p = 0.045), with an overall agreement of 87.1% and a kappa statistic of 0.81. There were no differences in the pass/fail rate (p > 0.99). We conclude that there are no differences in pass/fail rate, but there is a more standardized distribution of patient interaction assessments and utilization of the full spectrum of possible passing grades. We recommend that the current patient interaction assessment for third-year medical students in the surgical clerkship be replaced with that found through trained standardized patients in this three-station acute abdominal pain OSCE.

Trainees as Teachers in Team-Based Learning

Team-based learning is an active learning modality that is gaining popularity in medical education. The authors studied the effect of using trainees as facilitators of team-based learning sessions. Team-based learning modules were developed and implemented by faculty members and trainees for the third-year medical student clerkship in psychiatry in the 2007-2008 academic year. Evaluation forms were used to elicit student opinions about the team-based learning sessions. Scores for trainee and faculty facilitators were compared using Student's t tests. Overall scores were positive, reflecting acceptability of this form of instruction. Eight of nine comparisons showed no difference in students' ratings of faculty versus trainee facilitators. The other comparison showed a modest preference for faculty facilitators. Team-based learning modules can be led as effectively by trainees as by faculty members to teach medical students in the classroom setting.

Anxiety, Dissociative, and Somatoform Disorders: Team-Based Learning Module

Abstract This is used as the didactic method for our third-year medical student's clerkship in psychiatry at the University of Texas Medical Branch School of Medicine. It was developed in 2008, and...

360: The Emergency Department Involvement in a One-Year Longitudinal Integrated Clerkship for Third-Year Medical Students

360: The Emergency Department Involvement in a One-Year Longitudinal Integrated Clerkship for Third-Year Medical Students

Longitudinal Pedagogy: A Successful Response to the Fragmentation of the Third-Year Medical Student Clerkship Experience

A longitudinal clerkship was designed at Harvard Medical School (HMS) in 2004-2005 to emphasize continuity, empathy, learner-centeredness, and patient-centered care. In 2005-2006, the curriculum was piloted with eight students who voluntarily enrolled in the third-year curriculum, which focused on longitudinal mentorship and feedback, interdisciplinary care, integration of clinical and basic science, and humanism in patient care. Eighteen traditional curriculum (TC) students at HMS who were comparable at baseline served as a comparison group. SHELF exams and OSCE performance, monthly and end-of-year surveys, and focus groups provided comparisons between pilot and TC students on their performance, perceptions, attitudes, and satisfaction. Pilot students performed as well as or better than their peers in standardized measures of clinical aptitude. They demonstrated statistically significant greater preservation of patient-centered attitudes compared with declining values for TC students. Pilot students rated the atmosphere of learning, effective integration of basic and clinical sciences, mentorship, feedback, clerkship satisfaction, and end-of-year patient-care preparedness significantly higher than TC students. The authors conclude that implementation of a longitudinal third-year curriculum, with only modest alterations in existing clinical training frameworks, is feasible and effective in meeting its stated goals. "Exposing" the hidden curriculum through specific longitudinal activities may prevent degradation of student attitudes about patient-centered care. Minimizing the disjointed nature of clinical training during a critical time in students' training by providing a cohesive longitudinal curriculum in parallel to clinical clerkships, led by faculty with consistent contact with students, can have positive effects on both professional performance and satisfaction.

Inpatient and Ambulatory Community Pediatrics Student Evaluations

Abstract These competency-driven assessment instruments were used for the inpatient and ambulatory experiences of the third-year medical student clerkship at Morehouse School of Medicine. Competenc...

Geriatrics Training and Education for Nongeriatrician Faculty: The Dean's Faculty Scholars in Aging Program

The University of South Carolina School of Medicine in Columbia implemented the Dean's Faculty Scholars in Aging (DFSA) Program in 2001 to strengthen the knowledge of geriatrics of nongeriatrician faculty members. The primary indicator of strengthening physicians' geriatrics knowledge was the development of new educational experiences by physicians in the DFSA Program. Twenty-six nongeriatrician faculty in seven departments were recruited to participate as scholars. Most scholars were in key educational positions, including assistant deans, department chairs, and clerkship and residency directors. Scholars received special training to develop geriatrics educational experiences based on their medical specialty and interests. Training encouraged cross-departmental collaboration. Scholars also had access to resources, including professional geriatric educators. Funds were available to support development of educational experiences and for a small amount of salary support. Since the program was implemented, 36 new geriatric experiences have been developed, 29 of the 36 were implemented, and 11 of the 36 were evaluated. Experiences included an elective for residents in the care of older patients in the emergency room and a required hospice rotation in the psychiatry clerkship for third-year medical students. All scholars developed a geriatrics educational experience, and most implemented one. This suggests that scholars demonstrated successful progress in geriatrics training.

Case-Based Independent Study for Medical Students in Emergency Psychiatry

Brief cases designed for independent study were developed to allow third-year medical students some exposure to important concepts in emergency psychiatry during their required psychiatry clerkship. Five independent study cases were given to University of Michigan third-year medical students during their psychiatry clerkship, and their performance on a pre- and posttest of knowledge of emergency psychiatry management was compared between students who did and did not use the independent study cases. All of the students improved in their knowledge of emergency psychiatric management, but the students who completed the cases had a significantly better performance on the postrotation quiz. Case-based independent study is an effective method to improve exposure to emergency psychiatry cases during a third-year medical student clerkship.

BUILDING A LEARNING EXPERIENCE: THE IMPLEMENTATION OF A CLERKSHIP IN GERIATRIC MEDICINE

Recent curriculum changes at McGill University include a mandatory 4-week clerkship for third-year medical students. The basis of this clerkship is the assessment and management of frail elderly who have a combination of complex acute and chronic medical problems and functional disabilities. It includes the understanding of the need for continuity of care across settings and the transition from hospital to the community. Our main purpose is to offer students a learning experience based upon self-reflection, access to technology, interactive learning and permanent feedback. To accomplish the technological goals, didactic sessions were mostly electronic-based with two main components: web-based interactive modules that include the contents in seven web-based interactive lectures complemented with pre- and post-tests, and an electronic portfolio to assess students' acquisition of skills and attitudes. We expect that implementation of this model of clinical clerkship will prepare future physicians, not only for the practice of geriatric medicine, but also for different medical and surgical specialties, and will enhance the attitudes, knowledge, and skills practitioners need to care for older people.

Improving the physical diagnosis skills of third-year medical students: a controlled trial of a literature-based curriculum.

To determine if a literature-based physical diagnosis curriculum could improve student knowledge, skill, and self-confidence in physical diagnosis. Prospective controlled trial of an educational intervention. Required internal medicine clerkship for third-year medical students at Brown Medical School. Third-year medical students who completed the internal medicine clerkship during the academic year 1999-2000: 32 students at 1 clerkship site received the intervention; a total of 50 students at 3 other clerkship sites served as controls. Physical diagnosis curriculum based on 8 articles from the Journal of the American Medical Association's Rational Clinical Examination series. Intervention students met weekly for 1 hour with a preceptor to review each article, discuss the sensitivity and specificity of the maneuvers and findings, and practice the techniques with an inpatient who agreed to be visited and examined. Physical diagnosis knowledge for the 8 topics was evaluated using a 22-item multiple choice question quiz, skill was evaluated using trained evaluators, and self-confidence was assessed using an end-of-clerkship survey. Intervention students scored significantly higher than the control group on the knowledge quiz (mean correct score 70% vs 63%, P =.002), skills assessment (mean correct score 90% vs 54%, P <.001), and self-confidence score (mean total score 40 vs 35, P =.003), and they expressed greater satisfaction with the physical diagnosis teaching they received in the clerkship. This physical diagnosis curriculum was successful in improving students' knowledge, skill, and self-confidence in physical diagnosis.

CANDIDATES FOR SPEAKER-ELECT

CANDIDATES FOR SPEAKER-ELECT