Clerkship In Year Research Articles

Integrating basic sciences into clerkship rotation utilizing Kern’s six-step model of instructional design: lessons learned

BackgroundIt is generally agreed that basic and clinical sciences should be integrated throughout the undergraduate medical education, however, there is still need for continued formal integration of basic sciences into clinical clerkship in many medical schools across the globe.MethodsUtilizing Kern’s Six-Step Model of Instructional Design, we aimed to develop an intervention that would facilitate cognitive integration of basic and clinical sciences. After problem identification and targeted needs assessment through focused group discussion with the students and faculty, objectives were devised with an implementation plan of using flipped class approach to develop a content-focused and learner-centered teaching strategy. This intervention was piloted in the 2-week cardiology clerkship in Year 5. Evaluation of the content, integration, student and faculty experiences were recorded through in-depth interviews, FGDs and a formative MCQ test.ResultsFlipped classroom based integrated sessions were successfully developed. The implementation phase was met with challenges that primarily stemmed from the diverse teaching styles among faculty members, hesitance to deviate from conventional practices, variations in clinic timings, and demanding schedules. Noteworthy observations were in terms of ownership of the project, the need for faculty development in modern student-centered teaching pedagogies, opportunities for content improvement, scheduling of sessions, and suggestion of revisiting fundamental concepts in basic sciences through a brief boot camp-style session at the onset of the clerkship. The role of flipped case model and clinical cases in integrating basic sciences into clinical sciences were appreciated by the students. Standardization in teaching practices was identified as the major challenge by the faculty.ConclusionsA functional, learner-centered framework of cognitive integration of basic sciences in clinical sciences curriculum of cardiology rotation was developed with a potential to be implemented in other clerkship rotations.

Icahn School of Medicine at Mount Sinai.

Icahn School of Medicine at Mount Sinai.

Keck School of Medicine of the University of Southern California.

Keck School of Medicine of the University of Southern California.

Teaching Medical Students Optimal Consulting Skills: The Challenge of Generating Better Referring Physicians.

Rationale and objectivesWe sought to incorporate a new teaching module into the traditional medical student radiology clerkship, to improve the necessary skills for future referring physicians.Materials and methodsA new required and graded module was introduced in 2014 into the radiology clerkship in year three of medical school: the Mystery Case. Each student was provided a unique and undifferentiated case from a dedicated teaching file containing de-identified images and requisition data. Students were expected to complete three serial tasks over one week: 1) prepare a voice recognition-derived, structured radiological report utilizing appropriate and relevant vocabulary; 2) discuss pertinent additional clinical information; and 3) discuss appropriate follow-up imaging, in addition to information on how to best prepare patients for these potential patient exams (e.g., with or without contrast, bowel preparation, and length of study). Students were provided written examples and dedicated class instruction with interactive discussions covering specific cases and associated related cases through random pairing with radiology resident and attending mentors. At the close of the week, students gave brief oral presentations of their cases and submitted the tasks for a written evaluation. Upon completion of the clerkship, the students completed a Likert-type six-item survey to evaluate the perceived improvement in select skills.ResultsThe survey was completed by 82% (54/66) of the enrolled students, with 85% finding the Mystery Case an effective use of time. Medical students perceived an improved awareness of the patient care process (77%), awareness of the medical imaging resources available (89%), ability to understand a radiology report (74%), and ability to advise patients (69%).ConclusionIntroduction of the Mystery Case as a graded exercise in the medical school radiology clerkship was perceived by students as effective use of time, with an improvement in the skills essential for future referring physicians.

Social Medicine, New Medicine? A curricular integration driving deeper learning with the social drivers of patient care.

This article was migrated. The article was marked as recommended. In response to a curricular vision of improved social accountability, our Doctor of Medicine program launched a year-long integrated Social Medicine course designed and implemented for Year 1 medical school students. Our school is a moderate sized medical school serving a region of close to 2 M people in central Canada. The Schulich School of Medicine & Dentistry Doctor of Medicine Program at Western University, London, Ontario Canada, is grounded in a four-year curriculum, each year comprised of up to 171 students with a clinical clerkship in Year 3. Our curriculum is delivered in a distributed fashion between two campuses approximately 200 km apart: London (133) and Windsor (38) learners.The vision of our leadership and learner partners was to provide students with an opportunity to concentrate early in their career on the impact of social, cultural and economic forces on medicine and patient care. Under the umbrella of this new Social Medicine course, we incorporated previous courses in population health, epidemiology, ethics and service learning to provide an exposure to cultural and societal roots; social inequalities; factors impacting treatment outcomes; ethical challenges and experiential community learning opportunities. This article, based upon our Short Communication, "Social Medicine, New Medicine? Redefining Social Medicine for Year 1 medical students", presented at AMEE in Barcelona, 2016, will discuss the origins of our course design as well as the rationale, objectives and caveats of this particular course.

Wayne State University School of Medicine

Wayne State University School of Medicine

University of Missouri—Kansas City School of Medicine

University of Missouri—Kansas City School of Medicine

Growth of analytical thinking skills over time as measured with the MATCH test

Ber's Comprehensive Integrative Puzzle aims to assess analytical clinical thinking in medical students. We developed a paediatric version, the MATCH test, in which we added two irrelevant options to each question in order to reduce guessing behaviour. We tested its construct validity and studied the development of integrative skills over time. We administered a test (MATCH 1) to subjects from two universities, both with a 6-year medical training course. Subjects included 30 students from university 1 who had completed a paediatric clerkship in Year 4, 23 students from university 2 who had completed a paediatric clerkship in Year 5, 13 students from both universities who had completed an advanced paediatric clerkship in Year 6, 28 paediatric residents and 17 paediatricians. We repeated this procedure using a second test with different domains in a new, comparable group of subjects (MATCH 2). Mean MATCH 1 scores for the respective groups were: Year 4 students: 61.2% (standard deviation [SD] 1.3); Year 5 students: 71.3% (SD 1.6); Year 6 students: 76.2% (SD 1.5); paediatric residents: 88.5% (SD 0.7), and paediatricians: 92.2% (SD 1.1) (one-way ANOVA F = 104.00, P < 0.0001). Students of both universities had comparable scores. MATCH 1 and 2 scores were comparable. Cronbach's alpha-values in MATCH 1 and 2 were 0.92 and 0.91, respectively, for all subjects, and 0.82 and 0.87, respectively, for all students. Analytical clinical thinking develops over time, independently of the factual content of the course. This implies that shortened medical training programmes could produce less skilled graduates.

The Senior Mentor Program at Duke University School of Medicine

The Duke University School of Medicine has a unique curriculum in which students complete basic sciences in year 1 and clinical clerkships in year 2, making way for an entire year of independent study in year 3. Into this compact curriculum, education in geriatrics has been successfully introduced through focused exercises and activities strategically integrated in all four years. The most popular of these educational strategies is the Senior Mentor Program (SMP), through which second year students meet with a senior volunteer from the community. In addition to improving students' knowledge and skills in geriatric assessment, a central goal of the SMP is to increase students' appreciation for the heterogeneity of health and function among the older adult population. Students meet one-on-one with their senior mentor to practice communication skills and performance of key components of geriatric assessment. Afterward, students convene in small groups with division faculty to debrief. Successful implementation of the program has required a combination of rigorous logistical management and communication with key stakeholders. The program has spawned a number of different benefits beyond the curriculum, including faculty development in teaching skills and enhanced relationships with individuals and agencies from the community. We aspire to continue to improve the structure and content of the program to reflect the socioeconomic and ethnic diversity of the community and to offer students a longitudinal experience.

IS OSCE SUCCESSFUL IN PEDIATRICS

Background: The Faculty of Medical Sciences, University of Zahedan implemented the Objective Structured Clinical Examination (OSCE) in the final Examination during the 2003–2004 academic year. Simultaneously, the pediatric department initiated faculty and student training, and instituted the OSCE as an assessment instrument during the pediatric clerkship in year 5. The study set out to explore student acceptance of the OSCE as part of an evaluation of the Pediatric clerkship. Purpose: This study implemented to evaluate a new method of assessment in medical education in pediatrics. Methods: A self-administered questionnaire was completed by successive groups of students immediately after the OSCE at the end of each clerkship rotation. Main outcome measures were student perception of examination attributes, which included the quality of instructions and organization, the quality of performance, authenticity and transparency of the process, and usefulness of the OSCE as an assessment instrument compared to other methods. Results: There was overwhelming acceptance of the OSCE in Pediatric with respect to the comprehensiveness (90%), transparency (87%), fairness (57%) and authenticity of the required tasks (58–78%). However, students felt that it was a strong anxiety-producing experience. And concerns were expressed regarding the ambiguity of some questions and inadequacy of time for expected tasks.

University of Texas Medical Branch at Galveston.

University of Texas Medical Branch at Galveston.