Clinical Medicine Course Research Articles

Study on formative assessment in the course of clinical transfusion laboratory medicine

Objective To cultivate students innovative spirit and the ability of studying all their lives independently in the course of clinical transfusion laboratory medicine. Methods Beginning with examination reform, we adopted the teaching mode, problem situation setting up-guidance to research and cooperation-evaluation of the students＇ learning effect by use of formative assessment. Results New teaching mode acquired satisfactory results with development of students＇ activity and creativity. Key words: Formative assessment; Examination mode; Clinical transfusion

The educational and financial impact of using patient educators to teach introductory physical exam skills

Purpose: Physical exam skills are essential to core competencies for physicians in training. It is increasingly difficult to secure time and funding for physician faculty to teach these critical skills. This study was designed to determine whether Patient Educators (PE) (non-physician instructors) in an introductory clinical medicine (ICM) course (1) were as effective as physician faculty in teaching the physical exam, (2) impacted consistency of student performance on a final practical exam, and (3) whether this model was cost effective.Method: PE were introduced into an ICM course at the University of Minnesota from 2006 to 2008. Each year, students’ physical exam competencies were evaluated by a performance-based head-to-toe examination and 6 months later by an objective structured clinical examination (OSCE). Differences in test scores between years and variability (i.e., consistency) among yearly scores were assessed. The cost per student was calculated by considering a stable compensation cost per hour for the required number of physician faculty, standardized patients, and PE in each year.Results: Mean student performance was statistically lower with PE, but only by two percentage points. The amount of variation within the medical student classes’ physical exam skills remained stable as the use of PE expanded. Total educator salary costs per student declined from $449 in 2006 to $196 in 2008.Conclusions: In terms of sustainability and student performance, the use of trained lay educators has equivalent outcomes and is less costly for physical exam instruction in the pre-clinical years.

Where Do Medical Students Turn? The Role of the Assigned Mentor in the Fabric of Support During Medical School

Background: The University of Washington School of Medicine implemented an assigned mentoring program in 2002. The College Mentors are assigned at matriculation, advise students throughout medical school, and teach and evaluate students in the 2nd-year Introduction to Clinical Medicine course. Purpose: The purpose of the study was to determine from whom students report they would seek advice and support for academic, professional, personal, and research issues. Methods: A cross-sectional cohort survey asking students whom they would first contact about academic, personal, professional, and research issues was administered to three cohorts of students in 2007. Results: Students reported that they would contact their College Mentor first for general academic progress (49.6%), personal issues (36.2%), and professional issues (64.1%) but not for research issues. Conclusions: Students identified their College Mentor as a primary contact for academic, professional, and personal issues, suggesting that neither the mentors’ assigned status or evaluator role were barriers to the mentoring relationship.

Design and Effectiveness of a Required Pre-Clinical Simulation-based Curriculum for Fundamental Clinical Skills and Procedures

Background For more than 20 years, medical literature has increasingly documented the need for students to learn, practice and demonstrate competence in basic clinical knowledge and skills. In 2001, the Louisiana State University Health Science Centers (LSUHSC) School of Medicine – New Orleans replaced its traditional Introduction in to Clinical Medicine (ICM) course with the Science and Practice of Medicine (SPM) course. The main component within the SPM course is the Clinical Skills Lab (CSL). The CSL teaches 30 plus skills to all pre-clinical medical students (Years 1 and 2).Methods Since 2002, an annual longitudinal evaluation questionnaire was distributed to all medical students targeting the skills taught in the CSL. Students were asked to rate their self- confidence (Dreyfus and Likert-type) and estimate the number of times each clinical skill was performed (clinically/non-clinically). Of the 30 plus skills taught, 8 were selected for further evaluation.Results An analysis was performed on the eight skills selected to determine the effectiveness of the CSL. All students that participated in the CSL reported a significant improvement in self-confidence and in number performed in the clinically/non-clinically setting when compared to students that did not experience the CSL. For example, without CSL training, the percentage of students reported at the end of their second year self-perceived expertise as “novice” ranged from 21.4% (CPR) to 84.7% (GU catheterization). Students who completed the two-years CSL, only 7.8% rated their self-perceived expertise at the end of the second year as “novice” and 18.8% for GU catheterization.Conclusion The CSL design is not to replace real clinical patient experiences. It's to provide early exposure, medial knowledge, professionalism and opportunity to practice skills in a patient free environment.

The University of Texas Medical School at Houston

The University of Texas Medical School at Houston

Ponce School of Medicine

Ponce School of Medicine

Wayne State University School of Medicine

Wayne State University School of Medicine

University of Nevada School of Medicine

University of Nevada School of Medicine

State University of New York, Downstate Medical Center College of Medicine

State University of New York, Downstate Medical Center College of Medicine

Jefferson Medical College of Thomas Jefferson University

Jefferson Medical College of Thomas Jefferson University

University of Chicago Division of the Biological Sciences Pritzker School of Medicine

University of Chicago Division of the Biological Sciences Pritzker School of Medicine

Oregon Health & Science University School of Medicine

Number of Activities: 145 Number of Hours of Instruction: 1,964 Number of Physician Participants: 29,136 Number of Other Learners: 17,094 Received Commercial Support: Yes Received Income from Advertising or Exhibits: Yes Participated in Joint Providership: Yes Offered Courses: Yes Offered Enduring Materials: Yes Offered Internet Enduring Materials: Yes Offered Performance Improvement: Yes Offered RSS: Yes Offered Test Item Writing: Yes

Following the clues: Teaching medical students to explore patients’ contexts

Objective Physicians often overlook important contextual clues that patients give during an encounter. The objective of our study was to increase medical students’ knowledge and skills in identifying contextual issues. Methods Six consecutive learning experiences, including a standardized patient (SP) encounter and activities designed to trigger reflection, were implemented within a first-year Introduction to Clinical Medicine course. Evaluation of the intervention was measured through self-confidence, attitudes, SP history checklist, and student and small group facilitator evaluations. Results Standardized patient encounters, coupled with activities designed to trigger reflection, can help students identify patients’ contextual clues. Students’ confidence in eliciting patient clues significantly increased after the intervention. Our results suggest that some contextual clues were more difficult for students to elicit. Conclusion Multi-faceted approaches that include activities to trigger reflection are effective in teaching students to recognize and respond to contextual clues, however, more research is needed. Practice Implications While students elicited most clues in this study, they struggled with identifying some clues. These results suggest the need for additional research and educational development in this area.

Community Service and the Pediatric Exam: An Introduction to Clinical Medicine via a Partnership Between First Year Medical Students and a Community Elementary School

Background: Introduction to clinical medicine courses traditionally focus on inpatient wards or ignore the well-child exam. Purpose: This program uses an elementary school setting to give 1st-year medical students experience in the well pediatric exam while emphasizing service learning. The program has both learning and service objectives. Medical students learn the art of the pediatric exam while providing a service for an underserved population. Medical students visit a community school and receive lectures about the roles of different providers and the well being of school children. Under faculty guidance they conduct physical exams on kindergartners. Methods: For 2005–2007, 301 medical students participated. Results: Medical student evaluations of the experience, measured on a 5-point Likert scale, are overwhelmingly favorable. Conclusions: The program provides a model for early clinical experience that embraces service learning. It instills an ethic of service and illustrates how the community can be a valuable teaching resource.

Comparison of Medical and Physician Assistant Student Performance in Interprofessional Pharmacology and Clinical Medicine Courses

Introduction: This study replicates a study of interprofessional education (IPE) of physician assistant (PA) and second-year medical students conducted by Denis Oliver early in the history of the University of Iowa PA Program. Currently, there is resurgent interest in IPE in the health sciences, but sparse research evidence available on the topic. Methods: Mean exam score averages for PA and second-year medical (M2) students were compared over a recent 4-year period (August 2003–May 2007) for medical pharmacology and clinical medicine courses using de-identified existing data. Means were compared with t-tests utilizing SPSS 15. Results: Based on data gathered in 1978–1981, Oliver reported small significant differences between the groups: M2 students scored higher than PA students by 2.9 points in clinical medicine and 4.5 points in pharmacology. The current study showed less than a 1-point difference between the groups in both courses, which only reaches statistical significance in pharmacology, and which is likely of no practical significance. Discussion: The original study by Oliver validated an interprofessional approach to training PA students alongside medical students at the University of Iowa Carver College of Medicine. The current study supports the practicality of combining PA and M2 students in didactic settings, despite their disparate levels of prior academic preparation. Possible advantages include efficient use of faculty and institutional resources and the potential for fostering a team approach to medical care early in students’ professional development. This model may be most applicable to PA programs located at academic medical centers.

Impact of the Foundations of Clinical Medicine Course on USMLE Scores

The synthesis of basic and clinical science knowledge during the clerkship years has failed to meet educational expectations. We hypothesized that a small-group course emphasizing the basic science underpinnings of disease, Foundations of Clinical Medicine (FCM), could be integrated into third year clerkships and would not negatively impact the United States Medical Licensure Examination (USMLE) step 2 scores. In 2001-2002, all third year students met weekly in groups of 8-12 clustered within clerkships to discuss the clinical and basic science aspects of prescribed, discipline-specific cases. Students completing USMLE step 2 between 1999 and 2004 (n = 743). Course evaluations were compared with the overall institutional average. Bivariate analyses compared the mean USMLE steps 1 and 2 scores across pre- and post-FCM student cohorts. We used multiple linear regression to assess the association between USMLE step 2 scores and FCM cohort controlling for potential confounders. Students' average course evaluation score rose from 66 to 77 (2001-2004) compared to an institutional average of 73. The unadjusted mean USMLE step 1 score was higher for the post-FCM cohort (212.9 vs 207.5, respectively, p < .001) and associated with step 2 scores (estimated coefficient = 0.70, p < .001). Post-FCM cohort (2002-2004; n = 361) mean step 2 scores topped pre-FCM (1999-2001; n = 382) scores (215.9 vs 207.7, respectively, p < .001). FCM cohort remained a significant predictor of higher step 2 scores after adjustment for USMLE step 1 and demographic characteristics (estimated coefficient = 4.3, p = .002). A curriculum integrating clinical and basic sciences during third year clerkships is feasible and associated with improvement in standardized testing.

Changes in clinical skills education resulting from the introduction of the USMLE™ step 2 clinical skills (CS) examination

Background: Step 2 Clinical Skills (CS) was recently introduced into the United States Medical Licensing Examination (USMLE™) to ensure that successful candidates for licensure possess the clinical skills to provide safe and effective patient care.Aims: To explore if medical schools had changed the objectives, content, or emphasis in their pre-clinical curriculum in response to its implementation.Methods: In April 2005, the Clerkship Directors in Internal Medicine (CDIM) sent an electronic survey to a single member from each medical school with a CDIM member. The survey instrument included 26 pre-clinical curricular questions with nine questions specifically addressing changes in response to implementation of the Step 2 CS.Results: Forty-five percent of respondents reported changes to the Introduction to Clinical Medicine (ICM) course objectives while 39% and 40% reported changes in content and emphasis. Seventy-four percent felt their students were adequately prepared for the Step 2 CS and 18% were unsure.Conclusions: Over a third of medical schools are implementing changes to the objectives, content, and/or emphasis of their curriculum, at least partially in response to the institution of Step 2 CS.

A Student-Designed and Student-Led Sexual-History-Taking Module for Second-Year Medical Students

Background: Sexual history taking is a core clinical skill for all physicians, yet many medical schools do not adequately address this important topic within the curriculum. This article describes a sexual-history-taking module that was initiated, designed, and presented by 2nd-year medical students for their peers as part of the required Introduction to Clinical Medicine (ICM) course. Description: As part of this module, a group of 2nd-year medical students developed a large-group presentation and small-group role play cases to enhance students' basic sexual-history-taking skills in challenging situations, teach ways to ask nonjudgmental questions, and introduce legal issues that may arise. Under faculty supervision, the students recruited and trained peer and faculty facilitators and designed, developed, and analyzed the survey evaluation tools. Evaluation: Both the students and facilitators completed an anonymous questionnaire within 1 to 4 weeks of completing the activity. Of the 92 students completing an online survey, 92% rated the large group presentation good or excellent, and 89% rated the small-group role playing activities as good or excellent, as compared to overall ICM course ratings of 68% good or excellent. Facilitators were well prepared for their roles and reported that the students responded to them positively. Participating students reported that having students as teachers positively enhanced their small group learning experience. Students performed better on the sexual-history-taking questions on the final examination (97.5%) than on the final examination overall (89%). Conclusions: Medical students can successfully create and implement a curriculum module for their peers in a sensitive area such as sexual history taking. Due to changing responsibilities for students as they progress through medical school, sustainability may be challenging.

Ethnographic Studies in the Principles of Clinical Medicine

Ethnographic Studies in the Principles of Clinical Medicine

In Search of Home: From Home to Homeless to Housing

In 1992, Oregon Health and Sciences University (OHSU) introduced the Principles of Clinical Medicine (PCM) course with the intent of providing medical students early in their training with a patient-centered care context. Students are enrolled in this two-year longitudinal course at the same time they are learning basic sciences. PCM consists of two components: a weekly preceptorship in which students spend four hours each week with a community physician and four hours in classes focusing on the knowledge, skills, and attitudes involved in providing patient-centered care. One of the goals of this curriculum is to help students develop cultural sensitivity. This is not an opportunity to interview a patient from an ethnic or cultural background other than their own. They are then asked to relate the patient’s situation and to reflect upon the experience within the context of what was learned during the PCM quarters, including a discussion of US health care policy and economics. This assignment moves the students out of their comfort zone and enables them to learn things about patients and cultures that they never would otherwise. We consider it to be the best opportunity we offer to promote the practice of culturally sensitive medicine. Our faculty continue to be amazed not only that students learn so much, but that they often write so eloquently about these experiences.