Curriculum Deans Research Articles

Are Pre-clerkship Remediation, Grading, and Reporting Practices Equitable in the U.S.? A National Survey

Phenomenon: With the proliferation of pass/fail grading practices in the pre-clerkship phase of undergraduate medical education, questions arise about the transparency and variability of grading and grade reporting practices, raising issues of equity in assessment, particularly regarding residency matching. The purpose of this survey was to determine the remediation and academic performance reporting practices of United States (U.S.) allopathic medical schools in the pre-clerkship phase of their curricula. Approach: After an extensive literature search and feedback from curriculum deans and learning experts, we developed a survey that we sent in the Spring of 2022 to pre-clerkship curriculum officials at all 154 accredited U.S. allopathic medical schools. It addressed curriculum content and structure; pre-clerkship remediation (e.g., course retakes) and reporting (e.g., permanency of transcript notation) practices; documentation and reporting of nonacademic competencies; and participant opinions and recommendations regarding reporting, transparency, and equity. We generated descriptive statistics and did manifest coding of open-ended responses. Findings: We had a response rate of 40% (62/155), with over 71% indicating mainly organ systems-based curricula. Depending on the situation, there were a wide range of remediation approaches for single- and multiple-course failures, including tutoring or learning support, re-exams, and referrals to a promotion board. Professionalism concerns were a top priority to report to residency directors, with significant variability in respondent opinions and practices in reporting remedial activities. Respondents were concerned about equity, both in terms of flexible grading practices and transparency of reporting practices. Insights: The variability in reporting practices across schools, while allowing holistic and individualized approaches to academic support, also creates potential inequities. More work is needed to understand how different reporting practices across institutions may disadvantage marginalized and minoritized student groups at different points in their preparation.

The Changing Landscape of the Preclinical Medical School Curriculum: Results from a Nationwide Survey of United States Medical School Curriculum Deans

The Changing Landscape of the Preclinical Medical School Curriculum: Results from a Nationwide Survey of United States Medical School Curriculum Deans

The Consequences of Step 2 Clinical Skills Examination Discontinuation for Medical Schools and Sustainability Plans for Clinical Skills Assessment.

Comprehensive clinical skills examinations using standardized patients are widely used to assess multiple physician competencies. However, these exams are resource intensive. With the discontinuation of the Step 2 Clinical Skills (CS) exam in 2021, how medical schools will change their approaches to comprehensive clinical skills exams is unknown. This study explores school responses to this change and future directions of comprehensive clinical skills exams using the program sustainability framework. This cross-sectional, descriptive study surveyed medical school curriculum deans at 150 Liaison Committee on Medical Education-accredited U.S. medical schools from September to October 2021. The 30-question survey included questions about medical school and participant role, current comprehensive clinical skills exams, sustainability dimensions, and challenges and future directions. Descriptive statistics were used to characterize responses, and content analysis was used to identify themes in the open-ended responses. Educators at 75 of 150 institutions (50%) responded. Sixty-three respondents (84%) reported conducting a comprehensive clinical skills exam. The comprehensive clinical skills exam assessed readiness for graduation (51 [81%]), provided feedback for students (49 [78%]), evaluated curricula (38 [60%]), provided information for medical student performance evaluation or communication with residency (10 [16%]), and assessed other factors (6 [10%]), including preparation for Step 2 CS in the past and readiness for advancement to fourth year of medical school (multiple responses were allowed). Factors facilitating sustainability included sufficient funding to continue the exam (55 [87%]) and the belief that clinical skills assessment in medical school is now more important after discontinuation of the Step 2 CS exam (55 [87%]). Challenges to sustainability included organizational capacity and limited interinstitutional collaboration. Educators remain committed to the purpose of comprehensive clinical skills exams. Adapting to changed licensing requirements while sustaining clinical skills exams enables innovation and improvement in assessment of clinical competence.

Teaching About Intergenerational Dynamics: An Exploratory Study of Perceptions and Prevalence in US Medical Schools.

PurposePrior studies suggest a role for promoting recognition of generational differences as a part of workplace ethics. To our knowledge, there is no published comprehensive analysis demonstrating how commonly or by what methods intergenerational dynamics are taught as structured coursework in medical school curricula. To address this gap, we carried out a survey of curriculum leaders of US medical schools to assess the current practices and attitudes toward content related to generational differences in medical school coursework.MethodsA survey consisting of 23 closed- and open-ended questions that aimed to assess the presence, characteristics, and attitudes of participants towards intergenerational dynamics in medical school coursework was disseminated via email. Curriculum deans at 154 allopathic medical schools were invited to complete the survey and sent one reminder email. Quantitative responses were descriptively analyzed, and qualitative responses were thematically analyzed.ResultsThe response rate was 38.3%, with the majority (58%) of responding institutions stating that their curriculum did not include coursework on intergenerational dynamics. When taught, the most frequent method of instruction was small-group activities. Most stated that the educational content for intergenerational dynamics has been part of their curriculum for fewer than five years. In total, 34% of respondents agreed that some form of education about intergenerational dynamics should be required during medical education as they felt that content could improve cultural competence. Those that were less supportive of inclusion of intergenerational material stated concerns about stereotyping and the value of generational descriptions.ConclusionOur findings show a heterogeneity of responses on the perceptions and practice of curriculum leaders regarding inclusion of content related to intergenerational differences in medical school education. In summary, we present the first work assessing current practices and attitudes toward content related to the inclusion of material on intergenerational dynamics in undergraduate medical education in US allopathic medical schools.

The current state of headache medicine education in the United States and Canada: An observational, survey-based study of neurology clerkship directors and curriculum deans.

To investigate the current headache medicine education paradigm in allopathic and osteopathic medical schools in the United States and Canada. There is a disparity in the number of clinicians specially trained to treat patients with headache disorders and the number of people who have them. Early education and exposure to headache medicine is crucial to address this disparity. However, the current state of headache education within medical schools across the United States and Canada is unknown. The authors created a medical student headache education survey, which is a 20-question REDCap survey that was distributed via email to the neurology clerkship director, curriculum dean, or similar role at each US and Canadian MD or DO conferring medical school. The email listserv was created using the American Academy of Neurology Clerkship Directory, the Association of American Medical Colleges Organization Directory, the American Association of College of Osteopathic Medicine Organization Directory, manual searches of the institutions' websites, and phone calls and emails to administrators as needed. Of the 249 individuals contacted, 78 completed the survey, yielding a response rate of 31.3%. Of those responses, 84.6% of respondents (66/78) reported that their institution has at least one mandatory session on headache disorders. Many of these sessions (72.7% (48/78)) occurred during preclinical training, and 74.2% (49/78) occurred as part of the clinical curricula. Of respondents, 44.9% (39/78) reported that their institutions coordinate headache education across training levels (i.e., from preclinical to clinical), and only 17.9% (14/78) coordinate across clinical rotations. The most common topics covered were headache red flags, migraine, pharmacologic management, and differentiating primary versus secondary headache. 65.4% of respondents (51/78) felt that the preclinical headache curriculum prepares their students for the clinical experience, and 55.1% (43/78) felt that medical students were learning enough about headache medicine at their institution. Barriers to educating medical students about headache included insufficient time during courses, lack of administrative support in curricula development, lack of available resources, and lack of student interest. Case-based learning modules and online lectures were the most desired educational materials to improve medical student headache education at their institution. The majority of medical schools report incorporating headache medicine education into preclinical or clinical curricula and cover a range of topics in headache medicine. Yet there remains a lack of consistency, with some reporting limited headache education, citing barriers such as lack of administrative support and available educational resources. There is also variation in what is being taught at the medical student level. Future projects should aim to address said barriers, with the goal of providing a standardized headache medicine curriculum for use across medical schools.

The state of headache medicine education in North America: An observational, survey-based study of neurology clerkship directors and curriculum deans. (1393)

The state of headache medicine education in North America: An observational, survey-based study of neurology clerkship directors and curriculum deans. (1393)

Emory University School of Medicine.

Emory University School of Medicine.

A survey of the training of traditional, complementary, and alternative medicine in universities in Thailand.

BackgroundTraditional, complementary, and alternative medicine (TCAM) is popularly used by the Thai population. The aim of this study was to determine whether undergraduate medical curricula included TCAM and, if so, to ascertain what kind of education was provided. In addition, where undergraduate degrees in TCAM were offered, the type of TCAM curricula, research, training, and collaboration were examined.MethodsIn a cross-sectional survey, academic or curriculum deans and faculty at each of the medical schools (response rate 76.2% of 21) and each of the TCAM faculties and departments (response rate 77.8% of 18) in Thailand responded to a questionnaire on characteristics of their TCAM curriculum.ResultsHalf of the medical schools (50%) confirmed the presence of TCAM education in their medical school, of which most were a required and some an elective course. In all surveyed 14 TCAM departments or faculties a bachelor’s degree and in five institutions a master’s degree in TCAM are offered. Undergraduate and postgraduate degrees include Thai Traditional Medicine, Applied Thai Traditional Medicine, Chinese Traditional Medicine, and Oriental Medicine. All the programs offered a research course and almost all indicated that their curriculum covers “scientific proofs about the efficacy and safety of treatments.” More than half (9) indicated that their curriculum covers “how TCAM professionals should interact with biomedical peers in their practice.”ConclusionRegarding TCAM training modules of medical undergraduates, only 50% of medical schools had integrated TCAM training in their curriculum. It will be important to give all medical students exposure to TCAM practices in their curriculum. Regarding the implementation of TCAM bachelor’s degrees, the study confirmed the importance of the integration of research methodology, evidence-based health care, and interprofessional communication into the training of TCAM providers’ training and practice.

Integrating Information Literacy and Evidence-Based Medicine Content within a New School of Medicine Curriculum: Process and Outcome

ABSTRACTThis column describes a process for integrating information literacy (IL) and evidence-based medicine (EBM) content within a new school of medicine curriculum. The project was a collaborative effort among health sciences librarians, curriculum deans, directors, and faculty. The health sciences librarians became members of the curriculum committees, developed a successful proposal for IL and EBM content within the curriculum, and were invited to become course instructors for Analytics in Medicine. As course instructors, the librarians worked with the other faculty instructors to design and deliver active learning class sessions based on a flipped classroom approach using a proprietary Information Mastery curriculum. Results of this collaboration may add to the knowledge base of attitudes and skills needed to practice as full faculty partners in curricular design and instruction.

Physicians-in-training are not prepared to prescribe medical marijuana

BackgroundWhile medical marijuana use is legal in more than half of U.S. states, evidence is limited about the preparation of physicians-in-training to prescribe medical marijuana. We asked whether current medical school and graduate medical educational training prepare physicians to prescribe medical marijuana. MethodsWe conducted a national survey of U.S. medical school curriculum deans, a similar survey of residents and fellows at Washington University in St. Louis, and a query of the Association of American Medical Colleges (AAMC) Curriculum Inventory database for keywords associated with medical marijuana. ResultsSurveys were obtained from 101 curriculum deans, and 258 residents and fellows. 145 schools were included in the curriculum search. The majority of deans (66.7%) reported that their graduates were not at all prepared to prescribe medical marijuana, and 25.0% reported that their graduates were not at all prepared to answer questions about medical marijuana. The vast majority of residents and fellows (89.5%) felt not at all prepared to prescribe medical marijuana, while 35.3% felt not at all prepared to answer questions, and 84.9% reported receiving no education in medical school or residency on medical marijuana. Finally, only 9% of medical school curriculums document in the AAMC Curriculum Inventory database content on medical marijuana. ConclusionsOur study highlights a fundamental mismatch between the state-level legalization of medical marijuana and the lack of preparation of physicians-in-training to prescribe it. With even more states on the cusp of legalizing medical marijuana, physician training should adapt to encompass this new reality of medical practice.

A Comprehensive Survey of Preclinical Microbiology Curricula Among US Medical Schools.

A strong foundational understanding of microbiology is crucial for the 21st century physician. Given recent major advances in medical microbiology, curricular changes will likely be needed. Before transforming curricula, we must first obtain a comprehensive understanding of contemporary medical student microbiology education. We disseminated a 38-question survey to microbiology course directors and curriculum deans at 142 US medical schools accredited by the Liason Committee on Medical Education. Survey questions focused on course leadership, curricular structure, course content, and educator perceptions about microbiology education locally and nationally. One hundred and four (73%) of 142 schools completed the survey. Ninety-four (90%) schools identified a course director. Of these, 48% were led by microbiologists alone, 23% co-led by a microbiologist and a clinician, 20% by a clinician alone, and 8% by a laboratory medicine physician with or without a co-director. At 55 (53%) schools, the curricula were organized in a single block or course and at 47 (45%) it was integrated into other curricula. Areas of emerging importance, such as antimicrobial stewardship, global health, infection control, and the microbiome, were addressed at 66%, 65%, 64%, and 47% of institutions, respectively. Respondents reported the following concerns: challenges integrating microbiology into other courses, reduced total teaching hours, and difficulty balancing basic and clinical science topics. Preclinical microbiology course directors report significant challenges in meeting the needs of changing curriculum structure and content. Enhanced local collaboration between microbiologists and clinicians, as well as national collaboration among relevant societies to design best practices and support research, may be strategies for future success.

Medical Student Core Clinical Ultrasound Milestones: A Consensus Among Directors in the United States.

Many medical schools are implementing point-of-care ultrasound in their curricula to help augment teaching of the physical examination, anatomy, and ultimately clinical management. However, point-of-care ultrasound milestones for medical students remain unknown. The purpose of this study was to formulate a consensus on core medical student clinical point-of-care ultrasound milestones across allopathic and osteopathic medical schools in the United States. Directors who are leading the integration of ultrasound in medical education (USMED) at their respective institutions were surveyed. An initial list of 205 potential clinical ultrasound milestones was developed through a literature review. An expert panel consisting of 34 USMED directors across the United States was used to produce consensus on clinical ultrasound milestones through 2 rounds of a modified Delphi technique, an established anonymous process to obtain consensus through multiple rounds of quantitative questionnaires. There was a 100% response rate from the 34 USMED directors in both rounds 1 and 2 of the modified Delphi protocol. After the first round, 2 milestones were revised to improve clarity, and 9 were added on the basis of comments from the USMED directors, resulting in 214 milestones forwarded to round 2. After the second round, only 90 milestones were found to have a high level of agreement and were included in the final medical student core clinical ultrasound milestones. This study established 90 core clinical milestones that all graduating medical students should obtain before graduation, based on consensus from 34 USMED directors. These core milestones can serve as a guide for curriculum deans who are initiating ultrasound curricula at their institutions. The exact method of implementation and competency assessment needs further investigation.

An evaluation of lesbian, gay, bisexual, and transgender (LGBT) health education in pharmacy school curricula

BackgroundThe lesbian, gay, bisexual, and transgender (LGBT) community has increased health risks, including higher rates of certain cancers, depression, tobacco use, and substance abuse. These individuals are less likely to seek medical treatment and have higher rates of dissatisfaction with the health care system. It is unclear to what extent pharmacy school curricula prepare students to provide quality care to this population. ObjectiveThe objective of this study is to describe to what extent LGBT health content is integrated in the pharmacy curricula. MethodsBetween November 2011 and January 2012, curriculum Deans (or equivalent) from schools of pharmacy throughout the US were invited to complete a 14-item questionnaire to report the amount of LGBT health content taught in their respective schools. ResultsA total of 28 schools (n = 125, 22%) responded. Of the 28 respondents, 43% reported having LGBT content in the required curriculum, with 39% reporting one to three hours and 4% reporting four to ten hours. The topics most frequently taught by schools were human immunodeficiency virus (HIV) in LGBT people (71%) and sexually transmitted infections (non-HIV) (46%). Faculty development for teaching LGBT health content was provided by 18% of schools. The coverage of LGBT content was rated as “good” or “very good” by 14% and “very poor” by 32% of respondents. ConclusionsA review of how the schools of pharmacy curricula include LBGT health content is needed. We suggest strategies and resources that may help prepare faculty to teach LGBT health content and assist curriculum committees to integrate this material into the pharmacy curricula.

Complementary and Alternative Medicine in the Undergraduate Medical Curriculum: A Survey of Korean Medical Schools

The current status of complementary and alternative medicine (CAM) education in Korean medical schools is still largely unknown, despite a growing need for a CAM component in medical education. The prevalence, scope, and diversity of CAM courses in Korean medical school education were evaluated. Participants included academic or curriculum deans and faculty at each of the 41 Korean medical schools. A mail survey was conducted from 2007 to 2010. Replies were received from all 41 schools. CAM was officially taught at 35 schools (85.4%), and 32 schools (91.4%) provided academic credit for CAM courses. The most common courses were introduction to CAM or integrative medicine (88.6%), traditional Korean medicine (57.1%), homeopathy and naturopathy (31.4%), and acupuncture (28.6%). Educational formats included lectures by professors and lectures and/or demonstrations by practitioners. The value order of core competencies was attitude (40/41), knowledge (32/41), and skill (6/41). Reasons for not initiating a CAM curriculum were a non-evidence-based approach in assessing the efficacy of CAM, insufficiently reliable reference resources, and insufficient time to educate students in CAM. This survey reveals heterogeneity in the content, format, and requirements among CAM courses at Korean medical schools. Korean medical school students should be instructed in CAM with a more consistent educational approach to help patients who participate in or demand CAM.

Regulation of Medical Student Work Hours: A National Survey of Deans

Because of the impact of resident duty hours on resident and medical student education, it is important to determine curriculum deans' opinions toward and current status of student work hours regulations. In 2008, the authors electronically surveyed the curriculum deans at the 126 U.S. medical schools accredited by the Liaison Committee on Medical Education (LCME) regarding student work hours at their schools. Sixty-six respondents (82%) had a written policy restricting their students' work hours, and in 63% of these, the policy also extended to students visiting their institution. Policies applied to mandatory and elective (84%) or only mandatory (16%) rotations. About half the respondents supported a universal policy across medical schools, but of those who supported a policy, there was an equal split between whether individual schools or the LCME should create the policy. Deans felt strongly (>80%) that student well-being would be improved by work hours regulation, yet 48% noted that it would negatively affect scheduling required clerkship activities. Fifty-four percent supported the Accreditation Council for Graduate Medical Education work hours policy for students, and most (82%) felt that students should work no more than 80 hours/week. Students are always supervised, yet extended work hours can affect learning and patient and team interactions. Without a mandate, many schools have created policies to restrict student work hours. This study describes the current status and offers an opportunity for consensus building around this important issue.

Consequences Within Medical Schools for Students With Poor Performance on a Medical School Standardized Patient Comprehensive Assessment

Medical schools increasingly employ comprehensive standardized patient assessments to ensure medical students' clinical competence. The consequences of poor performance on the assessment and the institutional factors associated with imposing consequences are unknown. In 2006, the investigators surveyed 122 U.S. medical school curriculum deans about comprehensive assessments using standardized patients after core clerkships, with questions about exam characteristics, institutional commitment to the examination (years of experience, exam infrastructure, clerkship director involvement), academic consequences of failing the assessment, and satisfaction with remediation. Ninety-three of 122 (76%) deans responded. Eighty-two (88%) conducted a comprehensive assessment in years three or four of medical school. Of those, required remediation was the only consequence of failing employed by 61 schools (74%), and only 39 (47%) required retesting for graduation. Participants were somewhat satisfied with (mean 3.45 out of maximum 5, SD 1.08) and confident in (3.37, SD 1.17) their remediation process. Satisfaction and confidence were associated with requiring remediation (P = .003) and retesting (P < .001), but experience with the exam, exam infrastructure, and clerkship director involvement were not. No school demographic characteristics or measures of institutional commitment were related to external reporting of students' comprehensive assessment scores. Despite the prevalence of comprehensive assessments, schools attach few academic consequences to poor performance. Educators are only moderately satisfied with their efforts to remediate poor performers. However, schools with greater trust in their remediation process than other schools are more likely to enforce consequences of poor performance.

Preparing Medical Students for Clerkships: A Descriptive Analysis of Transition Courses

Students have reported several challenging aspects of the transition to clerkships, such as applying clinical knowledge, learning experientially, using clinical skills, adjusting to clinical settings, and understanding roles. In an effort to address some of these challenges, a number of medical schools have added transition courses to their curricula, but little information about these courses has been published. The authors draw on findings from a study of the design and content of 30 transition courses offered in U.S. medical schools, to examine various approaches and provide a framework to guide the design of transition courses. Most courses (83%) were between one day and one week long. The authors identified three primary course themes: presentation of new information and skills, review and application of content covered in the preclerkship curriculum, and student well-being. All courses presented new information and skills, and more than half of the courses (53%) addressed all three themes. The most common curricular topics were technical/procedural skills, safety precautions, orientation to clinical settings, review of clinical skills, and stress management. Hands-on experience was the most frequently used instructional approach. Few courses had explicit goals and objectives, and evaluation of students was rare. Transition courses can address some of the needs and challenges associated with early clerkship experiences. These courses should explicitly target areas of need that are described in the literature as well as those identified within one's own institution. They should include clear objectives, learning activities tailored to the areas of need and objectives, and student and course evaluations.

A National Study of Medical Student Clinical Skills Assessment

This study describes comprehensive standardized patient examinations in medical schools nationally. We surveyed 121 medical school curriculum deans regarding their use of standardized patient assessments. Questions addressed examination characteristics, funding sources, and collaborations. A total of 91 of 121 curriculum deans responded (75% response rate). The majority (84%) of respondents report conducting a comprehensive clinical skills assessment during the third or fourth year of medical school. Most programs are funded with dean's office monies. Although many collaborate with other institutions for examination development, the majority of schools score and remediate students independently. Two-thirds of all respondents (61/91) report that the new standardized patient licensing requirement elevates the importance of in-house clinical skills examinations. Most medical schools now conduct comprehensive clinical skills assessments after the core clerkships, and collaboration is common. These results suggest increasing emphasis on clinical and communication skills competency and opportunities for collaborative research.

Information and Informatics Literacy: Skills, Timing, and Estimates of Competence

Background: Computing and biomedical informatics technologies are providing almost instantaneous access to vast amounts of possibly relevant information. Although students are entering medical school with increasingly sophisticated basic technological skills, medical educators must determine what curricular enhancements are needed to prepare learners for the world of electronic information. Purpose: The purpose was to examine opinions of academic affairs and informatics administrators, curriculum deans and recently matriculated medical students about prematriculation competence and medical education learning expectations. Methods: Two surveys were administered: an Information Literacy Survey for curriculum/informatics deans and a Computing Skills Survey for entering medical students. Results: Results highlight differences of opinion about entering competencies. They also indicate that medical school administrators believe that most basic information skills fall within the domain of undergraduate medical education. Conclusions: Further investigations are needed to determine precise entry-level skills and whether information literacy will increase as a result of rising levels of technical competence.

Courses Involving Complementary and Alternative Medicine at US Medical Schools

With the public's increasing use of complementary and alternative medicine, medical schools must consider the challenge of educating physicians about these therapies. To document the prevalence, scope, and diversity of medical school education in complementary and alternative therapy topics and to obtain information about the organizational and academic features of these courses. Mail survey and follow-up letter and telephone survey conducted in 1997-1998. Academic or curriculum deans and faculty at each of the 125 US medical schools. Courses taught at US medical schools and administrative and educational characteristics of these courses. Replies were received from 117 (94%) of the 125 US medical schools. Of schools that replied, 75 (64%) reported offering elective courses in complementary or alternative medicine or including these topics in required courses. Of the 123 courses reported, 84 (68%) were stand-alone electives, 38 (31%) were part of required courses, and one (1%) was part of an elective. Thirty-eight courses (31%) were offered by departments of family practice and 14 (11%) by departments of medicine or internal medicine. Educational formats included lectures, practitioner lecture and/or demonstration, and patient presentations. Common topics included chiropractic, acupuncture, homeopathy, herbal therapies, and mind-body techniques. There is tremendous heterogeneity and diversity in content, format, and requirements among courses in complementary and alternative medicine at US medical schools.