Family Medicine Clerkship Research Articles

Student Reflections on Mandatory Encounters with Hospice Patients During a Family Medicine Clerkship (S703)

1.Apply content analysis methods to medical students' hospice experience reflective essays to evaluate both the clerkship and students' personal and educational outcomes.2.Evaluate the application of information gleaned from students' hospice experience reflective essays for specific clerkship improvements. As end-of life care curricula have been implemented throughout U.S. medical schools, educators have found that clinical exposure to hospice patients is an effective method to introduce compassionate care. The purpose of this study is to gain an understanding of third year medical students' perspectives on their clerkship experience with hospice patients. Results will provide information for course revisions and enhancements not otherwise found in standard clerkship evaluations. This is a descriptive, qualitative study. Researchers conducted a content analysis of students' written reflections using a phenomenographic approach and investigator triangulation. Outcome and content categories were analyzed in SPSS ©. The medical university IRB approved the study. There were 130 essays submitted; 20 were excluded for noncompliance with instructions or missing data. Evaluative outcomes of the experience identified were 1) positive, 2) negative, 3) personally fulfilling, 4) one that would impact them as future physicians, 5) enjoyed the non-clinical encounter. The experience was positive for 88% of students; only 2% described it as negative. Two learning outcomes were identified: 1) the student learned about life and death; 2) the student learned to talk to dying patients. Eight categories of content, each with several themes, were identified. Students' personal connections with patients and learning to talk to dying patients were associated with the positive evaluative outcomes. Descriptions of open, honest discussions and patients' views of living and dying were associated with learning about life and death. These overwhelmingly positive results will inform pre-clerkship preparations and rotation design to better prepare medical students for the range of experiences and emotions they will encounter and the learning opportunities to be gained.

Developing, evaluating and validating a scoring rubric for written case reports.

ObjectivesThe purpose of this study was to evaluate Family Medicine Clerkship students’ writing skills using an anchored scoring rubric. In this study, we report on the assessment of a current scoring rubric (SR) used to grade written case description papers (CDP) for medical students, describe the development of a revised SR with examination of scoring consistency among faculty raters, and report on feedback from students regarding SR revisions and written CDP.MethodsFive faculty members scored a total of eighty-three written CDP using both the Original SR (OSR) and the Revised SR1 (RSR1) during the 2009-2010 academic years.ResultsOverall increased faculty inter-rater reliability was obtained using the RSR1. Additionally, this subset analysis revealed that the five faculty using the Revised SR2 (RSR2) had a high measure of inter-rater reliability on their scoring of this subset of papers (as measured by intra-class correlation (ICC) with ICC = 0.93, p < 0.001.ConclusionsFindings from this research have implications for medical education, by highlighting the importance of the assessment and development of reliable evaluation tools for medical student writing projects.

Bringing Our Whole Person to Whole Person Care: Fostering Reflective Capacity with Interactive Reflective Writing in Health Professions Education

Reflective learning and practice foster personal, professional, and interprofessional identity development within health professions education to encourage humanistic, competent patient care. Reflection on experience nurtures mindful presence and adaptive expertise/”practical wisdom,” enabling the health care professional to recognize and address patients’ and families’ emotional, psychosocial, cultural, and spiritual needs for optimizing whole person care (WPC). By heightening awareness of strengths, values, biases, and/or limitations, reflection also helps the provider bring more of his/her “whole person” to WPC, strengthening the provider-patient therapeutic relationship (reciprocity for healing). The use of reflective writing (RW) to augment reflective practice is well documented. RW in the small group setting fosters narrative competence (hearing/responding to a patient’s story, awareness of one’s own stories), self-assessment, moral sensitivity, empathy, emotional processing, and provider well-being. At Alpert Med, we have implemented an “interactive reflective writing” (IRW) paradigm of guided individualized feedback from interdisciplinary faculty to students’ RW in a Doctoring course and Family Medicine clerkship (with small group peer-based narrative sharing and collaborative feedback). Frameworks for enhancing educational value of feedback (BEGAN and REFLECT-reflective level evaluation rubric) were developed, incorporated into student and faculty guides, and applied in faculty development.INTERACTIVE WORKSHOP OBJECTIVES: 1) Participants will be familiarized with constructs of reflective learning/practice and IRW, 2) Participants will apply BEGAN and REFLECT to a student’s reflective essay as exemplar, 3) Participants will engage in interactive dialogue with medical student presenters on positive learning outcomes of IRW for WPC 4) Participants will consider and share merits, limitations, and possible utility of presented curricula/evaluative tools for their settings. FORMAT/ACTIVITIES:1. Didactic - Reflective Learning/Practice for WPC2. Participants provide feedback to student’s RW3. Discussion4. Introduce BEGAN/REFLECT frameworks5. Participants re-craft feedback with frameworks/Discuss6. Student/faculty presenters share experiences of IRW pedagogy for fostering reflection and WPC7. Wrap-up/Q and A.

Reflective Impressions of a Precepted Clinical Experience Caring for People With Disabilities

There is evidence that early and frequent encounters with people with disabilities can improve medical students' knowledge, skills, and attitudes about disability. As part of a 4-year integrated curriculum in caring for patients with disabilities, third-year medical students (n = 144) in a Family Medicine clerkship participated in a day-long precepted clinical experience at a medical facility serving people with disabilities, predominantly developmental disabilities, where they met patients and worked with clinicians. At the conclusion of the program, students completed a reflective survey about their experience. These data were analyzed qualitatively using a constructivist grounded-theory approach. Students' responses indicated that the experience improved their comfort levels in working with people with disabilities and increased their awareness of attitudinal factors that influence patient care. Responses also demonstrated that students achieved an awareness of technical accommodations and organizational adaptations that improve patient care.

Tobacco dependence treatment teaching by medical school clerkship preceptors: Survey responses from more than 1000 US medical students

ObjectiveTo determine factors associated with tobacco cessation counseling in medical school clerkships. MethodsThird-year medical students at 10 medical schools across the United States completed a 100-item survey, measuring the frequency with which they experienced their preceptors providing clinical teaching components: clear instruction, feedback, modeling behavior, setting clear objectives, and responding to questions about tobacco dependence counseling as well as frequency of use of tobacco prompts and office systems. Our primary dependent measure was student self-reported skill level for items of tobacco dependence treatment (e.g. “5As”). ResultsSurveys were completed by 1213 students. For both family medicine and internal medicine clerkships, modeling and providing clear instruction on ways to provide tobacco counseling were reported most commonly. In contrast, providing feedback and clear objectives for tobacco dependence treatment lagged behind. Overall, students who reported preceptors' provision of optimal clinical teaching components and office system prompts in both family medicine and internal medicine clerkships had higher self-reported skill (P<0.001) than students with no exposure or exposure during only one of the clerkships. ConclusionsFuture educational interventions intended to help students adopt effective tobacco dependence treatment techniques should be engineered to facilitate these critical precepting components.

Meeting the Challenge of Evidence-Based Medicine in the Family Medicine Clerkship: Closing the Loop from Academics to Office

An EBM Seminar and POEM® project was developed to teach evidence-based medicine in a family medicine clerkship. The seminar focused on the application of preclinical coursework in biostatistics and epidemiology to the clinical third year. POEM projects involved answering clinical questions, derived from patient cases in the family medicine offices, with best available evidence. These questions and answers were archived in a wiki which was made available to the institution's family medicine physicians. Selected POEMs were also published in the in-house family medicine newsletter. The POEM projects evolved from an educational exercise for medical students to a valuable repository of evidence for clinicians.

Death is not always a failure: outcomes from implementing an online virtual patient clinical case in palliative care for family medicine clerkship

BackgroundThe dying patient is a reality of medicine. Medical students, however, feel unprepared to effectively manage the complex end-of-life (EOL) management issues of the dying patient and want increased experiential learning in Palliative Care.AimsTo address the need for more formal curriculum in EOL care, we developed and implemented an online virtual patient (VP) clinical case in Palliative Care into the 2010–2011 Year Three Family Medicine Clerkship rotation curriculum.MethodsA mixed-method design was used to measure the change in knowledge and perceived preparedness level in EOL care before and after completing the online VP case. A survey collected qualitative descriptions of the students’ educational experience of using this case.ResultsNinety five percent (130/137) of the students voluntarily consented to have their results analyzed. The group knowledge score (n=127) increased significantly from a pre-course average of 7.69/16±2.27, to a post-course average of 10.02/16±2.39 (p<0.001). The students’ self-assessed comfort level increased significantly with all aspects of EOL management from pre-course to post-course (p<0.001). Nearly, 91.1% of the students rated the VP realism as ‘Good to Excellent’, 86% rated the case as educationally beneficial. Nearly 59.3% of students felt emotionally engaged with the VP. Qualitative feedback found that the case content was very useful and realistic, but that the interface was sometimes awkward to navigate.ConclusionsThe online VP case in Palliative Care is a useful teaching tool that may help to address the need for increased formal Palliative Care experience in medical school training programs.

Problem-based learning: Where are we now? Guide supplement 36.3 – Practical Application

Background: Problem-based learning (PBL) is a well used educational strategy, more frequently used in the pre-clinical phase rather than the clinical phase of medical student learning. This practical application explores its use in a Family Medicine undergraduate clerkship.Method: The PBL application is described during a 10- week rotation in Family Medicine for final year medical students. 217 students were asked to rank 24 statements describing their PBL experience on a five-point Likert scale. The grading was supplemented by one qualitative question. The clinical tutors were asked to write an evaluation statement on their experience.Evaluation: The educational process was rated highly by students and faculty as a valuable learning methodology that enhanced their knowledge and understanding of patient problems, providing them with a more holistic approach to care.Conclusions: It would appear that PBL is infrequently used during clinical learning and specifically not in a Family Medicine clerkship. This small study supports its value to both student and faculty

Teaching family medicine: a longitudinal and modular competency-based approach

What problems were addressed? Our graduate medical school is located in Singapore. It runs a 4-year curriculum which closely follows the curriculum at Duke University (Durham, NC, USA). Basic sciences are taught during Year 1; clinical clerkships and electives are held in Years 2 and 4, and Year 3 is dedicated to research. The challenge was to design an innovative clerkship that complements the school’s unique curriculum. We abandoned the 4-week programme in Year 2 as taught at Duke University and adopted a modular competency-based approach. We created a year-long programme, allowing our students to experience care continuity and patient-centredness in the community. The first cohort of students completed the year-long clerkship in 2010 with encouraging results. What was tried? The family medicine clerkship is taught in three modules. The first is a knowledge foundation module, which is completed in the first 2 weeks of Year 3. Knowledge and skills learned during Year 2 clerkships are consolidated. Students learn to translate them to a family medicine setting, using team-based learning and clinical scenarios. These are supplemented with lectures and smallgroup discussions on conceptual topics in family medicine. Topics include family medicine principles, organisation of primary care, chronic disease management, preventative care and consultation skills. This is followed by two other modules, which are conducted in the community over the rest of the year. The continuity clinic module focuses on professionalism, patient care and system-based learning. Students are placed under the tutelage of two preceptors in community clinics. They complete a minimum of 20 clinic sessions distributed over a 1-year period. They are required to record their reflections after each session, using an electronic log book. In the patient-centred care module, students follow up two patients with chronic health issues, whom they encountered in their Year 2 clerkships. Students work in small groups of up to six and are supervised by a faculty member. Students make home visits and are encouraged to discover the perspectives of the patients and their caregivers as they cope with their illnesses. Students are encouraged to study system issues as they follow their patients’ journeys through the health care system. They are required to reflect on the impact of illness on the patients’ lives. Students ‘blog’ their reflections in their personalised web logs. We use a closed-access network which is shared only with team-mates and assigned faculty staff to maintain confidentiality. Students and teachers are encouraged to comment and interact with one another as they share experiences. What lessons were learned? An extended clerkship in which students are dispersed in the community is logistically challenging. Use of information technology, such as a web-based personal journal and electronic log books, is helpful. The programme was well accepted by faculty staff and students. On a scale of 0–5, the clerkship achieved a score of 4.21 in the students’ evaluation of the programme’s ability to achieve the goals and objectives of the rotation. Overall, 29.0% of students in the class gave the programme a score of 5 and 62.5% gave it a score of 4.

The Association Between Specialty Match and Third-Year Clerkship Performance

The United States is experiencing an accelerating physician shortage, especially within primary care. Medical educators are actively seeking ways to predict student specialty match and workforce requirements. Previous studies investigating specialty match have focused on factors known at the time of matriculation. This study examined whether third-year clerkship performance could be used to predict specialty match later in medical school. The authors evaluated the clerkship performance of 802 students graduating from the Uniformed Services University between 2007 and 2011. They examined the relationship of students' clerkship grades and National Board of Medical Examiners' clinical subject examination scores to specialty match. In addition, the authors combined student performance in family medicine, internal medicine, and pediatrics to create composite variables and assessed their associations with the match. Among 802 students, 339 (42.4%) students matched to primary care specialties. There was a positive association between higher family medicine (Odds ratio [OR] 1.65, 95% confidence interval [CI] 1.05, 2.59), general surgery (OR 1.91, 95% CI 1.22, 2.99), internal medicine (OR 2.17, 95% CI 1.35, 3.49), and pediatrics (OR 2.59, 95% CI 1.52, 4.43) clerkship grades and students matching into family medicine, general surgery, internal medicine, and pediatrics, respectively. Only family medicine showed a weak correlation between higher National Board of Medical Examiners' scores and specialty match. Higher clerkship performance in four of six Uniformed Services University third-year clerkships is associated with matching into the corresponding specialty. Clerkship performance provides a potential tool for educators in counseling students and predicting future specialty match.

A Replicable Model of a Health Literacy Curriculum for a Third-Year Clerkship

Contrary to recommendations from national medical organizations, medical school education often fails to train students to interact effectively with patients with limited health literacy. The objectives of a new health literacy curriculum in a family medicine clerkship were to increase students' knowledge of health literacy and develop comfort with specific communication skills. Instructional strategies included lectures, practice with standardized patients (SPs), and a facilitated discussion board. At the end of the first year of the curriculum, there was a statistically significant increase in students' knowledge of health literacy. During the final testing with SPs, students achieved high scores for health literacy related communication skills. The curriculum is replicable at other universities and was an effective and efficient way for medical students to learn about health literacy and to acquire valuable skills to improve their patients' understanding of health information.

STFM UNVEILS THE NATIONAL FAMILY MEDICINE CLERKSHIP CURRICULUM WEBSITE

STFM recently unveiled The National Family Medicine Clerkship Curriculum website. It outlines best practices for delivering and evaluating the core curriculum for 3rd-year family medicine clerkships and offers educational methods, assessment strategies, and resources for clerkship directors and

Don't select medical students -- convince them

Scott and colleagues presented a study of high quality, addressing an important topic.1 The authors encourage medical faculties to increase their output of family medicine residents by selecting and targeting students based on sociodemographic and attitudinal variables of predictive value. Such an approach would require the acquisition and storage of personal information. To our mind, this is concerning, given ethical consideration and data privacy. The education level of parents, relationship status and societal attitudes should not influence admission to medical school or course and content of medical education. We see a bigger benefit in understanding the variables that influence the decision-making process in the course of studies. Recent publications show that positive family medicine experiences, longitudinally implemented in the curriculum, positively influence the attractiveness of family medicine as a career.2–5 Obligatory and longer family medicine clerkships and exposure to role models influence students committed to primary care as well as those who are undecided.3 Several studies describe the positive effect of rural training experiences.4,6 So don’t select students — convince them.

Medical Readers' Theater: Relevance to Geriatrics Medical Education

Medical Readers' Theater (MRT) is an innovative and simple way of helping medical students to reflect on difficult-to-discuss topics in geriatrics medical education, such as aging stereotypes, disability and loss of independence, sexuality, assisted living, relationships with adult children, and end-of-life issues. The authors describe a required MRT experience involving third-year medical students on their Family Medicine clerkship and volunteer residents from a nearby continuing care retirement community. Evaluation of the program shows positive benefits to student and senior participants in terms of greater awareness of each other's perspectives and improved communication.

Can Blended Classroom and Distributed Learning Approaches be Used to Teach Medical Students How to Initiate Behavior Change Counseling During a Clinical Clerkship?

Medical school curricula often provide insufficient time and instruction for health behavior change counseling. We examined the feasibility of blending classroom and distributed learning experiences to teach medical students how to initiate health behavior change counseling and analyzed the impact of this approach on their attitudes, knowledge, and skills. Usage patterns and pre- to post-class attitude and knowledge changes were assessed with self-report questions among 153 third year family medicine clerkship students. Most students viewed at least 90% of the online written content and took an average of 41 min (SD = 24 min 35 s) to view all of the content. Students' confidence in their ability to help patients change unhealthy behaviors significantly improved (p < .01). The blended learning curriculum facilitated learning of behavior change skills, encouraged interaction with course materials, and improved medical students' self confidence for using health behavior change skills.

FAMILY MEDICINE CLERKSHIP IN BASIC MEDICAL EDUCATION

Primary care is the center of the health care systems in many developed countries. It has been awarded by improving health and well-being of the population, and decreasing health expenditure. Unfortunately, since the teachers’ expertise in medical faculties becomes more specific, the basic medical education (BME) becomes more specialization-oriented and the students do not have the opportunity to learn the actual profile of primary care and the needs of the community. The faculties of medicine should renovate their curriculum and should provide early clinical exposure to improve the student’s affinity to primary care. Family medicine clerkship should be a part of curriculum in each medical school and this period should be used as an opportunity for the young physicians’ career choice in Family Medicine.

Teaching Medical Students About Disability: The Use of Standardized Patients

Standardized patients (SPs), now a mainstay of the undergraduate medical education experience, are beginning to play larger roles in helping students build competencies to better serve patients who have disabilities, in educating students about the lived experiences of persons with disabilities, and in testing students' understanding of disability-related issues. In this article, the authors discuss several U.S. training programs that involve SPs who have disabilities or SPs who do not have disabilities but who portray patients who do. The authors review the goals of each program (e.g., to provide students with opportunities to gain experience with patients with disabilities), describe their commonalities (enhancing students' interview skills) and differences (some programs are educational; some are evaluative), and summarize the evaluative data of each. The authors also explore the benefits and challenges of working with SPs with disabilities and of working with SPs without disabilities. Finally, they consider the practical issues (e.g., recruiting SPs) of developing and implementing such programs.

Design, Implementation and Evaluation of a New Core Learning Objectives Curriculum for a Urology Clerkship

Until recently, medical students at the University of Wisconsin School of Medicine and Public Health participated in a traditional 2-week urology clerkship. We hypothesized that a new curriculum with core learning objectives and student oriented didactic sessions would increase learning and satisfaction compared to a traditional clerkship. Between July 2008 and June 2009, 55 medical students completed the urology clerkship following the traditional curriculum. Between July 2009 and June 2010, 51 students followed the core learning objectives curriculum. We compared the curriculum outcomes using objective and subjective measures. Overall student participation was 90%, with 95 of 106 students completing both assessment tools. The objective scores of the students following the core learning objectives were higher than those of the students following the traditional curriculum. The t test to evaluate the difference between the 2 curricula was statistically significant (t = 2.845, df = 93, p <0.05). Subjective scores for the core learning objectives group were lower in all but 1 category. Student perception of knowledge attainment for the core learning objectives cohort was higher than that of the traditional cohort, but none of the subjective scores was statistically significant. This study demonstrated that a core learning objectives curriculum was associated with higher objective test scores compared to a traditional model, suggesting that the core learning objectives curriculum increased student learning compared to the traditional curriculum. However, the core learning objectives cohort did not show greater satisfaction than students following the traditional curriculum.

Esther Hines: Culturally Competent Collaboration to Manage Diabetes

OPEN ACCESSJune 20, 2011Esther Hines: Culturally Competent Collaboration to Manage Diabetes Gail Marion, Carol Hildebrandt, BA, Sonia Crandall, PhD, MS, Julienne Kirk, PharmD, CDE Gail Marion Wake Forest School of Medicine of Wake Forest Baptist Medical Center Google Scholar More articles by this author , Carol Hildebrandt, BA Wake Forest University School of Medicine Google Scholar More articles by this author , Sonia Crandall, PhD, MS Wake Forest University School of Medicine Google Scholar More articles by this author , Julienne Kirk, PharmD, CDE Wake Forest University School of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.8368 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractThis resource is an 11-minute video with Facilitator Guide designed to be used formatively to instruct providers and health professions learners how to apply culturally responsive, patient-centered communication skills to effectively counsel patients on blood sugar control and weight loss. The video is not intended to portray a perfect provider-patient interview but rather an effective encounter to begin to address short- and long-term lifestyle strategies for improved patient health. Learners are encouraged to use the “6As” (Agenda Set, Assess, Advise, Agree, Assist, Arrange) and to consider the patient's health literacy level in exploring her perspective and negotiating a plan that will help her to more effectively address necessary lifestyle changes. The video was evaluated by three standardized patient instructors with experience as both a standardized patient for a diabetes counseling case and an instructor providing feedback using the Diabetes Risk Factor Interview Scale (DRFIS). Interrater reliability on the 12 DRFIS domains averaged 4.5. The resource can be used with a wide variety of health professions learners. It has been used for orientation to basic communication and counseling skills for first-year physician assistant students, in preparation for a diabetes counseling standardized patient encounter, and to introduce third-year medical students in the family medicine clerkship to effective counseling skills. Educational Objectives By the end of this session, learners will be able to: Recognize social determinants of health and other underlying factors related to being an African American woman.Recognize effective diabetes and weight loss counseling skills.Assess signs of health literacy challenges for the patient.Understand the complex set of factors that affect a patient's reticence to change.Identify the importance of diet and food preferences in a patient's life.Develop practical methods for effective patient-centered diabetes counseling that attends to the patient's culture in a respectful manner.Develop confidence-building strategies to help the patient make and sustain successful lifestyle changes. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Esther Hines Facilitator Guide.doc VIDEO_TS Folder To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. This publication includes large downloadable files. If you experience difficulty downloading these files, please contact [email protected] to receive a free DVD version via mail. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationMarion G, Hildebrandt C, Crandall S, Kirk J. Esther Hines: Culturally Competent Collaboration to Manage Diabetes. MedEdPORTAL. 2011;7:8368. https://doi.org/10.15766/mep_2374-8265.8368 Copyright & Permissions© 2011 Marion et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial license.KeywordsDiabetes ManagementBlood Sugar ControlWeight ManagementHealth Equity ResearchCounselingDiabetes Insipidus Disclosures None to report. Funding/Support None to report. Loading ...

Pilot Evaluation of a Biopsychosocial Integrated Standardized Patient Examination in a Family Medicine Clerkship

A new biopsychosocial Integrated Standardized Patient Examination (ISPE) was implemented to assess communication skills for medical students participating in a family medicine clerkship. Mixed method, multi-level evaluation. Pilot ISPE scores were significantly higher than previous Objective Structured Clinical Examination (OSCE) (p < .01). Family Physician and Social/Behavioral Scientist rater scores were correlated (p < .001), and Cronbach's alpha statistics were acceptable (FM: alpha = .837; BH: alpha = .768). Preceptor scores on "relations with professionals" (beta = .694, p = .008) significantly predicted ISPE scores, but other clerkship assignment grades were inversely associated with ISPE. Qualitative focus group themes included lack of readiness, divergence in beliefs on scope of physician practice, and focus on grade. This pilot project describes the process and demonstrates the possibility of implementing a complex standardized patient case to assess students' management of complicated primary care patients with medical, psychological, and social issues.