Second Year Of Medical School Research Articles

This Won't Hurt a Bit (and Other White Lies)

This Won't Hurt a Bit (and Other White Lies)

Preparing Future Pediatricians: Making Time Count

At the 2011 annual meeting of the Pediatric Academic Societies participants debated whether the duration of pediatric residency should be extended. Those favoring a longer residency argued that there is more to learn now than 30 years ago and, because of regulations curtailing resident work hours, less time in which to learn it. Their opponents argued that the purpose of residency is basic competence, not mastery, and there is still sufficient time and flexibility for residents to achieve basic competence. Moreover, adding time to the residency would be prohibitively expensive. A proposal to extend residency is a simple (and simplistic) solution to complex issues. In addition to the increase in medical knowledge in recent decades, the scope of pediatrics has widened, and subspecialization has progressed; learners' exposure to various aspects of pediatrics is now occurring, if at all, in distinct and separate silos. Although setting basic competence, rather than mastery, as the outcome measure may seem reassuring, defining “basic competence” is challenging: does the term refer to a basic level of competence in the vast breadth of pediatrics or to competence in a narrow basic “core” of pediatrics? This is a fundamental distinction for educators, future pediatricians, and the public, and there are implications for length of medical school and residency training and breadth of experiences required or necessary during training. The Association of American Medical Colleges is undertaking a pediatrics redesign project for students interested in pediatrics that begins in the second year of medical school and progresses to the end of residency.1 Transition from medical school to residency and residency to practice will be based on competence rather than time. This effort is an exciting opportunity to create a true … Address correspondence to Kenneth B. Roberts, MD, 3005 Bramblewood Drive, Mebane, NC 27302. E-mail: kenrobertsmd{at}gmail.com

Pediatrics Redesign Project: A Pilot Implementing Competency-Based Education Across the Continuum

Despite decades of discussion about the merits of a system of medical education based on achieving competence and specific outcomes, as yet no fully competency-based medical education system has been developed. Hodges1 recently discussed the concepts of tea-steeping (time in training) and i-Doc (attainment of defined outcomes) models as critical elements of a more comprehensive system of medical education. Quoting Hodges, “As we have seen, it is the kind of outcomes-based model that matters.” Superimposing a competency-based model onto a process-based system has led to significant challenges, the greatest of which is assessment. The most common solution to the difficulties of assessing competence is to reduce the competencies into smaller and smaller subunits (subcompetencies and subsubcompetencies), so that they can be measured in ways that we in U.S. medical education currently favor. The end result is measuring isolated skills that do little to assess whether one is a “good doctor.” However, building a system of learning and assessment based on Entrustable Professional Activities (EPAs) proposed by ten Cate and Scheele,2 which places competencies back into the context of clinical care, holds great promise for meaningful assessment and provides the foundation for our pilot education program. For the past two years representatives from pediatrics, including the American Board of Pediatrics, the American Council for Graduate Medical Education (ACGME), the Association of American Medical Colleges, and others in the medical education community have been working on a project involving five medical schools to redesign the education of pediatricians. This educational pilot bridges the medical education continuum from medical school through residency training and is based on the individual attainment of competence defined by the EPAs for general pediatrics. This pilot program, known to its members as the Pediatric Redesign Project, offers much beyond simply devising training differently for pediatricians. A small number of students in each school will enter the pilot program in the second year of medical school and will finish residency when they have completed all requirements for Board certification in Pediatrics. Students will pursue the standard basic science curriculum of each school, but will be offered some introductory experiences in pediatrics in the first year to aid the participant selection process for both faculty mentors and students. Key aspects of the project include a multiyear continuity clinic, through which each student will assume responsibility for increasing numbers of patients throughout the years of the program, and an integrated longitudinal clinical experience, which will be built around pediatrics but offer exposure to the other disciplines of medicine from the perspective of child health. Importantly, from early in their education, participating students will be exposed to working in different environments of the health care system and working with a variety of health professionals involved in the care of children for their normal growth and development as well as for illness. This concept of interprofessional team care and training is an important element of the project, and encourages acknowledging the child's family as members of the team. The goal of the program is to achieve a required level of independence in the EPAs and milestones for pediatrics established by the ACGME's Pediatrics Residency Review Committee. The rate of progression will probably differ for each trainee in the program. Thus, the program would address a key recommendation by the recent Carnegie Report: standardization of outcomes with flexibility in how one achieves them.3 In addition, opportunities for longitudinal follow-up of patients over a number of years of training in concert with a designated senior faculty advisor and with the data management of an electronic portfolio system will enable students to understand from early in their medical educational training the need for improvement in the outcomes of care in the population of patients for which they are responsible. Thus care based on outcomes and continuous improvement of the quality of care is an integral part of this project. Those involved in this redesign project for pediatric education do not envision that the model would replace the current system of medical education. Many medical students come to medical school uncertain of their ultimate career choice and need much more “tea-steeping” in the different disciplines to ascertain their specialty of choice. However, it is our belief that this model may be applicable for other disciplines in medicine and for a subset of medical students. Moreover it may offer some exciting educational opportunities that may be more broadly applicable and transportable to medical education at both the undergraduate and graduate medical education level.

This won’t hurt a bit

I entered medical school in 1978, the year that Samuel Shem’s novel House of God was published. I recall devouring the book, as did my classmates, anticipating with fear but also with some relish the rigors and horrors that awaited us in internship. This seminal work in the medical-reality genre seemed to stoke the endless appetite among the public and those inside the profession for the real story behind medical training and medical practice. Michelle Au’s This Won’t Hurt a Bit (And Other White Lies): My Education in Medicine and Motherhood provides an inside look at the author’s personal evolution from medical student to pediatrics resident to anesthesiology resident, as she simultaneously negotiates the demands of training, marriage, and motherhood. I can imagine students, residents, practicing physicians, and the curious public devouring Au’s memoir with the same enthusiasm (and trepidation) that my classmates and I experienced many years ago. Au is the author of a popular online journal, The Underwear Drawer, which she started in 2000 during her second year of medical school at Columbia University. She is also the artist/author of Scutmonkey comics. This Won’t Hurt a Bit is written in a first-person conversational style that feels very much like blogging, or even like reading the panels of a comic strip. This very informal you-are-there style can be a bit sensationalistic and off-putting, especially at the beginning of the book, where the use of italics, exclamation points, and capital letters emphasize (in case you missed it) how important or intense the experience is. I was pleased to find that as the book progressed, Au let the story tell itself; this was not going to be a nonfiction version of House of God, but rather a heartfelt and genuine look into the heart and mind of a woman undergoing tremendous personal and professional stress and growth. Au chronicles her years in medical school at Columbia, from the first years, which seemed to be completely devoid of clinical context, to her clinical rotations, in which all the previously learned scientific material seemed to be irrelevant to the survival of the students or the patients. I suspect her experience was not so black and white, but rather, that is how she remembered those years in retrospect. This very personal internalized style is most effective when the story unfolds of her day as a third-year medical student on surgery rotation on September 11, 2001. She is observing a circumcision when the initial news of the attack comes into the operating room through a nurse, and Au provides a masterful description of the team’s slow realization of the enormity of the events, the waiting for victims who never come, and the panic and concern about loved ones. Though a brief side story in the overall narrative, this description is beautifully rendered and memorable. Au’s residency years, first in pediatrics, then in anesthesiology, were intertwined with the challenges of marriage, dual careers, pregnancy, and parenthood. Au portrays a loving and supportive relationship with her husband, a resident in ophthalmology, but what strikes the reader is her lack of an outside support system. Where are her colleagues, her advisors, her close friends, her family? They seem to play a peripheral role at most as she negotiates such challenges as firing a nanny, caring for a sick child, and patient and team responsibilities. Again, the reader feels the author’s isolation as she must have experienced it. Au poignantly describes her anguish in leaving her own child in order to care for strangers. I found myself wondering why she didn’t just quit — and I am someone who truly believes that medicine and family life can be wonderfully compatible. Her arguments for leaving medicine seem more compelling than the vague rationale she articulates for continuing: “. . . just because something is hard is no reason not to do it . . . .” That’s not a very convincing argument, yet the episodes of satisfaction and even joy she found in patient care seemed to be enough for her to push forward. I suspect that most current students and residents will have a considerably different set of experiences than the constant sleep deprivation, mistreatment, and autonomy that Au describes. Current work-hour rules, supervision and documentation requirements, and the generally increased priority given to patient safety issues have changed the experience and the culture of residency training. However, the isolation, the feelings of inadequacy, the stress of decision making, and the difficulty in balancing work and home life remain, no matter what the duty-hour policies might be. And the privilege of being on the front line for patients when they are most vulnerable remains daunting, but irresistible. This Won’t Hurt a Bit provides a complicated but ultimately satisfying insider’s view of medical training and its many challenges.

A Community-Based Transformation

In the early stages of my medical training I wanted to be an academic. I saw little value in endeavours that extended beyond the tertiary-care hospital. This all changed when I was mandated to complete a community-based oncology research project as part of my second year of medical school. During that project, I had the good fortune to work with a motivated community agency and a strong focus group of individuals who were touched by cancer. This dynamic combination of mentors forced me to reevaluate my earlier assumptions about community-based research, and I ultimately left the project with a stronger sense of how my efforts as a clinician could make an impact in the community, supporting those who in turn support the patient outside of the hospital. Learning that the course of many illnesses is determined at least as much by caregiver support as it is by active intervention by the physician, I finally came to appreciate that community and hospital work support each other in modern medical care. By addressing the social determinants of health, physicians can improve the care of their patients, regardless of their prognosis, and increase the impact that they have on the health of entire families.

Conversation with Marc Schuckit

Conversation with Marc Schuckit

Pure and applied science

Pure and applied science

Standardized patient outcomes trial (SPOT) in neurology

Background: The neurologic examination is a challenging component of the physical examination for medical students. In response, primarily based on expert consensus, medical schools have supplemented their curricula with standardized patient (SP) sessions that are focused on the neurologic examination. Hypothesis-driven quantitative data are needed to justify the further use of this resource-intensive educational modality, specifically regarding whether using SPs to teach the neurological examination effects a long-term benefit on the application of neurological examination skills.Methods: This study is a cross-sectional analysis of prospectively collected data from medical students at Weill Cornell Medical College. The control group (n=129) received the standard curriculum. The intervention group (n=58) received the standard curriculum and an additional SP session focused on the neurologic examination during the second year of medical school. Student performance on the neurologic examination was assessed in the control and intervention groups via an OSCE administered during the fourth year of medical school. A Neurologic Physical Exam (NPE) score of 0.0 to 6.0 was calculated for each student based on a neurologic examination checklist completed by the SPs during the OSCE. Composite NPE scores in the control and intervention groups were compared with the unpaired t-test.Results: In the fourth year OSCE, composite NPE scores in the intervention group (3.5±1.1) were statistically significantly greater than those in the control group (2.2±1.1) (p<0.0001).Conclusions: SP sessions are an effective tool for teaching the neurologic examination. We determined that a single, structured SP session conducted as an adjunct to our traditional lectures and small groups is associated with a statistically significant improvement in student performance measured 2 years after the session.

Acute Intervention To Foster Reflection On Reciprocity In Relationships Increased Participants’ Patient- Or Student-Centered Orientation Scores In Association With A Medical Biochemistry Course

PurposeUsing an intervention to foster student and faculty awareness of the reciprocal influence of relationships, the authors measured whether participants’ patientor student-centered orientation scores improved following the intervention.MethodOne hundred seventy three first-year medical students and 64 faculty members participated in one of seven nearly identical, twohour seminars on relationship-centeredness including reflective writing, reading and small group discussion of the reflections. We conducted student sessions near the end of the second academic quarter of student training in February 2008. Students’ patient-centered orientation scores, obtained on two occasions prior to the intervention, were compared to those completed immediately following the intervention and near the ends of the first and second years of medical training. The authors collected faculty student-centered orientation scores immediately prior to and following the intervention.ResultsWhile students’ patientcentered orientation scores decreased somewhat during their first quarter of medical school, their scores improved significantly immediately after the intervention near the end of the second quarter of school. Faculty members’ student-centered orientation scores also improved after the intervention. The improvement in students’ scores eroded completely by the end of the first year and continued to deteriorate during the second year of medical school. ConclusionsAlthough encouraging, the effects of our intervention proved temporary, possibly in the context of a non-supportive hidden curriculum. It remains to be determined whether regular use of interventions, like the one in this study, or other changes in the cultures and curricula of medical education might sustain higher relationship-centered orientations in students, faculty and staff.

University of Cincinnati College of Medicine

University of Cincinnati College of Medicine

Development and Use of a Second-Year Musculoskeletal Organ-System Curriculum: A Forty-Year Experience

The rationale for a preclinical musculoskeletal course lies in the prevalence of musculoskeletal diseases, injuries, and disorders. More than 30% of Americans have a musculoskeletal condition requiring medical attention, and workers in the United States miss nearly 440 million days of work annually because of musculoskeletal injuries1. Musculoskeletal disorders cost the United States nearly 850 billion dollars yearly and are the leading cause of disability in the United States1. The economic impact of musculoskeletal disorders is also considerable. Yelin et al. estimated that the economic impact was nearly $200 billion per year, or approximately 2.5% of the annual U.S. gross domestic product2. Moreover, many studies have demonstrated a substantial deficit in musculoskeletal knowledge among recent medical school graduates and other practitioners3-5. There have been calls to reform the preclinical musculoskeletal medical school curriculum6, as well as proposals for a core set of standards for musculoskeletal content7. Two recent studies have described the development of a self-contained preclinical musculoskeletal course for either first or second-year students8,9. Another recent study described the process of curricular reform in the first and second years of medical school without a self-contained musculoskeletal course10. Both were designed with input from educators in several different medical and basic-science specialties, as was ours. The University of Minnesota course included seventeen hours of lecture content, similar to the amount in our course (twenty hours). The authors cited their small-group experience as essential to the success of the course8. The Louisiana State University course spanned six weeks and included forty-four hours of lecture and seventeen hours of small-group teaching9. Both studies emphasized anatomy and physical diagnosis and found substantial improvement in musculoskeletal knowledge and physical examination …

I am more than an MTAS score

MTAS (the UK Medical Training Application Service for allocating junior doctors’ training jobs) was introduced in our second year of medical school and has been quietly hanging over us since then. The goalposts were set—ranking of candidates and much more emphasis than before on free text questions rather than experience or exam results. In my first year I enjoyed university, got involved, and just passed my exams. This left my grades average. For the next three …

A Multiple-Case Simulation Module to Support a Second-Year Medical Student Respiratory Curriculum (Out of Print)

Abstract Introduction The resource is a simulation exercise designed to support clinical application of the principles from the second-year medical school respiratory system curriculum. The primary...

The Importance of Assigning Meaning to Life’s Events

The issue of assigning meaning to life events was first raised by one of my teachers. He was a psychiatrist and the course director for that discipline. I met him during my second year of medical school. He was a captivating lecturer. After sitting through countless hours and what seemed to be an endless array of basic science courses, it was refreshing to be able to attend to an instructor without much effort. He was that type of a speaker.

Pharmacology Simulation Scenario: Respiratory Failure Due to Asthma Exacerbation

OPEN ACCESSFebruary 23, 2010Pharmacology Simulation Scenario: Respiratory Failure Due to Asthma Exacerbation Jimmy Beck, Christie Romo, MD, Kent Denmark, MD Jimmy Beck Loma Linda University School of Medicine Google Scholar More articles by this author , Christie Romo, MD Loma Linda School of Medicine Google Scholar More articles by this author , Kent Denmark, MD Loma Linda School of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.7965 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstractThis resource is a manikin-based simulation case involving a 22-year-old male who presents to an emergency room with progressive shortness of breath due to an asthma exacerbation. The patient develops respiratory failure requiring intubation during the initial emergency room treatment. This resource is one of three respiratory simulation cases developed as part of a second-year medical school pharmacology curriculum. These cases were developed to help medical students integrate basic science principles taught in traditional lectures with real-life clinical scenarios. In this scenario, the learner needs to rapidly assess a patient with an acute asthma exacerbation, describe the mechanism of action of various pharmacologic agents used in the treatment of status asthmaticus, and then determine the most likely physiologic responses after the administration of select medications. Finally, the learner must proceed to intubation of this patient after pharmacologic therapy fails. This simulation scenario has been used by approximately 180 second-year medical students. The feedback we have received has been very favorable, with many of the students requesting that we incorporate more simulation exercises into the basic science curriculum. Educational Objectives By the end of this simulation, learners should be able to: Develop a plausible differential diagnosis from the history and physical examination findings for the scenario and explain how each diagnosis in the differential is consistent with the findings.Identify and discuss the pathophysiologic mechanisms that are most likely responsible for the patient-simulator's findings.Choose a treatment plan that utilizes medications and/or intravenous fluids to resolve the patient-simulator's condition.Determine what the most likely physiologic responses will be after the administration of select medications to the patient simulator. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Asthma Intubation Case.pdf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2010 Beck et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives license.KeywordsAsthmaRespiratory FailureIntubationPhysical Diagnosis Evaluation PathophysiologyRapid Sequence InductionBag Mask VentilationOxygen Consumption Disclosures None to report. Funding/Support None to report. Loading ...

Human vs Computer aided testing (C.A.T.) Results at Department of Anatomy, Histology and Forensic Medicine, University of Florence

At the Anatomical section of the Department of Anatomy, Histology and Forensic Medicine, University of Florence, a software for the administration of multiple-choice tests has been designed and developed in 2002. The program, called ATOL (Anatomy Test on Line), allows the integration, by web interface, into the same system of both the verification phase of learning (to be performed in controlled site with a personalized and unique profile) and the phase of remote self testing. The questions may be coupled to images. ATOL was used since May 2002 to December 2008 as a tool for exams concerning the Locomotor and Circulatory Systems for students attending the first and second year of Medical School. 1990 students were subjected to the exam concerning the Locomotor system, 1678 (88.8%) successfully, with an average score of 24.02±3.03 (mean±standard deviation). Starting from 2008/09 it was decided to go back to the oral exam. In recent sessions the ATOL tests on Locomotor was administered to a large cohort of students as a moment of self-evaluation, one day before the oral exam. This study presents the comparison between the results of 165 students (first year year of Medical School) who have been tested, almost simultaneously, by written and oral exam. Through statistical analysis, carried out with Origin 8 Pro (OriginLab), we examined whether a significant difference existed between scores obtained by CAT and traditional examination and if it was possible to find a correlation between the results obtained whit the two methods of examination. For the evaluation of the results, analysis of variance (ANOVA validated method of Bonferroni’s analysis of the means) and determination of Pearson’s coefficients were applied. In summary a clear difference exists between the groups Written test Oral exam (mean score±standard deviation 23,6±3,1 vs 28,6±2,4; p = 9,7 x 10-7) but the ATOL score and the subsequent oral exam score are also strongly correlated (rp = 0.52, p = 1,5 x 10 -12). These results indicate that the scores between the two methods, different and correlated, are a reasonable indication of the actual preparation of the examined students. The highest, on average, evaluation obtained by traditional examination is probably linked to the traditional teacher-learner interactions that take place during the exam and that generally direct to the correct answer, what usually does not happen with the use of CAT.

Pass–fail grading: laying the foundation for self-regulated learning

Traditionally, medical schools have tended to make assumptions that students will "automatically" engage in self-education effectively after graduation and subsequent training in residency and fellowships. In reality, the majority of medical graduates out in practice feel unprepared for learning on their own. Many medical schools are now adopting strategies and pedagogies to help students become self-regulating learners. Along with these changes in practices and pedagogy, many schools are eliminating a cornerstone of extrinsic motivation: discriminating grades. To study the effects of the switch from discriminating to pass-fail grading in the second year of medical school, we compared internal and external assessments and evaluations for a second-year class with a discriminating grading scale (Honors, High Pass, Pass, Fail) and for a second-year class with a pass-fail grading scale. Of the measures we compared (MCATs, GPAs, means on second-year examinations, USMLE Step 1 scores, residency placement, in which there were no statistically significant changes), the only statistically significant decreases (lower performance with pass fail) were found in two of the second-year courses. Performance in one other course also improved significantly. Pass-fail grading can meet several important intended outcomes, including "leveling the playing field" for incoming students with different academic backgrounds, reducing competition and fostering collaboration among members of a class, more time for extracurricular interests and personal activities. Pass-fail grading also reduces competition and supports collaboration, and fosters intrinsic motivation, which is key to self-regulated, lifelong learning.

Medical Students’ Attitudes about Team-Based Learning in a Pre-Clinical Curriculum

Background: Team-Based Learning is relatively new in medical education. Team-Based Learning was integrated into one medical school’s pre-clinical curriculum in 2002. Purpose: This study compared how medical students’ attitudes about the Team-Based Learning process changed between the first and second year of medical school.Method: 180 students responded to 19 statements regarding their attitudes about Team-Based Learning during their first and second year of medical school. Data were analyzed using a Mann-Whitney U test. Results: Significant changes in attitudes occurred in the areas of Professional Development, Satisfaction with Team Experience, and Satisfaction with Peer Evaluation but not in the areas of Team Impact on Quality of Learning and Team Impact on Clinical Reasoning Ability.Conclusion: This study demonstrates that students’ attitudes about working within teams, their sense of professional development, and comfort and satisfaction with peer evaluation change in a curriculum using Team-Based Learning.

Medical Students’ Attitudes about Team-Based Learning in a Pre-Clinical Curriculum

Background:Team-Based Learning is relatively new in medical education. Team-Based Learning was integrated into one medical school's pre-clinical curriculum in 2002. Purpose: This study compared how medical students’ attitudes about the Team-Based Learning process changed between the first and second year of medical school.Method:180 students responded to 19 statements regarding their attitudes about Team-Based Learning during their first and second year of medical school. Data were analyzed using a Mann-Whitney U test. Results: Significant changes in attitudes occurred in the areas of Professional Development, Satisfaction with Team Experience, and Satisfaction with Peer Evaluation but not in the areas of Team Impact on Quality of Learning and Team Impact on Clinical Reasoning Ability.Conclusion:This study demonstrates that students’ attitudes about working within teams, their sense of professional development, and comfort and satisfaction with peer evaluation change in a curriculum using Team-Based Learning.

Medical students' self-perceived competence and prescription of patient-centered physical activity

Objective The primary objective of this study was to explore medical students' perceptions of their own competence and the importance they assign to patient-centered physical activity (PA) prescription. Methods 246 undergraduate medical students (27% response rate) from two large universities in Western Canada completed an online survey designed to assess their perceived competence and importance related to patient-centered PA prescription. Data collection took place in September and October of 2007. Results While medical students perceived PA-related prescription to be important ( M response = 26.6 out of 36, SD = 5.1), students perceived they had only moderate competence at conducting PA-related prescription ( M response = 20.7 out of 36, SD = 6.8). Students achieving national PA guidelines perceived significantly higher competence than students not achieving PA guidelines. Students in their first or second year of medical school perceived PA-related prescription to be of higher importance than students in their third or fourth years. Conclusion Medical students indicated that patient-centered PA prescription was important. However, they indicated less than moderate competence at performing several fundamental PA prescription behaviors. This study suggests that medical students may not be adequately prepared to dispense patient-centered PA prescriptions with their patients.