Third-year Pediatric Clerkship Research Articles

A Team-based Learning Approach During Pediatric Clerkship to Promote Clinical Reasoning.

Clinical reasoning skills are essential to medical practice. The problem lies in assuming junior medical students with limited experience develop clinical reasoning and decision-making skills passively and solely through clinical exposure. To prepare learners for independent practice and care for future patients, explicit teaching and assessment of clinical reasoning in low-stakes, collaborative learning environments are needed. The key-feature question (KFQs) format is an assessment approach that focuses on the reasoning and decision-making aspects of medical problems rather than knowledge recall. This report describes the development, implementation, and evaluation of a team-based learning (TBL) approach using KFQs to foster clinical reasoning in the third-year pediatric clerkship at our institution. Over the first 2 years of implementation (2017-18, 2018-19), 278 students participated in TBL sessions. Mean individual student scores significantly improved in the group setting for both academic years (P<.001). Individual scores were moderately positively correlated with their total summative Objective Structured Clinical Examination score (r[275]=0.51; P<.001). The correlation between individual score and their multiple-choice question examination was weaker at 0.29 (P<.001) but remained positive. A TBL session using KFQs to both teach and assess clinical reasoning in clerkship students may help educators identify students with gaps in knowledge and/or reasoning. The next steps include developing and implementing individualized coaching opportunities, and expanding this approach within the undergraduate medical curriculum. Outcome measures to assess clinical reasoning in authentic patient encounters require further research and development.

Down to the Last Dollar: Utilizing a Virtual Budgeting Exercise to Recognize Implicit Bias.

IntroductionAs social determinants of health and implicit bias are recognized as critical components of medical education, there is a need for novel approaches beyond didactics. We developed a small-group budgeting exercise to simulate the impact of poverty. Pediatrics exemplifies the effects of poverty on the family. This exercise allowed students to recognize the effects of food insecurities on health and reflect on biases regarding patients living in poverty.MethodsThe virtual interactive budgeting exercise (1.5–2 hours) introduced third-year pediatric clerkship students to the challenges faced by a single parent living in poverty, requiring them to make choices on which budget items were most important. Students attempted to balance budgets within small breakout groups, followed by a group reflection on biases encountered. A faculty facilitator then debriefed with the larger group.ResultsWithin the first four rotations of the 2020–2021 academic year, 75 students completed the budgeting exercise and reflection, with 61 students completing the postexercise survey evaluation. Between 94% and 98% rated the objectives as met to a moderate, considerable, or very high degree. In addition, 98% of students noted the group discussion heightened their awareness regarding biases, and 95% agreed or strongly agreed the activity was conducted virtually without difficulty.DiscussionThis simulated budgeting exercise provides a well-rounded experience for medical students, that can be administered at either the preclerkship or clerkship level, at a minimal cost, with interactive engagement of students in a virtual environment and reflection on biases within a group context.

Remote Virtual Reality Teaching: Closing an Educational Gap During a Global Pandemic.

Resident physicians are expected to recognize patients requiring escalation of care on day 1 of residency, as outlined by the Association of American Medical Colleges. Opportunities for medical students to assess patients at the bedside or through traditional simulation-based medical education have decreased because of coronavirus disease 2019 restrictions. Virtual reality (VR) delivered remotely via video teleconferencing may address this educational gap. A prospective pilot study targeting third-year pediatric clerkship students at a large academic children's hospital was conducted from April to December 2020. Groups of 6 to 15 students participated in a 1.5-hour video teleconferencing session with a physician facilitator donning a VR headset and screen sharing interactive VR cases of a hospitalized infant with respiratory distress. Students completed surveys assessing the immersion and tolerability of the virtual experience and reported its perceived effectiveness to traditional educational modalities. Comparisons were analyzed with binomial testing. Participants included third-year medical students on their pediatric clerkship. A total of 140 students participated in the sessions, with 63% completing the survey. A majority of students reported VR captured their attention (78%) with minimal side effects. Students reported remote VR training as more effective (P < .001) than reading and online learning and equally or more effective (P < .001) than didactic teaching. Most students (80%) rated remote VR as less effective than bedside teaching. This pilot reveals the feasibility of remote group clinical training with VR via a video conferencing platform, addressing a key experience gap while navigating coronavirus disease 2019 limitations on training.

A Flipped Classroom and Case-Based Curriculum to Prepare Medical Students for Vaccine-Related Conversations with Parents

Immunizations, one of the most significant public health successes in the last century, have recently been met with a resistance that has resulted in populations with falling immunity and outbreaks of vaccine-preventable diseases. In response to this, we conducted a needs assessment of medical students at the University of California, Los Angeles David Geffen School of Medicine to assess attitudes towards vaccines, knowledge of vaccines and vaccine-preventable diseases, and confidence in discussing vaccines. The results informed the development of this interactive, flipped-classroom and case-based curriculum for third-year pediatric clerkship students. In our two-part curriculum, students independently view a short podcast with an overview of vaccines and vaccine-preventable diseases, then participate in a case-based workshop. For the workshop, students divide into small groups and are presented with a case-based scenario surrounding a child with a parent who has concerns about recommended vaccines. Students discuss the case in small groups, find answers to directed questions, and present the case and findings to the larger group, with specific focus on their approach to the vaccine hesitant parent. Anonymous student evaluations revealed that 93% of students enjoyed learning from this flipped classroom and case-based format. Likewise, 98% of students felt more confident in their approach to vaccine discussions. Vaccine hesitancy is becoming an increasingly common and worrisome problem. Our curriculum provides students with knowledge about the importance of childhood immunizations as well as an opportunity to practice addressing common concerns and misconceptions they will encounter in clinical settings.

Does Medical Student Hand-Over Training on a Third-Year Pediatric Clerkship Improves Skill and Confidence Level?

Purpose Patient hand-over is a critical skill to develop in the era of reduced duty hours. There is insufficient data in the literature that medical students, especially in the third year, are being instructed to participate in a patient hand-over. Early introduction into the curriculum should provide earlier competency which has the potential to decrease the number of medical errors related to communication.

Team-Based Simulation for Medical Student Handoff Education.

Good handoffs require teamwork, clear communication, a cognitively safe environment, and a good understanding of the patient's medical needs. Complex tertiary care training institutions require multiple handoffs over a patient's time in the hospital. Medical students need better handoff education. We designed a handoff training exercise using a simulated patient care environment for students to practice and observe multiple handoffs over time. An initial large-group didactic session provides direct instruction on handoffs. In small groups, students are subsequently assigned roles as individual physicians in a chain of providers during a simulated patient hospitalization over several days, with an additional student as an observer. Blinded to any prior discussion, student physicians sequentially give and receive handoffs about the patient from a previous physician as their simulated hospital course evolves. The observer shares his or her insights, and a large-group structured debriefing exercise follows. In both 2015 and 2016, we implemented this session with a cohort of 30 fourth-year medical students. Most recently we implemented this with chief residents, and a group of 20 third-year pediatric clerkship students. We reviewed a selection of the discussion guides and found reporters/ observers noted that participants stated the primary problem 95% of the time (19 of 20 handoffs), the patient acuity 90% of the time (18 of 20 handoffs), and a clear contingency plan 85% of the time (17 of 20 handoffs). We found students initially to be preoccupied with making correct clinical decisions instead of giving effective handoffs, and consequently we clarified details and adjusted clinical information to be more transparent. Results suggest the session achieves our goals of using a structured handoff method to communicate higher-level information and debrief effectively with peers. We envision this activity to be applicable to teaching handoffs to residents, nurses, and other health care professionals, as well as possibly in diverse clinical environments or in collaboration with outpatient providers.

Team-based learning on a third-year pediatric clerkship improves NBME subject exam blood disorder scores

PurposeAt our institution, speculation amongst medical students and faculty exists as to whether team-based learning (TBL) can improve scores on high-stakes examinations over traditional didactic lectures. Faculty with experience using TBL developed and piloted a required TBL blood disorders (BD) module for third-year medical students on their pediatric clerkship. The purpose of this study is to analyze the BD scores from the NBME subject exams before and after the introduction of the module.MethodsWe analyzed institutional and national item difficulties for BD items from the NBME pediatrics content area item analysis reports from 2011 to 2014 before (pre) and after (post) the pilot (October 2012). Total scores of 590 NBME subject examination students from examinee performance profiles were analyzed pre/post. t-Tests and Cohen's d effect sizes were used to analyze item difficulties for institutional versus national scores and pre/post comparisons of item difficulties and total scores.ResultsBD scores for our institution were 0.65 (±0.19) compared to 0.62 (±0.15) nationally (P=0.346; Cohen's d=0.15). The average of post-consecutive BD scores for our students was 0.70(±0.21) compared to examinees nationally [0.64 (±0.15)] with a significant mean difference (P=0.031; Cohen's d=0.43). The difference in our institutions pre [0.65 (±0.19)] and post [0.70 (±0.21)] BD scores trended higher (P=0.391; Cohen's d=0.27). Institutional BD scores were higher than national BD scores for both pre and post, with an effect size that tripled from pre to post scores. Institutional BD scores increased after the use of the TBL module, while overall exam scores remained steadily above national norms.ConclusionsInstitutional BD scores were higher than national BD scores for both pre and post, with an effect size that tripled from pre to post scores. Institutional BD scores increased after the use of the TBL module, while overall exam scores remained steadily above national norms.

One Tool for Many Tasks: Integrating Ipads into the Third-Year Learning Experience

Librarians worked with faculty in the School of Medicine to integrate iPad tablets into the third-year pediatric clerkship. The use of the technology allowed students instant access to information in the clinical setting and simplified the management of the course. In addition, a variety of tablet and e-reader devices were purchased for patron check-out. Library management of the devices is discussed. Use of the devices is described, and student reactions are presented.

The Role of the Librarian and Allied Health Professional in a Third-Year Pediatric Clerkship Journal Club

During the past decade, medical education has evolved from the traditional classroom and bedside clinical instruction to system-based instruction with emphasis on small-group interaction with a fac...

Evolving Technologies Support Mobile and Collaborative Curriculum: A Case Study

This case study describes the efforts of librarians to integrate mobile devices, collaboration tools, and resources into a School of Medicine third-year pediatric clerkship. Additional class emphasis is on evidence-based searching and journal article evaluation and presentation. The class objectives ensure that students are comfortable with mobile devices and collaboration tools. Over the eight-year history of the course, student acceptance of the mobile devices used diminished as the devices aged, necessitating the evaluation and selection of new technologies. Collaboration tools and mobile applications employed in the course evolved to accommodate curriculum changes.

Evaluating the Utility of Peer-Assisted Learning in Pediatrics

Peer-assisted learning (PAL) is the signature teaching/learning strategy for training young physicians. This study reports on a PAL program held during the third-year pediatric clerkship. Respondents felt PAL was useful. A senior elective incorporating PAL is now an official course. PAL is an effective adjunct to traditional teaching methods.

Family-Centered Rounds and Medical Student Education: A Qualitative Examination of Students’ Perceptions

Although current literature supports the benefits of family-centered rounds on medical education, few studies have explored students' perceptions of family-centered rounds. The aim of this study was to provide a better and broader understanding of the effect of family-centered rounds on medical student education. During the inpatient portion of the third-year pediatric clerkship at a southeastern United States 4-year medical school, students were exposed to family-centered and conference room work rounds and completed a post-hoc reflective open-ended questionnaire. The study was conducted from July to December 2007 and the inpatient experience was at one of two large academic medical centers. Using a constant comparative approach, the qualitative content of 45 of the 63 potential students' responses was analyzed. Family-centered rounds served as an opportunity for medical students to build their practice-based knowledge through direct and simultaneous interaction with the medical team, patients, and families. Family member communication, medical team communication, and increased exposure to patients allowed for unique learning opportunities such as augmentation of communication skills, practice with use of lay terms, legitimate peripheral participation, and humanizing cognitive understanding of diseases. Areas of concern noted by the students included space limitations, length of rounds, potential anxiety provoked in the patient, and faculty and resident comfort with teaching certain topics. Our qualitative analysis of medical student perceptions on family-centered rounds suggests that pediatric medical student education may benefit by improving knowledge and practice with communication and humanizing disease processes. However, perceived barriers, such as concerns about space or instructor comfort with teaching certain topics, existed. Further studies are warranted to gain a better understanding of the educational impact of conducting this type of rounds.

Pediatric Abdominal Pain and Mass Team-Based Learning Module (Out of Print)

OPEN ACCESSNovember 16, 2010Pediatric Abdominal Pain and Mass Team-Based Learning Module (Out of Print) Patricia Keefer, Nicole Frei, Jocelyn Schiller, Terrance Murphy Patricia Keefer University of Michigan Medical School Google Scholar More articles by this author , Nicole Frei University of Michigan Google Scholar More articles by this author , Jocelyn Schiller University of Michigan Google Scholar More articles by this author , Terrance Murphy University of Michigan Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.8371 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractThis resource is a part of a six-module curriculum which uses team-based learning (TBL) approaches to teach medical students clinical applications of general pediatric topics. Included are questions, an answer keys, citations for reference articles, and descriptions of how to facilitate and evaluate a team-based learning exercise. This module deals with abdominal pain and mass. The other modules deal with asthma, nutrition, fever, anemia, and pneumonia. These TBL modules have been used on the third-year pediatric clinical clerkship for 1 year as part of the core pediatric curriculum at the University of Michigan Medical School. Faculty and student suggestions for improvements in both the reading material and exercises have been incorporated over the course of the year to enhance the modules. Our analysis indicates that student performance on the NBME examinations and on the clerkship overall has remained consistent after inclusion of TBL into the clerkship curriculum. The pilot trial of this exercise is in the process of being formally evaluated as part of a prospective study comparing team-based learning with lectures. Educational Objectives By the end of the module, the learner will be able to: Identify the risk factors in a history, physical examination, and laboratory work-up that would classify a child as high-risk for an acute surgical abdomen.Describe the pathophysiology, etiologies, clinical presentations, diagnostic testing, and management for gastroenteritis, constipation, appendicitis, intussusception, small bowel obstruction, incarcerated hernia, Meckel's diverticulum, colic, pyloric stenosis, malrotation with midgut volvulus, and necrotizing enterocolitis.Identify the differential diagnosis of abdominal mass in children and how it varies by age.Explain the age-appropriate approach to the evaluation of a child with an abdominal mass. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Pediatric Abdominal Pain TBL Facilitator's Guide.docx Pediatric Abdominal Pain and Mass TBL Answers.docx Pediatric Abdominal Pain and Mass TBL Questions.docx 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. CitationKeefer P, Frei N, Schiller J, Murphy T. Pediatric Abdominal Pain and Mass Team-Based Learning Module (Out of Print). MedEdPORTAL. 2010;6:8371. https://doi.org/10.15766/mep_2374-8265.8371 Copyright & Permissions© 2010 Keefer et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial license.KeywordsAbdominal PainAsthmaFeverTBLConstipationPneumoniaTeam-Based LearningAppendicitisGastroenteritisAnemia Disclosures None to report. Funding/Support None to report. Loading ...

The University of Texas Medical School at Houston

The University of Texas Medical School at Houston

2. Students' Reflections on a Self-Directed Module Method of Learning in a Third-Year Pediatric Clerkship

2. Students' Reflections on a Self-Directed Module Method of Learning in a Third-Year Pediatric Clerkship

Standardized Patient Case Using the HEEADSSS Model for an Adolescent Interview

OPEN ACCESSOctober 30, 2008Standardized Patient Case Using the HEEADSSS Model for an Adolescent Interview Janice Hanson, PhD, Woodson Jones, MD, Michael Pelzner, MD, Peter Zawadsky, MD Janice Hanson, PhD Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine Google Scholar More articles by this author , Woodson Jones, MD Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine Google Scholar More articles by this author , Michael Pelzner, MD Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine Google Scholar More articles by this author , Peter Zawadsky, MD Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.1681 SectionsAboutAbstract ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: This resource is a standardized patient (SP) case for medical student education in pediatrics. Within a 15-20 minute time frame, the students are asked to interview a female adolescent using the HEEADSSS (Home environment, Education and employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression, and Safety) model and then identify risky behaviors of the adolescent and provide brief counseling. Methods: A standard history and physical examination are not performed, but are presumed to have occurred already and are normal. A SP postencounter checklist and a student postencounter form are used to determine pass/fail for the student and for faculty to use for formative feedback to the student. The case requires a trained SP female, dressed in typical adolescent fashion. The training summary is provided. When used for formative evaluation, faculty must be available to observe and provide feedback to the learners. Postencounter exercises for students and SP checklists require either paper checklists or a web-based SP encounter system to record data. Results: This case was developed, tested, and modified over seven separate testing dates from 2005 and 2006, with an average of six students per test date. The failure rate for the 38 encounters was 10.5%. All failures were due to the student not identifying two of three most urgent risky behaviors. Data presented here are from the encounters completed after modifications by the faculty, which improved the clarity of the educational objectives and the ability of the postencounter form to measure whether the student met the objectives. All encounters occurred in the same facility and all SPs were trained by the same trainers. Discussion: We have used this case in a third-year pediatric clerkship that incorporates teaching about the HEEADSSS interview. We have also used it for formative evaluation with faculty feedback. This case could also be used for summative feedback, if appropriate teaching were provided. Our data suggest we used appropriate pass/fail criteria for third-year medical students and that this criteria could also be applied to fourth-year students. If pass/fail criteria were adjusted for expected residency-level performance, the case could be used for formative or summative evaluation in pediatric and family medicine residencies. Educational Objectives By the end of this case, learners should be able to: Establish rapport with a female adolescent when asking sensitive questions about lifestyle choices that affect health and safety.Discuss at least six of the 10 components of the Home environment, Education and employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression, and Safety interview.Identify at least four of the eight risk factors that the adolescent displays.Identify two of the three risk factors that require urgent attention. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: HEEADSSS SPE.doc 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. Related Standardized Patient Case Using the HEEADSSS Model for an Adolescent Interview Standardized Patient Case: Health Supervision Encounter for a Child 6–24 Months of Age Copyright & Permissions© 2008 Hanson et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsRisk BehaviorsInterviewRisk-TakingHEEADSSS Disclosures None to report. Funding/Support None to report. Loading ...

Evaluation of an innovative pediatric clerkship structure using multiple outcome variables including career choice

Few studies have examined alternative structures for inpatient clerkships. Compare 2 inpatient clerkship structures using multiple outcome variables. Prospective, randomized controlled trial. Tertiary-care, freestanding children's hospital. All medical students enrolled in the third-year pediatric clerkship in the 2001-2003 academic years. A clerkship structure consisting of an academic attending, a third-year pediatric resident, and 4 third-year medical students, but no interns. Student end-of-rotation examinations, evaluations, a questionnaire, and career choices were used to evaluate the intervention. Patient logs and resource utilization were also assessed. Statistical analysis included evaluating differences between groups and measuring effect size. Two hundred and three students were randomized. Compared with those on the traditional services, students on the intervention service encountered more key diagnoses in the patients they cared for (4.4 vs. 3.6, P < .01). These students also gave higher ratings to their overall attitude (4.48 vs. 4.26, P = .02) and input into patient care decisions (4.45 vs. 3.98, P < .01). More than twice as many students on the intervention service matched in pediatrics (OR 2.52, 95% confidence interval 0.99-6.38). Multivariate analysis of length of stay and total charges for selected patients revealed similar outcomes. A third-year pediatric clerkship that focuses on students is associated with increased satisfaction, higher interest in pediatrics, and consistent resource utilization. The intervention, therefore, merits continuation, whereas further research is required to identify which aspects of the intervention are responsible for its positive effects.

Successful Use of Problem-Based Learning in a Third-Year Pediatric Clerkship

To determine the effect of changing from lectures to a problem-based learning (PBL) curriculum on student knowledge accrual and satisfaction with the didactic portion of a clerkship. Study of cohorts before and after PBL introduction and in comparison with unchanged medicine clerkship. Third-year pediatric clerkship at 5 clinical sites. The PBL curriculum was introduced in the 1996 academic year. The 2 classes before the intervention served as historic controls (n = 319), whereas the 2 classes after PBL served as the intervention group (n = 320). Small groups of students worked through 6 PBL cases representing common pediatric illnesses. Knowledge was assessed with the pediatric and internal medicine subject examination of the National Board of Medical Examiners (NBME); student satisfaction was assessed by an anonymous end-of-rotation questionnaire. Scores on the pediatric subject examination improved significantly from means of 69.2 and 70.0 in the historic control group to 73.6 and 74.2 in the PBL cohort (P <.01). Scores on the internal medicine subject exam during the same time periods remained unchanged until the second year after the change (69.1 and 70.2, respectively, before the change; 70.1 and 72.4, respectively, after the change). Analysis of variance results indicated a significant increase in pediatric subject examination scores associated with the introduction of PBL (P <.01). Overall student satisfaction with the pre-PBL lecture series was 3.3, whereas PBL sessions received a score of 4.3. Use of PBL in a clinical clerkship was associated with higher scores on the NBME subject examination and increased student satisfaction. These results should encourage the use of PBL during the clinical years.

Assessing student performance on a pediatric clerkship.

To determine whether any of 4 parameters used as evaluation methods in the pediatric clerkship at Children's National Medical Center, Washington, DC, could predict a student's performance, as measured by the final grade. A retrospective study in which the following data were collected: (1) a record of the diagnoses and total number of patients seen during the rotation, (2) clinical performance grade, (3) the National Board of Medical Examiners (NBME) pediatric shelf test score, (4) case presentation grade, and (5) the final clerkship grade for overall performance. Third-year pediatric clerkship in the 1987-1988 academic year at Children's National Medical Center, the George Washington University School of Medicine. A total of 128 students had complete data. Correlations among the clinical parameters, ie, number of patients seen, clinical grade, case grade, and the NBME shelf test score were all statistically nonsignificant. In addition, multiple regression modeling of NBME test scores, using measures such as clinical grade, average case grade, and number of patients seen, was unsuccessful, with only clinical performance entering the regression model. In contrast, modeling of the final clerkship grade resulted in explaining almost 80% of the variation on a student's final grade (R2 = 0.79). Variables submitted to the model were number of patients seen, clinical grade, average case presentation grade, and ordered examination score. Last, a highly significant relationship (chi 2 = 15.98, P < .001) was noted between students receiving a final grade of honors and an "A" on their case grade. Results confirmed that there is no single best predictor of performance on a pediatric clerkship. While there was only a weak correlation between each single measure and the final grade, together these accounted for 80% of the variation in students' scores. Based on the study data, the use of varied evaluative methods to determine a student's final grade is recommended.