University Of Washington School Of Medicine Research Articles

A comparison of four models of professionalism in medical education

Introduction: The prevailing consensus is that medical professionalism must be formally included as a programme in the undergraduate medical curriculum. Methods: A literature search was conducted to identify institutions that can serve as models for incorporating professionalism in medical education. Differences and similarities were highlighted based on a framework for the comparison which included the following features: definition of professionalism, curricular design, student selection, teaching and learning innovations, role modelling and methods of assessment. Results: Four models for integrating professionalism in medical education were chosen: Vanderbilt University School of Medicine (VUSM), University of Washington School of Medicine (UWSOM), University of Queensland (UQ) School of Medicine, and Mayo Clinic and Mayo Medical School. The task of preparing a programme on medical professionalism requires a well-described definition to set the direction for planning, implementing, and institutionalizing professionalism. The programmes are best woven in all levels of medical education from the pre-clinical to the clinical years. The faculty physicians and the rest of the institution’s staff must also undergo a similar programme for professionalism. Conclusion: The development of all scopes of professionalism requires constant planning, feedback and remediation. The students’ ability to handle professionalism challenges are related to how much learning situations the students encounter during medical school. The learning situations must be adjusted according to the level of responsibilities given to students. The goal of learning is to enable students to grow from a novice to a competent level and afterwards to a proficient and expert level handling professionalism challenges in medicine.

An Orthopaedic Department's Response to the COVID-19 Health-Care Crisis: Indirect and Direct Actions with Thoughts for the Future.

An Orthopaedic Department's Response to the COVID-19 Health-Care Crisis: Indirect and Direct Actions with Thoughts for the Future.

A Novel Curriculum for Medical Student Training in LGBTQ Healthcare: A Regional Pathway Experience.

Background:Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals face considerable health disparities, often due to a lack of LGBTQ-competent care. Such disparities and lack of access to informed care are even more staggering in rural settings. As the state medical school for the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region, the University of Washington School of Medicine (UWSOM) is in a unique position to train future physicians to provide healthcare that meets the needs of LGBTQ patients both regionally and nationally.Objective:To describe our methodology of developing a student-driven longitudinal, region-wide curriculum to train medical students to provide high-quality care to LGBTQ patients.Methods:A 4-year LGBTQ Health Pathway was developed and implemented as a student-led initiative at the UWSOM. First- and second-year medical students at sites across the WWAMI region are eligible to apply. Accepted Pathway students complete a diverse set of pre-clinical and clinical components: online modules, didactic courses, longitudinal community service/advocacy work, a scholarly project, and a novel clinical clerkship in LGBTQ health developed specifically for this Pathway experience. Students who complete all requirements receive a certification of Pathway completion. This is incorporated into the Medical Student Performance Evaluation as part of residency applications.Results:The LGBTQ Health Pathway is currently in its fourth year. A total of 43 total students have enrolled, of whom 37.3% are based in the WWAMI region outside of Seattle. Pathway students have completed a variety of scholarly projects on LGBTQ topics, and over 1000 hours of community service/advocacy. The first cohort of 8 students graduated with a certificate of Pathway completion in spring 2020.Conclusions:The LGBTQ Health Pathway at UWSOM is a novel education program for motivated medical students across the 5-state WWAMI region. The diverse milestones, longitudinal nature of the program, focus on rural communities, and opportunities for student leadership are all strengths and unique aspects of this program. The Pathway curriculum and methodology described here serve as a model for student involvement and leadership in medical education. This program enables medical students to enhance their training in the care of LGBTQ patients and provides a unique educational opportunity for future physicians who strive to better serve LGBTQ populations.

Effect of Regional Medical Campus Education on Student Pursuit of Primary Care Specialties

Purpose
 To investigate whether education at a regional medical campus (RMC) affects the likelihood of University of Washington School of Medicine (UWSOM) students choosing a primary care specialty.
 Method
 Two approaches were taken to answer the study question. First, the percentage of UWSOM students who matched to a primary care residency program between 1996-2016 was compared between two groups of students: those educated at an RMC and those educated at the academic medical center (a non-RMC). Second, physician specialty data was obtained from the AMA Physician Masterfile for UWSOM graduates from 1996-2011. Physicians were again split into RMC and non-RMC groups, and the percentage of primary care physicians was compared between the two groups. This study was completed in 2016.
 Results
 Among graduates from 1996-2016, 33% (564/1707) of those educated at an RMC were matched to a primary care residency program compared to 39% (787/2003) of students educated at the non-RMC (P < 0.001). Graduates from 1996-2011 had similar likelihoods of becoming a primary care physician regardless of first year education site (37% [395/1078] versus 39% [551/1403], P = 0.18, Figure 2).
 Conclusions
 The results of this study did not support the hypothesis that the WWAMI RMCs produce more primary care physicians than the non-RMC. A greater percentage of students who attended the non-RMC matched into a primary care residency program compared to the RMC group, while the percentage of students who ultimately chose a primary care specialty was quite similar.
 
 Financial support: Mr. Collins was supported in part for this study by the Smith Family Endowed Chair in Medicine.
 Ethical Approval: The University of Washington Institutional Review Board approved the acquisition and analysis of subject data. Application #52065. Approval date 5/24/2016.

Randomized Trial of Smartphone-Based Evaluation for an Obstetrics and Gynecology Clerkship

We hypothesized that compared to paper evaluations, a smartphone-based quick response (QR) evaluation tool would improve timeliness of feedback, enhance efficacy of giving and receiving feedback, and be as easy to use. We performed a randomized controlled trial of student and instructor experience with two evaluation tools in the OB/GYN clerkship at University of Washington School of Medicine (UWSOM). Sites were randomized to the QR or paper tool; students at QR sites received individualized QR codes at the beginning of the clerkship. Instructors and students completed postintervention surveys regarding the evaluation tool and associated feedback. We compared responses between groups using chi-squared tests. Participating clerkship sites included primary, tertiary, private practice and institutional settings affiliated with the University of Washington in the Washington, Wyoming, Alaska, Montana and Idaho region. Of the 29 OB/GYN UWSOM clerkship sites, 18 agreed to participate and were randomized. Of 29 eligible instructors, 25 (86%) completed the survey, with n = 18 using QR and n = 7 using paper. Of 161 eligible students, 102 (63%) completed the survey, with n = 54 using QR and n = 48 using paper. Compared to those using paper evaluations, instructors using QR evaluations were significantly more likely to agree that the evaluation tool was easy to understand (100% QR vs 43% paper, p = 0.002), the tool was effective in providing feedback (78% QR vs 29% paper, p = 0.002), and they felt comfortable approaching students with the tool (89% QR vs 43% paper, p = 0.002). Compared to those using paper evaluations, students using QR evaluations were less likely to agree the tool was effective in eliciting feedback (QR 43% vs paper 55%, p = 0.042). Instructors found QR evaluations superior to paper evaluations for providing feedback to medical students, whereas students found QR evaluations less effective for feedback.

RELM: Developing a Serious Game to Teach Evidence-Based Medicine in an Academic Health Sciences Setting

Gaming as a means of delivering online education continues to gain in popularity. Online games provide an engaging and enjoyable way of learning. Gaming is especially appropriate for case-based teaching, and provides a conducive environment for adult independent learning. With funding from the National Network of Libraries of Medicine, Pacific Northwest Region (NN/LM PNR), the University of Washington (UW) Health Sciences Library, and the UW School of Medicine are collaborating to create an interactive, self-paced online game that teaches players to employ the steps in practicing evidence-based medicine. The game encourages life-long learning and literacy skills and could be used for providing continuing medical education.

The university of washington pediatric alaska track: a novel approach to training primary care pediatricians.

The University of Washington School of Medicine (UWSOM) has been a leading medical school in training primary care physicians. Yet due to the small number of residency positions in the Pacific Northwest, the 5-state region of Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) has some of the lowest physician-to-population, graduate medical education (GME) positions-to-population ratios in the nation, and has the lowest pediatrician-to-child ratio in the country. The UW Pediatric Alaska Track was designed to increase the number of primary care pediatricians serving rural and underserved populations. The goals are to increase quality and access to health care for children and families throughout the WWAMI region, and to improve the learning environment for residents with a career interest in primary care pediatric practice.The Alaska Track is a primary care track within the UWSOM categorical pediatrics residency. The Alaska Track enrolls 4 residents each year for a total of 12 residents in the program. Each year, Alaska Track residents complete 2 four-week block rotations in a community practice in Anchorage, Alaska, and 2 four-week block rotations in a community practice in either Bethel or Fairbanks, Alaska. To maintain continuity, residents return to the same Alaska sites each year. Over the course of 3 years, each resident completes 12 four-week block rotations devoted exclusively to ambulatory, primary care training, and newborn nursery experiences with both Alaska Native and non-native populations. In Seattle, each Alaska Track resident completes 9 four-week block rotations each year for a total of 27 rotations that include the inpatient, intensive care unit, subspecialty, emergency department, and supervisory rotations specified by the Accreditation Council for Graduate Medical Education requirements.The Alaska Track rotations extended, community-based ambulatory experiences allow residents to see well-child, acute illness, follow-up, and posthospital discharge visits in a manner identical to that of the pediatricians in their assigned practices. Each site also allocates time for residents to develop ongoing quality improvement projects and health advocacy projects in the local community.Didactic education occurs weekly by video conference between the 4 Alaska Track residents, the program director, and selected faculty. Alaska Track faculty have clinical appointments in the UWSOM, and GME oversight is provided by the UWSOM GME office. Resident salaries are assessed monthly according to site of rotation. Cost of travel, housing, and transportation during the Alaska rotation is provided by the Alaska sites. To maximize the time for shared experiences and class cohesion with their categorical track colleagues, R1s do not begin their Alaska block rotations until March of the R1 year. Alaska Track residents have some interaction with residents from the Alaska Family Medicine Residency.The first group of first-year residents began training in the Alaska Track in July 2012. We have recruited exceptional trainees whose medical school credentials equal their colleagues in the categorical program. Based on the first 18 months of faculty evaluations, the performance of Alaska Track is indistinguishable from that of categorical residents (table).We anticipate that long-term outcomes for the Alaska Track residents will include increased likelihood of practice in rural or underserved areas and increased readiness for primary care practice. Preliminary results for these outcomes will be available with the first graduating class in July 2016.A widely accepted method for meeting the nation's goal of increased numbers of primary care providers is to develop more primary care training sites in community settings. Many elements of the UW Pediatric Alaska Track are generalizable to other primary care residency programs, although specific structural components likely will vary by location.

Primary Care Residency Choice and Participation in an Extracurricular Longitudinal Medical School Program to Promote Practice With Medically Underserved Populations

In 2006, the University of Washington School of Medicine (UWSOM) launched the Underserved Pathway (UP), an extracurricular longitudinal experience supporting student interest in caring for underserved populations. This study examined the association between UP participation and residency choice. The study population was 663 UWSOM graduates who matched to a residency from 2008 to 2011; 69 were UP participants. Outcomes included matching to primary care residencies (family medicine, internal medicine, pediatrics, or medicine-pediatrics). The authors calculated graduate rates and odds of UP participants versus nonparticipants matching to primary care residencies overall and to residencies in individual primary care specialties. This analysis included all graduates and 513 graduates who had dual interest in primary care and underserved care at matriculation. Of 336 graduates matching to primary care, the authors calculated rates of entering the individual specialties with respect to UP participation. UP participants matched at significantly higher rates than nonparticipants to primary care (72.5% versus 48.1%, adjusted odds ratio [OR] 2.2) and family medicine residencies (33.3% versus 15.0%, adjusted OR 2.9). Of graduates with dual matriculation interest in primary care and underserved care, 73.4% of participants versus 53.5% of nonparticipants matched to primary care (adjusted OR 1.9), and 31.2% of participants versus 18.0% of nonparticipants matched to family medicine (adjusted OR 2.1). Of primary care matched graduates, 46.0% of participants versus 31.1% of nonparticipants entered family medicine. Supporting student interest in underserved careers is associated with higher rates of graduates entering primary care residencies, specifically family medicine.

Regional Solutions to the Physician Workforce Shortage: The WWAMI Experience

With major medical organizations predicting a national shortage of physicians in coming years, a number of institutional models are being considered to increase the numbers of medical students. At a time when the cost of building new medical schools is extremely expensive, many medical schools are considering alternative methods for expansion. One method is regional expansion. The University of Washington School of Medicine (UWSOM) has used regional expansion to extend medical education across five states without the need to build new medical schools or campuses. The WWAMI program (the acronym for Washington, Wyoming, Alaska, Montana, Idaho), which was developed in the early 1970s, uses existing state universities in five states for first-year education, the Seattle campus for second-year education, and clinical sites across all five states for clinical education. Advantages of regional expansion include increasing enrollment in a cost-effective fashion, increasing clinical training opportunities, responding to health care needs of surrounding regions and underserved populations, and providing new opportunities for community-based physicians to enhance their practice satisfaction. Challenges include finding basic-science faculty at regional sites with backgrounds appropriate to medical students, achieving educational equivalence across sites, and initiating new research programs. UWSOM's successful long-term regional development, recent expansion to Wyoming in 1997, and current consideration of adding a first-year site in Spokane, Washington, indicate that regional expansion is a viable option for expanding medical education.

The Public Hospital Mission at Seattle???s Harborview Medical Center: High-Quality Care for the Underserved and Excellence in Medical Education

United States public hospitals and medical schools commonly enter into partnerships that serve the patient care, education, and research missions of both institutions. Harborview Medical Center, the county hospital in Seattle, Washington, and the University of Washington School of Medicine (UWSOM) have enjoyed a long affiliation that began at the medical school's founding 60 years ago. A formal agreement in 1967 turned over responsibility for all Harborview operations to UWSOM at a time when Harborview's facilities had fallen into serious disrepair and public hospitals were closing across the United States. All faculty and staff based at Harborview are employed by the University of Washington. By the mid-1970s a revitalization was underway at Harborview. The Medic One paramedic program drew national acclaim for pioneering prehospital emergency cardiac care, and the trauma and burn centers grew rapidly to meet specialized intensive care needs of the Pacific Northwest. Today, the success of the trauma, specialty surgery, and rehabilitation services have allowed Harborview to consistently maintain a positive operating margin while caring for the county's uninsured and indigent patients ($98 million in charity care in 2005). The hospital also offers nationally recognized residency programs and supports nationally and internationally acclaimed research. Harborview faces significant challenges for the future, including rapid growth of the indigent patient load, continually changing expectations for physician training, and growing cost pressures.

Professionalism in Medical Education: An Institutional Challenge

Despite considerable attention to professionalism in medical education nationwide, the majority of attention has focused on training medical students, and less on residents and faculty. Curricular formats are often didactic, removed from the clinical setting, and frequently focus on abstract concepts. As a result of a recent curricular innovation at the University of Washington School of Medicine (UWSOM) in which role-model faculty work with medical students in teaching and modeling clinical skills and professionalism, a new professionalism curriculum was developed for preclinical medical students. Through student feedback, that curriculum has changed over time, and has become more focused on the clinical encounter. This new and evolving curriculum has raised awareness of the existence of an "ecology of professionalism." In this ecological model, changes in the understanding of and attention to professionalism at one institutional level lead to changes at other levels. At the UWSOM, heightened attention to professionalism at the medical student level led to awareness of the need for increased attention to teaching and modeling professionalism among faculty, residents, and staff. This new understanding of professionalism as an institutional responsibility has helped UWSOM teachers and administrators recognize and promote mechanisms that create a "safe" environment for fostering professionalism. In such an institutional culture, students, residents, faculty, staff, and the institution itself are all held accountable for professional behavior, and improvement must be addressed at all levels.

Meeting the Needs of Regional Minority Groups: The University of Washington???s Programs to Increase the American Indian and Alaskan Native Physician Workforce

Minority populations in the United States are growing rapidly, but physician workforce diversity has not kept pace with the needs of underserved communities. Minorities comprised 26.4% of the population in 1995; by 2050, these groups will comprise nearly half. Medical schools must enlist greater numbers of minority physicians and train all physicians to provide culturally responsive care. The University of Washington School of Medicine (UWSOM) is the nation's only medical school that serves a five-state region (Washington, Wyoming, Alaska, Montana, and Idaho). Its mission addresses the need to serve the region, rectify primary care shortages, and meet increasing regional demands for underserved populations. The UWSOM Native American Center of Excellence (NACOE) was established as one important way to respond to this charge. The authors describe pipeline and minority recruitment programs at UWSOM, focusing on the NACOE and other activities to recruit American Indian/Alaskan Native (AI/AN) applicants to medical schools. These programs have increased the numbers of AI/AN medical students; developed the Indian Health Pathway; worked to prepare students to provide culturally responsive care for AI/AN communities; researched health disparities specific to AI/AN populations; provided retention programs and services to ensure successful completion of medical training; developed mentorship networks; and provided faculty-development programs to increase entry of AI/AN physicians into academia. Challenges lie ahead. Barriers to the pipeline will continue to plague students, and inadequate federal funding will have a significant and negative impact on achieving needed physician-workforce diversity. Medical schools must play a larger role in resolving these, and continue to provide pipeline programs, retention programs, and minority faculty development that can make a difference.

The Evolution of a Required Research Program for Medical Students at the University of Washington School of Medicine

The concepts and tools clinicians use to understand disease and treat patients are the direct product of basic and applied scientific inquiry. To prepare physicians to participate in this tradition of medical science, the University of Washington School of Medicine (UWSOM) created a research requirement in 1981. The objective was to provide students, during their clinical years of medical school, with first-hand experience in hypothesis-driven inquiry and an understanding of the philosophies and methods of science integral to the practice of medicine. A comprehensive curriculum review in 1998-2000 identified several limitations of this requirement. Although many students completed it successfully, others struggled to find mentors, funding, or time as coursework became more demanding. Other students found they had no interest in or aptitude for the research process itself. Accordingly, UWSOM has reaffirmed its commitment to independent inquiry but expanded the ways in which students can meet the requirement. Three research options are now available under the Independent Investigative Inquiry (III) program, generally completed the summer after students' first year of medical school. These are the hypothesis-driven inquiry, a critical review of the literature, or an experience-driven inquiry in community medicine. The goal of UWSOM is to shape new physicians who can manage rapidly changing medical science, information technology, and patient expectations in clinical practice and/or laboratories. The role of III is to teach students to develop personal methods of acquiring new knowledge and integrate it into their professional lives. Faculty support, program oversight, and funding have been increased.

The WAMI Program: 25 Years Later

The Washington, Alaska, Montana and Idaho (WAMI) Program is a four-state decentralized medical education program initiated at the University of Washington School of Medicine (UWSM) in 1972 with the goals of: (1) admitting more students to medical school from all states, (2) training more primary care physicians, (3) bringing the UWSM's resources to needy communities, (4) redressing the maldistribution of physicians by placing more MDs in predominantly rural states and (5) avoiding new construction costs. The program consists of a University Phase and a Community Phase, the latter extending to residency/postgraduate medical training. Thirty-three years on, and now renamed WWAMI (with the inclusion of the State of Wyoming), nearly 1200 students have been admitted to the program, with 5947 clerkship experiences and 2282 resident rotations, and the original goals of this experiment in decentralized medical education have been largely met. Almost half of all residents supported by the program return home to practice, and of graduates who underwent a part of their training in Alaska, Montana and Idaho, 64.7% returned home to practice. This paper reports on some lessons learned and speculates whether the WAMI program can keep pace with the rapid changes in medical education.

Medical students reach out to rural communities in "WWAMI Land".

ARMED WITH A COLLECTION OF “Got Milk?” advertisements and brittle cow bones she gathered from a ranch in Montana, Sarah Hollopeter set out on what for her was one of the most tantalizing aspects of medical school: teaching seventh and eighth grade students in Hailey, Idaho, about the debilitating effects of osteoporosis. For Hollopeter, an Idaho native who received her medical degree in June from the University of Washington School of Medicine (UWSOM), the disease is personal; she has seen its adverse effects in relatives. So she decided to focus on osteoporosis prevention during a special third-year program that sends medical students for 6 months of extended education in selected rural and medically underserved areas. During her time in Hailey, Hollopeter also helped women in the community receive bone density testing by convincing the local hospital to give discounts on screening with its underused dual-energy x-ray absortiometry scanner. Working in rural communities, says Hollopeter, was by far her favorite part of medical school. “I got to be part of patients’ lives, and that’s why I want to be a physician.”

A collaborative approach to a primary care preclinical preceptorship for underserved settings

This study describes the first few years of a collaborative effort undertaken by the University of Washington School of Medicine (UWSM), the Washington-Alaska-Montana-Idaho (WAMI) Area Health Education Center program, the Washington Academy of Family Practice, and the Family Health Foundation of Washington to provide students with an early introduction to primary care practice in rural and urban underserved settings. Starting in 1988, these collaborators organized a summer preceptorship that offered placements in the WAMI region to 23 student volunteers who were between their first and second years at the UWSM in 1989 and to 51 such students in 1990. A preliminary evaluation of the program indicated that the students (73 of whom participated in the evaluation) were extremely satisfied with the program's ability to provide them with firsthand exposure to community medicine. In conclusion, the authors discuss the advantages of collaboration and make suggestions for identifying potential educational partners.

Medical education for minorities at a US medical school.

The University of Washington School of Medicine (UWSM) has initiated new efforts to build a regional minority applicant pool and to expand its educational programmes to accommodate students from disadvantaged backgrounds. Specific interventions include: establishment of medical career planner position to coordinate region-wide outreach; pre-entry education; and support activities once enrolled. This study describes specific services and presents sociodemographic and performance data on 56 minority and 280 majority students entering the UWSM between 1981 and 1985. Economic status and educational background of minority students were significantly below that of majority students, several flexible academic policies enabled most students to achieve mastery in courses and to progress through the curriculum. The educational data base utilized in this study, and those at other institutions, can assume important roles in the identification of problem areas in the education of disadvantaged students and in evaluation of the interventions attempted.