Year Of Clinical Training Research Articles

Resident perceptions of anatomy education: A survey of medical school alumni from two different anatomy curricula and multiple medical specialties

In 2004, the University of Michigan Medical School reduced its gross anatomy curriculum. To determine the effect of this reduction on resident perceptions of their clinical preparedness, we surveyed alumni that included residents from the original and new shortened curricula. A Likert-scale survey was sent to four classes of alumni. Respondents were compared in old curriculum (OC) and new curriculum (NC) groups, surgical specialty (SS) and nonsurgical specialty (NS) groups, and subgroups of SS and NS were compared for differences between OC and NC. Mean response scores were compared using independent samples T-tests. As a single population (n = 110), respondents felt their anatomy education prepared them well for residency, that a more robust anatomy curriculum would be helpful, that dissection was important to their residency preparation, and that a 4th year anatomy elective was effective in expanding their anatomy education and preparing them for residency. No significant difference existed between OC and NC groups, neither as a whole nor as SS and NS subgroups. The SS group felt dissection was more important to their residency preparation than the NS group (P = 0.001) and that a more robust anatomy curriculum would have better prepared them for residency (P = 0.001). Thirty percent of SS respondents who did not take a 4th year elective commented that they wish they had. Fourth year anatomy electives were highly valued by residents, and respondents felt that they should be offered to students as a way of revisiting anatomy following the 1st year of clinical training.

Burnout risk in medical students in Spain using the Maslach Burnout Inventory-Student Survey

It is questionable whether the Maslach Burnout is suitable for studying burnout prevalence in preclinical medical students because many questions are patient-centered and the students have little or no contact with patients. Among factors associated with burnout in medical students, the gender shows conflicting results. The first aim of this study was to investigate the prevalence of the risk of burnout in medical students in preclinical and clinical years of training, using the Maslach Burnout Inventory-Student Survey, specifically designed and validated to assess the burnout in university students, and secondly, to investigate the association between gender and burnout subscales. A cross-sectional study was carried out in a sample of 270 Spanish medical students-176 (65%) in the third year and 94 (35%) in the sixth year of training-using the Maslach Burnout Inventory-Student Survey questionnaire. Internal consistencies (Cronbach's alpha) for the three subscales on the whole sample were as follows: for exhaustion 0.78, cynicism 0.78, and efficacy 0.71. Moreover, the prevalence of burnout risk was significantly higher in sixth-year students 35 (37.5%) compared with students in third year of training 26 (14.8%) (χ(2) test, p<0.0001). No significant association was found between gender and burnout subscales. The Maslach Burnout Inventory-Student Survey overcame difficulties encountered when students have little or no contact with patients. Our findings show that the risk of burnout prevalence doubled from the third year to sixth year of training and that gender was not significantly associated with any of the subscales of burnout.

The “cash or care” conflict in general practice – A cautionary tale with methodological reflections

Considerable enthusiasm and good intentions in my luggage, I made myway back to Germany in 2005 after having worked at the Glasgow Center for Integrative Care (writes E.K.). It was time to set upmy own practice as a general practitioner (GP) in Germany. This is the cautionary tale of what happened, interwoven with reflections on what the outcome reveals about today’s practice of healthcare, and some methodological implications for Health Communication Research. In my preceding 9 years of clinical training, I realized that the panorama of diseases and medical challenge had dramatically shifted, but our response lagged behind. Today’s epidemics and everyday stories in general practice are long term conditions, degenerative problems like diabetes, heart disease, depression, anxiety, chronic pain, chronic fatigue, obesity. Embedded in social contexts and ways of living, these problems need approaches beyond the drug model. Good care needs people’s conditions to be seen in the context of their life, their inner narrative and their wider social system. Article history: Received 31 July 2010 Received in revised form 17 January 2011 Accepted 20 January 2011

Training gastroenterology fellows to perform gastric polypectomy using a novelex vivomodel

To evaluate the effect of hands-on training of gastroenterology fellows in gastric polypectomy using an ex vivo simulator. Eight gastroenterology fellows at Mackay Memorial Hospital, Taipei were evaluated in gastric polypectomy techniques using a pig stomach with artificial polyps created by a rubber band ligation device. The performance of four second year (year-2) fellows who had undergone one year of clinical training was compared with that of four first year (year-1) fellows both before and after a 4-h workshop using the ex vivo simulator. The workshop allowed for hands-on training in the removal of multiple artificial polyps and the placement of hemoclips at the excision site. Evaluation included observation of technical skills, procedure time, and the fellows' confidence scale. One week after the workshop, the year-1 fellows were re-evaluated and had significantly improved mean performance scores (from 17.9 ± 1.8 to 22.5 ± 0.7), confidence scale (from 4.5 ± 1.0 to 7.8 ± 0.5) and procedure time (from 615.0 ± 57.4 s to 357.5 ± 85.0 s) compared with their baseline performance. After 4 h of training using the ex vivo simulator, the skills of the year-1 fellows were statistically similar to those of the year-2 fellows. Use of this ex vivo simulator significantly improved the endoscopic gastric polypectomy skills of gastroenterology fellows who had not had previous clinical training in gastric polypectomy.

Association Between National Board Dental Examination Part II Scores and Comprehensive Examinations at Harvard School of Dental Medicine

Harvard School of Dental Medicine (HSDM) uses a hybrid problem-based approach to teaching in the predoctoral program. The objective structured clinical examination (OSCE) is a formative examination designed to assess the performance of students in the problem-based learning (PBL) curriculum. At HSDM three comprehensive examinations with OSCE components are administered during the third and fourth years of clinical training. The National Board Dental Examination (NBDE) Part II is taken in the final year of the predoctoral program. This study examines the association between the NBDE Part II and the comprehensive exams held at HSDM. Predoctoral students from the HSDM classes of 2005 and 2006 were included in this study. The outcome variable of interest was the scores obtained by students in the NBDE Part II, and the main independent variable of interest was the performance of students in the comprehensive exams (honors, pass, make-up exam to pass). The Mann-Whitney U-test was used to examine the association between the grades obtained in the each of the three comprehensive exams and the NBDE Part II scores. Multivariable linear regression analysis was also used to examine the association between the NBDE Part II scores and the comprehensive exam grades. The effect of potential confounding factors including age, sex, and race/ethnicity was adjusted. The results suggest that students who performed well in the comprehensive exams performed better on the NBDE Part II, even after adjusting for confounding factors. Future studies will examine the long-term impact of PBL on postdoctoral plans and career choices.

How Assigned Faculty Mentors View their Mentoring Relationships: An Interview Study of Mentors in Medical Education

This qualitative study of 29 physician mentors reports their perspectives on mentoring medical students in a well‐respected medical school’s formal, assigned, longitudinal mentoring program that has a curricular component in the second year. Using a phenomenologic inductive approach, common themes identified centered on mentors’ relationships with their students and the characteristics of the relationships. Most mentors said their relationships solidified in the second year, where curricular responsibilities included teaching and evaluation. Mentors saw their roles change, yet relationships continued to develop as mentees advanced through medical school. They were surprised when students sought contact, support, and advice in years three and four of their programs. Mentors worried whether they “did enough” for their students, yet described their experiences and relationships as rewarding. Mentors subsequently found satisfaction in the continuing relationship during the clinical training years. The researchers note the importance of the curricular component for providing a purpose and structure for relationship development and in facilitating relationship development in this assigned mentoring program.

Saulo Klahr Was as Good as It Gets

Saulo Klahr was a brilliant, cultured man; a physician who excelled in both clinical and basic medical research. He was born in 1935 and raised in the small town of Santendar, Colombia. When Saulo was still in high school, he shared an experience with many of us. He read Microbe Hunters , and from that point on, medicine and medical research would be his chosen fields. Graduating from the Universidad National de Colombia School of Medicine at the top of his class, he remained in Colombia for 3 years of clinical training and then embarked on what proved to be a life-changing event. Saulo decided to become a nephrologist and moved to the United States, where, being a graduate of a foreign medical school and speaking less than perfect English, his hopes for a career in academic medicine had to be regarded as a long shot. In 1966, he visited me at Washington University in St. Louis hoping for a fellowship. This was a moment when nephrology was a new field …

Die Lehre in Orthopädie und Unfallchirurgie im klinischen Studienabschnitt und im Praktischen Jahr (PJ)

The fusion of orthopaedic and trauma surgery into a combined specialty requires a new evaluation of postgraduate and undergraduate training. This study presents a structured analysis of the implementation possibilities for undergraduate training. After defining 3 implementation alternatives for both clinical training and last year electives, SWOT analyses were performed. RESULTS. The SWOT analysis demonstrates for each of these 6 implementation models the strengths, weaknesses, opportunities and threats. In order to strengthen undergraduate training in the “new” specialty all medical faculties should discuss and define their implementation concepts.

There Is a Role for Industry-Sponsored Education in Cardiology

Education: “The process or art of imparting knowledge, skill and judgment; Facts, skills and ideas that have been learnt, either formally or informally.” — Wikipedia 1 The term profession is applied to those persons who have specialized and technical skill or knowledge which they apply, for a fee, to certain tasks that ordinary and unqualified people cannot ordinarily undertake. The term derives from the Latin: “to swear (an oath) …” . — Wikipedia 2 Let’s consider how we as cardiovascular medicine specialists spend our days in the care of people with cardiovascular disease. In the office or making rounds in the hospital, we prescribe drugs and order diagnostic tests; in the noninvasive laboratory, we obtain and interpret images of the heart; in the electrophysiology and cardiac catheterization laboratories, we program and implant devices in patients. When antithrombotic and fibrinolytic drugs are administered, and primary percutaneous coronary intervention is done using balloon catheters and intracoronary stents, lives are saved among patients with acute myocardial infarction. Response by Avorn and Choudhry see p 2221 The mortality risk from heart failure decreases and quality of life increases from the proper and appropriate use of angiotensin-converting enzyme inhibitors and β-blockers. Lipid lowering through the use of statin drugs saves lives and reduces serious cardiovascular complications such as myocardial infarction and stroke when properly prescribed to patients with a variety of manifestations of atherosclerotic vascular diseases. According to a recent publication by Ford and colleagues,3 deaths due to coronary heart disease in the United States declined substantially from 1980 to 2000, resulting in >340 000 fewer deaths in 2000. The authors attributed approximately half of this decline to changes in cardiac risk factors and half to the application of evidence-based therapies. An underlying theme in all of this is that the pharmaceutical, biotechnology, and …

Communities of clinical practice and normalising technologies of self: learning to fit in on the surgical ward

This paper reports observational research of Fourth Year medical students in their first year of clinical training doing their surgical attachment. Previously, the authors have argued that medical curricula constitute normalising technologies of self that aim to create a certain kind of doctor. Here, they argue that a key mechanism through which these normalising technologies are exercised in the workplace is Etienne Wenger's communities of practice. In the clinical environment the authors identify communities of clinical practice (CoCP) as groups of health professionals that come together with the specific and common purpose of patient care. Fourth Year medical students join these transient communities as participants who are both peripheral and legitimate. Communities of clinical practice are potent vehicles for student learning. They learn and internalise the normative professional values and behaviours that they witness and experience within the disciplinary block of the medical school and teaching hospital; specifically, the authors suggest, it is through their participation in communities of clinical practice that medical students learn how to ‘be one of us’.

Postgraduate training and career choices: an analysis of the National Physicians Survey in Japan

This study analyses and discusses recent changes in young Japanese doctors' career paths, in terms of their distribution in different types of facilities and specialties, following changes to the postgraduate clinical training system in 2004. Data from the National Survey of Physicians, Dentists and Pharmacists conducted by Japan's Ministry of Health, Labour and Welfare were used for this study. After the introduction of the new postgraduate training system, 2 years of clinical training became mandatory and a doctor-to-facility matching system was introduced. Since then, more young doctors have migrated from academic hospitals to non-academic hospitals. The number of first-year doctors at non-academic hospitals increased, whereas the number at academic hospitals decreased. In terms of the distribution of doctors per specialty, the decreasing tendency of doctors to choose internal medicine and surgery has accelerated. These results illustrate the significant changes that have affected young doctors' career paths since the new system was introduced. Designing and providing desirable postgraduate clinical training and achieving appropriate doctor distribution are important policy issues. Appropriate policy interventions regarding a mechanism to ensure the appropriate distribution of doctors should be established and attention should be paid to expanding doctors' choices and increasing patient satisfaction and general cost-effectiveness.

Predicting Success on the Certification Examinations of the American Board of Anesthesiology

Currently, residency programs lack objective predictors for passing the sequenced American Board of Anesthesiology (ABA) certification examinations on the first attempt. Our hypothesis was that performance on the ABA/American Society of Anesthesiologists In-Training Examination (ITE) and other variables can predict combined success on the ABA Part 1 and Part 2 examinations. The authors studied 2,458 subjects who took the ITE immediately after completing the first year of clinical anesthesia training and took the ABA Part 1 examination for primary certification immediately after completing residency training 2 yr later. ITE scores and other variables were used to predict which residents would complete the certification process (passing the ABA Part 1 and Part 2 examinations) in the shortest possible time after graduation. ITE scores alone accounted for most of the explained variation in the desired outcome of certification in the shortest possible time. In addition, almost half of the observed variation and most of the explained variance in ABA Part 1 scores was accounted for by ITE scores. A combined model using ITE scores, residency program accreditation cycle length, country of medical school, and gender best predicted which residents would complete the certification examinations in the shortest possible time. The principal implication of this study is that higher ABA/ American Society of Anesthesiologists ITE scores taken at the end of the first clinical anesthesia year serve as a significant and moderately strong predictor of high performance on the ABA Part 1 (written) examination, and a significant predictor of success in completing both the Part 1 and Part 2 examinations within the calendar year after the year of graduation from residency. Future studies may identify other predictors, and it would be helpful to identify factors that predict clinical performance as well.

Pilot testing of an assessment tool for competency in mastoidectomy

To determine the feasibility, validity, and reliability of an evaluation tool for the assessment of competency in mastoid surgery. This study tests the hypothesis that residents of dissimilar training levels differ in their technical performance as measured by this tool. Cross-sectional validation study. Two or more faculty otolaryngologists evaluated each resident performing a cortical mastoidectomy on a cadaveric temporal bone. Performance was rated using global and checklist components of a mastoidectomy assessment tool. Fifteen internal and external faculty members evaluated 23 residents over 3 years resulting in 118 evaluations. Construct validity was observed as scores increased with clinical training year. These differences were greater for more complex tasks. There was a percentage agreement of 78.5% between evaluator pairs in the determination of pass (score 3-5) versus fail (score 1-2) for the checklist instrument, and an agreement of 74.4% for the global instrument. Although agreement was lower for the exact score on a scale of 1 to 5, differences of 1 or less occurred in over 80% of evaluator pairs. Regression analysis confirmed faculty perception that sharpening of the posterior external auditory canal cortex and opening of the antrum from posterior to anterior are strong predictors of overall surgical performance. Our results indicate that the tool we have developed is a feasible, valid, and reliable instrument for the assessment of competency in mastoidectomy. The instrument can be used to provide formative feedback and to identify procedural tasks for which additional training may be necessary.

Considerações sobre o ensino médico no Brasil: consequências afetivo-emocionais nos estudantes

Faz-se uma revisão não exaustiva da evolução do ensino médico no Brasil desde sua origem, passando pelas inúmeras reformas praticadas, que buscam melhorar a formação técnica dos estudantes. Chama-se a atenção para o fato de nessas reformas nunca terem sido referidas questões como o bem-estar e a saúde mental dos alunos. O curso de Medicina sempre foi considerado estressante, mas a preocupação com esse aspecto é recente na história. Alguns estudos tentam identificar a fase do curso mais estressante, e a maioria indica a primeira série do ciclo clínico. Outros tentam apontar os fatores mais responsáveis pelo estresse, buscando-os nas características dos alunos e do curso. São apontados os diagnósticos mais frequentes citados na literatura e sugestões para minimizar esse processo no âmbito das escolas médicas.

Freedom of choice in childbirth: women need time to make a decision

I am a final-year student at the University of Plymouth. The first two years of my clinical training were spent at a consultantled unit which, in 2007, introduced an integrated pattern of midwifery with a core team of hospital-based midwives and four separate teams of integrated midwives who deliver care to women antenatally and during the intrapartum and postnatal periods. Even in its infancy, this integrated pattern of care was soon recognized by both women and midwives as one that provided continuity of care. As a first-year student, I readily accepted it as being the only way care was provided to women. In discussions with fellow student midwives, however, it soon became clear that this model was not replicated in all areas in the southwest.

The future of fellowship training in clinical cardiac electrophysiology: Program directors' perspective 2008

At the Clinical Cardiac Electrophysiology (CCEP) program directors' annual meeting during the 2008 scientific sessions of the Heart Rhythm Society, a consensus emerged for an urgent need to strengthen and rejuvenate fellowship training in clinical cardiac electrophysiology. A writing group of the Heart Rhythm Society Clinical Research and Training Committee was charged with defining these issues. A comprehensive questionnaire designed by the writing group was used to conduct an on-line survey of the 101 CCEP program directors in the United States. Data collected included types of programs, current status of programs, duration of fellowship, teaching responsibilities of faculty, responsibilities of fellows, and volume of electrophysiology procedures. Survey responses were collated and analyzed by the writing group. Given the rapid evolution and increased complexity of current electrophysiology procedures, program directors were of the opinion that 1 year of clinical electrophysiology training may no longer be adequate. A need to strengthen both research and didactic training components of fellowship training was also acknowledged. The number of electrophysiology procedures performed by trainees varied greatly between programs, and standardization of didactic training and procedural volume would be welcomed. Recent trends were recognized that indicate the need for a detailed national work-force analysis in CCEP. Through this national survey, program directors identified specific areas of need for standardization and strengthening of current fellowship training in CCEP. Based on these, specific measures can be taken to ensure the future of CCEP training.

Preliminary Evaluation of a Genitourinary Skills Training Curriculum for Medical Students

Basic urology training in medical school is considered important for many medical and surgical disciplines. We developed a 2-day intensive genitourinary skills training curriculum for medical students beginning their clinical clerkship training years and evaluated the initial experience with this program. All 94 third-year medical students at the University of California, Irvine were required to participate in a 5.5-hour genitourinary examination skills training program. The teaching course included 1.5 hours of didactic lecture and video presentation with questions and answers, followed by 5, 45-minute hands-on stations including male Foley catheter placement, female Foley catheter placement, testicular examination and digital rectal examination training with a standardized patient, virtual reality cystourethroscopy and, lastly, a urologist led tutorial of abnormal genitourinary findings. The students completed questionnaires before and after the course concerning their experience. At the end of the course the students rated the usefulness of each part of the curriculum and evaluated the faculty. In addition, they were required to complete a multiple choice examination that included 4 genitourinary specific questions. All 94 medical students completed the genitourinary skills training course. Before the course less than 10% of students reported comfort with genitourinary skills, including testicular examination (5%), digital rectal examination (10%), male Foley catheter placement and female Foley catheter placement (2%). Following the course the comfort level improved in all parameters of digital rectal examination (100%) and testicular examination, male Foley catheter placement and female Foley catheter placement (98%). The students rated in the order of most to least useful training 1) standardized patient for testicular examination and digital rectal examination teaching, 2) male Foley catheter placement and female Foley catheter placement training, 3) didactic lecture, 4) tutorial of abnormal genitourinary examination findings and 5) virtual reality cystourethroscopy. On the examination questions following the course 80% to 98% of the class answered each urology content question correctly. An intensive skills training curriculum significantly improved medical student comfort and knowledge with regard to basic genitourinary skills including testicular examination, rectal examination, and Foley catheter placement in the male and female patient. Further followup will be performed to determine the application of these skills during clinical clerkship rotations.

Predictive Factors in Identifying Subspecialty Fellowship Applicants Who Will Have Academic Practices

The challenge of subspecialty fellowship directors is to recruit surgeons who are motivated to continue the tradition of teaching by entering academic medicine. The authors looked for predictive factors to help with more accurate selection of applicants. Application and follow-up data from plastic surgery subspecialty fellows in craniofacial surgery, hand surgery, and microsurgery from the University of California, Los Angeles were reviewed for the years 1987 through 2002 (n = 62). Fellows were divided into three groups as follows: group 1, full-time academic; group 2, part-time clinical faculty; and group 3, private practice at 1 year and 5 years after fellowship. Common factors of fellows within the three groups were listed. Although a majority of applicants (95 percent) indicated an aspiration to practice academic medicine, only one-third remained in full-time academics 5 years after their subspecialty training. There was a trend toward leaving academic practice: the rates at 1 year were 74 percent for group 1 (academic) and 5 percent for group 3 (private practice), but by 5 years this had equalized (group 1, 34 percent; group 3, 32 percent). Group 1 (academic) showed more academic productivity publications per year, academic titles, editorial boards, and active participation in medical societies compared with group 3 (private practice). The factors that were more common to group 1 were married or married with children, five or more publications, one or more years of research, and 7 or more years of training. Plastic surgery fellowship directors may look at the following predictive factors of applicants if they would like their graduates to carry on the tradition of teaching future plastic surgeons: (1) previous dedicated research training, (2) more years of clinical training, and (3) more scientific publications.

Assessment of clinical reasoning skills in veterinary students prior to and after the clinical year of training

To examine the effect of various clinical tracks within the veterinary medical clinical curriculum at Texas A&M University on clinical diagnostic proficiency as determined by pre- and post-training assessment. We expected that the clinical track chosen by the student would impact their measured outcome with bias toward higher scores in their chosen field. Prospective cohort study. 32 students from the College of Veterinary Medicine and Biomedical Sciences at Texas A&M University. By use of standardized, written case scenarios, clinical reasoning was assessed twice: once prior to the clinical (fourth) year of the curriculum and again at completion of the clinical year. Students demonstrated their abilities to collect and organize appropriate clinical data (history, physical examination, and laboratory findings), determine clinical diagnoses, and formulate and implement acceptable treatment modalities. Data from clinical assessments were compared for a given cohort and correlated with other measures (eg, grades, standardized test scores, and species-specific curricular track). Differences were detected in clinical diagnostic proficiency among students in different clinical tracks and for different species groups in the case scenarios. Tracking by species group in the clinical veterinary curriculum appeared to affect development of clinical reasoning and resulted in differential proficiency among cases for differing species groups. Differences in clinical experiences between small animal tracks and all other track opportunities (large animal, mixed animal, and alternative) influenced the development of clinical proficiency in fourth-year veterinary students during their clinical training period.

The Long-term Impact of Preclinical Education on Medical Students' Opinions About Radiology

It has been previously shown that integrating radiology teaching into the first year of medical education has an immediate positive effect on medical students' attitudes toward the practice of radiology. The purpose of this study is to determine whether these changes in attitude persist through the clinical years of training and whether preclinical exposure to radiology has a long-term effect on medical students' opinions about radiology and radiologists. The first-year medical curriculum at the University of Pittsburgh School of Medicine was revised between the 2003 and 2004 academic years, with 2.5 hours of additional radiology lectures integrated into the existing preclinical coursework. Additionally, radiology consult sessions were integrated into problem-based learning sessions. An initial survey was administered in the preclinical years of training to assess first-year medical students' attitudes toward radiology before and after the changes to the curriculum. A follow-up survey was administered before graduation to determine whether the changes in attitude revealed in the first survey persisted throughout the remaining years of training, and to assess students' opinions about negative radiologist stereotypes. Students who had undergone the revised curriculum were compared to students who had undergone the traditional curriculum. There were statistically significant differences between the two graduating classes in terms of interest in, and perceptions of, the field of radiology. At graduation, students exposed to the revised preclinical curriculum with a greater exposure to radiology had a greater interest in radiology as a discipline and were more likely to have taken senior electives in radiology. These graduating students were also less likely to agree with negative stereotypes about radiologists. Dedicated medical student teaching from an academic radiologist during the first year of medical school has a positive, long-lasting effect on medical students' attitudes toward radiology. The prevalence of negative stereotypes about radiologists among graduating medical students can be reduced by appropriate teaching of radiology in the preclinical years of medical school.