Showing papers in "Academic Medicine in 2005"
TL;DR: A large number of studies of self-assessment ability in medical education, health professional education, and professions educat have identified self-Assessment as a vital aspect of professional self-regulation.
Abstract: Many researchers and educators have identified self-assessment as a vital aspect of professional self-regulation.1,2,3 This rationale has been the expressed motivation for a large number of studies of self-assessment ability in medical education, health professional education, and professions educat
871 citations
TL;DR: It is concluded that irrespective of local context, precise, unambiguous, face-to-face communication is the best way to ensure effective handoffs of hospitalized patients and that students and residents must be taught the most effective, safe, satisfying, and efficient ways to perform handoffs.
Abstract: Handoffs involve the transfer of rights, duties, and obligations from one person or team to another. In many highprecision, high-risk contexts such as a relay race or handling air traffic, handoff skills are practiced repetitively to optimize precision and anticipate errors. In medicine, wide variation exists in handoffs of hospitalized patients from one physician or team to another. Effective information transfer requires a solid foundation in communication skills. While these skills have received much attention in the medical literature, scholarship has focused on physician-topatient, not physician-to-physician, communication. Little formal attention or education is available to reinforce this vital link in the continuity of patient care. The authors reviewed the literature on patient handoffs and evaluated the patient handoff process at Indiana University School of Medicine’s internal medicine residency. House officers there rotate through four hospitals with three different computer systems. Two of the hospitals employ a computer-assisted patient handoff system; the other two utilize the standard pen-to-paper
516 citations
TL;DR: Four criteria for critically evaluating new or existing simulations are offered, based on the theoretical framework outlined above, which suggest a supportive, motivational, and learner-centered milieu which is conducive to learning.
Abstract: Simulation-based learning is becoming widely established within medical education. It offers obvious benefits to novices learning invasive procedural skills, especially in a climate of decreasing clinical exposure. However, simulations are often accepted uncritically, with undue emphasis being placed on technological sophistication at the expense of theory-based design. The author proposes four key areas that underpin simulation-based learning, and summarizes the theoretical grounding for each. These are (1) gaining technical proficiency (psychomotor skills and learning theory, the importance of repeated practice and regular reinforcement), (2) the place of expert assistance (a Vygotskian interpretation of tutor support, where assistance is tailored to each learner's needs), (3) learning within a professional context (situated learning and contemporary apprenticeship theory), and (4) the affective component of learning (the effect of emotion on learning). The author then offers four criteria for critically evaluating new or existing simulations, based on the theoretical framework outlined above. These are: (1) Simulations should allow for sustained, deliberate practice within a safe environment, ensuring that recently-acquired skills are consolidated within a defined curriculum which assures regular reinforcement; (2) simulations should provide access to expert tutors when appropriate, ensuring that such support fades when no longer needed; (3) simulations should map onto real-life clinical experience, ensuring that learning supports the experience gained within communities of actual practice; and (4) simulation-based learning environments should provide a supportive, motivational, and learner-centered milieu which is conducive to learning.
390 citations
TL;DR: Insight is provided as to why supervisors fail to fail the poorly performing student and resident and suggestions of how to support supervisors are offered, increasing the likelihood that they will provide a valid ITER when faced with an underachieving trainee.
Abstract: Background Clinical supervisors often do not fail students and residents even though they have judged their performance to be unsatisfactory. This study explored the factors identified by supervisors that affect their willingness to report poor clinical performance when completing In-Training Evaluation Reports (ITERs). Method
379 citations
TL;DR: The work of an Ad Hoc Faculty Mentoring Committee whose tasks were to define “mentorship,” specify concrete characteristics and responsibilities of mentors that are measurable, and develop new tools to evaluate the effectiveness of the mentoring relationship is presented.
Abstract: “Mentor” is a term widely used in academic medicine but for which there is no consensus on an operational definition. Further, criteria are rarely reported for evaluating the effectiveness of mentoring. This article presents the work of an Ad Hoc Faculty Mentoring Committee whose tasks were to define “mentorship,” specify concrete characteristics and responsibilities of mentors that are measurable, and develop new tools to evaluate the effectiveness of the mentoring relationship. The committee developed two tools: the Mentorship Profile Questionnaire, which describes the characteristics and outcome measures of the mentoring relationship from the perspective of the mentee, and the Mentorship Effectiveness Scale, a 12-item six-point agree–disagree-format Likert-type rating scale, which evaluates 12 behavioral characteristics of the mentor. These instruments are explained and copies are provided. Psychometric issues, including the importance of content-related validity evidence, response bias due to acquiescence and halo effects, and limitations on collecting reliability evidence, are examined in the context of the mentor– mentee relationship. Directions for future research are suggested. Acad Med. 2005; 80:66–71.
368 citations
TL;DR: The author proposes a more comprehensive approach to changing the culture of medical education to favor an approach he calls narrative-based professionalism and to address the tension between self-interest and altruism.
Abstract: Professionalism is au courant in medicine today, but the movement to teach and evaluate professionalism presents a conundrum to medical educators. Its intent is laudable: to produce humanistic and virtuous physicians who will be better able to cope with and overcome the dehumanizing features of the health care system in the United States. However, its impact on medical education is likely to be small and misleading because current professionalism curricula focus on lists of rules and behaviors. While such curricula usually refer to virtues and personal
340 citations
TL;DR: MCAT scores essentially replace the need for uGPAs in their impressive prediction of Step scores, and performs well as an indicator of academic preparation for medical school, independent of the school-specific handicaps of u GPAs.
Abstract: PurposeSince the introduction of the revised Medical College Admission Test (MCAT®) in 1991, the Association of American Medical Colleges has been investigating the extent to which MCAT scores supplement the power of undergraduate grade point averages (uGPAs) to predict success in medical sc
326 citations
TL;DR: The validity of faculty, department, and leadership characteristics identified in the Bland et al. (2002) model were confirmed as necessary for high levels of research productivity and were influenced more by individual and institutional characteristics.
Abstract: PurposeAlthough numerous characteristics impact faculty research productivity, and although researchers have suggested comprehensive theoretical models to explain the relationship between these characteristics and levels of faculty research productivity, few studies have assessed these model
320 citations
TL;DR: Controllable lifestyle was strongly associated with the recent trends in specialty choice for both women and men and could not be explained solely by the specialty preferences of women.
Abstract: PURPOSE To determine whether the preferences of female medical students are sufficient to explain the recent trend of U.S. medical students choosing specialties with controllable lifestyles. METHOD Specialty choice for graduating U.S. medical students by sex was determined from the responses to the Association of American Medical Colleges' 1996-2003 Medical School Graduation Questionnaires. Using earlier research, specialties were classified as having an uncontrollable or controllable lifestyle. Log-linear models were constructed to assess the strength of association among trends in specialty choice, controllable lifestyle, and sex. RESULTS The percentage of women choosing specialties with controllable lifestyles increased from 18% in 1996 to 36% in 2003. For men, the percentage grew from 28% to 45%. The change in preference for controllable lifestyle specialties accounted for a large proportion of the variability in specialty choices for both women and men from 1996-2003 (chi2 for changes common to women and men = 920, 1 df, p < .0001). The difference between women and men in the trend toward controllable lifestyle specialties was small relative to the common changes (chi2 for differences = 12, 1 df, p = .0005). CONCLUSION Controllable lifestyle was strongly associated with the recent trends in specialty choice for both women and men and could not be explained solely by the specialty preferences of women.
314 citations
TL;DR: Deep shortcomings exist in the literature on medical ethics education and the field would benefit from further theoretical work aimed at better delineating the core content, core processes, and core skills relevant to the ethical practice of medicine.
Abstract: PurposeThe authors’ primary goal was to provide a comprehensive and current review of the literature surrounding ethics education for medical students. Following this review, the authors summarize the deficits in the current literature and provide recommendations for future inquiries on medi
300 citations
TL;DR: Strategies for strengthening academic medicine's recruitment and retention of Generation X into faculty and leadership roles are suggested and supports and adaptations are indicated to assure that academic health centers maintain traditions of excellence.
Abstract: Differences and tensions between the Baby Boom generation (born 1945-1962) and Generation X (born 1963-1981) have profound implications for the future of academic medicine. By and large, department heads and senior faculty are Boomers; today's residents and junior faculty are Generation X'ers. Looking at these issues in terms of the generations involved offers insights into a number of faculty development challenges, including inadequate and inexpert mentoring, work-life conflicts, and low faculty morale. These insights suggest strategies for strengthening academic medicine's recruitment and retention of Generation X into faculty and leadership roles. These strategies include (1) improving career and academic advising by specific attention to mentoring "across differences"--for instance, broaching the subject of formative differences in background during the initial interaction; adopting a style that incorporates information-sharing with engagement in problem solving; offering frequent, frank feedback; and refraining from comparing today to the glories of yesterday; to support such improvements, medical schools should recognize and evaluate mentoring as a core academic responsibility; (2) retaining both valued women and men in academic careers by having departments add temporal flexibility and create and legitimize less-than-full-time appointments; and (3) providing trainees and junior faculty with ready access to educational sessions designed to turn their "intellectual capital" into "academic career capital."Given the trends discussed in this article, such supports and adaptations are indicated to assure that academic health centers maintain traditions of excellence.
TL;DR: Although graduating residents appear to be better off than the population norms, some domains of their mood disturbances and empathy never fully recover from their internship year.
Abstract: PurposeTo examine longitudinal changes in mood and empathy over the course of the internal medicine residency.MethodThe authors conducted a cohort study of 61 residents who completed the Profile of Mood States (POMS) and the Interpersonal Reactivity Index (IRI) at six time points during thei
TL;DR: Lifestyle and income have become more important to medical students in their career choice, and the relative influence of these factors varies considerably between specialties.
Abstract: PurposeRecent reports on medical students' career choices suggest that lifestyle increasingly influences career decisions. The authors addressed the changing influence of lifestyle and income on career choice, how these influences differ by specialty, and the specific careers students identi
TL;DR: The author updates the agenda for research in CBL (including Web-based learning), saying that CBL is not a panacea, but holds great promise, and that media-comparative studies be replaced by rigorous, theory-guided comparisons of CBL interventions.
Abstract: Media-comparative research-that is, the comparison of computer-based learning (CBL) to noncomputer instruction-is logically impossible because there are no valid comparison groups. Results from media-comparative studies are thus confounded and difficult to meaningfully interpret. In 1994, Friedman proposed that such research be supplanted by investigations into CBL designs, usage patterns, assessment methods, and integration. His proposal appears to have largely been ignored. In this article, the author updates the agenda for research in CBL (including Web-based learning). While media-comparative studies are confounded, CBL-CBL comparisons are often not. CBL instructional designs vary in configuration (e.g., discussion board or tutorial), instructional method (e.g., case-based learning, personalized feedback, or simulation), and presentation (e.g., screen layout, hyperlinks, or multimedia). Comparisons within one level (for example, comparing two instructional methods) facilitate evidence-based improvements, but comparisons between levels are confounded. Additional research questions within the CBL-CBL framework might include: Does adaptation of CBL in response to individual differences such as prior knowledge, computer experience, or learning style improve learning outcomes? Will integrating CBL with everyday clinical practice facilitate learning? How can simulations augment clinical training? And, how can CBL be integrated within and between institutions? In addressing these questions it is important to remember the most important outcome-effect on patients and practice-and outcomes specific to CBL including costs, cognitive structuring, and learning unique to the computer-based environment. CBL is not a panacea, but holds great promise. Realization of this potential requires that media-comparative studies be replaced by rigorous, theory-guided comparisons of CBL interventions.
TL;DR: The authors define the work that faculty engage in with communities, consider whether all work by faculty in community-based settings is actually scholarship, and propose a framework for documenting and assessing community-engaged scholarship for promotion and tenure decisions.
Abstract: Since Ernest Boyer's landmark 1990 report, Scholarship Reconsidered: Priorities of the Professoriate, leaders in higher education, including academic medicine, have advocated that faculty members apply their expertise in new and creative ways in partnership with communities. Such community engagement can take many forms, including community-based teaching, research, clinical care, and service. There continues to be a gap, however, between the rhetoric of this idea and the reality of how promotion and tenure actually work in health professions schools. The Commission on Community-Engaged Scholarship in the Health Professions was established in October 2003 with funding from the W.K. Kellogg Foundation to take a leadership role in creating a more supportive culture and reward system for community-engaged faculty in the nation's health professions schools. The authors prepared this article to inform the commission's deliberations and to stimulate discussion among educators in the health professions. The authors define the work that faculty engage in with communities, consider whether all work by faculty in community-based settings is actually scholarship, and propose a framework for documenting and assessing community-engaged scholarship for promotion and tenure decisions. They conclude with recommendations for change in academic health centers and health professions schools.
TL;DR: It is suggested that exposure to gender discrimination and sexual harassment during undergraduate education may influence some medical students' choice of specialty and, to a lesser degree, ranking of residency programs.
Abstract: PurposeTo examine the role of gender discrimination and sexual harassment in medical students' choice of specialty and residency program.MethodAnonymous, self-administered questionnaires were distributed in 1997 to fourth-year students enrolled in 14 public and private U.S. medical schools.
TL;DR: Among U.S. medical graduates, women were not more responsible than were men for the trend away from uncontrollable lifestyle specialties over the time period studied.
Abstract: PURPOSE: Women have been postulated to be more responsible than men for the recent trend of lifestyle factors influencing the specialty choices of graduating U.S. medical students. The authors looked at the specialty choices of U.S. medical students between 1990 and 2003 to determine whether and to what degree women were responsible for the trends toward controllable lifestyle specialties. METHOD: Specialty preference was based on analysis of results from the American Association of Medical Colleges' Medical School Graduation Questionnaire. Specialty lifestyle (controllable vs. uncontrollable) was classified using a standard definition from prior research. A random effects regression model was used to assess differences between men and women in specialty choice over time and the proportion of variability in specialty preference from 1990 to 2003 explained by women. RESULTS: Overall, a greater proportion of women planned to pursue uncontrollable specialties compared with men in every year analyzed. Both women and men demonstrated a decreasing interest in uncontrollable lifestyle specialties by almost 20%. However, regression analysis found that women were more slightly more likely to choose an uncontrollable lifestyle specialty compared to men over time (p < .01). CONCLUSION: Among U.S. medical graduates, women were not more responsible than were men for the trend away from uncontrollable lifestyle specialties over the time period studied. Men and women expressed similar and significant rates of declining interest in specialties with uncontrollable lifestyles.
TL;DR: Revisiting the principles of David Kolb’s Learning Styles Inventory, the authors propose applying his experiential learning model to overall curriculum design work and argue that promoting the application of all learning styles in sequence in an educational encounter is a most desirable approach.
Abstract: As changes in health care delivery systems and in the global burden of disease call for a reassessment of how tomorrow's physicians should be educated--indeed, for a reconsideration of the diversity of roles the physician should play--there is an immediate need to produce continuing medical education (CME) programs with real impact. Curriculum planners are questioning both the content of medical education and the methods of instruction and training. The product, or content, and the mechanism for its delivery have been defined and discussed, but a significant body of literature has shown that new knowledge does not necessarily lead to new behavior. Ample evidence exists in the CME literature to support the implementation of more active and self-directed learning strategies to promote the desired change in behaviors. The question, then, that is the focus of this article is how educational planning might be better guided by an understanding of how physicians learn within the continuing medical education domain. Revisiting the principles of David Kolb's Learning Styles Inventory, the authors propose applying his experiential learning model to overall curriculum design work. The authors argue that promoting the application of all learning styles in sequence in an educational encounter is a most desirable approach, and that this approach to learning could extend far beyond individual learners to influence how every component of medical education is designed, from the individual lecture or class activity to entire courses or programs.
TL;DR: Although students with higher debt levels were less likely than were their counterparts to pursue a career in primary care, the effect was modest and factors such as gender and race appeared to have more explanatory power.
Abstract: PurposeTo examine the hypothesis that medical students' rising total educational debt is one of the factors that explains the recent decline in students' interest in family medicine and primary care.MethodThe authors used results from questions on the Association of American Medical Colleges
TL;DR: There is limited empirical support for the current model of progressive independence in clinical learning; however, diverse theoretical perspectives raise concern about the potential educational consequences of eroding progressive independence.
Abstract: Background Progressive independence is a traditional premise of clinical training. Recently, issues such as managed care, work hours limitation, and patient safety have begun to impact the degree of autonomy afforded to clinical trainees. This article reviews empirical evidence and theory pertaining to the role of progressive autonomy in clinical learning. Method A computerized literature search was performed using Medline, PsycINFO, Social Sciences Citation Index, and Educational Resources Information Center. This article presents a synthetic review of relevant empirical and theoretical concepts from the domains of medicine, psychology, education, kinesiology, and sociology. Results The clinical psychology and medical education literatures provide evidence that clinical trainees act more independently as their training progresses, but have not yet evaluated the educational efficacy of providing progressive independence, or the consequences of failing to do so. The expertise and motor learning literatures provide some theoretical evidence (as yet untested in complex clinical environments) that the provision of too much guidance or feedback to trainees could be educationally detrimental in the long term. The sociology literature provides insight into the cultural values underlying the behavior of clinical teachers and trainees relating to issues of supervision and independence. Conclusions There is limited empirical support for the current model of progressive independence in clinical learning; however, diverse theoretical perspectives raise concern about the potential educational consequences of eroding progressive independence. These perspectives could inform future research programs that would create a creative and effective response to the social and economic forces impacting clinical education.
TL;DR: In this paper, the authors conducted a qualitative study to explore residents experience in trying to answer their clinical questions and found that residents face several EBM barriers, some of which are unique to their status as trainees.
Abstract: Purpose Physicians fail to pursue answers to most of their clinical questions, despite exhortations to practice evidence-based medicine (EBM). While studies have revealed several barriers practicing physicians experience in answering clinical questions, residents may encounter unique obstacles. The authors conducted a qualitative study to explore residents experience in trying to answer their clinical questions. Method In 2003, the authors studied a convenience sample of 34 residents, representing 54% of the residents in a universitybased internal medicine program. A professional facilitator convened and audiotaped three focus groups with the residents, following a discussion guide. The key question elicited the barriers residents encountered in attempting to answer their clinical questions. A thematic analysis of the transcripts was performed, using the constant comparison method of analysis. Two investigators met after independently analyzing each of the transcripts to compare coding structures, review theme exemplars, and reach consensus for differences. Results Eight main themes emerged that characterize the EBM barriers, including access to medical information, skills in searching information resources, clinical question tracking, time, clinical question priority, personal initiative, team dynamics, and institutional culture. The analysis suggested a conceptual model in which residents may encounter different barriers in every step of the EBM process. Furthermore, attitudinal or cultural barriers may lead a resident to abandon the pursuit of a question before some of the technical barriers would be encountered. Conclusion Residents face several EBM barriers, some of which are unique to their status as trainees. While increased informatics training and reliable, rapid, and point-ofcare access to electronic information resources remain necessary, they are not sufficient to help residents practice EBM. Educators must also attend to their attitudes toward learning and to the influence of programmatic and institutional cultures. Acad Med. 2005; 80:176–182.
TL;DR: There are few well-documented studies of instruments that can be used to measure professionalism in formative or summative evaluation, and when evaluating the tools described in published research it is essential for faculty to look critically for evidence related to the three fundamental measurement properties of content validity, reliability, and practicality.
Abstract: PurposeTo describe the measurement properties of instruments reported in the literature that faculty might use to measure professionalism in medical students and residents.MethodThe authors reviewed studies published between 1982 and 2002 that had been located using Medline and four other da
TL;DR: The authors describe the development of optimal mentoring relationships, emphasizing the importance of experience and flexibility in working with beginning to advanced students of different learning styles, genders, and races.
Abstract: Mentoring skills are valuable assets for academic medicine faculty, who help shape the professionalism of the next generation of physicians Mentors are role models who also act as guides for students' personal and professional development over time Mentors can be instrumental in conveying explicit academic knowledge required to master curriculum content Importantly, they can enhance implicit knowledge about the "hidden curriculum" of professionalism, ethics, values and the art of medicine not learned from texts In many cases, mentors also provide emotional support and encouragement The relationship benefits mentors as well, through greater productivity, career satisfaction, and personal gratification Maximizing the satisfaction and productivity of such relationships entails self-awareness, focus, mutual respect, and explicit communication about the relationship In this article, the authors describe the development of optimal mentoring relationships, emphasizing the importance of experience and flexibility in working with beginning to advanced students of different learning styles, genders, and races Concrete advice for mentor "do's and don'ts"is offered, with case examples illustrating key concepts
TL;DR: Lack of methodological rigor limits the evidence for the impact of cultural competence training on minority health care quality and more attention should be paid to the proper design, evaluation, and reporting of these training programs.
Abstract: Purpose To systematically examine the methodological rigor of studies using cultural competence training as a strategy to improve minority health care quality To the authors' knowledge, no prior studies of this type have been conducted Method As part of a systematic review, the authors appraised the methodological rigor of studies published in English from 1980 to 2003 that evaluate cultural competence training, and determined whether selected study characteristics were associated with better study quality as defined by five domains (representativeness, intervention description, bias and confounding, outcome assessment, and analytic approach) Results Among 64 eligible articles, most studies (no = 59) were published recently (1990-2003) in education (no = 26) and nursing (no = 14) journals Targeted learners were mostly nurses (no = 32) and physicians (no = 19) Study designs included randomized or concurrent controlled trials (no = 10), pretest/posttest (no = 22), posttest only (no = 27), and qualitative evaluation (no = 5) Curricular content, teaching strategies, and evaluation methods varied Most studies reported provider outcomes Twenty-one articles adequately described provider representativeness, 21 completely described curricular interventions, eight had adequate comparison groups, 27 used objective evaluations, three blinded outcome assessors, 14 reported the number or reason for noninclusion of data, and 15 reported magnitude differences and variability indexes Studies targeted at physicians more often described providers and interventions Most trials completely described targeted providers, had adequate comparison groups, and reported objective evaluations Study quality did not differ over time, by journal type, or by the presence or absence of reported funding Conclusions Lack of methodological rigor limits the evidence for the impact of cultural competence training on minority health care quality More attention should be paid to the proper design, evaluation, and reporting of these training programs
TL;DR: There has been a dramatic decrease in the number of internal medicine residents planning to pursue careers in general medicine, and this trend will likely continue for the next few years, at least, and may have an impact on the manner in which the health needs of patients are met in the future.
Abstract: Purpose Fewer medical students are pursuing residency training in primary care disciplines. This report describes the career plans of residents enrolled in internal medicine training programs and their reasons for pursuing either generalist or subspecialist career paths. Method From 1998 to 2003, questionnaires were administered to residents participating in the Internal Medicine In-Training Examination. Each year, the survey included questions on career choices. In 2002, residents completed a more detailed survey about the specific reasons for their career choices. The authors report their responses. Results There has been a steady decline in the percentage of internal medicine residents planning to pursue generalist careers. In 1998, 54% of PGY3s planned to practice general internal medicine compared with 27% in 2003. Strikingly, in 2003, only 19% of PGY1s planned to pursue careers in general medicine. Results Residents choosing careers as generalists were influenced by opportunities for long-term relationships with patients, a broad content area of practice, caring for ambulatory patients, and time with family. The specific reasons for choosing one subspecialty over another varied greatly among the subspecialty disciplines. Women residents preferred disciplines that allowed more time for family. Both genders were attracted to a particular subspecialty for similar reasons. Conclusions There has been a dramatic decrease in the number of internal medicine residents planning to pursue careers in general medicine. This trend will likely continue for the next few years, at least, and may have an impact on the manner in which the health needs of patients are met in the future.
TL;DR: A process and a list of core competencies for teaching emergency preparedness to students in the health care professions, developed in 2003 and 2004 by a team of experts from the four health professions schools of Columbia University in New York City are described.
Abstract: The recent increased threat of terrorism, coupled with the ever-present dangers posed by natural disasters and public health emergencies, clearly support the need to incorporate bioterrorism preparedness and emergency response material into the curricula of every health professions school in the nation. A main barrier to health care preparedness in this country is a lack of coordination across the spectrum of public health and health care communities and disciplines. Ensuring a unified and coordinated approach to preparedness requires that benchmarks and standards be consistent across health care disciplines and public health, with the most basic level being education of health professions students. Educational competencies establish the foundation that enables graduates to meet occupational competencies. However, educational needs for students differ from the needs of practitioners. In addition, there must be a clear connection between departments of public health and all other health care entities to ensure proper preparedness. The authors describe both a process and a list of core competencies for teaching emergency preparedness to students in the health care professions, developed in 2003 and 2004 by a team of experts from the four health professions schools of Columbia University in New York City. These competencies are directly applicable to medical, dental, nursing, and public health students. They can also easily be adapted to other health care disciplines, so long as differences in levels of proficiency and the need for clinical competency are taken into consideration.
TL;DR: For a variety of reasons, new radiological imaging techniques are supplanting traditional cadaver dissection in the teaching of human anatomy, and the best models for teaching gross anatomy will incorporate both cadavers dissection and radiological Imaging.
Abstract: For a variety of reasons, new radiological imaging techniques are supplanting traditional cadaver dissection in the teaching of human anatomy. The authors briefly review the historical forces behind this transition, and then explore the advantages and drawbacks of each approach. Cadaver diss
TL;DR: The authors discuss the need to teach the applied science of information management along with, or perhaps even instead of, teaching the basic science of evidence-based medicine.
Abstract: To encourage high-quality patient care guided by the best evidence, many medical schools and residencies are teaching techniques for critically evaluating the medical literature. While a large step forward, these skills of evidence-based medicine are necessary but not sufficient for the practice of contemporary medicine. Incorporating the best evidence into the real world of busy clinical practice requires the applied science of information management. Clinicians must learn the techniques and skills to focus on finding, evaluating, and using information at the point of care. This information must be both relevant to themselves and their patients as well as being valid. The authors discuss the need to teach the applied science of information management along with, or perhaps even instead of, teaching the basic science of evidence-based medicine. All students, residents, and practicing physicians need three skills to practice the best medicine: the ability to select foraging—“keeping up”—tools that filter information for relevance and validity, the skill to select and use a
TL;DR: Medical students experienced patient deaths as emotionally powerful even when they were not close to the patients and the amount of support from supervisors as extremely inadequate.
Abstract: Purpose To examine medical students' emotional reactions to their "most memorable" patient death and the support they receive. Method In 2000-01, 65 third-year medical students at two Northeastern U.S. medical schools were randomly selected to participate in 60-90-minute interviews of open-ended and structured questions and a written questionnaire (using a ten-point scale) about their "most memorable" patient death. Independent reviewers coded each interview to identify the analytical categories. Descriptive data were generated from the written questionnaire. Results A total of 32 interviews were used in the analysis. Twelve (38%) students were in contact with the patient for less than 24 hours and 23 (73%) were not at all or minimally close to the patient (0-3 on ten-point scale). Sixteen of 28 students (57%) rated the impact of the death as highly emotionally powerful (7-10 on ten-point scale). The finality of deaths, particularly sudden deaths, evoked strong emotions. Four of 16 (25%) students who found the death highly emotionally powerful rated the amount of support from supervisors as extremely inadequate (0-3 on ten-point scale). There was no discussion of the death in 17 (63%) of the 27 cases in which the patient was cared for by the student's team. Students perceived from supervising physicians that death and emotions are negative aspects of medicine. Conclusions Medical students experienced patient deaths as emotionally powerful even when they were not close to the patients. Debriefing sessions with students were rare, and many students felt inadequately supported. Thus, a unique opportunity to teach about death, emotions and coping with stress is often lost.
TL;DR: Third-year medical students’ experiences with dying patients affect their skills and attitudes in EOL care, as well as the emergence of their professional identities, in the first core internal medicine clerkship.
Abstract: Purpose To explore third-year medical students’ experiences with death and dying patients during the first internal medicine clerkship. Method In August 2002, through purposeful sampling, the authors targeted for open-ended interviews 32 third-year medical students at the University of California, San Francisco in the first core internal medicine clerkship. Interviews averaged 45 minutes in length and were audiotaped, transcribed, and analyzed using a grounded theory approach. Results Twenty-eight (87.5%) students participated in interviews. All students encountered death or dying patients, and most cared directly for at least one dying patient. Students’ relationships with patients were characterized by attachment, empathy, and advocacy. Students valued preparation by preclinical end-of-life (EOL) courses, but assigned greater value to patient care experiences guided by teams that acknowledged deaths, role-modeled EOL care, and respected students’ participation in patient care. Clerkship experiences in EOL care affected students’ developing professional identities by affording opportunities to manage strong emotions, understand the challenges of transitioning to residency, and gain a sense of self-efficacy as future physicians providing EOL care. Conclusions Third-year medical students’ experiences with dying patients affect their skills and attitudes in EOL care, as well as the emergence of their professional identities. The behaviors and attitudes modeled by residents and attendings during the clerkships can strongly influence students’ perceptions of and self-efficacy in EOL care. Further research and interventions into how residents and attendings model responses to death in the clinical clerkship may suggest strategies not only for EOL training, but also for mentoring professional development.