Evaluating immediate and long-range effect of a geriatric clerkship using reflections and ratings from participants as students and as residents.

This article describes a longitudinal study developed to assess perceived usefulness of a mandatory geriatric clerkship from the perspective of junior students completing the newly initiated program in 1998-1999 and 1999-2000 and these same students as second- or third-year residents. End-of-clerkship student evaluations were compared with follow-up resident surveys of those same students to identify the utility of information provided and strengths and weaknesses of the initial course experience. Students participated in hospice, outpatient clinics, nursing homes, and transitional care venues during their clerkship experience at the Donald W. Reynolds Department of Geriatrics, College of Medicine, University of Arkansas for Medical Sciences. Two hundred eighty-five student evaluations were collected, and 143 resident surveys were returned. Quantitative and qualitative data from students and residents corroborated each other in identifying strengths and weaknesses of the clerkship. Hospice information was successfully incorporated into residency practice. In contrast, outpatient clinic, nursing home, and transitional care segments of the clerkship were perceived as inadequate. Survey responses validated faculty changes that were initiated in the following years. These changes use settings and patients that more accurately mirror those seen in typical resident encounters.

The use of standardized patients to teach and test interpersonal and communication skills with students in speech-language pathology.

The purpose of this study was to investigate the use of standardized patients (SPs) with aphasia to teach interpersonal and communication skills to new graduate student-clinicians in Speech-Language Pathology, and to test those skills via serial Objective Structured Clinical Examinations (OSCEs). This study had three phases: (1) clinical teaching using SPs, (2) mid-term evaluation via a single case OSCE, and (3) end-of-term evaluation via a multi-case OSCE. These phases were integrated with classroom teaching and testing components over a 16-week academic semester. Eighteen students participated while concurrently enrolled in a course on diagnosis and management of aphasia taught by the first author. One half of the class received initial instruction via a combination of didactic lecture and standardized patient interaction, while the other half of the class was taught initially via didactic lecture only. On OSCE I, there was no statistically significant difference between the two groups in their interpersonal and communication skills, with the class as a whole demonstrating less than acceptable competency. After targeting these skills in all students via additional class lectures, there was a statistically and clinically significant improvement in their competency in this area on OSCE II. Student feedback was positive.

Use of computer-assisted learning module to achieve ACGME competencies in orthopaedic foot and ankle surgery.

The Accreditation Council for Graduate Medical Education (ACGME) has charged academic institutions with finding methods to assess learning in specific areas of resident education. Computer-assisted education offers a reliable mode for teaching residents important information and skills. The CD-ROM "Fundamentals of Orthopaedic Foot Care," produced by the American Academy of Orthopaedic Surgeons, was tested as a tool to provide nonoperative foot and ankle care education for a group of orthopaedic residents (N = 14) and a group of family practice residents (N = 11). The CD-ROM's educational format includes an interactive tutorial on anatomy, video demonstrations on selected topics in physical examination and basic treatment of nonoperative problems of the foot and ankle, and patient education information sheets on multiple common foot disorders. Both resident groups scored significantly higher on their post-test exams after spending 1 hour with the computer program (p < or = .05). This study suggests that this program can be used reliably in an orthopaedic residency program to achieve ACGME required competency of "medical knowledge" in evaluation and nonoperative management of common foot and ankle problems.

Assessing the needs of residency program directors to meet the ACGME general competencies.

OBJECTIVE: New accreditation requirements for residency training programs require residents to have educational experiences that allow them to demonstrate competency in the following areas: (1) patient care, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism, and (6) systems-based practice. Residents' competence must be assessed with dependable measures. Residency training program directors (PDs) need assistance in complying with these new requirements. DESCRIPTION: Using a survey modified from Michigan State University, we asked PDs to rate their current understanding of and preparation for the general competencies and to provide written comments. PDs of the 47 ACGME-accredited programs received e-mailed instructions to complete the Web-based survey. Twenty-four PDs (51%) complied by the deadline. The mean ratings were calculated from a five-point scale (1 = strongly disagree, major impediment or least useful, 5 = strongly agree, not an impediment, or most useful). PDs felt they were informed (3.45) and understood (3.67) the requirements, but they were not well prepared to meet them (2.95). The perceived impediments to implementation included amount of PD time (2.27), amount of residents' protected time for the curriculum (2.30), amount of residency support staff (2.73), lack of expertise in curriculum development (2.73) and evaluation (2.41), and lack of funding for resources other than personnel (2.91). PDs rated types of assistance that would be helpful: developing workshops or presentations on curriculum development and evaluation techniques (3.82), developing curricula (4.14), providing one-on-one consultation (4.23), receiving examples of materials, methods, and ideas from other programs (4.41), and describing evaluation methods/instruments (4.50). Written comments stated that time to concentrate on the topic, release time from clinical responsibilities, and technical computer support would be helpful. Of the six competency areas, PDs were most interested in receiving assistance in developing curricular materials for the competencies of systems-based practice (4.50), professionalism (4.36), and practice-based learning and improvement (4.27). PDs were most interested in receiving assistance in developing evaluations for practice-based learning and improvement (4.59), professionalism (4.59), interpersonal and communication skills (4.45), and systems-based practice (4.36). PDs responded that they currently use written faculty evaluations to assess all six general competency areas. DISCUSSION: Results of the survey indicate that PDs require assistance to comply with the new ACGME requirements. Curricular materials and valid and reliable evaluation methods need to be developed. In order to assist PDs, the following activities are under way: (1) PDs are members of a listserve for sharing ideas and examples of curricular and evaluation materials; (2) PDs attend a monthly seminar series that provides practical information for curricular material development and specific evaluation methods, including indications for use and feasibility; (3) educators from our Office of Educational Development provide individual consultations with each PD; (4) PDs participate in an eight hour workshop with practical sessions for developing curricular materials and evaluations; and (5) two institution-wide assessments are being developed: a patient-satisfaction survey and a 360-degree evaluation to assess communication skills and professionalism.

Implementing a mandatory geriatrics clerkship.

Due to the rapid growth in the proportion of U.S. citizens aged 65 and older (20% by 2030) it is imperative that U.S. medical schools train students who can provide quality care to the older population. Consequently, the objective of this paper is to report the experience of creating a 4-week, mandatory geriatrics clerkship for junior medical students. Funded by a grant from the Donald W. Reynolds Foundation, the University of Arkansas for Medical Sciences developed a mandatory, third-year clerkship in geriatric medicine. The clerkship included clinical experiences in outpatient clinics, transitional care units, nursing homes, hospice programs, and core didactic sessions. The sites for the clerkship were the University of Arkansas for Medical Sciences Hospital, the Central Arkansas Veterans Healthcare System Hospital, community nursing homes, and community hospice programs in Little Rock, Arkansas. The entire junior class of 135 students participated in the new clerkship. Students were assessed through a three-station Objective Structured Clinical Examination followed by a brief post- encounter examination and faculty preceptor evaluations collected from each clinical site. Students evaluated the clerkship through written evaluations and focus group discussions. This paper demonstrates that students acquired sufficient cognitive knowledge to satisfactorily complete the clerkship but did not highly value the experience.