Multiple variables influence the educational value of surgical clerkship sites.

BACKGROUND: Students' satisfaction with the educational quality of a surgical clerkship is influenced by their experiences at assigned clinical sites. We sought to identify key variables perceived by students to be associated with educationally valued clerkship sites. METHODS: Between 1998 and 2002, third-year medical students completed a surgery site survey for each of the 2 sites on which they rotated during their required 2-month surgery rotation, representing a total of 16 sites. Students rated each site using a Likert scale on 8 educational variables as well as the overall educational value of the site. Students recorded the hours per week of direct instructional contact with attendings and, in the 2001/2002 academic year, provided narrative comments regarding site-specific strengths and weaknesses. The relationship between site variables and overall educational value across all sites was examined by stepwise multiple regression analysis. Content analysis of narrative responses was performed to surface major strengths and weaknesses associated with site-specific educational value. RESULTS: From 1,377 completed surveys, representing an 87% completion rate, a statistically significant relationship was identified between sites' overall educational value and 6 variables. The most significant variables were as follows: "direct instructional contact with attendings in the operating room" and "quality of house staff teaching" (accounted for 33% and 13% of the total variance in educational value, respectively). Content analysis from 359 narrative responses, representing a 92% response rate, revealed 5 major categories, with operating room experience receiving the most "strength" comments (28.8%). CONCLUSIONS: Specific variables influencing the perceived educational quality of clerkship sites can be identified. The single largest influence emerging independently from both the quantitative and qualitative analyses was the students' experiences in the operating room. Emphasis on the educational experience in the operating room should be a priority when seeking to improve the educational value of clerkship sites.

Outcomes results from the evaluation of the APA/HRSA Faculty Scholars Program.

BACKGROUND: The goal of the Ambulatory Pediatric Association/Health Resources and Services Administration National Faculty Development Scholars Program was to improve primary care education in the pediatric setting. The program evaluation focused on four stake-holder objectives: 1) increase the educational skills of community and generalist faculty; 2) create pediatric leadership focused on changing the culture within the medical community to support primary care education; 3) develop an infrastructure that supports sustained faculty development efforts at the local, regional, and national level; and 4) include content areas consistent with Health Resources and Services Administration contract requirements. METHODS: A multimethod evaluation plan, focused on the 107 completing scholars, was implemented utilizing six evaluation instruments. RESULTS: Key outcomes from both quantitative and qualitative outcome measures reveal that all evaluation objectives were achieved. Scholars presented 438 local workshops and 161 regional/national workshops focused on pediatric education with a combined attendance of 7939 participants. More than half of the scholars have now assumed a leadership position in education associated with program participation. Ninety-three percent of the scholars reported organizational/infrastructure changes associated with their program participation ranging from increased numbers of community teaching sites to specific resource allocations to support of faculty development. CONCLUSIONS: The outcomes of this evaluation reveal that the faculty development program achieved its objectives, with participants leading workshops, impacting faculty development infrastructure, advancing their own careers, and being strategically positioned in leadership roles with the skills to improve primary care education in the ambulatory setting.

Primary care residents self assessment skills in dementia.

The ability to accurately self-assess is a critical component of professionalism and is included in the newly required Accreditation Council of Graduate Medical Education (ACGME) core competencies. To assess residents' ability to accurately self-assess their competencies related to a commonly presenting problem in geriatrics, a Standardized Patient, portraying an individual with early signs of dementia, was inserted into family medicine residents' clinic schedules. Immediately post the encounter, each resident self-assessed his/her performance using a four category (Communication, History of Present Illness, Social History, Functional Assessment), 17-item behavioral checklist. The items in each category highlighted items specific to a dementia-screening interview (e.g., HPI: Used a standardized exam which includes orientation, memory, recall and registration). Resident ratings were compared to ratings from two faculty assessors who independently viewed the videotape of each resident's SP interview. While statistically significant differences between the self-assessment and expert assessors appeared in only one of the four major checklist categories (functional assessment), item specific analysis revealed significant differences on discrete items within the dementia screening interview. Implications for teaching and assessment consistent with the ACGME required competency assessment category of professionalism are discussed.

Simple feedback notes enhance specificity of feedback to learners.

BACKGROUND: Learners reported that physician educators give insufficient and general feedback. OBJECTIVE: This study analyzed faculty's use of 3 x 5-inch feedback notes (preprinted with "well done" or "needs improvement") for quantity and specificity of feedback. Learners evaluated these notes compared with other feedback methods. DESIGN/METHODS: Seven experienced clinician educators presented the feedback notes to learners during the 10-month trial. A carbonless duplicate was retained for qualitative analysis of content. The specificity of comments was categorized as general (no clarifiers) or detailed if it contained 1 or more clarifiers. Additionally, the learners were surveyed regarding utility of notes on the basis of characteristics of effective feedback. RESULTS: A total of 770 notes containing 1607 individual comments were presented to learners, with significantly more (P <.001) "well done" comments (69%) than "needs improvement" comments (31%). Eleven content areas emerged. The most frequently coded "well done" content areas were assessment (n = 258), treatment (n = 208), and physical examination (n = 176). The most frequently coded "needs improvement" content areas were documentation (n = 161) and expanding knowledge (n = 102). Eighty-two percent of the comments were specific, and the specificity increased significantly from 24% in the initial 4-month time frame to 46% in the last 3 months (P <.001, Pearson chi-square test). Learners agreed that feedback notes provided more constructive (94%), timely (92%), and concrete (94%) feedback when compared with other feedback methods. Learners preferred feedback given face-to-face (96%) or by written notes (96%) rather than by e-mail (30%). CONCLUSIONS: Cued feedback notes provided learners with detailed feedback in a format that learners prefer. Over time, simple feedback notes lead to more specific feedback for trainees.

A pathway to advancing end-of-life education.

OBJECTIVE: This paper identifies key features associated with high-quality educational materials for end-of-life curriculum. METHODS: The End of Life Physician Education Resource Center (EPERC), located on the Internet at provides a clearinghouse for end-of-life materials. All materials posted on EPERC are peer reviewed by content and education experts for quality. An analysis of reviewers' ratings, from the EPERC rating form and their narrative comments, revealed common strengths and weaknesses of submitted materials. Examples of exemplar materials from the EPERC website are presented to highlight key strengths. DISCUSSION: Articulating the best qualities of submitted materials provides clear standards for those seeking to develop or adopt high quality end-of-life educational materials.