Medical Student Interpretation of Visual Art: Who's Got Empathy?

This article was migrated. The article was marked as recommended. Introduction: Physician empathy is a highly desired characteristic in clinical practice with benefits for both patients and doctors. Increasingly, medical educators have acknowledged the importance of empathy and sought effective ways of inculcating and strengthening this quality in medical students. However, empathy remains difficult to measure because of differing definitions and theoretical dimensions. Our goal was to develop a de novo visual Art scale, devised to evaluate empathetic response in medical students as well as a de novo Biosocial scale to measure medical student socioeconomic and experiential stress during childhood and adolescence; and to compare these exploratory measures to the reliable and well-validated Jefferson Scale of Empathy JSE). Methods: We constructed a survey incorporating a visual Art empathy measure, a Biosocial scale, and the JSE, which we sent to approximately 200 allopathic preclinical medical students at our home institution. We received 71 complete responses. Results: Cronbach's alpha testing found that the items in both new scales had adequate reliability. Multivariate regression analysis found a significant, positive association between both the visual art and biosocial scores and the JSE. Discussion: These results support the idea that response to visual stimuli, as well as life stressors, may be factors in medical students' capacity to formulate an empathetic response to patients.

The Changing Landscape of Surgical Education: What are Residency Education Teams and do we Need Them?

OBJECTIVES: This study aims to understand how general surgery training programs constitute their residency education team (RET), how they define the roles of RET members, and how they measure success of the team. It fundamentally asks the question, "What is a RET and do we need one?" DESIGN AND PARTICIPANTS: Program directors, associate program directors, educators, program coordinators, and chief residents from Accreditation Council for Graduate Medical Education (ACGME) general surgery training programs were asked to anonymously complete a survey categorized into 3 sections: (1) roles and responsibilities, (2) views of his/her RET and team members, and (3) general views about RETs. All respondents provided their opinions on the importance of a RET for administering and leading a surgical residency, whom the ideal members would be, and the main outcomes of a high-functioning RET. RESULTS: Respondents (n = 167) included 59 (35.3%) program directors, 16 (9.6%) associate program directors, 8 (4.8%) educators, 67 (40.1%) program coordinators, and 6 (3.6%) chief residents. Overall, 84.4% of respondents were a part of a RET, defined as 2 or more individuals who are responsible and accountable for oversight and conduct of the residency training program. RET respondents expressed statistically significantly and higher importance for a RET (p < 0.0001) than their non-RET counterparts. CONCLUSIONS: This study provides a snapshot of how some associated with general surgery residencies view and value RETs. The results of this survey are preliminary and suggest a need for educators within surgery programs and ambiguity about the role of associate program director. It also suggests that a closer look at role responsibilities may be of value, especially in view of the changing landscape of surgical education. Overall, most respondents felt that a RET was important to the main outcomes of a successful residency program.

National survey of bedside ultrasound use in pediatric critical care.

OBJECTIVES: The use of bedside ultrasound in critically ill adults has become standard practice. The current state of bedside ultrasound use in pediatric critical illness is unknown. The purpose of this study was to describe the use of bedside ultrasound in critically ill children with an emphasis on its use for establishing central vascular access. We also sought to describe current methods of training for bedside ultrasound use in pediatric critical care. DESIGN: We conducted a cross-sectional survey on the use of bedside ultrasound in pediatric intensive care units in the United States. MEASUREMENTS AND MAIN RESULTS: Pediatric critical care medical directors or their representatives from 128 of 230 eligible hospitals responded (56% response rate). The use of bedside ultrasound for vascular access was statistically more likely in units with >12 beds, >1,000 yearly admissions, and those with an active fellowship or pediatric cardiothoracic surgery program. Ultrasound was used at least once for vascular access in 82% (105 of 128) of responders, with 86% (90 of 105) using it on a regular basis. When using bedside ultrasound for vascular access, the preferred site is the internal jugular vein. A significant portion of responders use bedside ultrasound for nonvascular procedures such as assessing pleural or pericardial effusions. Despite the widespread use of bedside ultrasound, formal training is rare, occurring in only 20% (18 of 90) of current institutions that utilize bedside ultrasound. CONCLUSIONS: This national survey of the use of bedside ultrasound in pediatric critical care reveals widespread use of the technology. When using bedside ultrasound for vascular access, the preferred site is the internal jugular vein. Despite widespread use of bedside ultrasound, formal training that occurs routinely in other subspecialties is lacking. This survey provides meaningful demographic data that can be useful in planning future prospective studies and implementing formal training in bedside ultrasound for pediatric critical care fellows.

Immediate impact of participation in the electronic residency application service on a fellowship program.

OBJECTIVE: This study sought to evaluate the immediate impact of participation in the Electronic Residency Application Service (ERAS) on a single cardiology fellowship program. METHOD: The study reviewed all applications (n = 1824) made to the Geisinger Medical Center cardiology fellowship program over a 4-year period (2004-2007). The aggregate data for the first 2 years (pre-ERAS, 2004 and 2005) was compared to that of the last 2 years (post-ERAS, 2006 and 2007). RESULTS: Compared to the pre-ERAS period, the total number of applications in the post-ERAS period increased by 49% (732 versus 1092; p<.05) and the number of complete applications increased by 70% (577 versus 983; p<.05). Other significant differences (p<.05) included a higher percentage of applications from female candidates (81 of 732 [11%] versus 186 of 1092 [17%]), and a greater geographic distance from applicants' internal medicine residency institutions (420 ± 454 miles versus 585 ± 559 miles]. Comparison of applicants' age, citizenship status, graduation origin, years since medical school graduation, and United States Medical Licensing Examination scores yielded no significant differences between pre-ERAS and post-ERAS periods. CONCLUSION: Participation in ERAS resulted in an immediate increase in the total number of applications, higher proportion of applications with complete data, a higher number and proportion of female applicants, and a wider geographic distribution of applications. This likely reflects ease of application submission through a central electronic service. However, the administrative burden on fellowship programs and the effects of wider geographic distribution of applications on the fellowship-matching process merit further evaluation.

Relationship of creative projects in anatomy to medical student professionalism, test performance and stress: an exploratory study.

BACKGROUND: The anatomy course offers important opportunities to develop professionalism at an early stage in medical education. It is an academically significant course that also engenders stress in some students. METHODS: Over a three-year period, 115 of 297 students completed creative projects. Thirty-four project completers and 47 non-completers consented to participate in the study. Projects were analyzed for professionalism themes using grounded theory. A subset of project completers and non-completers were interviewed to determine their views about the stress of anatomy and medical school, as well as the value of the creative projects. We also compared test performance of project completers and non-completers. RESULTS: Projects completed early in the course often expressed ambivalence about anatomy, whereas later projects showed more gratitude and sense of awe. Project completers tended to report greater stress than noncompleters, but stated that doing projects reduced stress and caused them to develop a richer appreciation for anatomy and medicine. Project completers performed significantly lower than non-completers on the first written exam (pre-project). Differences between groups on individual exams after both the first and second creative project were nonsignificant. CONCLUSION: For some students, creative projects may offer a useful way of reflecting on various aspects of professionalism while helping them to manage stress.

A prospective study of the longitudinal effects of an embedded specialty curriculum on physical examination skills using an ophthalmology model.

PURPOSE: To prospectively evaluate effects of a longitudinal specialty curriculum on acquisition and retention of ophthalmic screening examination skills in a single class across three years of medical school (2004-2007). METHOD: Immediately after initial Year 2 skills training, preceptors evaluated students' (N=84) acquisition of basic eye screening examination skills. Similarly, the students self-assessed their skills. In Year 3, a required ophthalmology small-group module during the family medicine (FM) clerkship reinforced these skills. The authors audited history and physicals in two Year 3 clerkships and in one Year 4 subinternship to evaluate charted examination performance. They objectively assessed simulator-based ophthalmoscopy post-FM clerkship and post-Year 3 training. RESULTS: Preceptors rated 100% of students competent in all eye examination modalities post initial training; 98% of students self-rated themselves competent in disc visualization. An expert auditor found documented FM funduscopies (46%) surpassed those in a prior observational study (11%). Funduscopic retraining significantly improved performance on post-Year 3 objective assessment (mean score 55% retrained versus 19% nonretrained, P=.0005). However, 43% of FM and 91% of internal medicine workups reflected inadequate overall eye evaluations. Subinternship notes documented muscle excursions in 95% and pupils in 71% but recorded no funduscopies. CONCLUSIONS: Additional training successfully reinforced skills performance, which nonetheless decayed when not habitually practiced. Neither physical diagnosis preceptor ratings nor excellent performance in the FM ophthalmology module predicted subsequent skills performance in other clerkships or on simulator testing. The present study supports a reiterative retraining model for teaching this and other specialty physical examination skills.

Interpreting values conflicts experienced by obstetrics-gynecology clerkship students using reflective writing.

PURPOSE: To examine students' responses to reflective practice assignments used in medical ethics and professionalism education. The study goals include an examination of what reflective writing reveals about students' personal and professional values, identification of the narrative typologies students use to tell stories of ethical dilemmas, and a determination of the usefulness of reflective writing in informing ethics/professionalism curricula assessment and development. METHOD: This study employed a mixed-methods design generating both descriptive data and interpretive analysis. Students' reflective writing assignments, guided by a series of six questions designed to elicit students' perceptions of moral conflicts they have encountered and their personal and professional ethical values, were collected from three successive cohorts of third-year medical students (n = 299) from July 2002 to January 2006 during an obstetrics-gynecology clerkship at the University of California, Irvine, School of Medicine. Content, thematic, and global narrative analyses of students' reflective writing were conducted, drawing on content analysis, grounded theory, and narrative methodologies. RESULTS: Values conflicts usually were patient centered (181; 60.5%) and student centered (172; 57.5%), without much regard for important contextual issues such as patients' socioeconomic status, insurance coverage, or culture. Common personal values included religious beliefs (82; 27.4%), respect (72; 24.1%), and the Golden Rule (66; 22.1%); frequent professional values were respect (72; 25.1%), beneficence (71; 23.7%), nonmaleficence (69; 23.1%), and autonomy (65; 21.7%). Whereas 35.5% (106) claimed to have addressed conflicts, 23.4% (70) said they did nothing. Restitution narratives (113; 37.8%) dominated. CONCLUSIONS: This analytic approach facilitated assessment of student values, conflict sources, and narrative types. Findings reveal aspects of the influence of the hidden curriculum and can inform strategies for effective implementation of bioethics/professionalism curricula.

Assessing medical students' skills in working with interpreters during patient encounters: a validation study of the Interpreter Scale.

PURPOSE: Interpreted patient encounters require distinct communication skills. The absence of available reliable, valid, and practical measures hinders the assessment of these skills; therefore, the authors aimed to construct and validate the Interpreter Scale (IS). METHOD: The authors constructed the IS based on expert consensus and prior studies. They administered the IS to two classes (n = 182) in an interpreted standardized patient (SP) case setting. Standardized interpreters in the examination room assessed, using the IS, students' communication skills. Concurrently, SPs, using the validated Patient-Physician Interaction scale (PPI) and the Interpreter Impact Rating Scale (IIRS), also assessed students' skills. Trained observers watched DVDs and used the Faculty Observer Rating Scale (FORS) to assess student performance. A prior study documented the qualities of the IIRS and FORS. The authors determined the internal consistency reliability and examined construct validity of IS scores through factor analysis and concordance with other measures' scores. RESULTS: IS reliability analysis yielded Cronbach alpha = 0.77. Factor analysis demonstrated two IS dimensions. Nine items, "managing the encounter," and four items, "setting the stage," explained 76% and 15% of score variance, respectively. IS and FORS scores significantly correlated (r = 0.385; P < .0001). IS factor 1 scores significantly correlated (all P < .0001) with FORS (r = 0.402), IIRS (r = 0.277), and PPI (r = 0.332) scores. CONCLUSIONS: The IS has reasonable internal consistency reliability and construct validity to warrant use for formatively measuring student communication skills in interpreted SP encounters, and it needs testing in actual patient encounters.

Attributes of effective community preceptors for pre-clerkship medical students.

BACKGROUND: Attributes of effective precepting of pre-clerkship medical students in community settings are not adequately described. As part of preceptor needs assessment, we conducted site visits over three consecutive years. We also measured the preceptorships' educational quality, using students' post-rotation data, to identify priority areas for faculty development, corroborate site visit findings, and assess functions of the site visit. METHODS: Three university faculty directly observed teaching encounters in 83 community preceptors' offices during a 12-18-week second year (pre-clerkship) medical student rotation. Data were collected on practice demographics, teaching content, and educational quality, using multiple measures. Narrative responses to interview questions were coded for prevalent themes. Student post-rotation assessments were obtained by anonymous online evaluations. RESULTS: Good precepting attributes and suggestions for improvement were identified from both narrative analysis and student post-rotation evaluations in these key areas: independence in patient assessment, time spent teaching, giving feedback and orientation to the preceptor's practice. Student evaluations of preceptors' effectiveness significantly improved from year 1 to 2 and persisted into year 3. Appropriate faculty development strategies were derived from the combined results. CONCLUSIONS: The site visit by university faculty allows real-time observation and may itself be an effective intervention for improving teaching and learning.

Using virtual patients to improve cardiac examination competency in medical students.

BACKGROUND: Cardiac examination (CE) skills are in decline. Most prior studies employed audio recordings, evaluating only one aspect of CE (i.e., auscultation) that precluded correlation with visible observations. To address these deficiencies, we developed a curriculum using virtual patient examinations (VPEs); bedside recordings of patients with visible and audible cardiovascular findings presented as interactive multimedia. HYPOTHESIS: The purpose of this study was to evaluate whether VPEs improve CE skills, and whether any improvements are retained. We assessed CE competency overall and in 4 categories: inspection, auscultation, knowledge, and integration of audio and visual skills. METHODS: Students (n = 24) undergoing the 8-wk Internal Medicine (IM) clerkship rotation and receiving supervised instruction with VPEs (intervention group) were compared with students (n = 58) undergoing IM clerkship rotation without supplemental CE instruction (control group). The groups were tested at the beginning and the end of their rotations. RESULTS: The Intervention group improved significantly in overall mean scores: from 58.7 to 73.5 (p = 0.0001). The Control group did not improve: from 60.1 to 59.5 (p = 0.788). The Intervention group improved inspection, auscultation, and knowledge (all p

Innovative web-based multimedia curriculum improves cardiac examination competency of residents.

BACKGROUND: Proper diagnosis of cardiac disorders is a core competency of internists. Yet numerous studies have documented that the cardiac examination (CE) skills of physicians have declined compared with those of previous generations of physicians, attributed variously to inadequate exposure to cardiac patients and lack of skilled bedside teaching. With growing concerns about ensuring patient safety and quality of care, public and professional organizations are calling for a renewed emphasis on the teaching and evaluation of clinical skills in residency training. OBJECTIVE: The objective of the study was to determine whether Web training improves CE competency, whether residents retain what they learn, and whether a Web-based curriculum plus clinical training is better than clinical training alone. Journal of Hospital Medicine 2008;3:124-133. (c) 2008 Society of Hospital Medicine. DESIGN: This was a controlled intervention study. PARTICIPANTS: The intervention group (34 internal and family medicine interns) participated in self-directed use of a Web-based tutorial and three 1-hour teaching sessions taught by a hospitalist. Twenty-five interns from the prior year served as controls. MEASUREMENTS: We assessed overall CE competency and 4 subcategories of CE competency: knowledge, audio skills, visual skills, and audio-visual integration. RESULTS: The over mean score of the intervention group significantly improved, from 54 to 66 (P = .002). This improvement was retained (63.5, P = .05). When compared with end-of-year controls, the intervention group had significantly higher end-of-year CE scores (57 vs. 63.5, P = .05), knowledge (P = .04), and audio skills (P = .01). At the end of the academic year, all improvements were retained (P

Immediate impact of an intensive one-week laparoscopy training program on laparoscopic skills among postgraduate urologists.

INTRODUCTION: Laparoscopic techniques are difficult to master, especially for surgeons who did not receive such training during residency. To help urologists master challenging laparoscopic skills, a unique 5-day mini-residency (M-R) program was established at the University of California, Irvine. The first 101 participants in this program were evaluated on their laparoscopic skills acquisition at the end of the 5-day experience. METHODS: Two urologists are accepted per week into 1 of 4 training modules: (1) ureteroscopy/percutaneous renal access; (2) laparoscopic ablative renal surgery; (3) laparoscopic reconstructive renal surgery; and (4) robot-assisted prostatectomy. The program consists of didactic lectures, pelvic trainer and virtual reality simulator practice, animal and cadaver laboratory sessions, and observation or participation in human surgeries. Skills testing (ST) simulating open, laparoscopic, and robotic surgery is assessed in all of the M-R participants on training days 1 and 5. Tests include ring transfer, suture threading, cutting, and suturing. Performance is evaluated by an experienced observer using the Objective Structured Assessment of Technical Skill (OSATS) scoring system. Statistical methods used include the paired sample t test and analysis of variance at a confidence level of P

Revising the Tool for Assessing Cultural Competence Training (TACCT) for curriculum evaluation: Findings derived from seven US schools and expert consensus.

BACKGROUND: The 67-item TACCT currently used for needs assessment has potential for evaluating evolving cultural competence (CC) curricula. PURPOSE: To validate a shortened, more practical TACCT measure. METHODS: The 67-item TACCT was administered to students and course directors at 7 US schools. Course directors and students reported which of 67 TACCT items were taught. Intraclass correlation coefficients (ICC) examined faculty-student agreement. Under-addressed content was identified. A new and shortened TACCT configuration was proposed and validated with expert educator input. RESULTS: Across-school faculty and student response rates ranged from 75% to 100%. Aggregate ICC was 0.90 (95% CI: 0.84, 0.94) for the 67-item TACCT demonstrating faculty-student agreement. Experts agreed on reduction from 67 to 42 items and domain revision from five to six domains to match under-addressed content. Item analysis showed high internal consistency for all 6 new domains and the total revised 42-item TACCT. CONCLUSIONS: A shorter, more practical TACCT measure is valid and reliable and focuses on under-addressed CC content. Use for curricular evaluation is suggested.

Validating measures of third year medical students' use of interpreters by standardized patients and faculty observers.

BACKGROUND: Increasing prevalence of limited English proficiency patient encounters demands effective use of interpreters. Validated measures for this skill are needed. OBJECTIVE: We describe the process of creating and validating two new measures for rating student skills for interpreter use. SETTING: Encounters using standardized patients (SPs) and interpreters within a clinical practice examination (CPX) at one medical school. MEASUREMENTS: Students were assessed by SPs using the interpreter impact rating scale (IIRS) and the physician patient interaction (PPI) scale. A subset of 23 encounters was assessed by 4 faculty raters using the faculty observer rating scale (FORS). Internal consistency reliability was assessed by Cronbach's coefficient alpha (alpha). Interrater reliability of the FORS was examined by the intraclass correlation coefficient (ICC). The FORS and IIRS were compared and each was correlated with the PPI. RESULTS: Cronbach's alpha was 0.90 for the 7-item IIRS and 0.88 for the 11-item FORS. ICC among 4 faculty observers had a mean of 0.61 and median of 0.65 (0.20, 0.86). Skill measured by the IIRS did not significantly correlate with FORS but correlated with the PPI. CONCLUSIONS: We developed two measures with good internal reliability for use by SPs and faculty observers. More research is needed to clarify the reasons for the lack of concordance between these measures and which may be more valid for use as a summative assessment measure.

Reduced annexin II protein expression in high-grade prostatic intraepithelial neoplasia and prostate cancer.

CONTEXT: Annexin II is a calcium-dependent phospholipid-binding protein that plays a role in many cellular functions, including apoptosis, signal transduction, and cellular motility. The protein is strongly expressed in normal prostatic epithelial glands, but its expression in benign prostatic lesions has not been reported. Although commonly underexpressed in prostate cancer, the association of reduced expression with pathologic grade and stage is unknown. OBJECTIVE: To compare annexin II expression in benign prostatic lesions with expression in high-grade prostatic intraepithelial neoplasia and prostate cancer, as well as to correlate expression levels with pathologic grade and stage. DESIGN: A semi-quantitative assessment of annexin II expression was performed in radical prostatectomy specimens from 74 patients and prostate needle core biopsy specimens from 13 patients. Foci with normal prostatic glands, atrophic glands, basal cell hyperplasia, high-grade prostatic intraepithelial neoplasia, and prostatic adenocarcinoma were evaluated. RESULTS: Annexin II expression was present in more than 50% of glands in most (>85%) samples of benign prostatic epithelium, atrophic glands, and basal cell hyperplasia. In high-grade prostatic intraepithelial neoplasia, annexin II staining was markedly reduced in epithelial cells but not in basal cells. Annexin II was absent or focally present in moderately differentiated adenocarcinoma but was retained in poorly differentiated adenocarcinomas. CONCLUSIONS: Reduced annexin II expression may be a useful diagnostic biomarker to help identify small foci of moderately differentiated adenocarcinoma on needle core biopsy specimens since it is consistently expressed in benign prostatic glands. Re-expression of annexin II in poorly differentiated adenocarcinoma may provide prognostic information.

Faculty training in evidence-based medicine: improving evidence acquisition and critical appraisal.

INTRODUCTION: Evidence-based medicine (EBM) integrates published clinical evidence with patient values and clinical expertise, the output of which is informed medical decision making. Key skills for evidence-based practice include acquisition and appraisal of clinical information. Faculty clinicians often lack expertise in these skills and are therefore unable to demonstrate this process for students and residents. METHODS: We conducted a yearlong case-based EBM workshop for 28 clinician educators, with precourse and postcourse evaluations of EBM resource use and literature appraisal skills. RESULTS: Of the original 28 participants, 26 completed the course. Self-assessed EBM resource use improved significantly. Self-reported EBM knowledge correlated with measured skill (r = 0.45), and both improved with the intervention (both p < .001). Higher EBM skills scores correlated with time logged on the course's EBM Web sites (r = 0.56; p < .05), workshop attendance rates (r = 0.55; p = .003), and fewer years since medical school graduation (r = -0.56; p < .005). DISCUSSION: An interactive, longitudinal, EBM course derived from a needs assessment can improve 2 skills important for evidence-based practice: online literature retrieval and critical appraisal skills.

A study of the physician workforce supply for the latino population in California.

PURPOSE: To determine the physician supply during two decades to the workforce available to California Latinos from two separate training tracks at the University of California, Irvine School of Medicine (UCI)--the Fifth Pathway Program (FPP) and the traditional medical school curriculum. METHOD: In 2002, the authors compared two groups of physicians practicing in California to ascertain the percentage of Latino patients in their practices. One group had completed the FPP (n = 229) during the period 1971-1991, and UCI graduates from the same period composed the second group (n = 960). The authors also examined Latino population statistics for California communities where physicians located their practices. RESULTS: Both groups practiced in California (71.5%) and in primary care (59.9%) at the same rates. Women were underrepresented among FPP physicians (12.2% versus 33.3%). FPP physicians self-reported seeing significantly more Latino patients (14.3% versus 9.2%; P < .001). However, the groups did not significantly differ in the rates at which they practiced in communities with 40% or more Latino residents (18.1% versus 12.9%). CONCLUSIONS: Reactivating the FPP may increase the raw number of physicians in California, but two decades of this program did not recruit physicians to practice in California's Latino community at a rate much above that for traditional medical school graduates, especially for communities having the highest Latino population densities.

Comparative survey of Complementary and Alternative Medicine (CAM) attitudes, use, and information-seeking behaviour among medical students, residents & faculty.

BACKGROUND: There is significant and growing national interest for introducing Complementary and Alternative Medicine (CAM) instruction into allopathic medical education. We measured CAM attitudes, use, and information-seeking behaviors as a baseline to evaluate future planned CAM instruction. METHODS: Cross-sectional and longitudinal survey data on CAM attitudes, modality use, and common information resources was collected for (a) medical students (n = 355), (b) interns entering residencies in medical and surgical disciplines (n = 258), and (c) faculty from diverse health professions attending workshops on evidence-based CAM (n = 54). One student cohort was tracked longitudinally in their first, second and third years of training. RESULTS: Compared to medical students and interns, faculty who teach or intend to integrate CAM into their instruction had significantly (p < .0005) more positive attitudes and used CAM modalities significantly (p < .0005) more often. Medical students followed longitudinally showed no change in their already positive attitudes. The 3 survey groups did not differ on the total number of CAM information resources they used. Each group surveyed used about two out of the five common information sources listed, with the Internet and journals most frequently cited. CONCLUSION: Students, interns and a selected faculty group demonstrate positive attitudes toward CAM and frequently use various CAM modalities. CAM instruction should therefore be focused on acquiring knowledge of available CAM modalities and skills to appraise evidence to appropriately advise patients on best approaches to CAM use. Trainees may benefit from exposure to a wider array of CAM information resources.

Short-term impact of a laparoscopic "mini-residency" experience on postgraduate urologists' practice patterns.

BACKGROUND: To assist practicing urologists incorporate laparoscopic urology into their practice, a 5-day mini-residency (M-R) program with a mentor, preceptor, and proctor experience was established at the University of California, Irvine, and we report the initial results. STUDY DESIGN: Thirty-two urologists underwent laparoscopic ablative (n=17) or laparoscopic reconstructive (n=15) training, including inanimate model skills training, animal laboratory, and operating room observation. A questionnaire was mailed 1 to 15 months (mean, 8 months) after their M-R program, and responses were reviewed. RESULTS: A 100% response rate was achieved. The mean M-R participant age was 49 years (range 31 to 70 years). The majority of the participants (72%) had laparoscopic experience during residency training and had performed between 5 and 15 laparoscopic cases before attending the M-R program. Within 8 months after M-R, 26 participants (81%) were practicing laparoscopic surgery. Participants were performing laparoscopic radical nephrectomy (p=0.008), nephroureterectomy (p<0.0005), and pyeloplasty (p=0.008) at substantially higher rates after training. At the same time, fewer of the M-R participants were performing hand-assisted laparoscopic surgery after training (p=0.008) compared with before the M-R. Ninety-two percent of the participants indicated that they would recommend this training program to a colleague. CONCLUSIONS: A 5-day intensive laparoscopic ablative and reconstructive surgery course seems to encourage postgraduate urologists, already familiar with laparoscopy, to successfully expand the scope of their procedures to include more complex laparoscopic techniques such as nephrectomy, nephroureterectomy, and pyeloplasty into their clinical practice.

Student Senior Partnership Program: University of California Irvine School of Medicine.

The Student Senior Partner Program (SSPP) forms the core of the required medical student geriatrics curriculum at the University of California-Irvine School of Medicine (UCISOM). The program utilizes a longitudinal modular format that extends over the first three years of medical school. Instruction is presented in didactic, patient interactive, and facilitated small group discussion sessions. Initial educational outcomes have been positive. Ongoing challenges include faculty recruitment and retention, recruiting a group of senior partners that reflects the diversity of the community, and managing generational and ethno-cultural conflicts. The program offers unique opportunities for innovative development in geriatrics education.