Teaching the pediatric ear exam and diagnosis of Acute Otitis Media: a teaching and assessment model in three groups.

BACKGROUND: The serious consequences of inaccurate diagnosis of acute otitis media have led to a call for greater education to develop proficient pediatric otoscopy skills. Despite the clinical and educational needs, peer-reviewed standardized curricula with validated assessment instruments remain limited. This study evaluated a pediatric otoscopy curriculum incorporated into the Pediatric medical student clerkship with use of outcome measures that included assessment of skills with real patients. The objective was to determine whether students who received the intervention would demonstrate significant gains in pediatric otoscopy skills when compared with students with only routine immersion learning exposure. METHODS: During their Pediatric clerkship, an intervention group (IG) of 100 medical students received routine instruction and a curriculum intervention. A non-intervention group (NIG) of 30 students received only routine instruction. Outcome measures included written tests and assessment of skills with real patients. A retention group (RG) consisted of 79 students in the IG who completed a written test at the end of medical school. Paired t-tests were used to compare differences in pre-intervention, post-intervention, and retention scores for the IG, NIG, and RG, while analysis of covariance tests were used to compare differences in scores between the IG and NIG. RESULTS: Pre-intervention scores were similar for the IG and NIG for the written test (mean/SD of 12.9/2.9 for IG and 12.9/1.8 for NIG, p = 0.78) and skills checklist (mean/SD of 11.1/4.4 for IG and 10.9/4.0 for NIG, p = 0.88). The IG had significantly higher post-intervention scores than the NIG for the written test (mean/SD of 22.6/1.7 for IG and 13.9/2.5 for NIG, p < 0.001) and skills checklist (mean/SD of 19.2/3.4 for IG and 11.0/3.8 for NIG, p < 0.001). The IG also had significantly higher gain in scores than the NIG for the written test (mean/SD +9.6/2.8 for IG and +1.0/2.3 for NIG, p < 0.001) and skills checklist (mean/SD of +8.1/4.8 for IG and +0.1/4.5 for NIG, p < 0.001). For the RG, there was a significant decrease (p < 0.001) from the post-intervention scores to retention scores (mean/SD of -7.4/2.7) but a significant increase (p < 0.001) from the pre-intervention score to retention score (mean + 2.6/3.3). CONCLUSIONS: Medical students who received a formal curriculum intervention demonstrated significant gains in pediatric otoscopy skills when compared with students with only routine immersion learning exposure. However, learning gains diminished over time, emphasizing the need for continued practice opportunities to reinforce students' skills. Our study provides a formal curriculum to meet identified educational gaps in the important topic of pediatric otoscopy and offers a model for teaching of other clinical skills using rigorous outcome measures including assessment of skills in real patients.

Understanding the needs and concerns of senior faculty in academic medicine: building strategies to maintain this critical resource.

PURPOSE: The average age of medical school faculty is increasing, with 30% over age 55 in 2007. In 2012, 56% of Society of Teachers of Family Medicine (STFM) members were at least 50 years old. The authors sought to identify the transition and faculty development needs of this group of senior faculty. METHOD: In 2012 the authors electronically surveyed 1,708 U.S. STFM members who were 50 or older, asking about demographics, highest degree, primary employer, career options considered in the previous year, issues of concern, mentoring needs, retirement plans, and likely activities in retirement. RESULTS: The response rate was 45%, with 73% MD/DOs, 62% men, 89% white, and 64% employed by academic institutions. The most frequent issues of concern were balancing personal and work time (67%), maintaining health (66%), and planning for retirement (60%). Nearly a third had considered career advancement, changing employers, or reducing full-time employment. Fifty-one percent were not receiving mentoring of any kind, but 47% reported they would like to have a mentor. Sixty-four percent were planning to retire; in retirement, 75% said they would like to remain active in teaching and 55% in mentoring. CONCLUSIONS: Senior faculty in family medicine have significant career concerns and mentoring needs as they approach retirement, and these faculty can be valuable resources after retirement. As the age of faculty continues to rise, medical schools and specialty organizations can develop specific programs to meet the needs of these medical educators and better use this expertise in a time of limited resources.

Nursing students' attitudes toward video games and related new media technologies.

Little is known about Millennial nursing students' attitudes toward computer games and new media in nursing education and whether these attitudes differ between undergraduates and graduates. This study elicited nursing students' experience with computer games and new media, their attitudes toward various instructional styles and methods, and the role of computer games and new media technologies in nursing education. We e-mailed all nursing students enrolled in two universities to invite their participation in an anonymous cross-sectional online survey. The survey collected demographic data and participants' experience with and attitudes toward video gaming and multi-player online health care simulations. We used descriptive statistics and logistic regression to compare the differences between undergraduates and graduates. Two hundred eighteen nursing students participated. Many of the nursing students support using new media technologies in nursing education. Nurse educators should identify areas suitable for new media integration and further evaluate the effectiveness of these technologies.

Medical student attitudes toward video games and related new media technologies in medical education.

BACKGROUND: Studies in K-12 and college students show that their learning preferences have been strongly shaped by new media technologies like video games, virtual reality environments, the Internet, and social networks. However, there is no known research on medical students' game experiences or attitudes towards new media technologies in medical education. This investigation seeks to elucidate medical student experiences and attitudes, to see whether they warrant the development of new media teaching methods in medicine. METHODS: Medical students from two American universities participated. An anonymous, 30-item, cross-sectional survey addressed demographics, game play experience and attitudes on using new media technologies in medical education. Statistical analysis identified: 1) demographic characteristics; 2) differences between the two universities; 3) how video game play differs across gender, age, degree program and familiarity with computers; and 4) characteristics of students who play most frequently. RESULTS: 217 medical students participated. About half were female (53%). Respondents liked the idea of using technology to enhance healthcare education (98%), felt that education should make better use of new media technologies (96%), and believed that video games can have educational value (80%). A majority (77%) would use a multiplayer online healthcare simulation on their own time, provided that it helped them to accomplish an important goal. Men and women agreed that they were most inclined to use multiplayer simulations if they were fun (97%), and if they helped to develop skill in patient interactions (90%). However, there was significant gender dissonance over types of favorite games, the educational value of video games, and the desire to participate in games that realistically replicated the experience of clinical practice. CONCLUSIONS: Overall, medical student respondents, including many who do not play video games, held highly favorable views about the use of video games and related new media technology in medical education. Significant gender differences in game play experience and attitudes may represent male video game design bias that stresses male cognitive aptitudes; medical educators hoping to create serious games that will appeal to both men and women must avoid this.

Gender and patient complaints: are they related?

BACKGROUND: Several studies suggest that the gender of patients and their healthcare providers affects overall patient satisfaction. AIMS: We sought to determine whether the gender of patients or providers was associated with the number of complaints filed by patients against providers. METHODS: In this case-controlled study, complaints from a health maintenance organisation were analysed for gender disparity during a 12-month period. RESULTS: The odds ratio for patients' female gender to be associated with complaints was 3.10 (95% confidence interval 1.73-5.55, P<0.001). Women were also more likely than men to cite providers' behaviour as the cause of complaints. No significant associations were noted between the number of complaints and a complainant's age, diagnosis of chronic pain or psychiatric illness, or with the provider's gender, age or length of employment in the organisation. The heterogeneity of gender effect demonstrated in the literature suggests that this effect is likely to be unique to the different practice settings. CONCLUSION: Evaluating the presence of this phenomenon in the different practice settings is recommended, to improve patient satisfaction and subsequently the quality of care.

Long-term outcomes of a primary care faculty development program at the University of Wisconsin.

BACKGROUND AND OBJECTIVES: To meet a need for primary care teachers, the Bureau of Health Professions funds faculty development programs for primary care preceptors. The purpose of this study was to determine how graduates of our faculty development program identified its long-term effect on professional outcomes. METHODS: Our program was a year-long series of five weekend workshops focusing on the preparation of preceptors to teach curricular areas relatively new to medical education--evidence-based medicine, teaching skills, technology tools, doctor-patient communication, quality improvement, and advocacy. Participants included physicians in community-based practices and university-based physicians. We surveyed the first 100 graduates of our program about professional and academic outcomes they attributed to program participation. Outcomes were categorized using the Kirkpatrick evaluation model; open-ended comments were analyzed thematically. RESULTS: Eighty responses were received (80% response rate). Ninety percent of respondents were teaching medical students and residents. Outcomes attributed to the program included improvement in teaching skills, improvement in clinical skills, intrapersonal growth and increased self-confidence, and increased interdisciplinary networking and mentoring. Ninety-one percent had recommended the program to others. CONCLUSIONS: Graduates identified positive outcomes and found the fellowship useful for developing the skills and self-confidence required of teachers. This training may be valuable for teachers in today's learning environment.

Can an online osteoporosis lecture increase physician knowledge and improve patient care?

Internet-based lectures are a popular means of disseminating medical knowledge, but the impact of osteoporosis lectures on physician knowledge and patient care is unknown. We designed an Internet-based lecture discussing the prevalence of, screening guidelines for, risk factors for, and physical signs of osteoporosis. Immediately before and after viewing the lecture, 6 physician participants completed questionnaires to gauge change in knowledge. From each participant's clinic, we randomly selected and reviewed 10 charts of new female patients at least 60 yr old, half before and half after the lecture. Charts were blindly scored to determine physician attention to screening guidelines for, risk factors for, and signs of osteoporosis. Physician knowledge increased significantly after the lecture, with mean pretest and posttest scores of 63% and 99%, respectively (p=0.03). However, physician attention to patient risk factors for and signs of osteoporosis did not change after lecture "attendance." Surprisingly, no patients who met age-specific screening guidelines (age> or =65 yr and no prior dual energy X-ray absorptiometry [DXA]) were referred for DXA, either before or after study participation. We conclude that physician knowledge can increase after a single online osteoporosis lecture, but patient care is not altered. Further research is needed to discern optimal osteoporosis educational encounters that enhance patient care.

Toward the development of advocacy training curricula for pediatric residents: a national delphi study.

BACKGROUND: Training in child advocacy is now required in pediatric residency program curricula. No national consensus exists regarding the content of such advocacy training. OBJECTIVE: To identify an operational definition of advocacy, as well as knowledge, skills, and attitude objectives for advocacy training in pediatric residency programs. METHODS: Professionals experienced in pediatric advocacy and training (n = 53) were invited to participate in a sequence of surveys to define the content of a pediatric residency advocacy curriculum that would result in acquisition of appropriate knowledge, skills, and attitudes related to advocacy for children. Three rounds of surveys were distributed, collected, and analyzed using a modified Delphi technique, in which the results from an antecedent survey were used to refine responses in a subsequent survey. RESULTS: Participants (n = 36), comprising a group of experienced leaders with diverse training and experience in child advocacy and resident education, created a consensus definition for advocacy. They initially identified 179 possible objectives for advocacy curricula. Through the iterative process of the Delphi technique, 32 of those objectives were identified as necessary for inclusion in a child advocacy curriculum for pediatric residents. CONCLUSIONS: Using a modified Delphi technique, a group of experienced leaders in pediatric advocacy were able to reach consensus on an operational definition of child advocacy and a set of objectives for a resident advocacy curriculum. Programs may use these findings to assist in developing an advocacy curriculum based on their own faculty assets and community resources.

Career influence of an international health experience during medical school.

BACKGROUND AND OBJECTIVES: International health (IH) experiences are popular among medical students and may influence career choices. The International Health Fellowship Program (IHFP) consisted of preparatory coursework and field experience in a developing country. We conducted a survey 4-7 years later to assess the career influence of IHFP participation. METHODS: Fellows completed a questionnaire regarding training, practice setting, patient population, further international work, and knowledge and attitudes about IH. RESULTS: Surveys were completed by 42 (70%) fellows; 31% spend most of their time working with underserved populations, 67% have been involved in community health projects, 74% practice primary care, 29% have an MPH degree, 57% have done further work in developing countries, while 90% named one or more barriers to further IH experiences. Knowledge and attitudes about IH were largely retained. Most fellows (67%) believed the IHFP influenced their careers. CONCLUSIONS: Most fellows felt that IHFP participation had a positive influence on their careers. While a causative relationship cannot be inferred, fellows demonstrate a strong preference to work with underserved populations and engage in community service activities. Compared with US physicians, IHFP fellows are more likely to practice primary care and obtain MPH degrees. Medical schools that seek to produce graduates with these qualities should make efforts to increase quality IH opportunities for their students.

Teaching patient-centered tobacco intervention to first-year medical students.

The University of Wisconsin's Tobacco Intervention Basic Skills curriculum (TIBS) was inaugurated to begin training 147 first-year medical students in skills for promoting health behavior change. Learning activities included lecture, demonstration, reading, quiz, role-play exercises, and standardized patient interviews. After TIBS, the 69 students who provided pre- and postintervention data exhibited more therapeutic attitudes and increased knowledge and self-confidence in applying TIBS skills. Two months later, 52% of the 109 posttest respondents had applied TIBS in clinical settings, often for behaviors other than tobacco use. We conclude that medical students can gain from early training on promoting behavior change.

Teaching of medical informatics in UME-21 medical schools: best practices and useful resources.

OBJECTIVES: Information-based decision making is important to modern medical practice. This report identifies learning objectives, teaching innovations, and student outcomes for teaching medical informatics (MI) in medical schools that participated in the Undergraduate Medical Education for the 21st Century (UME-21) curriculum project. METHODS: Project reports by the UME-21 schools were analyzed, and curricular content was classified in terms of the five categories for MI literacy adapted from the Medical School Objectives Project. Student self-assessments of adequacy of exposure to MI were reviewed. RESULTS: Teaching methods included demonstrations, lectures, small-group tutorials, hands-on labs, and task-based assignments. The curriculum was taught during the first 3 years of medical school with medical librarians participating. Content examples in the five categories of medical literacy were: "Role of the Lifelong Learner" (accessing, evaluating, and using information and databases), "Role of Clinician" (obtaining patient information, using decision support), "Role of Educator/Learner/Communicator" (accessing information for patient education, student-teacher communication, studying Web-based cases, making presentations, accessing on-line course information), "Role of Researcher/Evaluator" (documenting patient encounters), and "Role of Manager" (using drug formularies and clinical guidelines). Seniors exposed to the UME-21 curriculum reported higher levels of exposure to MI than did untrained seniors 2 years earlier; however, seniors at non-UME-21 schools reported equally high levels. CONCLUSIONS: UME-21 schools developed creative materials for teaching students to use computers for learning, communication, and searching for information. Outcome measures suggest that MI has become an important curriculum topic in most medical schools.

Teaching the basics of clinical pharmaceutical care: innovative pharmacy workshops at the University of Wisconsin and the University of Nebraska.

BACKGROUND: Safe and effective prescription writing, using drug formularies, and managing pharmaceutical care are skills medical students need to acquire. Spurred by the Undergraduate Medical Education for the 21st Century (UME-21) grants, the University of Wisconsin and the University of Nebraska independently developed educational workshops to address these competencies. METHODS: The University of Wisconsin's workshop is presented to medical students at the start of their third year. They receive information from pharmacists on medication errors, prescription writing, and drug formularies. A "learners guide" summary is discussed by a physician, which brings into focus the clinical application of the didactic session. A small-group session follows with hands-on experience in writing prescriptions and using formularies for three patient case scenarios. The workshop at the University of Nebraska consists of three sessions during the third-year internal medicine clerkship. In the first session, pharmacists discuss formularies, the Pharmacy and Therapeutics (PT) committee, and the preparation of a drug monograph. During the second session, students develop an evidence-based drug monograph on a product or herbal. In the final session, the class functions as a mock PT committee, and after listening to the drug monographs, determines whether the product should be added to the formulary. We evaluated students' satisfaction with the workshops using Likert scales and assessed students' ability to correctly fill out a prescription form. RESULTS: Both workshops were well received. The mean rating at University of Wisconsin was 1.7 on a scale of 1 (satisfied) to 7 (dissatisfied), and at University of Nebraska it was 3.8 with 5 (outstanding) to 1 (unacceptable). At the University of Wisconsin, on a year-end skills assessment involving 148 students, 100% of the students properly filled out a prescription. Ninety-four percent received an excellent grade, 6% a pass, and no marginal or failing grades were given out. CONCLUSIONS: The workshop on pharmaceutical prescribing was rated favorably by students. After participating in the workshop, students acquired skills in prescription writing.

A weekend program model for faculty development with primary care physicians.

BACKGROUND: Medical teachers are expected to be proficient at teaching students and residents about the changing health care system. The University of Wisconsin established a faculty development fellowship program to better prepare clinical teachers in family medicine, general pediatrics, and general internal medicine. This paper describes our fellowship program, presents data on program accomplishments, and discusses what we have learned. METHODS: We developed a year-long series of five weekend workshops. A core group of faculty provided 2- to 4- hour sessions on topics including evidence-based medicine, physician leadership, advocacy, doctor-patient communication, quality, technology tools, and teaching skills. Evaluation data were used to shape the program, make improvements, and assess impact. Fellows self-assessed their ability to perform skills at the beginning and ending of the year; paired t tests were used to compare these changes. RESULTS: Attendance and program completion rates were more than 94% for the 84 fellows taught over 6 years. Individual sessions and the overall program were well-rated by fellows. Participants reported improvements in targeted skills; statistical analyses confirmed many significant pre-post improvements. LESSONS LEARNED: To obtain high ratings, faculty must apply adult learning and active learning principles; lectures were not well tolerated. Initial technology skills were often low; computer labs needed many helpers. Participants needed extensive faculty support on their projects. It facilitated coordination and learning to have a core group of fellowship faculty who did most of the teaching. Graduates have become enthusiastic recruiters for new fellows. Our 5-weekend program has proven to be an effective faculty development model.

Collaborating to integrate curriculum in primary care medical education: successes and challenges from three US medical schools.

BACKGROUND AND OBJECTIVES: Traditional medical school department-based clerkship structures can lead to redundancy and/or gaps in curriculum, inefficient administrative systems, and academic isolation for clerkship directors. This paper describes the approaches, successes, and challenges three institutions experienced when implementing an interdepartmental collaboration to create an integrated primary care clerkship experience. METHODS: Each school combined family medicine, ambulatory pediatrics, and ambulatory medicine into contiguous clerkship blocks. In all institutions, each clerkship maintained certain distinct features while the integrated aspects contained longitudinal curriculum of certain primary care topics. RESULTS: Evaluations by students demonstrated favorable responses to the new content and integrated methods of teaching, as did results of the Association of American Medical Colleges graduation survey. Faculty at each institution reported that their multidisciplinary approach has stimulated important educational collaborations, many of which require an economy of scale not often achievable within a single clerkship. These included innovative evaluation/documentation efforts; centralization of administrative tasks; enhanced recruitment, retention, and development of community-based faculty; an increase in the active core group of local and national primary care leaders; and an increase in scholarly activities. The collaborations have not occurred without challenges, primarily in the need for identifying sustainable resources for these and future collaborative educational endeavors. CONCLUSIONS: The benefits involved in developing an integrated primary care experience include expansion of curriculum content and methods, as well as enhancement of collegial support and resources to community-based and academic faculty. These integrations do, however, bring added challenges, time, and costs to traditional independent clerkships.