Cause or effect? The relationship between student perception of the medical school learning environment and academic performance on USMLE Step 1.

BACKGROUND: A school's learning environment is believed to influence academic performance yet few studies have evaluated this association controlling for prior academic ability, an important factor since students who do well in school tend to rate their school's environment more highly than students who are less academically strong. AIM: To evaluate the effect of student perception of the learning environment on their performance on a standardized licensing test while controlling for prior academic ability. METHODS: We measured perception of the learning environment after the first year of medical school in 267 students from five consecutive classes and related that measure to performance on United States Medical Licensing Examination (USMLE) Step 1, taken approximately six months later. We controlled for prior academic performance by including Medical College Admission Test score and undergraduate grade point average in linear regression models. RESULTS: Three of the five learning environment subscales were statistically associated with Step 1 performance (p < 0.05): meaningful learning environment, emotional climate, and student-student interaction. A one-point increase in the rating of the subscales (scale of 1-4) was associated with increases of 6.8, 6.6, and 4.8 points on the Step 1 exam. CONCLUSION: Our findings provide some evidence for the widely held assumption that a positively perceived learning environment contributes to better academic performance.

Palliative medicine Death Rounds: small group learning on a vital subject.

BACKGROUND: The medical student's experience with patients' dying and death has profound impact on personal and professional development. Death Rounds at the University of New Mexico School of Medicine is a small group educational model that promotes student self-reflection, metacognition, professional growth, and collegial support. OBJECTIVE: To describe the implementation and evaluation activities of a third year clerkship Death Rounds which are a structured, institutionally supported resource for helping students to understand the clinical, ethical, legal, professional, cultural, and spiritual aspects of death. DESIGN: Medical students attend 2 to 3 small group palliative medicine Death Rounds sessions, facilitated by the attending clerkship director, chief residents, and a palliative care physician. CONCLUSIONS: The students' assessment of their palliative medicine knowledge and skills in 5 categories before and after participation in Death Rounds rated their skills after Death Rounds higher with effect sizes ranging from 0.9 to 1.9. Evidence from both the Death Rounds Questionnaire and Facilitators' Logs demonstrates that multiple issues and topics were addressed and all associated with the School of Medicine's 6 core competencies. Death Rounds minimally affect on clerkship time and faculty resources.

Fitting it all in: integration of 12 cross-cutting themes into a School of Medicine curriculum.

Changing demographic, social, economic and technological trends have impacted the expectations of the Academic Health Center in preparing physicians to serve the needs of the American society, resulting in revisions to current curricula. In addition to the traditional basic sciences and clinical disciplines, accredited medical schools are required to provide curriculum exposure in behavioral health, communication skills, diversity and cultural awareness, ethics, evidence-based medicine, geriatrics, integrative medicine, pain management, palliative care, public health, socio-economic dynamics, and domestic violence. These themes are considered 'cross-cutting' since it is recognized these important curricular components apply across all years of medical school. In this article, the authors describe a strategic model developed at the University of New Mexico School of Medicine (UNMSOM) to integrate horizontally and vertically 12 cross-cutting themes as an evolving interdisciplinary curriculum reform process. These areas were defined through a combination of internal self-study, external requirements, and student and faculty interest. In the early stage of use of this model at UNMSOM, the authors describe the new cross-cutting themes that have been integrated. Minimal disruption and a spirit of cooperation and acceptance have characterized the curricular change that has been required. Preliminary assessment indicates that the program has been successful.

Palliative care: an emerging issue for American Indians and Alaskan Natives.

Over 4 million American Indians and Alaskan Natives live in communities that receive health care primarily from the federal Indian Health Service or tribal health programs. Palliative care has only recently been formally addressed for these communities. An Indian Health Service program introduced the topic and several programs are ongoing. Needs for and barriers to palliative care in native peoples' communities are discussed and several successful programs at various stages of development and implementation are described.