The Urban Medicine Program: Developing Physician-Leaders to Serve Underserved Urban Communities.

PURPOSE: Medical school graduates are poorly prepared to address health care inequities found in urban, underserved communities. The University of Illinois College of Medicine developed the Urban Medicine Program (UMed) to prepare students for the roles of advocate, researcher, policy maker, and culturally competent practitioner through a four-year curriculum integrating principles of public health with direct interventions in local, underserved communities. This study assessed the program's effectiveness and evaluated early outcomes. METHOD: The authors analyzed data for UMed students (graduating classes 2009-2013) from pre- and postseminar assessments and longitudinal community project progress reports. They also compared UMed and non-UMed outcomes from the same classes, using graduation data and data from two surveys: Medical Students' Attitudes Toward the Underserved (MSATU) and the Intercultural/Professional Assessment. RESULTS: UMed students were more likely than non-UMed students to endorse MSATU constructs ("Universal medical care is a right" [P = .01], "Access to basic medical care is a right" [P = .03], "Access is influenced by social determinants" [P = .03]); to be selected for the Gold Humanism Honor Society (P < .0001); to complete joint degrees (P < .0001); and to enter primary care residencies (P = .002). CONCLUSIONS: Early outcomes reveal that a longitudinal, experiential curriculum can provide students with competencies that may prepare them for leadership roles in advocacy, research, and policy making. Contact with diverse communities inculcates-in medical students with predispositions toward helping underserved populations-the self-efficacy and skills to positively influence underserved, urban communities.

Discussion: 'Factor V Leiden mutation' by Kjellberg et al.

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research.

Teaching students to question.

OBJECTIVE: The purpose of the study was to teach medical students the strategies of critical questioning to determine the effect on students' critical thinking skills, confidence in their ability to ask questions, and interaction between student and instructor. STUDY DESIGN: Workshops were developed to teach medical students how to systematically ask critical questions. Sixty-two consenting students in their third-year obstetrics and gynecology clerkship were divided according to alternate rotations to either attend the workshops (n = 28) or not (n = 41). RESULTS: Medical students who attended the workshops scored higher on the California Critical Thinking Skills Test mean total score (study group 25.1 [+/- 0.7 SEM] vs control group 22.9 [+/- 0.6 SEM], P = .028), subscales of inference (12.6 [+/- 0.3 SEM] vs 11.2 [+/- 0.3 SEM], P = .003), and of deductive reasoning (12.7 [+/- 0.4 SEM] vs 10.9 [+/- 0.3 SEM], P = .001). CONCLUSION: Teaching students to ask critical questions improves critical thinking as measured by the California Critical Thinking Skills Test.