Investing in success: student experiences in a structured, decelerated preclinical medical school curriculum.

PURPOSE: Many students in the Michigan State University College of Human Medicine (CHM) are non-traditional with unique needs and experiences. To meet these needs, in 1988 CHM developed a structured Extended Curriculum Program (ECP), which allows students to take longer than 2 years to complete the preclinical curriculum. This work examined the reasons why students extended their programs, their perceptions of that experience, and the outcome with respect to satisfaction and success in their careers after graduation. METHODS: The analysis used data from the college database, follow-up surveys of residency directors and graduates, surveys of graduates who extended, and the AMA Physician Masterfile. RESULTS: Graduates who responded to the survey were evenly split between those who extended for academic reasons and those who extended for other reasons. Although feelings about extending were mixed at the time of extension, nearly all respondents agreed that extending was the right decision in the long run. Extended students continued to face academic challenges having lower basic science averages, lower USMLE Step 1 and 2 first attempt pass rates, and more instances of repeated clerkships compared to those who did not extend, however, most were able to secure a residency in the specialty they desired and had comparable career satisfaction ratings. CONCLUSIONS: The ECP allows some students to complete medical school who otherwise may not have been able to do so. This analysis has provided valuable information that was used to improve the program, allowing CHM to continue its mission of training a diverse set of students to be exemplary physicians.

An educational strategy for treating chronic, noncancer pain with opioids: a pilot test.

UNLABELLED: Chronic pain is common and can be devastating to the patient and challenging to the health care provider. Despite the importance of the topic, pain management curricula are incomplete in health professionals' training. We developed a longitudinal curriculum to teach therapy for chronic noncancer pain over four units and pilot-tested the teaching of one unit (opioids) to internal medicine residents. The educational strategies we used included didactic sessions, write-up of a management plan following a model, case discussions, and role-play group activities. We pilot-tested one unit (opioid therapy) in March 2008. We performed learner evaluations, using a pretest and posttest, a write-up plan following a model, and a learner knowledge questionnaire. Results showed significant improvement in knowledge. Residents found the sessions and educational strategy to be excellent and reported higher confidence levels in managing patients with chronic noncancer pain. PERSPECTIVE: This article demonstrates that multiple teaching modalities-including didactic lectures, case discussions, write-up of a management plan following a model, and role-play group activities-are effective methods of teaching internal medicine residents how to use opioids to manage chronic noncancer pain.

A repurposed tool: the Programme Evaluation SOAP Note.

CONTEXT: Doctors have used the subjective-objective-assessment-plan (SOAP) note format to organise data about patient problems and create plans to address each of them. We retooled this into the 'Programme Evaluation SOAP Note', which serves to broaden the clinician faculty member's perspective on programme evaluation to include the curriculum and the system, as well as students. METHODS: The SOAP Note was chosen as the method for data recording because of its familiarity to clinician-educators and its strengths as a representation of a clinical problem-solving process with elements analogous to educational programme evaluation. We pilot-tested the Programme Evaluation SOAP Note to organise faculty members' interpretations of integrated student performances during the Year 3 patient care skills objective structured clinical examination (OSCE). RESULTS: Eight community clerkship directors and lead clerkship faculty members participated as observers in the 2007 gateway examination and completed the Programme Evaluation SOAP Note. Problems with the curriculum and system far outnumbered problems identified with students. CONCLUSIONS: Using the Programme Evaluation SOAP Note, clerkship leaders developed expanded lists of 'differential diagnoses' that could explain possible learner performance inadequacies in terms of system, curriculum and learner problems. This has informed programme improvement efforts currently underway. We plan to continue using the Programme Evaluation SOAP Note for ongoing programme improvement.

Implementation of curriculum by family medicine fellows: what factors help and what factors hinder?

BACKGROUND AND OBJECTIVES: The need for change in medical curricula is increasing, due partially to tougher curriculum and evaluation standards. Participants in our academic medicine fellowship learn to develop curricula, but not all are successful at fully implementing them. This study looked for facilitators of and barriers to curriculum implementation by individual fellows. A literature review uncovered studies identifying institutional variables relating to successful curriculum innovation but little that identified variables pertaining to the individual curriculum developer. METHODS: We interviewed alumni of the curriculum development track of the Primary Care Faculty Development Fellowship at Michigan State University, asking what promoted or hindered their curriculum implementation. We analyzed interview notes to identify themes according to a theoretical framework. RESULTS: Common facilitators were (1) having a strong advocate, (2) perception of need for the curriculum by both fellow and institution, and (3) having a curriculum plan. Common barriers were (1) no time slot for curriculum, (2) fellow had left job, and (3) curriculum was too large or complex. CONCLUSION: Successful curriculum developers have powerful advocates of well-designed curriculum plans that address recognized institutional needs.

Facilitators' influence on student PBL small group session online information resource use: a survey.

BACKGROUND: In problem-based learning curricular research has focused on the characteristics of good facilitators and how they influence student performance and satisfaction. Far less frequently addressed has been the question of how PBL facilitators influence the small group session activity of students. We investigated the impact that facilitators' encouragement of use or non-use of the Internet would have on the students' use of online information resources. METHODS: Survey of student and facilitator perceptions of facilitator behavior and student use of online information resources. RESULTS: Students who used online information resources rated their facilitators' behavior as more encouraging, while students in groups who didn't use online information resources during problem-based learning small group sessions rated their facilitators' behavior as less encouraging. This result was statistically significant. CONCLUSIONS: Our study supports the role of the facilitator as an influence on medical students in small groups, particularly with respect to facilitator verbal behavior encouraging or discouraging student use of information technology in the problem-based learning small group session.

Creating Online Lessons: A Faculty Development Seminar Series.

The World Wide Web is being used increasingly to deliver instruction in medical education. Consequently, there is a need to train faculty in developing and implementing online instruction. We developed and implemented a seminar series to teach faculty to create educationally sound, well-designed online instruction. Instruction was delivered to 15 participants via a six-session seminar on developing web-based lessons, supplemented with web-based instruction. First, the participants learned the basics of instructional design via a web-based module. They then completed content outlines for their online lessons prior to the first seminar. Lesson development, web site development and the use of a web-based instructional shell to imp lement the online lessons were each taught in two two-hour sessions. Eight participants developed online lessons and four actually implemented them. Feedback was mostly positive, with suggestions for improvement. All eight participants who completed the series said they would recommend it to their colleagues. Because a longitudinal workshop type of seminar series requires a large amount of participant time outside of class, a six-month seminar series may be too long. It is important at the beginning of the series to help participants select topics suitable for online instruction and to help them narrow their topics. We may change the attendance guidelines so faculty would attend only the session on instructional design and have their staff attend the technical sessions on web site design, HTML editing and online course delivery systems. This would better match the actual practice of faculty designing the instruction and staff developing it.

Family medicine clerkship web sites: the state of the art.

BACKGROUND AND OBJECTIVES: The use of on-line syllabi to acquire information about a course, clerkship, or rotation is growing. This study investigated the number of existing family medicine clerkship Web sites with syllabi and determined their completeness and usability. METHODS: In sping 1999, all schools with third-year family medicine clerkship Web sites were identified (n = 71) using Association of American Medical Colleges and American Academy of Family Physicians clerkship directories to identify required family medicine clerkships, followed by a Web search to identify any associated Web sites. A checklist with 11 content and 5 technical categories was developed and pilot tested. All sites were evaluated by at least two investigators. Two identifiable checklist characteristics were required to be present for a site to be identified as an on-line syllabus and included in the study. RESULTS: Of the 71 sites initially identified, 40 were included in the study, 22 were excluded, and 9 required further review by an additional evaluator. A total of 44 sites were included in the study. The most common content features identified were instructor information, goals, overview, and requirements. Less-common features included objectives, learning resources, schedule, and grading policy. CONCLUSIONS: A minority of family medicine clerkships have on-line syllabi. Most sites have basic information, but other relevant clerkship information is absent. New and revised family medicine clerkship on-line syllabus development would benefit from using the checklist to guide the creation of instructionally sound educational resources.