Students' perceptions of the impact a creative arts journal has on their medical education.

BACKGROUND AND OBJECTIVES: Student-produced creative arts journals now exist in several medical schools. The Florida State University College of Medicine (FSUCOM) has created HEAL: Humanism Evolving through Arts and Literature. This study sought to determine what influence, if any, HEAL publications may have on medical students. METHODS: A survey utilizing Likert scale questions was sent to Florida State University medical students. Student responses were tabulated and analyzed using SAS 9.2 and MS Excel. A total of 241 (49.5%) students responded to the survey. RESULTS: About 81% of the respondents enjoyed reading HEAL. Many respondents agreed that HEAL promoted patient-centered care (55.9%) and could prevent burnout (61.8%). Sixty-four percent thought that HEAL helped them to understand their colleagues and classmates. CONCLUSIONS: This survey found that the medical students perceive HEAL as having positive value.

A hospital-randomized controlled trial of a formal quality improvement educational program in rural and small community Texas hospitals: one year results.

OBJECTIVE: To investigate the effectiveness of a quality improvement educational program in rural hospitals. DESIGN: Hospital-randomized controlled trial. PARTICIPANTS: A total of 47 rural and small community hospitals in Texas that had previously received a web-based benchmarking and case-review tool. INTERVENTION: The 47 hospitals were randomized either to receive formal quality improvement educational program or to a control group. The educational program consisted of two 2-day didactic sessions on continuous quality improvement techniques, followed by the design, implementation and reporting of a local quality improvement project, with monthly coaching conference calls and annual follow-up conclaves. MAIN OUTCOME MEASURES: Performance on core measures for community-acquired pneumonia and congestive heart failure were compared between study groups to evaluate the impact of the educational program. RESULTS: No significant differences were observed between the study groups on any measures. Of the 23 hospitals in the intervention group, only 16 completed the didactic program and 6 the full training program. Similar results were obtained when these groups were compared with the control group. CONCLUSIONS: While the observed results suggest no incremental benefit of the quality improvement educational program following implementation of a web-based benchmarking and case-review tool in rural hospitals, given the small number of hospitals that completed the program, it is not conclusive that such programs are ineffective. Further research incorporating supporting infrastructure, such as physician champions, financial incentives and greater involvement of senior leadership, is needed to assess the value of quality improvement educational programs in rural hospitals.

Promoting regional disaster preparedness among rural hospitals.

CONTEXT AND PURPOSE: Rural communities face substantial risks of natural disasters but rural hospitals face multiple obstacles to preparedness. The objective was to create and implement a simple and effective training and planning exercise to assist individual rural hospitals to improve disaster preparedness, as well as to enhance regional collaboration among these hospitals. METHODS: The exercise was offered to rural hospitals enrolled with the Rural and Community Health Institute of the Texas A&M University System Health Science Center, and 17 participated. A 3-hour tabletop exercise emphasizing regional issues in a pandemic avian influenza scenario followed by a 1-hour debriefing was implemented in 3 geographic clusters of hospitals. Trained emergency preparedness evaluators documented observations of the exercise on a standard form. Participants were debriefed after the exercise and provided written feedback. RESULTS: Observations included having insufficient staff for incident command, facility constraints, the need to further develop regional cooperation, and operational and ethical challenges in a pandemic. CONCLUSIONS: The tabletop exercise gave evidence of being a simple and acceptable tool for rural medical planners. It lends itself well to improving medical preparedness, analysis of weak spots, development of regional teamwork, and rapid response.

The effect of two different faculty development interventions on third-year clerkship performance evaluations.

BACKGROUND AND OBJECTIVES: Clinical performance evaluations of medical students often fail to identify significant deficiencies. Many physicians are unwilling to give a poor or failing performance evaluation. Consequently, many clinical rotation grades are inflated and do not reflect actual student performance. We developed a computer-based faculty development tutorial designed to teach faculty members to use defined standards in the evaluation process and to give accurate performance grades to students and residents. METHODS: We administered the tutorial to 25 family medicine faculty members. Immediate posttests and 3-month posttests were given to determine their mastery of the material. Grades were tracked for 2 years prior to the intervention and for the year following the intervention. After the 1-year intervention, the clerkship director went to each site and met directly with each faculty member. The computer tutorial material was reviewed again with faculty members. Grades for this academic year were tracked and compared with the control years and first intervention year. RESULTS: The faculty demonstrated mastery of the material and retention at 3 months, yet the grades for the first year following the computer tutorial by itself did not change. However, after establishing a face-to-face intervention, the grades were significantly lower overall, compared to the control (88.3 versus 91.8). CONCLUSIONS: Self-directed, computer-based faculty development resulted in knowledge mastery and retention but was by itself not enough to change faculty grading practices. An additional face-to-face intervention did change grading practices. Faculty development via independent study may provide basic knowledge, but it must be combined with direct interaction, feedback, and policy change to influence clinical grading practices.

Developing disaster preparedness competence: an experiential learning exercise for multiprofessional education.

BACKGROUND: The hurricane disasters of 2005 and the threat of pandemic infectious diseases compel medical educators to develop emergency preparedness training for medical students and other health care professional students. DESCRIPTION: This article describes an experiential exercise for learning a number of the general core competencies in the 2003 AAMC report titled "Training Future Physicians about Weapons of Mass Destruction." A modified tabletop exercise for medical and veterinary students, which was developed and implemented in 2005, is described. The exercise focused on Highly Pathogenic Avian Influenza (HPAI), an emerging infectious disease scenario that raised the possibility of biological attack. The students were assigned roles in small groups, such as community physicians, hospital personnel, public health officials, veterinarians, school nurses, and emergency managers. Fifteen faculty members were recruited from these various areas of expertise. Pre- and posttesting of medical students showed significant gains in knowledge. The authors describe the scenario, small-group role playing, study questions, injects, Web sites and readings, and evaluation tools. CONCLUSIONS: This experiential exercise is an effective, inexpensive, and easily adapted tool for promoting multiple competencies in mass health emergency preparedness for a variety of health care students including medical, veterinary, public health, and nursing students.

Sustainability of partnership projects: a conceptual framework and checklist.

BACKGROUND: There is growing recognition that the health care delivery system in the United States must make major changes. Intervention projects focusing on quality and patient safety offer the potential for reshaping the future of medicine. Sustainability of the Partnerships for Quality (PFQ) projects and other patient safety and quality improvement projects that provide evidence of effectiveness is essential if progress is to be made. METHODS: For the purposes of these projects, a conceptual framework and a checklist for sustainability were developed. The framework consists of two dimensions: (1) the goals--what is to be sustained--and (2) elements for sustainability--infrastructure, incentives, incremental opportunities for involvement, and integration. The checklist is designed to trigger planning for sustainability early in a project's design. Specific questions about each of the elements can cue planners and project leaders to build in the goals for sustainability and change processes. RESULTS: A pilot test showed that the framework and checklist are relevant and helpful across a variety of projects. DISCUSSION AND CONCLUSION: Two extended examples of planning and action for sustainability from the PFQ projects are described. It is too early to claim sustainability for these project. However, continued monitoring for at least three years with the checklist could result in valuable national data with which to design and implement future projects.

Evaluating the impact of partnerships to improve clinical quality.

BACKGROUND: Translating research into practice and policy is a complex process that links the research enterprise and health care delivery system of the United States. The Agency for Healthcare Research and Quality (AHRQ) Partnerships for Quality (PFQ) initiative expanded the scope of research translation beyond clinical practice, highlighting the role of strategic partners. A work group of AHRQ grantees developed a framework for systematic evaluation of the impact of strategic partnerships on research translation. METHODS: The evaluation framework posits a hierarchy of impacts that cumulatively lead to observable patient outcomes. The evaluation framework captures (1) health care outcomes improvement, (2) clinical practice changes, (3) policies, procedures, and protocols, and (4) research and knowledge. After the framework and tool were subjected to face-validity critique among PFQ investigators, the concept of synergy was added. PFQ investigators pilot-tested the evaluation framework, and the PFQ tool was refined further. RESULTS: Early feedback from PFQ grantees suggested that the framework is generalizable and potentially useful to guide investigators in capturing impacts of their work that might otherwise go unrecognized or trivialized. DISCUSSION: The PFQ Evaluation Tool, a pragmatic approach for evaluating the impact of partnership-driven translation projects, provides a comprehensive evaluation of impacts, including synergistic outcomes.

The role of public health nurses in bioterrorism preparedness.

BACKGROUND: Public health nurses have a central function in the public health system. Nurses conduct disease surveillance, which is an important first step in recognizing diseases caused by bioterrorist agents. Unfortunately, the current public health infrastructure and expectations for public health nurses are not clearly defined and therefore pose serious difficulties for conducting disease surveillance. Increased surveillance activities for bioterrorism preparedness add more responsibilities to the work of public health nurses. METHODS: A qualitative study on disease surveillance was conducted with public health officials at regional and local levels, working in a variety of urban and rural settings in one large public health region in Texas. Data analysis was supported by qualitative research software, The Ethnograph. RESULTS: The study found that the nurses working at the local level were extremely dedicated to serving their communities, had formed informal partnerships that are essential for disease surveillance, and effectively used informal communication channels to obtain critical surveillance information. The study revealed that nurses had unmet needs and experienced multiple barriers to conducting disease surveillance. CONCLUSIONS: The study's findings could have implications for public policy and nursing leadership. Defining the structure of the public health system and the scope of public health nurses' responsibilities will serve as the cornerstone for improvement of bioterrorism preparedness.

Lessons learned from a regional strategy for resource allocation.

Two qualitative case studies focus on the allocation of CDC funds distributed during 2002 for bioterrorism preparedness in two Texas public health regions (each as populous and complex as many states). Lessons learned are presented for public health officials and others who work to build essential public health services and security for our nation. The first lesson is that personal relationships are the cornerstone of preparedness. A major lesson is that a regional strategy to manage funds may be more effective than allocating funds on a per capita basis. One regional director required every local department to complete a strategic plan as a basis for proportional allocation of the funds. Control of communicable diseases was a central component of the planning. Some funds were kept at the regional level to provide epidemiology services, computer software, equipment, and training for the entire region. Confirmation of the value of this regional strategy was expressed by local public health and emergency management officials in a focus group 1 year after the strategy had been implemented. The group members also pointed out the need to streamline the planning process, provide up-to-date computer networks, and receive more than minimal communication. This regional strategy can be viewed from the perspective of adaptive leadership, defined as activities to bring about constructive change, which also can be used to analyze other difficult areas of preparedness.

A survey of basic technical skills of medical students.

PURPOSE: In 1998, the Medical Schools Objectives Project (MSOP) Report listed the minimum routine technical procedures that graduating medical students should be proficient to perform. The authors conducted a survey to determine to what extent basic technical skills are being taught formally and how student competence in these skills is being evaluated in U.S. medical schools. METHOD: A questionnaire of five items, designed to supplement existing information in CurrMIT, the national curriculum database for medical schools, was transmitted electronically via the AAMC listserv to associate deans for academic affairs. RESULTS: Sixty-two of the 126 medical schools (52%) responded to the survey. Most agreed that graduating medical students should be proficient to perform basic technical skills. Fifty-five percent of the respondents required students to keep logs of procedures performed. A majority responded that their students were proficient to perform venipuncture, IV placement, suturing lacerations, Foley catheter placement, and arterial puncture. The responding schools stated that few students are proficient in thoracentesis and intubation of children and neonates. CONCLUSIONS: It is likely that half of the medical schools are not attaining the MSOP objective of rigorously teaching and evaluating technical procedures. Currently, more measures and more sophisticated measures of physicians' performance are being implemented in medical practice. The authors' findings call attention to this educational need and act as a stimulus to improve this aspect of medical education.

Veterinary school admission interviews, part 3: strategies for increasing interview validity.

The veterinary school admission interview is a widely used selection tool, yet concerns persist about its reliability, validity, and cost. Relative to medicine, optometry, and dentistry schools, veterinary schools have been more likely to conduct panel interviews and to fix the interview's weight in selection decisions, strategies that increase interview validity. This article provides strategies for further increasing the veterinary school interview's validity. Interview reliability and validity studies point to key strategies the veterinary school admissions committee can implement before the interview: (1) establishing the interview's purpose(s); (2) conducting a "job" analysis to identify desirable candidate skills, knowledge, and attributes; (3) developing a structured and panel interview where interviewers, if possible, are blind to other admission data; (4) training interviewers; (5) setting a reasonable interview schedule; and (6) determining methods for analyzing applicant data. During the interview, interviewers should proceed through a structured series of steps: (1) open the interview with a specified agenda; (2) probe for information using structured questions and anchored rating scales; (3) close the interview to allow for candidate questions; and (4) evaluate the interview data. After the interview, the admissions committee should (1) analyze the interview data within and across interviewers and (2) analyze the data across all selection tools in order to assign relative weights to the selection tools.

Attitudes of veterinary medical students and medical students toward collaborative learning: an experiment.

This study measured the attitudes of 55 medical students and 30 veterinary medical students as they participated in an experiment of collaborative teaching and learning about basic surgical skills. Two parallel forms of an attitude questionnaire were developed, with three subscales: confidence in one's own surgical skill; collaboration with the other type of student; and inter-professional collaboration in general. These attitude scales were administered before and after an experiment involving the veterinary medical students teaching the medical students incision and exploratory laparoscopy in a laboratory setting using live rabbits. After the experiment, measures of the medical students' attitudes had increased significantly on all three subscales. Measures of the veterinary students' attitudes increased significantly on two subscales but declined on the subscale of inter-professional collaboration.

Teaching medical students complementary and alternative medicine using evidence-based principles.

OBJECTIVES: Introducing new ideas such as complementary and alternative medicine (CAM) and evidence-based medicine (EBM) to medical students early in their education may help to nurture their interest. This study evaluated the effectiveness of teaching CAM using EBM principles and assessed changes in student perceived knowledge, attitudes, and skills following a new curriculum on CAM. DESIGN: A before-and-after evaluation using a one-page, anonymous questionnaire. SETTING AND SUBJECTS: All third year students of a state, public medical school in Texas. INTERVENTION: A new curriculum comprising interactive sessions on CAM, EBM, and basic principles of epidemiology and biostatistics. OUTCOME MEASURES: Changes in student-perceived knowledge, attitudes, and skills. RESULTS: Of 67 students, complete data were obtained for 54 (81%). The majority reported that the new instruction in CAM (98%), EBM (96%), biostatistics (91%), and epidemiology (87%) would be of some benefit in their future work. Significant changes were reported in the areas of appraising a clinical trial (p < 0.0001), critiquing the medical literature (p < 0.01), and the appropriateness of integrating EBM and CAM in the medical school curriculum (p < 0.05). There were modest increases in the mean responses on their skill level in reading/understanding the medical literature (3.40-3.52), comfort level in reading the medical literature (3.53-3.67), and preparedness in designing a research study (2.12-2.39) based on a five-point Likert scale, although not statistically significant. CONCLUSIONS: Medical students could be effectively taught CAM using EBM principles. In addition, a short, interactive curriculum on an important topic has a positive impact on medical students' desires to acquire new knowledge. This should be a good motivational message to family medicine educators regarding the contribution to new knowledge such as CAM.