The Community Preceptor Crisis: Recruiting and Retaining Community-Based Faculty to Teach Medical Students-A Shared Perspective From the Alliance for Clinical Education.

ISSUE: Community-based instruction is invaluable to medical students, as it provides "real-world" opportunities for observing and following patients over time while refining history taking, physical examination, differential diagnosis, and patient management skills. Community-based ambulatory settings can be more conducive to practicing these skills than highly specialized, academically based practice sites. The Association of American Medical Colleges and other national medical education organizations have expressed concern about recruitment and retention of preceptors to provide high-quality educational experiences in community-based practice sites. These concerns stem from constraints imposed by documentation in electronic health records; perceptions that student mentoring is burdensome resulting in decreased clinical productivity; and competition between allopathic, osteopathic, and international medical schools for finite resources for medical student experiences. EVIDENCE: In this Alliance for Clinical Education position statement, we provide a consensus summary of representatives from national medical education organizations in 8 specialties that offer clinical clerkships. We describe the current challenges in providing medical students with adequate community-based instruction and propose potential solutions. IMPLICATIONS: Our recommendations are designed to assist clerkship directors and medical school leaders overcome current challenges and ensure high-quality, community-based clinical learning opportunities for all students. They include suggesting ways to orient community clinic sites for students, explaining how students can add value to the preceptor's practice, focusing on educator skills development, recognizing preceptors who excel in their role as educators, and suggesting forms of compensation.

Evaluating educators using a novel toolbox: applying rigorous criteria flexibly across institutions.

Valuing faculty as educators is essential for medical schools to fulfill their unique mission of educating physicians. The 2006 Consensus Conference on Educational Scholarship, sponsored by the Association of American Medical Colleges (AAMC) Group on Educational Affairs, provided educators seeking academic promotion with a portfolio-based format for documenting activities in five domains, using evidence of quantity, quality, a scholarly approach, and educational scholarship. Yet, the lack of a rigorous, widely accepted system to assess educator portfolio submissions during the promotion and tenure process continues to impede the ability to fully value educators and educational scholars.The AAMC Task Force on Educator Evaluation was formed in 2010 to establish consensus guidelines for use by those responsible for the rigorous evaluation of the educational contributions of faculty. The task force delineated the educational contributions currently valued by institutions and then fulfilled its charge by creating the Toolbox for Evaluating Educators, a resource which contains explicit evidence-based criteria to evaluate faculty in each of the five domains of educator activity. Adoption of such criteria is now the rate-limiting step in using a fair process to recognize educators through academic promotion. To inform institutional review and implementation of these criteria, this article describes the iterative, evidence- and stakeholder-based process to establish the criteria. The authors advocate institutional adoption of these criteria so that faculty seeking academic promotion as educators, like their researcher colleagues, can be judged and valued using established standards for the assessment of their work.

Tracking development of clinical reasoning ability across five medical schools using a progress test.

PURPOSE: Little is known about the acquisition of clinical reasoning skills in medical school, the development of clinical reasoning over the medical curriculum as a whole, and the impact of various curricular methodologies on these skills. This study investigated (1) whether there are differences in clinical reasoning skills between learners at different years of medical school, and (2) whether there are differences in performance between students at schools with various curricular methodologies. METHOD: Students (n = 2,394) who had completed zero to three years of medical school at five U.S. medical schools participated in a cross-sectional study in 2008. Students took the same diagnostic pattern recognition (DPR) and clinical data interpretation (CDI) tests. Percent correct scores were used to determine performance differences. Data from all schools and students at all levels were aggregated for further analysis. RESULTS: Student performance increased substantially as a result of each year of training. Gains in DPR and CDI performance during the third year of medical school were not as great as in previous years across the five schools. CDI performance and performance gains were lower than DPR performance and gains. Performance gains attributable to training at each of the participating medical schools were more similar than different. CONCLUSIONS: Years of training accounted for most of the variation in DPR and CDI performance. As a rule, students at higher training levels performed better on both tests, though the expected larger gains during the third year of medical school did not materialize.

Toward hypothesis-driven medical education research: task force report from the Millennium Conference 2007 on educational research.

PURPOSE: In May 2007, the Association of American Medical Colleges and the Carl J. Shapiro Institute for Education and Research cosponsored "Millennium Conference 2007: A Collaborative Approach to Educational Research" (MC07). Educational leaders from eight U.S. medical schools and the host school (Harvard Medical School) sought to develop an operational list of the national medical education research priorities identified at the MC07. METHOD: The authors asked a diverse group of medical educators to evaluate the research priorities broadly outlined by MC07 participants, further refining the priorities, framing them into research questions with testable hypotheses, and ranking them. Through an iterative process among representatives from each of the MC07 participating institutions, 11 research priorities were identified, and each was reframed as a problem to be addressed with a testable hypothesis. Then, in a multiinstitutional survey, MC07 participants ranked each priority by its perceived national importance, feasibility, fundability, and amenability for multiinstitutional research. RESULTS: The impact of medical school simulation training on residents' performance emerged as the highest-rated priority, and the impact of faculty development on learner outcomes was the lowest-rated priority among MC07 participating schools. CONCLUSIONS: The process of framing medical education priorities in the form of testable hypotheses with measurable outcomes was an effective way for a diverse group of national medical education leaders to develop an agenda for educational research. The authors hope that this list will inform the national discussion on priorities in medical education research and will serve to help move this agenda forward.

Basic science right, not basic science lite: medical education at a crossroad.

This perspective is a counterpoint to Dr. Brass' article, Basic biomedical sciences and the future of medical education: implications for internal medicine. The authors review development of the US medical education system as an introduction to a discussion of Dr. Brass' perspectives. The authors agree that sound scientific foundations and skill in critical thinking are important and that effective educational strategies to improve foundational science education should be implemented. Unfortunately, many students do not perceive the relevance of basic science education to clinical practice.The authors cite areas of disagreement. They believe it is unlikely that the importance of basic sciences will be diminished by contemporary directions in medical education and planned modifications of USMLE. Graduates' diminished interest in internal medicine is unlikely from changes in basic science education.Thoughtful changes in education provide the opportunity to improve understanding of fundamental sciences, the process of scientific inquiry, and translation of that knowledge to clinical practice.

Advancing educators and education by defining the components and evidence associated with educational scholarship.

OBJECTIVE: This study aimed to establish documentation standards for medical education activities, beyond educational research, for academic promotion consistent with principles of excellence and scholarship. METHODS: In 2006 a Consensus Conference on Educational Scholarship was convened by the Association of American Medical Colleges (AAMC) Group on Education Affairs (GEA) to outline a set of documentation standards for use by educators and academic promotion committees. Conference participants' work was informed by more than 15 years of literature on scholarship, educator portfolios and academic promotion standards. RESULTS: The 110 conference participants, including medical school deans, academic promotion committee members, department chairs, faculty and AAMC leaders, re-affirmed the 5 education activity categories (teaching, curriculum, advising and/or mentoring, education leadership and/or administration, and learner assessment), the contents of each category, and cross-category documentation standards. Educational excellence requires documentation of the quantity and quality of education activities. Documenting a scholarly approach requires demonstrating evidence of drawing from and building on the work of others, and documenting scholarship requires contributing work through public display, peer review and dissemination; both involve engagement with the community of educators. Implementation of these standards - quantity, quality and engagement with the education community - should occur in parallel with the development of an infrastructure to support educators, including sustained faculty development for educators, access to educational resources and journals, peer review mechanisms and consultation and support specific to each activity category. CONCLUSIONS: Educators' contributions to their institutions must be visible to be valued. The establishment of documentation standards for education activities provides the foundation for academic recognition of educators.

The scholarship of teaching in health science schools.

Teaching is a core mission for all health science schools. Despite its key role in training new generations of health care professionals, teaching has been overshadowed by the revenue- and prestige-generating activities of research and clinical care. Research, both basic and clinical, is equated with scholarship and is rewarded in the promotion and tenure process, as well as with intramural and extramural funding. Clinical service generates revenue for schools; teaching, however, does not generate revenue, and, traditionally, teaching and the creative activity related to it have been seen not as scholarship but as an expectation. Over the last decade or so, scholars of teaching have called for a new view of scholarship that includes the scholarship of teaching. This view is broader in scope than scholarly teaching within a classroom or clinic. It refers to scholarly activity related to teaching that results in enduring products that are peer reviewed and broadly disseminated. These are examples of scholarly work and should be recognized as such. Academic institutions should value high-quality teaching and educational innovations and reward them as scholarly work. This article presents an overview of what the scholarship of teaching means, how it can be assessed, and the needed next steps.

Gender discrimination and sexual harassment in medical education: perspectives gained by a 14-school study.

PURPOSE: The authors attempted to determine male and female medical students' exposures to and perceptions of gender discrimination and sexual harassment (GD/SH) in selected academic and nonacademic contexts. METHOD: An anonymous, self-report questionnaire was administered in the spring of 1997 to senior medical students at 14 U.S. medical schools. Data were collected about students' exposures to GD/SH during undergraduate medical education and outside the medical training environment. Students' perceptions of GD/SH in various medical specialties and practice settings were also measured. RESULTS: Of the 1,911 questionnaires administered, 1,314 were completed (response rate, 69%). Both men and women reported exposures to GD/SH. More women than men reported all types of exposures to GD/SH across all academic and nonacademic contexts. Differences between men and women in the frequencies of exposures were greatest outside the medical training environment (t = 15.67, df = 1171, p

Health science learning academy: a successful "pipeline" educational program for high school students.

OBJECTIVE: The objective of the Health Professions Partnership Initiative is to increase the number of underrepresented minority Georgia residents who become health care professionals by (1) creating a pipeline of well-qualified high school and college students interested in health care careers, (2) increasing the number of well-qualified applicants to medical and other health professions schools, and (3) increasing the number of underrepresented minority students at the Medical College of Georgia (MCG). DESCRIPTION: The Health Professions Partnership Initiative at MCG was created in 1996 by collaboration among the MCG Schools of Medicine and Nursing, two Augusta high schools attended primarily by underrepresented minority students, three historically black colleges and universities, the Fort Discovery National Science Center of Augusta, community service organizations, and MCG student organizations. The project was funded by the Association of American Medical Colleges and The Robert Wood Johnson Foundation. The high school component, the Health Science Learning Academy (HSLA), was designed to strengthen the students' educational backgrounds and interest in professional careers as evidenced by increased standardized test scores and numbers of students entering college and health professions schools. Additional goals included a system to track students' progress throughout the pipeline as well as professional development sessions to enrich faculty members' knowledge and enhance their teaching expertise. The HSLA began with ninth-grade students from the two high schools. During its second year, funding from the Health 1st Foundation allowed inclusion of another high school and expansion to ninth grade through twelfth grade. The HSLA's enrichment classes meet for three hours on 18 Saturday mornings during the academic year and include computer-interactive SAT preparation and English composition (tenth grade); biology, algebra, calculus, and English composition (eleventh grade); and advanced mathematics and biology (twelfth grade). DISCUSSION: The ultimate solution to the paucity of underrepresented minority physicians resides largely in successful pipeline programs that expand the pool of well-qualified applicants, matriculants, and graduates from medical schools. Intermediate results of the HSLA support the success of the program. Since its creation in the 1996-1997 academic year, 203 students have participated in the HSLA and all 38 (from the original two schools) who completed the four-year program have enrolled in college. The mean SAT score for students who completed the HSLA program was 1,066, compared with a mean of 923 for all college-bound students in the participating schools. The mean increases in SAT scores for students who completed the four-year program were.5% (1,100 to 1,105) for students attending a magnet high school and 18% (929 to 1,130) for students attending the comprehensive high school. The mean overall increases in SAT scores for students in the two high schools were 1% (1,044 to 1,048) and 9.1% (765 to 834), respectively. The HSLA is accomplishing its goals and, while it is too early to know if these students will participate in MCAT preparatory programs and apply to medical and other health professions schools, their sustained commitment and enthusiasm bode well for continued success.