An Early Assessment of the ACGME CLER Program: A National Survey of Designated Institutional Officials.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review (CLER) is an innovative element of the ACGME's new accreditation system. To date, little information has been collected regarding the value of CLER. OBJECTIVE: The purpose of this study is to collect information on designated institutional officials' (DIOs') perspectives about the initial CLER visits conducted at their institutions. METHODS: The authors created and distributed a survey to DIOs about their initial CLER visits. Demographic data were compared across survey responses with Spearman's rank correlation and the Kruskal-Wallis test. RESULTS: The authors received responses from 63% of DIOs (186 of 297) at institutions that participated in the initial CLER visits, with 88% (164 of 186) having served as DIO during the visit. Seventy-two percent (114 of 158) reported institutional changes to address CLER focus areas prior to the visit, yet only 32% (51 of 157) reported that additional resources were allocated to these areas after the site visit. Sixty-five percent (102 of 156) reported institutional executive leadership was positive about participating in CLER; 85% (134 of 158) reported that ACGME conducted the visits efficiently; 84% (133 of 158) reported that the site visit accurately assessed the institution's performance in the CLER focus areas; and 60% (93 of 156) reported CLER provided high-value information. CONCLUSION: Survey results from DIOs suggest that CLER is an effective mechanism to improve the learning environment. Common concerns included limited advance notice for the site visit and disruptions of clinical practice.

Improvement in student science proficiency through InSciEd out.

Integrated Science Education Outreach (InSciEd Out) is a collaboration formed between Mayo Clinic, Winona State University, and Rochester Public Schools (MN) with the shared vision of achieving excellence in science education. InSciEd Out employs an equitable partnership model between scientists, teachers, education researchers, and the community. Teams of teachers from all disciplines within a single school experience cutting-edge science using the zebrafish model system, as well as current pedagogical methods, during a summer internship at the Mayo Clinic. Within the internship, the teachers produce new curriculum that directly addresses opportunities for science education improvement at their own school. Zebrafish are introduced within the new curriculum to support a living model of the practice of science. Following partnership with the InSciEd Out program and 2 years of implementation in the classroom, teacher-interns from a K-8 public school reported access to local scientific technology and expertise they had not previously recognized. Teachers also reported improved integration of other disciplines into the scientific curriculum and a flow of concepts vertically from K through 8. Students more than doubled selection of an Honors science track in high school to nearly 90%. 98% of students who took the Minnesota Comprehensive Assessments in their 5(th) and 8(th) grade year (a span that includes 2 years of InSciEd Out) showed medium or high growth in science proficiency. These metrics indicate that cooperation between educators and scientists can result in positive change in student science proficiency and demonstrate that a higher expectation in science education can be achieved in US public schools.

Impact of direct-to-consumer predictive genomic testing on risk perception and worry among patients receiving routine care in a preventive health clinic.

OBJECTIVE: To assess the impact of direct-to-consumer (DTC) predictive genomic risk information on perceived risk and worry in the context of routine clinical care. PATIENTS AND METHODS: Patients attending a preventive medicine clinic between June 1 and December 18, 2009, were randomly assigned to receive either genomic risk information from a DTC product plus usual care (n=74) or usual care alone (n=76). At intervals of 1 week and 1 year after their clinic visit, participants completed surveys containing validated measures of risk perception and levels of worry associated with the 12 conditions assessed by the DTC product. RESULTS: Of 345 patients approached, 150 (43%) agreed to participate, 64 (19%) refused, and 131 (38%) did not respond. Compared with those receiving usual care, participants who received genomic risk information initially rated their risk as higher for 4 conditions (abdominal aneurysm [P=.001], Graves disease [P=.04], obesity [P=.01], and osteoarthritis [P=.04]) and lower for one (prostate cancer [P=.02]). Although differences were not significant, they also reported higher levels of worry for 7 conditions and lower levels for 5 others. At 1 year, there were no significant differences between groups. CONCLUSION: Predictive genomic risk information modestly influences risk perception and worry. The extent and direction of this influence may depend on the condition being tested and its baseline prominence in preventive health care and may attenuate with time.