Effect of an integrated nutrition curriculum on medical education, student clinical performance, and student perception of medical-nutrition training.

BACKGROUND: Ninety-eight percent of medical schools report nutrition as a component of medical education. However, most schools do not have an identifiable nutrition curriculum. Medical schools that do include nutrition have not evaluated its effect on clinical skills. OBJECTIVE: The objective was to determine the efficacy of an integrated undergraduate medical curriculum to increase the quantity of nutrition instruction and to advance nutrition clinical skills demonstrated by medical students. DESIGN: A quasiexperimental design was constructed to determine whether an integrated nutrition curriculum increased the performance on nutrition-oriented clinical examinations of medical school classes that received 1, 2, or 3 y of the curriculum. The evaluation of the curriculum focused on 3 areas: 1) hours of nutrition instruction, 2) the application of nutrition within a clinical setting, and 3) perceptions about the nutrition curriculum. The Objective Structured Clinical Examination (OSCE) nutrition score was compared between graduating classes by use of analysis of variance. Data from the American Association of Medical Colleges were analyzed to determine the change in the proportion of students who reported that the amount of time devoted to nutrition was adequate. RESULTS: The implementation of the integrated nutrition curriculum resulted in a doubling of the total hours of required instruction in the medical curriculum (35 compared with 75 h). The mean (+/-1 SEM) OSCE nutrition score significantly improved after the implementation of the curriculum (41.7 +/- 0.9% compared with 50.6 +/- 1.1%) and the percentage of students who reported that the amount of nutrition taught during medical school was inadequate decreased (68.4% compared with 11.5%). CONCLUSION: Medical students improved their clinical nutrition practice skills through participation in an integrated nutrition curriculum.

Performances of underrepresented-minority students at the University of Arizona College of Medicine, 1987-1991.

PURPOSE: To compare the academic performances of underrepresented-minority (African American, Native American, and Hispanic) students and all other students at the University of Arizona College of Medicine. METHOD: The performances of 42 underrepresented-minority and 368 other students who graduated between 1987 and 1991 were compared using the following variables: undergraduate science, non-science, and overall grade-point average (GPA); scores on the Medical College Admission Test (MCAT); subtest and total scores on the National Board of Medical Examiners (NBME) Part I and Part II examinations; and three types of evaluations from a required family practice clerkship. In addition, a comparison was made of scores on an objective structured clinical examination (OSCE) taken in the fourth year by 25 underrepresented-minority and 165 other students. Data were analyzed using a three-way analysis of variance and Pearson correlation analysis. RESULTS: The underrepresented-minority students earned significantly lower GPAs and scored significantly lower on all standardized paper-and-pencil tests and the family practice clerkship final examination. There was no significant group difference in the family practice clerkship clinical evaluations or the majority of the OSCE scores. For both groups, overall GPAs and MCAT scores correlated equally well with NBME total scores but were not significantly corrected with OSCE scores or family practice clerkship clinical evaluations. CONCLUSION: While the underrepresented-minority students entered medical school with significant educational disadvantages and continued to score lower than the other students on paper-and-pencil tests, their clinical performances on the OSCE and family practice clerkship were nearly equivalent to those of the other students.

Correlations of family medicine clerkship evaluations with scores on standard measures of academic achievement.

BACKGROUND: The family medicine clerkship at the University of Arizona uses three methods to evaluate students. The purpose of this study is to 1) look for possible sources of bias in each method, 2) validate the evaluation methods by correlating with other measures of academic achievement, and 3) measure the amount of correlation between the three evaluation methods. METHODS: The three clerkship evaluation methods include a final exam, clinical evaluations, and problem-solving scores. The clerkship evaluations received by 482 students were correlated with undergraduate grade point averages, MCAT scores, National Board of Medical Examiners parts I and II subtests and total scores, gender, age, race, college major, and timing of the clerkship. RESULTS: Females and older students scored higher on problem solving and minority students scored lower on the final exam. Students in the second half of the year scored higher on the final exam. There were significant correlations found between the final exam score and all the scores on standard measures of academic performance except the MCAT quantitative subtest. Problem-solving scores correlated only with NBME part II. The clinical evaluations correlated with five NBME part I subtest scores, three NBME part II subtest scores, and both parts I and II total scores. All three evaluation methods correlated significantly with each other. CONCLUSIONS: These analyses highlight the need to examine all evaluation methods used in order to improve their validity and reliability and to find potential biases. In addition, more work is needed to document the predictive validity of clerkship evaluations by correlating them with future clinical performance.

Characteristics influencing career decisions of academic and nonacademic emergency physicians.

STUDY OBJECTIVE: To determine characteristics motivating physicians to choose careers in academic and nonacademic emergency medicine. DESIGN: A written survey of 1,017 active members of the Society for Academic Emergency medicine and of a random sample of 2,000 members of the American College of Emergency Physicians was performed. Questions were asked regarding medical school, residency, and fellowship training; the importance of specific factors in influencing career decisions; and perceived obstacles to emergency medicine research. Responses from nonfaculty and adjunct, clinical, and research faculty were compared using chi 2 analysis for discrete variables and a four-group analysis of variance for continuous variables. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Responses were obtained from 1,203 physicians (41.3%). Those choosing academic careers were significantly more likely to complete a residency in emergency medicine or internal medicine and fellowship training in research or toxicology compared with nonacademic physicians. Nonfaculty and clinical faculty considered family obligations, leisure time, and personal income to be the most important factors influencing their career decisions; research faculty considered role models and the value of research to be most important. There was no difference in indebtedness among the groups. Finding time and funding, administrative obligations, and pressures to do clinical work were the most important obstacles to research productivity. CONCLUSION: Factors influencing career decisions can be used to plan strategies to meet the future needs of academic emergency medicine.

Factors influencing resident career choices in emergency medicine.

OBJECTIVE: To assess the attitudes of residents in emergency medicine regarding a career in academics. DESIGN: A 22-item questionnaire was administered to residents in conjunction with the yearly American Board of Emergency Medicine inservice examination. Demographic information and factors influencing career intent were elicited. Respondents were classified by intent on a career in emergency medicine. A three-way analysis of variance was used to address group differences for eight specific factors impacting on career decision. Chi-square analysis was used to address questions involving relationships among variables with dichotomous or categorical responses. RESULTS: The survey was distributed to 1,654 residents, and 1,238 (75%) completed the questionnaire. Motivating factors demonstrating significant differences between those residents planning an academic career and those not interested in academe were a desire to do research, desire to teach, desire to make a contribution to medicine, and exposure to role models, with less emphasis on the need for free time for other interests and less concern regarding practice location. More than 80% of those not going into academic emergency medicine believed they were adequately exposed to research in residency compared with 65% of those intent on a career in academe (P less than .01). Research in medical school, residency, and authorship of a research paper were significantly more prevalent for those residents desiring a career in academe (P less than .01). Twenty-six percent of residents responded that their role models for research were less than adequate. Seventeen percent of residents intend to take fellowship training. The most popular fields for fellowships were toxicology (25%), emergency medical services (21%), pediatrics (15%), and research (9%). CONCLUSION: The results of this survey address attitudes among residents toward a career in academic emergency medicine. Factors such as motivation, role models, and exposure to research may help academicians plan strategies to meet the future needs of academic emergency medicine.

Structural equation modeling in clinical assessment research with children.

The use of structural equation modeling has gained increased interest in recent years in the social and behavioral sciences. This article reviews the basic tenets of structural modeling in relation to issues in research and practice involving clinical assessment and compares this approach with more traditional psychometric approaches to the validation of assessment instruments with children. Arguments for and against the inclusion of nonexperimental variables in causal studies aimed at establishing construct validity are also discussed. An illustrative example of the application of structural equation modeling in clinical assessment research is provided, and a comparison is made between this approach and traditional psychometric procedures. Implications and suggestions for the use of structural modeling are discussed for both the practitioner and the clinical researcher.

Sharing of information by students in an objective structured clinical examination.

Increasing numbers of medical schools are using Objective Structured Clinical Examinations (OSCEs) to evaluate students. An Objective Structured Clinical Examination employs a multiple-station format and standardized patients to document students' clinical skills. A lengthy format is necessary; testing an entire class often necessitates multiple repetitions of the same examination. This dictates a need to minimize sharing of information among students. We studied six administrations of an Objective Structured Clinical Examination designed to measure skills. Analyses were conducted to detect changes in scores over the administrations as well as over the 8.5 hours of each day of testing. An increase in either might indicate information sharing had occurred. No significant increase occurred. If information was shared, it had no significant effect on scores. Skills a student uses to approach a patient should not change even if the patient's complaints are known.

Research and research training in academic radiology departments. A survey of department chairmen.

We surveyed 121 chairmen of academic radiology departments to assess how these departments select and educate their residents and fellows in research. Eighty-six chairmen responded (71%). The majority of their programs select at least some of their trainees for their potential as researchers and nearly all encourage trainees to perform research. The more the selection process focuses on research, the greater the percentage of residents and fellows that participate in research during training. Nonetheless, only about one-third of residents and half of the fellows perform and publish research. Only half the programs offer formal research seminars and few trainees opt for additional research training. These results may relate to the relatively small percentage of faculty performing prospective clinical and laboratory research. These findings are disappointing in the light of previous results suggesting that performing research, publication, and formal research education during training correlate highly with the development of successful research careers. Chairmen could increase the likelihood of trainees choosing research careers and being successful in publishing research by providing early exposure to research experiences and providing formalized research training.

Influences affecting radiologists' choices of academic or private practice careers.

The authors surveyed 5,000 practicing radiologists and 3,000 individuals currently in radiology training to determine the aspects of their backgrounds, education, training, and attitudes that most affected their career decisions. The choice of academic radiology was associated with receiving medical school education or radiology training at an institution ranking among the 20 with the most federal grant funding, publishing research articles, and participating in a variety of interpersonal research experiences during radiology training. Academic radiologists were more likely to choose their careers because of their interests, aptitudes, and greater concern for the value of doing research. Private practitioners rated family obligations, leisure time, and level of personal income as more significant influences on their career choices. Programs interested in training more academic radiologists should reconsider how they select trainees and provide an appropriate research environment during training.

Factors influencing radiologists to choose research careers.

The future of radiology is threatened by the paucity of competent researchers who are radiologists. To determine what influences are most important in selecting and training potential radiology researchers, we conducted a survey of 5000 practicing radiologists, including all members of the Association of University Radiologists. We also surveyed 3000 randomly selected radiology trainees. A research career was empirically defined as 20% or more of a radiologist's time being involved with research. Response to the practicing radiologists and radiology trainees surveys was 28% and 19%, respectively. Radiologists who attended medical school or trained in radiology at an institution among the top 20 for research funding more frequently chose careers in research than those who matriculated and trained elsewhere. Publishing at least one research article, having a dedicated radiology research fellowship, having access to grant funds, and using computers during medical school or radiology training were factors typifying radiologists who chose research careers. Research radiologists were more concerned about the value of performing research and less concerned about personal income than those choosing careers not focusing on research. These results suggest that it might be possible to select radiology trainees who are more likely to become researchers based on their backgrounds and attitudes. An appropriate milieu during training enhances the likelihood of radiologists choosing research careers.

Factors influencing the success of academic radiologists in publishing research.

To guide changes that might improve radiologists' research productivity, we surveyed 1400 members of the Association of University Radiologists. We evaluated the impact of influences related to background, education, training, attitudes, and practice environment on 558 respondents' frequency of research publication. Attending medical school, obtaining radiology training, and practicing at an institution among the 20 with the highest amount of research funding was associated with the highest research productivity in academic practice. Taking a radiology research fellowship, regularly attending research seminars, and association with a research mentor during training were also associated with higher career productivity. Virtually all aspects of the academic practice milieu, and particularly having time set aside for research, were significant influences on radiologists' frequency of publication. Men published research more frequently than women. This phenomenon appears related to women being afforded fewer research experiences during radiology training and a greater concern on the part of women about obstacles that hinder their doing research. These data might be employed to guide changes that would improve the selection and nurturing of individuals likely to be productive in research.

A schema for teaching differential diagnosis.

Eighty-one third-year and early fourth-year medical students were taught a simple schema for generating differential diagnoses. Significant gain in listing correct diagnoses was realized following training.