Utility of a Standardized Fourth-Year Medical Student Surgical Preparatory Curriculum: Program Director Perceptions.

OBJECTIVE: Each July, surgical interns arrive to residency with variable skills, knowledge, and clinical experience. To standardize and improve intern preparation, the American College of Surgeons (ACS), Association of Program Directors in Surgery, and Association for Surgical Education developed a pilot Resident Prep Curriculum (RPC). To date, no studies have analyzed these efforts. We aimed to discern program director (PD) perceptions of RPC participants as an initial means of analysis. DESIGN: A 17-question PD survey was designed to assess variable preparedness and performance between RPC participants and nonparticipants. PDs reporting matriculation of a RPC participant were first asked to globally compare the participant to nonparticipants. Using a 5-point Likert scale, PDs were then asked to compare participants to nonparticipants in 7 distinct categories, which were based on course objectives that parallel the Accreditation Council for Graduate Medical Education competencies. Descriptive statistics and tests of significance were performed to evaluate the responses. PARTICIPANTS: The survey was sent via electronic mail to 245 accredited general surgery residency PDs. RESULTS: A total of 103 (42.0%) PDs responded. Of the respondents, 27 (26.2%) reported matriculation of a RPC participant. When assessing efficiency in intern responsibilities, 26.9% of PDs noted participant advantage, and when gauging comfort in intern-role, 25.9% of PDs reported participant benefit. Across the 7 queried course objectives, there was a statistically significant improvement in the technical skill domain (p = 0.007) and a nonsignificant trend toward improvement in several of the other 6 domains: interpersonal skills (p = 0.055), medical knowledge (p = 0.067), patient care (p = 0.081), systems-based practice (p = 0.085), problem-based learning (p = 0.106), and professionalism (p = 0.357). CONCLUSIONS: PD perceptions revealed global advantage to RPC participation Furthermore, 1/4 of the time and specific competency performance showed substantial improved performance in technical skills. Survey timing and washout may bias this study, and the results should be compared to learner and senior resident perceptions, where observations may be more granular.

Monitoring the Veterinary Medical Student Experience: An Institutional Pilot Study.

Veterinary medical school challenges students academically and personally, and some students report depression and anxiety at rates higher than the general population and other medical students. This study describes changes in veterinary medical student self-esteem (SE) over four years of professional education, attending to differences between high and low SE students and the characteristics specific to low SE veterinary medical students. The study population was students enrolled at the Michigan State University College of Veterinary Medicine from 2006 to 2012. We used data from the annual anonymous survey administered college-wide that is used to monitor the curriculum and learning environment. The survey asked respondents to rate their knowledge and skill development, learning environment, perceptions of stress, skill development, and SE. Participants also provided information on their academic performance and demographics. A contrasting groups design was used: high and low SE students were compared using logistic regression to identify factors associated with low SE. A total of 1,653 respondents met inclusion criteria: 789 low SE and 864 high SE students. The proportion of high and low SE students varied over time, with the greatest proportion of low SE students during the second-year of the program. Perceived stress was associated with low SE, whereas perceived supportive learning environment and skill development were associated with high SE. These data have provided impetus for curricular and learning environment changes to enhance student support. They also provide guidance for additional research to better understand various student academic trajectories and their implications for success.

Refining a brief decision aid in stable CAD: cognitive interviews.

BACKGROUND: We describe the results of cognitive interviews to refine the "Making Choices©" Decision Aid (DA) for shared decision-making (SDM) about stress testing in patients with stable coronary artery disease (CAD). METHODS: We conducted a systematic development process to design a DA consistent with International Patient Decision Aid Standards (IPDAS) focused on Alpha testing criteria. Cognitive interviews were conducted with ten stable CAD patients using the "think aloud" interview technique to assess the clarity, usefulness, and design of each page of the DA. RESULTS: Participants identified three main messages: 1) patients have multiple options based on stress tests and they should be discussed with a physician, 2) take care of yourself, 3) the stress test is the gold standard for determining the severity of your heart disease. Revisions corrected the inaccurate assumption of item number three. CONCLUSIONS: Cognitive interviews proved critical for engaging patients in the development process and highlighted the necessity of clear message development and use of design principles that make decision materials easy to read and easy to use. Cognitive interviews appear to contribute critical information from the patient perspective to the overall systematic development process for designing decision aids.

Documenting clinical performance problems among medical students: feedback for learner remediation and curriculum enhancement.

INTRODUCTION: We operationalized the taxonomy developed by Hauer and colleagues describing common clinical performance problems. Faculty raters pilot tested the resulting worksheet by observing recordings of problematic simulated clinical encounters involving third-year medical students. This approach provided a framework for structured feedback to guide learner improvement and curricular enhancement. METHODS: Eighty-two problematic clinical encounters from M3 students who failed their clinical competency examination were independently rated by paired clinical faculty members to identify common problems related to the medical interview, physical examination, and professionalism. RESULTS: Eleven out of 26 target performance problems were present in 25% or more encounters. Overall, 37% had unsatisfactory medical interviews, with 'inadequate history to rule out other diagnoses' most prevalent (60%). Seventy percent failed because of physical examination deficiencies, with missing elements (69%) and inadequate data gathering (69%) most common. One-third of the students did not introduce themselves to their patients. Among students failing based on standardized patient (SP) ratings, 93% also failed to demonstrate competency based on the faculty ratings. CONCLUSIONS: Our review form allowed clinical faculty to validate pass/fail decisions based on standardized patient ratings. Detailed information about performance problems contributes to learner feedback and curricular enhancement to guide remediation planning and faculty development.

Shared Decision Making Guidance Reminders in Practice (SDM-GRIP).

OBJECTIVE: Develop a system of practice tools and procedures to prompt shared decision making in primary care. SDM-GRIP (Shared Decision Making Guidance Reminders in Practice) was developed for suspected stable coronary artery disease (CAD), prior to the percutaneous coronary intervention (PCI) decision. METHODS: Program evaluation of SDM-GRIP components: Grand Rounds, provider training (communication skills and clinical evidence), decision aid (DA), patient group visit, encounter decision guide (EDG), SDM provider visit. RESULTS: Participation-Physician training=73% (21/29); patient group visits=25% of patients with diagnosis of CAD contacted (43/168). SDM visits=16% (27/168). Among SDM visit pairs, 82% of responding providers reported using the EDG in SDM encounters. Patients valued the SDM-GRIP program, and wanted to discuss comparative effectiveness information with a cardiologist. SDM visits were routinely reimbursed. CONCLUSION: Program elements were well received and logistically feasible. However, recruitment to an extra educational group visit was low. Future implementation will move SDM-GRIP to the point of routine ordering of non-emergent stress tests to retain pre-decision timing of PCI and to improve coordination of care, with SDM tools available across primary care and cardiology. PRACTICE IMPLICATIONS: Guidance prompts and provider training appear feasible. Implementation at stress testing requires further investigation.

Better data for teachers, better data for learners, better patient care: college-wide assessment at Michigan State University's College of Human Medicine.

When our school organized the curriculum around a core set of medical student competencies in 2004, it was clear that more numerous and more varied student assessments were needed. To oversee a systematic approach to the assessment of medical student competencies, the Office of College-wide Assessment was established, led by the Associate Dean of College-wide Assessment. The mission of the Office is to 'facilitate the development of a seamless assessment system that drives a nimble, competency-based curriculum across the spectrum of our educational enterprise.' The Associate Dean coordinates educational initiatives, developing partnerships to solve common problems, and enhancing synergy within the College. The Office also works to establish data collection and feedback loops to guide rational intervention and continuous curricular improvement. Aside from feedback, implementing a systems approach to assessment provides a means for identifying performance gaps, promotes continuity from undergraduate medical education to practice, and offers a rationale for some assessments to be located outside of courses and clerkships. Assessment system design, data analysis, and feedback require leadership, a cooperative faculty team with medical education expertise, and institutional support. The guiding principle is 'Better Data for Teachers, Better Data for Learners, Better Patient Care.' Better data empowers faculty to become change agents, learners to create evidence-based improvement plans and increases accountability to our most important stakeholders, our patients.

Being uninformed on informed consent: a pilot survey of medical education faculty.

BACKGROUND: This paper describes a pilot survey of faculty involved in medical education. The questionnaire focuses on their understanding of IRB policies at their institution, specifically in relation to the use of student assessment and curriculum evaluation information for scholarship. METHODS: An anonymous survey was distributed to medical educators in a variety of venues. Two brief scenarios of typical student assessment or curriculum evaluation activities were presented and respondents were asked to indicate their likely course of action related to IRB approval. The questionnaire also asked respondents about their knowledge of institutional policies related to IRB approval. RESULTS: A total of 121 completed surveys were obtained; 59 (50%) respondents identified themselves as from community-based medical schools. For the first scenario, 78 respondents (66%) would have contact with the IRB; this increased to 97 respondents (82%) for the second scenario. For both scenarios, contact with the IRB was less likely among respondents from research-intensive institutions. Sixty respondents (55%) were unsure if their institutions had policies addressing evaluation data used for scholarship. Fifty respondents (41%) indicated no prior discussions at their institutions regarding IRB requirements. CONCLUSION: Many faculty members are unaware of IRB policies at their medical schools related to the use of medical student information. To the extent that policies are in place, they are highly variable across schools suggesting little standardization in faculty understanding and/or institutional implementation. Principles to guide faculty decision-making are provided.

Lessons learned from implementing multidisciplinary health professions educational models in community settings.

This article addresses sustainability elements for multidisciplinary health professions education in communities. The results are based on a 5 year program involving multiple health professions education institutions in seven states within the USA. We offer observations and suggestions to others who plan and implement multidisciplinary programs for health professions educators. Our findings are based on the outcomes of the Community Partnerships in Health Professions Education (CPHPE) initiative funded by the W. K. Kellogg Foundation. Data sources included pre and post surveys of students and faculty, site visits, published evaluations and site reports, and a 2 year follow-up evaluation after the external funding phase. Elements of the partnership that facilitated the sustainability of the models were: leadership, complementary missions, curriculum that mirrors clinical community practice, change from outside in, partnership boards, and faculty development. Those elements that were barriers to sustaining the efforts were: professional identities and territorial boundaries, structural differences, costs, and unclear goals. The multidisciplinary components of the community partnership initiative were the most challenging. However, in most programs, they did succeed and are currently in place. By paying attention to the elements that enhance and detract from teaming, one can plan for more successful multidisciplinary education.

A strategy for developing educational evaluations for learner, course, and institutional goals.

The curricula for both veterinary and human medicine are undergoing review and change as a new and highly competitive practice environment influences what abilities graduates require to be successful. Concerning many is the contention that some graduates lack skills and aptitudes necessary for economic success. If significant changes are to be considered for the curricula of either profession, it will be difficult to plan for meaningful change in the absence of high-quality information about the needs of graduates and related curriculum gaps. The purpose of this article is to argue why educators should design more effective systems of evaluation that are responsive to the needs of educational program planning. One example from a medical school is described. In this case, the authors discuss how their institution's evaluations were insufficient for answering new and important questions that go beyond traditional cognitive measures: specifically, no data set was available that allowed the institution to answer questions about practice environment and curricular innovations. More recently, institutions have become interested in learning to what extent their broad missions are accomplished or not. Similarly, academic leaders are not simply interested in performance of learners on tests of competence; they want to know more about how their graduates are doing in the practice setting. To answer questions such as these, educators must expand their systems of evaluations to address these broader themes. The authors conclude by identifying several lessons learned from their experiences in developing a new system of educational program evaluation.