Students perceive skills learned in pre-clerkship PBL valuable in core clinical rotations.

Purpose: Problem-based learning (PBL) is an instructional method widely used by medical educators that promotes an environment in which students effectively learn the foundational knowledge and skills that are prerequisites for graduation. This study evaluated medical students' perceptions of the helpfulness of skills acquired in PBL to core clerkship rotations.Methods: A 25-item survey was designed to assess students' perceptions of skills learned in PBL that were helpful on core clerkships and transferable to the clinical setting. A random sample of students with at least 8 months of clerkship experience were invited to complete the survey.Results: Of 68 students, 35 (52%) returned questionnaires. Results suggest a clustering of themes based on their perceived value. Skills learned in PBL that students rated most highly as helpful or very helpful during core clinical rotations include: comfort discussing concepts, identifying key information, presentation skills, interpersonal skills, diagnostic thinking, finding information, self-awareness, and organizing information. Other items rated highly included: forming questions, time management, primary literature (engaging with published original research articles), and leadership. The skills acquired in PBL were associated with multiple competency domains.Conclusions: Although conditions of the pre-clerkship curriculum are substantially different from the learning environment of clerkship rotations, skills learned in PBL are perceived as applicable to authentic clinical training.

Scholarship in Teaching: An Approach to Enhancing the Value and Academic Standing of Teaching.

BACKGROUND: In our effort to increase the value and academic standing of teaching, we implemented an initiative focused on scholarship in teaching. Our program was narrowly focused, project-based, peer-reviewed, resource-neutral, and open to all faculty. Faculty members are invited annually to submit a description of their educational projects in keeping with Glassick's criteria. Our purpose was to assess the effects of this award program. METHOD: We reviewed the distribution of applications over a 3-year period and determined the academic departments, academic rank of applicants, and focus of projects. A questionnaire assessed applicants' perceptions of the value of participation, its contribution to promotion and advancement, and its role in subsequent dissemination activities. RESULTS: Slightly fewer than half (60 of 124, 48%) of the applications submitted during 2016 through 2018 were judged by peer review to meet Glassick's criteria for scholarship and received the award. Most applicants were junior faculty, and most applications were from the department of medicine though all departments who taught students in core clinical rotations were represented during the years studied. The projects that were awarded were more likely to be disseminated when compared with those who were not awarded. LESSONS LEARNED: Our scholarship in teaching program seemingly advanced educational scholarship among teaching faculty and provided a way of recognizing projects that advanced educational initiatives. Further efforts are required to promote support from departmental leadership, to enhance faculty participation, and to encourage success through mentoring and assistance in project preparation.

The effects of an intervention to teach medical students about obstructive sleep apnea.

BACKGROUND AND PURPOSE: To assess the effects of teaching clinically relevant core concepts about obstructive sleep apnea (OSA) to third-year core clerkship students in internal medicine. PATIENTS AND METHODS: The curriculum included a lecture and case-based discussions about OSA at one clerkship site consisting of six groups of core clerkship students in the graduating Classes of 2000 and 2001 at Case Western Reserve University School of Medicine. Students who received exposure to a lecture followed by case-based discussions (n=130) were compared to students at clerkship sites who did not (n=129). Outcomes were measured using a station on the required end-of-rotation Objective Structured Clinical Examination (OSCE), consisting of 13 items and 36 points. RESULTS: When compared to groups of students who did not have a scheduled lecture and case-based discussions, those who did scored significantly higher (P

A program on complementary therapies for long-term care nursing assistants.

Nursing assistants (NAs) receive insufficient support in the face of heavy workloads and challenging job demands. This article describes a course on complementary therapies (CTs) intended to improve NAs' quality of life by helping them plan, develop, implement, and evaluate CTs. Future studies may examine the impact, if any, such courses have on recruitment and retention.

Medical student competence in eliciting a history for "chronic fatigue".

PURPOSE: We report an observational study of medical students' abilities in taking a complex history for which sleep disorders is one of several possible conditions. METHODS: Students are observed taking a focused history from a simulated patient whose chief complaint is "I am tired. I cannot get anything done." Nine groups of students (n = 360) completing the internal medicine core-clerkship were evaluated by one of three examiners. Students received full, partial, or no credit for each item on a uniform behavioral checklist, which included prompts for common medical and psychiatric disorders associated with chronic fatigue. RESULTS: Observed means were lowest for items pertaining to sleep behaviors and head trauma. Fewer than half of the students inquired about whether or not the person had difficulty falling asleep at night, family history of sleep apnea, and frequency and length of naps. In contrast, the majority of students inquired about heart disease, metabolic disorders, the use of illicit drugs, alcohol consumption, and the taking of medications. Examiners accounted for a significant source of variance in scores; yet the station discriminated among top and bottom students as measured by the Objective Structured Clinical Examination (OSCE) overall. No statistically significant differences were observed on the basis of clerkship site, primary care versus traditional-track students, time of year, or gender. CONCLUSION: A majority of students do not adequately cover issues relevant to sleep in contrast to other associated disorders when taking a focused history for chronic fatigue.

Attitudes of faculty, housestaff, and medical students toward clinical practice guidelines.

PURPOSE: To examine attitudes of faculty, housestaff, and medical students toward clinical practice guidelines. METHOD: In a 1997 cross-sectional survey, a two-part, 26-item, self-administered questionnaire was mailed to all faculty, housestaff, and medical students in the department of internal medicine at Case Western Reserve University School of Medicine. The questionnaire asked for demographic information and attitudes toward clinical guidelines. RESULTS: Of 379 persons surveyed, 254 (67%) returned usable questionnaires: 56% of the medical students, 70% of the housestaff, and 73% of the full-time faculty. Medical students reported learning about guidelines predominantly during clerkships in internal medicine (71%) and pediatrics (68%). Overall, the respondents agreed most strongly that guidelines are "useful for the care of common problems," and least strongly that guidelines are "difficult to apply to individual patients" and "reduce physician options in patient care." Faculty were more likely to consider guidelines a "good educational tool" and less likely than were medical students and housestaff to agree that they promote "cookbook medicine." Of 11 influences on clinical decision making, the three groups together rated practice guidelines eighth or ninth. The use of guidelines for academic investigations was rated most appropriate, overall. In terms of their appropriateness, faculty consistently rated the use of guidelines more favorably except for use in malpractice suits. CONCLUSION: Faculty, housestaff, and medical students have significantly different perceptions of and attitudes toward clinical practice guidelines. Further studies are needed to explain the reasons for these differences. Considerable education and involvement must occur at all levels for practice guidelines to be successfully implemented and understood.

Performance of third-year primary-care-track students in an integrated curriculum at Case Western Reserve University.

In 1994, Case Western Reserve University School of Medicine established a Primary Care Track (PCT) with an integrated curriculum as part of The Robert Wood Johnson Foundation's Generalist Physician Initiative. This study compared the performance of the first cohort of students to participate in the PCT third year with that of their classmates and determined student attitudes toward their experiences. The performances of 24 PCT and 81 traditional students on the Medical School Admissions Test (MCAT) and the United States Medical Licensure Examination (USMLE) Step 1 and 2 were compared using analysis of variance. Grades on the six core clerkships were compared using chi-square analysis. Performances of the PCT students and a subset of traditional students on the generalist school's objective structured clinical exam (OSCE) were compared using multivariate analysis. The students reported their perceptions on a questionnaire. The traditional students had significantly higher scores on the physical science section of the MCAT and on the USMLE Step 1, but at the end of year three, their USMLE Step 2 scores did not differ. Grade distributions in the core clerkships did not differ, except in psychiatry, where the PCT students received honors significantly more often. The PCT students had a lower mean score on the internal medicine National Board of Medicine Examiners shelf exam but performed better on the generalist OSCE exam. A majority of PCT students reported that they would choose the integrated third year again and recommend it to others.

The relationship between criteria used to select residents and performance during residency.

PURPOSE: Can data available at time of interview and evaluation predict level of performance during residency? METHODS: General surgery residents were studied. Applicant information available prior to admission was used to predict performance during residency as measured by faculty judgment of residents' knowledge, technical skill, maturity and judgment, and overall ability. RESULTS: No relationship was found between admission data and final evaluation (using Spearman's coefficient r(s) = 0.27; p = 0.13). We could not distinguish between the top 10 and the bottom 10 ranked residents on admission variables. Nine of the top 10 and 3 of the bottom 10 residents remained in general surgery. Performance on the American Board of Surgery In-Training Examination accounted for 37% of the variance in faculty grading (F(5,28;.05) = 3.26; P = 0.02). CONCLUSIONS: Residents' interpersonal and technical skills and qualities of character may have a significant role in faculty perception of success during surgical residency. These qualities are not well reflected in candidates' credentials at admission.

Practicing primary care physicians' perspectives on the junior surgical clerkship.

PURPOSE: Changing emphasis on educating generalist physicians prompted us to survey practicing primary care physicians to determine their perception of the lecture content and clinical skills required of students in our third-year surgical clerkship. METHODS: A 72-item questionnaire was developed. Respondents were asked to evaluate the relative importance of lecture topics and clinical skills on a 5-point Likert-type scale. Respondents were also asked about their medical practice and demographic information. Primary care physicians were randomly selected from among those registered in our state's medical association. RESULTS: Nearly 70% of physicians in the sample responded. Although there were significant differences in responses among the primary care physicians surveyed, virtually all indicated that faculty should teach pathways in surgical management with emphasis on when to refer the patient to a surgeon. CONCLUSIONS: The changing health care climate necessitates a closer examination of undergraduate surgical curricula with attention to the educational needs of the generalist physician.

Oral presentations for surgical meetings.

Each year the Association for Academic Surgery sponsors the "Fundamentals of Surgical Research" course which is established for residents who are beginning research training. A lecture outlining various aspects of effective scientific presentations, such as that delivered at a national or regional surgical meeting, is part of the course. Faculty from our institution have organized this lecture for several years. The lecture content has been revised each year to reflect the recommendations of the participating residents and faculty. Herein, we summarize the requirements for composing and delivering a scientific surgical presentation that is noted for its clarity, easily understood methods, interpretable data, and scientific and/or clinical implications.

A required trauma lecture series for junior medical students.

OBJECTIVE: The lecture series portion of the Advanced Trauma Life Support Course is taught by full-time surgical faculty as part of the orientation process for an 8-week required surgery clerkship for third-year medical students at the University of Louisville School of Medicine. The objective of this study was to assess the effect of this lecture series on student learning and retention. MATERIALS AND METHODS: A pre- and post-lecture series test and control group design was used. Complete data were obtained on 299 students in 15 consecutive rotations. MEASUREMENTS AND MAIN RESULTS: Those students who attended the lecture series achieved a significantly higher score on the post-lecture series test than did the control group (70% vs. 53%). The long-term retention of the material, as measured by a delayed post-lecture series test 7-weeks after the lectures occurred, was high. CONCLUSIONS: The data indicate that the ATLS lecture series alone results in gains in knowledge for junior medical students. We believe that these data indicate that ATLS lectures should be adopted as a minimum requirement for teaching trauma principles in all medical schools.

Development of an effective short introductory course in diagnostic radiology.

As part of a general medical curriculum renewal, a new one-week course in diagnostic radiology was given to students at the beginning of their third year. The course format consisted of didactic presentations to the entire class, a single afternoon session of small group discussions of unknowns, and three daily case-of-the-day unknowns with prizes for correct responses. One hundred fifty-eight students were tested on the first and last days of the course; testing consisted of two parallel 46-item multiple choice questions given in a crossed design. Questions covered radiographic anatomy and pathology as well as proper test ordering. Differences in achievement before and after the course as measured by the pre- and post-tests were highly significant. The class achieved a mean of 27 (59%) correct responses on the pre-test and a mean of 37 (80%) on the post-test (F(1156) = 15.79; P less than .001). The reliability coefficient of the pre- and post-tests was about .30. A course critique was returned by 88 students. There was anticipated variation in the evaluations of the different didactic lecturers. Instructors receiving the highest scores were cited for their enthusiasm, clarity, and the relevance of their presentation. Conversely, those receiving low marks were cited as being unenthusiastic and boring, merely presenting example after example of radiographic abnormalities with little explanation. The afternoon small group discussions were perceived as the best part of the course. Despite the fact that moderator experience ranged from second year resident to full professor, the seminars received uniformly positive comments.

Medical students' evaluation in obstetrics and gynecology.

A system for the evaluation of clinical clerks in obstetrics and gynecology is presented. Final grades were assigned through faculty judgment rather than by the use of a numerical formula. Judgment was based on narratives and grades on clinical performance as well as results of oral and written examinations. All elements of the evaluation correlated with the final grade. The clinical grade correlated best. The final grades assigned by judgment were compared with those that would have resulted from applying a numerical formula. They differed in the distribution of higher grades, but were identical for the lower grades. Both correlated equally with the Obstetrics and Gynecology subtest of the National Boards, Part II examination.

Relationship between type of surgical clerkship, order of completion, and achievement on patient management problems.

Complex cognitive skills, such as interpretation of information and problem solving, are essential for the practice of medicine. Patient management problems (PMPs) are used by both medical school faculty and certifying boards to measure higher-order cognitive skills. This study investigates two questions that relate to PMPs. Whether there is a difference among students in their achievement on PMPs that may be attributed to their clinical experience is examined. In addition, the effect of the order in which PMPs are taken is evaluated. For the purpose of this study, three PMPs were developed measuring three different areas of surgical problem solving. One hundred four third-year medical students who took their surgery clerkship during a 9-month period in 1982 were examined. Students were randomly assigned to one of three rotations for an 8-week period. At the end of the rotation, they each took three PMPs in random order. The multivariate analysis of variance procedure was used to examine the hypothesis of no relationship between clinical rotation and order of completion. The proficiency score for each PMP was considered the dependent variable. There was no difference in performance between groups rotating in different clinical surgical settings (multivariate F (6186) = 0.67; p = 0.67.) This suggests that generalization occurs with patient management and problem-solving skills. Statistically significant differences were found between groups on the basis of the order in which they took the PMPs (multivariate F (6186) = 4.07; p less than 0.001.) There are several plausible explanations for this finding. One explanation is that all three problems were difficult. As a result, students' perceptions about their performance on each problem may have influenced their performance on subsequent problems. Another explanation is that motivation to achieve may have diminished with time. These data suggest that there are basic management skills that may be taught in a variety of surgical experiences. Care must be taken in the use of the PMP as a tool for evaluation so that noneducational factors such as order do not play a role in the results.