Do we pay our community preceptors? Results from a CERA clerkship directors' survey.

BACKGROUND AND OBJECTIVES: Family medicine clerkships depend heavily on community-based family physician preceptors to teach medical students. These preceptors have traditionally been unpaid, but in recent years some clerkships have started to pay preceptors. This study determines trends in the number and geographic region of programs that pay their community preceptors, identifies reasons programs pay or do not pay, and investigates perceived advantages and disadvantages of payment. METHODS: We conducted a cross-sectional, electronic survey of 134 family medicine clerkship directors at allopathic US medical schools. RESULTS: The response rate was 62% (83/132 clerkship directors). Nineteen of these (23%) currently pay community preceptors, 11 of whom are located in either New England or the South Atlantic region. Sixty-three percent of programs who pay report that their community preceptors are also paid for teaching other learners, compared to 32% of those programs who do not pay. Paying respondents displayed more positive attitudes toward paying community preceptors, though a majority of non-paying respondents indicated they would pay if they had the financial resources. CONCLUSIONS: The majority of clerkships do not pay their community preceptors to teach medical students, but competition from other learners may drive more medical schools to consider payment to help with preceptor recruitment and retention. Medical schools located in regions where there is competition for community preceptors from other medical and non-medical schools may need to consider paying preceptors as part of recruitment and retention efforts.

Effect of Spanish language immersion rotations on medical student Spanish fluency.

BACKGROUND AND OBJECTIVES: The study's objective was to determine whether participation in an international health rotation in a Spanish-speaking country (immersion) is associated with improved Spanish fluency compared to participation in domestic medical Spanish coursework alone. METHODS: Participants matriculated at one US medical school in the years 2004--2008. At matriculation (baseline), all had intermediate to advanced Spanish fluency based on a standardized, oral fluency test. All took didactic coursework in years 1 and 2 of medical school. Some elected to participate in a post-year 1 immersion rotation in a Spanish-speaking Latin American country. Oral fluency was reassessed using the same method in years 2 and 4 by independent evaluators who were blind to individuals' immersion participation status and prior fluency scores. The authors compared participants' likelihood of demonstrating greater Spanish fluency over baseline among those who did post-year 1 immersion versus those who did US-based coursework alone (controls). RESULTS: The likelihood of having greater Spanish fluency at the second-year assessment was 80% (45/56) among immersion participants, compared with 46% (21/46) for controls. The likelihood of having increased fluency at the fourth-year assessment was 65% (13/20) among those who did immersion versus 28% (7/25) for controls. Odds of having improved fluency for immersion participants remained statistically significantly higher after adjusting for baseline fluency (AOR [95%CI]=4.3 [1.7, 10.6], at year 2 and 5.1 [1.2, 21.6], at year 4). CONCLUSIONS: Among medical students with intermediate to advanced baseline Spanish fluency, participants in a post-year 1 Spanish language international health immersion rotation were more likely to improve their Spanish fluency than participants in US-based coursework alone.

Creating a multi-institutional family medicine clerkship examination: lessons learned.

BACKGROUND AND OBJECTIVES: Multiple choice examinations assess learners' attainment of medical knowledge. Developing multiple choice examinations that discriminate among learners is difficult and time-consuming. Many institutions avoid this effort by using the National Board of Medical Examiners (NBME) subject examinations, which can also provide comparisons to a national norm. The family medicine subject examination has been criticized, however, because the test's content does not reflect the learning expected during the clerkship. Additionally, the test results cannot guide clerkship directors sufficiently to help students study or to improve the curriculum. METHODS: Family medicine clerkships at three different institutions used a common 75-item examination based on the textbook Essentials of Family Medicine, Fifth Edition, for one academic year. Data were pooled and analyzed. The Raush Item Response Theory assessed student and item performance. RESULTS: A total of 451 students took the examination. Across the three schools: (1) item separations (Rasch) were high (8.64), indicating good spread in item difficulty, (2) person separations were lower (1.65), indicating that medical students are likely a relatively homogeneous group, (3) Rasch item reliabilities were strong (ranging from .96-.99), and (4) Rasch person reliabilities (.54-.73) were lower. True internal consistencies across items as measured by the Kuder-Richardson 20 (KR-20) reliabilities were just adequate at .71-.77. CONCLUSIONS: By pooling resources, clerkship directors can share the creation and implementation of a written examination that has acceptable reliability and greater face validity than the NBME subject examination. They also have more control over examination content and can guide students' learning and curriculum improvements more accurately.

Teaching Advanced Leadership Skills in Community Service (ALSCS) to medical students.

Inadequate access to health care, lack of health insurance, and significant health disparities reflect crises in health care affecting all of society. Training U.S. physicians to possess not only clinical expertise but also sufficient leadership skills is essential to solve these problems and to effectively improve health care systems. Few models in the undergraduate medical curriculum exist for teaching students how to combine needed leadership competencies with actual service opportunities.The Advanced Leadership Skills in Community Service (ALSCS) selective developed in response to the shortage of leadership models and leadership training for medical students. The ALSCS selective is designed specifically to increase students' leadership skills, with an emphasis on community service. The selective integrates classroom-based learning, hands-on application of learned skills, and service learning. More than 60 medical students have participated in the selective since inception. Short-term outcomes demonstrate an increase in students' self-efficacy around multiple dimensions of leadership skills (e.g., fundraising, networking, motivating others). Students have also successfully completed more than a dozen leadership and community service projects. The selective offers an innovative model of a leadership-skills-based course that can have a positive impact on leadership skill development among medical school students and that can be incorporated into the medical school curriculum.

Accuracy of self-assessed Spanish fluency in medical students.

BACKGROUND: Non-English language fluency is increasingly important in patient care. Fluency self-assessment is easily obtained, but its accuracy is unknown. PURPOSES: The purpose is to determine accuracy of medical students' self-assessed Spanish fluency. METHODS: Four matriculating classes assessed their own oral fluency as ("none":"novice";"intermediate";"advanced";"native-speaker"). Participants who rated themselves greater than "novice" and who expressed interest in medical Spanish coursework took a standardized fluency test (Spoken Language Evaluation, scaled 1-12). Using predetermined test categories (1-5 = novice, 6-8 = intermediate, 9-12 = advanced/native), we determined the predictive value of self-assessment for predicting the same or greater fluency on the test. RESULTS: Of 102 participants, 12 (12%) tested below their self-assessed level, 77 (75%) tested at their self-assessed level, and 13 (13%) tested above. The predictive value of self-assessment for having at least that fluency level was 88% (95% CI = 80, 94). CONCLUSIONS: In medical students reporting greater than "novice" capability and interest in medical Spanish coursework, fluency self-assessment was a good indicator of scores on a standardized fluency test.

A longitudinal medical Spanish program at one US medical school.

INTRODUCTION: Policymakers have recommended recruiting or training (or both) more US physicians who can provide care in Spanish. Few longitudinal medical Spanish programs have been described and evaluated. OBJECTIVE: This study aims to describe development and evaluation of the preclinical phase of a 4-y program designed to graduate physicians who can provide language-concordant care in Spanish. SETTING: Study was done in one public medical school in southeastern USA. PROGRAM DESCRIPTION: The program targeted intermediate/advanced Spanish speakers. Standardized fluency assessments were used to determine eligibility and evaluate participants' progress. Curriculum included didactic coursework, simulated patients, socio-cultural seminars, clinical skills rotations at sites serving Latinos, service-learning, and international immersion. PROGRAM EVALUATION: For the first two cohorts (n = 45) qualitative evaluation identified program improvement opportunities and found participants believed the program helped them maintain their Spanish skills. Mean interim (2-y) speaking proficiency scores were unchanged from baseline: 9.0 versus 8.7 at baseline on 12-point scale (p = 0.15). Mean interim listening comprehension scores (second cohort only, n = 25) increased from a baseline of 77 to 86% (p = 0.003). Proportions "passing" the listening comprehension test increased from 72 to 92% (p = 0.06). DISCUSSION: We describe development of a longitudinal Spanish program within a medical school. Participation was associated with improved Spanish listening comprehension and no change in speaking proficiency.

Sexually transmitted infections and increased risk of co-infection with human immunodeficiency virus.

The incidence of trichomoniasis (Trichomonas vaginalis) in the United States is estimated at 5 million cases annually; chlamydia (Chlamydia trachomatis) at 3 million; gonorrhea (Neisseria gonorrhoeae), 650,000; and syphilis (Treponema pallidum), 70,000. However, most sexually transmitted infections (STIs) are asymptomatic-contributing to underdiagnosis estimated at 50% or more. Diagnosis of an STI signals sexual health risk because an STI facilitates the transmission and acquisition of other STIs, including human immunodeficiency virus (HIV). In fact, comorbid STIs increase patients' susceptibility of acquiring and transmitting HIV by two- to fivefold. Several studies have shown that aggressive STI prevention, testing, and treatment reduces the transmission of HIV. The authors discuss common clinical presentations, screening, diagnosis, and treatment for trichomoniasis, chlamydia, gonorrhea, syphilis, and herpes simplex virus.