Positive impact of a master of science in applied anatomy program on USMLE Step 1 performance.

In this retrospective study of medical student data from Case Western Reserve University School of Medicine, we examined the impact of the Master of Science in Applied Anatomy (MS) program on medical student performance on the United States Medical Licensing Examination(®) (USMLE(®)) Step 1 and Step 2. From 2002 to 2010, 1,142 students matriculated as either students in the medical curriculum (MD group; 1,087 students) or MD students who also participated in the MS program (MD/MS group; 55 students). In addition, students were grouped as in either the Western Reserve Curriculum (2002-2005; WR1) or the Western Reserve 2 Curriculum (2006-2010; WR2). Data were analyzed using SPSS statistical package. The mean Medical College Admission Test(®) (MCAT(®)) score of all students increased significantly between the WR1 and WR2 curricula [from 32.48 ± 3.73 to 34.00 ± 2.92 (P < 0.00)], but MD and MD/MS students showed similar mean MCAT scores in each curriculum. In contrast, the mean USMLE Step 1 score for the MD/MS group (241.45 ± 18.90) was significantly higher than that of the MD group (229.93 ± 20.65; P < 0.00). The MD/MS group in the WR2 curriculum showed significantly higher USMLE Step 1 scores than the MD group. No significant difference was observed in the USMLE Step 2 Clinical Knowledge scores between the groups. The results show that MD/MS students performed better on the USMLE Step 1 than MD students in the WR2 curriculum, although MCAT scores were similar between the two groups. Together, these results suggest that medical student participation in the Masters in Applied Anatomy program enhances student performance on the USMLE Step 1.

Readability of Patient-oriented Online Dermatology Resources.

BACKGROUND: Supplemental educational reading material is of no value to patients if it is not read and comprehended. OBJECTIVE: Using standardized research tools, online patient education materials were comparatively assessed for readability and length in words to identify the strengths and weaknesses of widely utilized sources. METHODS: Three sources of patient-education material on the internet (WebMD.com, Wikipedia.org, and MedicineOnline.com) were compared with materials produced by the American Academy of Dermatology for readability utilizing Flesch-Kincaid Grade Level and Flesch Reading Ease Scale. Automated word counts were used to determine the length of each educational piece. RESULTS: The information presented in American Academy of Dermatology electronic pamphlets on the internet is significantly harder to comprehend than MedicineOnline.com, but easier than Wikipedia.org. The latter site proved significantly harder to comprehend than all other sources. The American Academy of Dermatology electronic pamphlets and MedicineOnline.com materials were the most concise, averaging 1,200 words or less, although this was not a statistically significant difference in length compared to other online patient-education resources. No single source of online patient-education material demonstrates optimal features with regard to each of these parameters. LIMITATIONS: Only 15 topic areas in the four most commonly accessed sources of patient information were analyzed in this study. CONCLUSION: No single source of commonly used internet patient-education material demonstrates optimal features with regard to readability, length, and presence of photographic illustrations. These educational materials should target a length of 1,200 words, be illustrated with clinical images, and readability should correspond with the national average reading level.

Cancer risk assessment: examining the family physician's role.

BACKGROUND: Cancer risk assessment begins in the primary care clinician's office. Essential components of that process include: 1) documentation of personal and family cancer information; 2) identification of families at increased risk for cancer; 3) modification of cancer screening recommendations according to degree of risk; 4) referral of high-risk individuals to cancer genetics clinics. The purpose of this study was to examine these 4 components of primary care cancer risk assessment using data abstracted from patient records at an academic family medicine center. METHODS: Ambulatory records of 734 patients were reviewed in their entirety for information relevant to cancer risk assessment. Detail of cancer information was categorized as comprehensive, adequate, or inadequate. Patient records were categorized as suggestive of average, moderate, or high genetic risk for cancer. For patients with a family history of colorectal cancer, modification of colon cancer screening to reflect degree of cancer risk was assessed. Finally, the frequency of cancer genetic referral in high-risk individuals was noted. RESULTS: The presence or absence of a family history of cancer was documented in 97.8% of records. There was insufficient information to adequately assess risk in 69.5% of charts. Detail of family cancer documentation was associated with personal history of cancer (P = .001), patient age (P = .001), and physician training status (P = .042), but not with patient or physician gender, duration of care, or completion of a genogram. For persons with a family history of colorectal cancer, compliance with cancer screening individualized to degree of risk was achieved in 50% of patients. Ten patients met criteria for moderate or high genetic risk for cancer. None had been offered cancer genetics consultation. CONCLUSIONS: Nearly all records documented the presence or absence of a family history of cancer. However, in those with a positive family history, the detail of information was insufficient to permit risk assessment in over two thirds of individuals; risk-stratified colon cancer screening was not achieved in half of the patients with a family history of colorectal cancer; individuals at moderate or high cancer risk were not identified as such; and those at high risk were not offered cancer genetics referral. In addition to collecting adequate family cancer information, family physicians need to adopt explicit risk assessment criteria to identify, and to optimally care for, those at increased genetic risk for cancer.

Effect of communications training on medical student performance.

CONTEXT: Although physicians' communication skills have been found to be related to clinical outcomes and patient satisfaction, teaching of communication skills has not been fully integrated into many medical school curricula or adequately evaluated with large-scale controlled trials. OBJECTIVE: To determine whether communications training for medical students improves specific competencies known to affect outcomes of care. DESIGN AND SETTING: A communications curriculum instituted in 2000-2001 at 3 US medical schools was evaluated with objective structured clinical examinations (OSCEs). The same OSCEs were administered to a comparison cohort of students in the year before the intervention. PARTICIPANTS: One hundred thirty-eight randomly selected medical students (38% of eligible students) in the comparison cohort, tested at the beginning and end of their third year (1999-2000), and 155 students in the intervention cohort (42% of eligible students), tested at the beginning and end of their third year (2000-2001). INTERVENTION: Comprehensive communications curricula were developed at each school using an established educational model for teaching and practicing core communication skills and engaging students in self-reflection on their performance. Communications teaching was integrated with clinical material during the third year, required clerkships, and was supported by formal faculty development. MAIN OUTCOME MEASURES: Standardized patients assessed student performance in OSCEs on 21 skills related to 5 key patient care tasks: relationship development and maintenance, patient assessment, education and counseling, negotiation and shared decision making, and organization and time management. Scores were calculated as percentage of maximum possible performance. RESULTS: Adjusting for baseline differences, students exposed to the intervention significantly outperformed those in the comparison cohort on the overall OSCE (65.4% vs 60.4%; 5.1% difference; 95% confidence interval [CI], 3.9%-6.3%; P<.001), relationship development and maintenance (5.3% difference; 95% CI, 3.8%-6.7%; P<.001), organization and time management (1.8% difference; 95% CI, 1.0%-2.7%; P<.001), and subsets of cases addressing patient assessment (6.7% difference; 95% CI, 5.9%-7.8%; P<.001) and negotiation and shared decision making (5.7% difference; 95% CI, 4.5%-6.9%; P<.001). Similar effects were found at each of the 3 schools, though they differed in magnitude. CONCLUSIONS: Communications curricula using an established educational model significantly improved third-year students' overall communications competence as well as their skills in relationship building, organization and time management, patient assessment, and negotiation and shared decision making-tasks that are important to positive patient outcomes. Improvements were observed at each of the 3 schools despite adaptation of the intervention to the local curriculum and culture.

A comparison of ambulatory services for patients with managed care and fee-for-service insurance.

OBJECTIVES: To determine whether family physicians provide different ambulatory care to patients with health insurance from managed care organization (MCO) versus fee-for-service (FFS) plans. STUDY DESIGN: Multimethod cross-sectional observational study. PATIENTS AND METHODS: A total of 4454 patients made office visits to 138 family physicians in northeastern Ohio. Direct observation with the Davis Observation Code and a structured checklist were used to assess the process of care. Patient satisfaction was measured with the Medical Outcomes Study 9-Item Visit Rating Form. RESULTS: Among 1588 patients with MCO insurance and 876 with FFS insurance, no differences were noted in the number of visits per year, length of visits, percentage of visits for well care, or the percentage of visits in which medicines were prescribed in analyses controlling for patient mix. Visits by patients with MCO insurance were more likely to involve referrals to another physician than visits by patients with FFS insurance. Patient satisfaction and time use during visits were comparable for the 2 groups. CONCLUSIONS: Managed care insurance appears to increase involvement of the primary care provider in the referral process. However, in a healthcare market with moderate managed care penetration in which the same physicians see patients with different types of insurance, the process of care is affected little by type of insurance coverage.