American medical education 100 years after the Flexner report.
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Biomedical Research↗
Biomedical subjects
David M Irby
Publications and source records attributed to David M Irby.
Impact of the United States Medical Licensing Examination Step 2 Clinical Skills exam on medical school clinical skills assessment.
BACKGROUND: Medical schools face a new responsibility to prepare students for the United States Medical Licensing Exam Step 2 Clinical Skills (CS) exam. METHOD: We conducted semistructured interviews with 25 leaders of medical school clinical skills assessments to explore purposes of in-house assessment and the impact of the Step 2 CS exam. Interviews were coded to identify major themes. RESULTS: Competency assessment, student and curricular feedback, and preparation for the licensing exam emerged as major purposes of in-house exams. Participants asserted that in-house exams assessed faculty-identified competencies, although not all schools had defined competencies. Limited resources made balancing formative and summative assessment goals problematic for some schools. Curricular feedback was general but valued. All schools, even those that disagreed with aspects of the licensing exam, acknowledged their roles in preparing students for the Step 2 CS. CONCLUSION: An external licensing requirement engenders debate and motivates changes in clinical skills assessment and, in some cases, curricula.
Clinical Competence↗
Educational fellowship programs: common themes and overarching issues.
The trend toward intensive faculty development programs has been driven by a variety of factors, including institutional needs for educational expertise and leadership, as well as individual faculty members' motivation to augment their educational expertise, teaching skills, and leadership skills. The nine programs described in this issue possess several common features that can be ascribed to shared perceptions of pervasive needs coupled with feasible educational resources and strategies to meet these needs. All programs identify a clear set of goals and objectives for their respective curricula. Curriculum domains include not only teaching skills but also educational research, curriculum development, and educational leadership. In spite of many similarities, each program reflects the unique character of its home institution, the faculty, educational resources, and the specific goals of the program. Each program has documented gains in such key outcomes as participant promotions, new leadership positions both locally and nationally, and scholarly productivity in the form of peer-reviewed papers and presentations. Evidence of institutional benefits includes the production of innovative curricula and a pool of educational leaders. The programs have also developed a community of knowledgeable scholars who interact with each other and serve as a catalyst for continuing change and educational improvement. Although each program was developed largely independently of the others, the common elements in their design provide opportunities to evaluate collaboratively the successful aspects of such programs and to share ideas and resources for program curricula between existing programs and with institutions considering implementing new programs.
Adult↗
Developing educational leaders: the teaching scholars program at the University of California, San Francisco, School of Medicine.
A Teaching Scholars Program (TSP) was established in 1998 in the University of California, San Francisco (UCSF), School of Medicine with the mission of building knowledgeable and skilled educational leaders, teachers, and scholars. Conducted through the Office of Medical Education (OME), the TSP is a 10-month program that accepts 12 scholars per year. Financial support for the program, including salary support for co-directors and staff, is provided by the OME. Scholars' departments are required to provide release time for one afternoon per week for 10 months. The TSP provides participants with an intensive weekly seminar series, collaborative learning experiences, mentored projects, and a network of educational colleagues. The weekly seminars use an interactive format to address topics within seven targeted areas: (1) learning theory; (2) teaching methods; (3) curriculum development/evaluation; (4) assessment of learning; (5) leadership and organizational change; (6) career development; and (7) educational research. Since its inception, 76 scholars have graduated from or are currently enrolled in the TSP. The majority are clinicians at assistant professor rank, although four basic scientists, two medical students, and three OME staff members have also participated in the program. The TSP is highly valued by participants, and preliminary evaluation data suggest that the program has resulted in an increase in educational research, scholarly activities, and the number of skilled and knowledgeable faculty with major leadership roles in medical education at UCSF. Challenges facing the TSP include scholar release time, mentoring time, and follow-up contact to encourage TSP graduates' postgraduation productivity, continuing educational development, and support.
Adult↗
Frank T. Stritter, PH.D. Educationist: teacher, coach and researcher.
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Career Mobility↗
A national study of medical student clinical skills assessment.
BACKGROUND: This study describes comprehensive standardized patient examinations in medical schools nationally. METHOD: We surveyed 121 medical school curriculum deans regarding their use of standardized patient assessments. Questions addressed examination characteristics, funding sources, and collaborations. RESULTS: A total of 91 of 121 curriculum deans responded (75% response rate). The majority (84%) of respondents report conducting a comprehensive clinical skills assessment during the third or fourth year of medical school. Most programs are funded with dean's office monies. Although many collaborate with other institutions for examination development, the majority of schools score and remediate students independently. Two-thirds of all respondents (61/91) report that the new standardized patient licensing requirement elevates the importance of in-house clinical skills examinations. CONCLUSIONS: Most medical schools now conduct comprehensive clinical skills assessments after the core clerkships, and collaboration is common. These results suggest increasing emphasis on clinical and communication skills competency and opportunities for collaborative research.
Clinical Competence↗
Effectiveness of the one-minute preceptor model for diagnosing the patient and the learner: proof of concept.
PURPOSE: To compare the One-Minute Preceptor (OMP) and traditional models of ambulatory teaching in terms of the preceptors' (1) ability to correctly diagnose patients' medical problems, (2) ability to rate students' skills and confidence in doing so, and (3) satisfaction with both models. METHOD: A within-groups experimental design study was conducted with 116 preceptors at seven universities in 2000. Participants viewed scripted, videotaped precepting encounters of both models using two cases and were asked to rate students' abilities, their confidence in rating the students' abilities, and the effectiveness and efficiency of the teaching encounters. RESULTS: Preceptors who viewed the videotapes of the OMP model were equally or better able to correctly diagnose the patients' medical conditions than those viewing the traditional model. Preceptors viewing the OMP rated students' abilities higher on history taking/physical examination, presentations, clinical reasoning, and fund of knowledge than did those viewing the traditional model. Preceptors viewing the OMP rated themselves as more confident in rating students' abilities in presentation, clinical reasoning, and fund of knowledge. Preceptors rated the OMP as more effective and more efficient than the traditional model. CONCLUSIONS: Preceptors viewing scripted, videotaped teaching encounters using the OMP model were equal to or better able to correctly diagnose patients' medical problems, had greater self-confidence in rating students, and rated the encounter as more effective and efficient than when viewing the traditional model.
Ambulatory Care↗
Teaching points identified by preceptors observing one-minute preceptor and traditional preceptor encounters.
PURPOSE: This study examined the teaching points made by preceptors in response to two videotaped teaching encounters to determine if (1) different preceptors use similar teaching points in response to the same case, (2) preceptors' teaching points vary by case, and (3) preceptors' teaching points vary by teaching model (One-Minute Preceptor and traditional preceptor models). METHOD: Preceptors (n = 116) at seven universities participated in a within-groups experimental design study in 2000. The preceptors viewed videotaped encounters depicting two cases and two precepting models. They were asked to list two teaching points after viewing the initial case presentations and after the teaching encounters were completed. Frequency of teaching points listed by preceptors was examined for each case and teaching model. Teaching points were coded using qualitative methods and then analyzed using repeated-measures analysis of variance. RESULTS: Of the 843 total teaching points identified by preceptors, 63 were discrete teaching points that were aggregated into 15 categories. Most preceptors (82%) listed three to five separate teaching points, which varied significantly by case and model. Those observing the traditional precepting model were more likely to teach generic skills such as history-taking skills, presentation skills, and risk factors, and those observing the One-Minute Preceptor were more likely to teach about the illness focusing on a broader differential diagnosis, further diagnostic tests, and the natural presentation of disease. CONCLUSIONS: Preceptors use three to five common teaching points that vary by case and teaching model. The One-Minute Preceptor model shifted teaching points away from generic clinical skills toward disease-specific teaching.
Clinical Competence↗
The academy movement: a structural approach to reinvigorating the educational mission.
Despite its fundamental importance, the educational mission of most medical schools receives far less recognition and support than do the missions of research and patient care. This disparity is based, in part, on the predominance of discipline-based departments, which focus on the more sustainable enterprises of research and patient care. Where departmental teaching is emphasized, it tends to center on trainees directly associated with the department-leaving medical students unsupported. The authors argue that the ongoing erosion of the educational mission will never be reversed unless there are changes in the underlying structure of medical schools. Academies of medical educators are developing at a number of medical schools to advance the school-wide mission of education. The authors describe and compare key features of such organizations at eight medical schools, identified through an informal survey of the Society of Directors of Research in Medical Education, along with direct contacts with specific schools. Although these entities are relatively new, initial assessments suggest that they have already had a major impact on the recognition of teaching efforts by the faculty, fueled curricular reform, promoted educational scholarship, and garnered new resources to support teaching. The academy movement, as a structural approach to change, shows promise for reinvigorating the educational mission of academic medicine.
Academic Medical Centers↗
Promoting research in medical education at the University of California, San Francisco, School of Medicine.
Over the past seven years, educational innovations and scholarship have flourished at the University of California, San Francisco, (UCSF) School of Medicine. Prior to 1998, there was no infrastructure to support educational research and yet a few faculty members published in medical education journals and were active in national professional associations. With the initiation of curriculum reform in 1998, a great deal of excitement about education was generated and innovative new educational programs were envisioned. These changes became opportunities for educational scholarship. With the development of an Office of Medical Education in 1997 and the Haile T. Debas Academy of Medical Educators in 2001, the infrastructure was in place to expand educational research and the scholarship of teaching. The components of this support include educational leadership, faculty development, the Teaching Scholars Program, the Office of Educational Research and Development, the Academy, a Fellowship in Medical Education Research, collaborative research, and extramural grants. As a result of these investments, the number of UCSF faculty members who are involved in educational research has increased significantly. There has been a four-fold increase in peer-reviewed articles published in medical education journals and a greater increase in the publication of educational abstracts, editorials, chapters, and books, plus presentations at U.S. professional association meetings. In this article, the authors describe the changes that have occurred at UCSF to achieve these results.
Curriculum↗
Charles W. Dohner, PhD: an evaluator and mentor in medical education.
As one of the first generation medical education pioneers, Charles W. Dohner, PhD established the ninth office of medical education at the University of Washington (UW) where he served as chairman from 1967-1996. With a background in education and measurement, he focused his work on evaluation of educational programs and faculty development. The Department of Medical Education went through three distinct stages of development: pathfinding 1967-1972 focused on developing working relationships with the faculty and clarifying identity, integration into academic affairs 1972-1980, and direct leadership by department faculty 1980-1996. Dohner helped to create and evaluate the WAMI program, a regional medical education program for the states of Washington, Alaska, Montana, and Idaho. He served as a consultant to a specialty board, the founding president of the Society of Directors of Research in Medical Education, and a frequent consultant in international medical education. Dohner identified three important innovations in medical education: educators in academic medicine, simulations and performance assessment, and community-based medical education. Success factors for professional education include technical competence in education, interpersonal communication and collaboration skills, a plan for personal growth, and use of mentors. Future trends in medical education will involve information technology, professionalism, wellness and complementary medicine, and performance assessment. He has been a passionate spokesman for excellence in medical education and most noted for his roles as an evaluator, program developer, and mentor of academic leaders.
Education, Medical↗
Educational innovations in academic medicine and environmental trends.
Fifteen educational innovations in academic medicine are described in relation to 5 environmental trends. The first trend, demands for increased clinical productivity, has diminished the learning environment, necessitating new organizational structures to support teaching, such as academies of medical educators, mission-based management, and faculty development. The second trend is multidisciplinary approaches to science and education. This is stimulating the growth of multidisciplinary curricular design and oversight along with integrated curricular structures. Third, the science of learning advocates the use of case-based, active learning methods; learning communities such as societies and colleges; and instructional technology. Fourth, shifting views of health and disease are encouraging the addition of new content in the curriculum. In response, theme committees are weaving content across the curriculum, new courses are being inserted into curricula, and community-based education is providing learning experiences outside of academic medical centers. Fifth, calls for accountability are leading to new forms of performance assessment using objective structured clinical exams, clinical examination exercises, simulators, and comprehensive assessment programs. These innovations are transforming medical education.
Academic Medical Centers↗
The UCSF Academy of Medical Educators.
The Academy of Medical Educators at the University of California, San Francisco (UCSF), was established in 2000 to (1) foster excellence in teaching, (2) support teachers of medicine, and (3) promote curricular innovation. A membership organization, it recognizes five categories of educational activity: direct teaching, curriculum development and assessment of learner performance, advising and mentoring, educational administration and leadership, and educational research. Excellent medical student teaching and outstanding accomplishment in one or more areas of educational activity qualify a teacher for membership. Candidates prepare a portfolio that is reviewed internally and by national experts in medical education. Currently 37 faculty members, 3% of the entire school of medicine faculty, belong to the academy. The academy's innovations funding program disburses one-year grants to support curricular development and comparisons of pedagogical approaches; through this mechanism, the academy has funded 20 projects at a total cost of $442,300. Three fourths of expended funds support faculty release time. Faculty development efforts include promotion of the use of an educator's portfolio and the establishment of a mentoring program for junior faculty members built around observation of teaching. The Academy of Medical Educators vigorously supports expanded scholarship in education; the academy-sponsored Education Day is an opportunity for educators to present their work locally. Recipients of innovations-funding program grants are expected to present their work in an appropriate national forum and are assisted in doing this through quarterly scholarship clinics. The Academy of Medical Educators has been well received at UCSF and is enhancing the status of medical education and teachers.
California↗
The UCSF Academy of Medical Educators.
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Adult↗
Assessing quality and costs of education in the ambulatory setting: a review of the literature.
PURPOSE: Time-pressured interactions with little direct observation or feedback characterize teaching in ambulatory settings. The authors report findings from the literature on teaching and learning in the ambulatory setting and propose opportunities for further research that addresses these barriers. METHOD: The authors searched 1995-1999 databases for all empirical studies that focused on research conducted in ambulatory settings. Publications were reviewed for evidence of inclusion criteria. Findings were sorted into categories previously described for defining and evaluating quality of ambulatory care educational programs. RESULTS: Most studies were conducted in departments of internal medicine (40%), focused on medical students (43%), and took place in a single program (77%), making generalizations difficult. Students and residents are learning in ambulatory environments, and the types of patients they encounter are likely to prepare them for practice. Patient care outcomes have emerged as a measure of learning. Teachers may be the single most important factor, yet they lack self-confidence as teachers. Community-based preceptors teach because of enjoyment of teaching and the opportunity to stay current. However, none of the studies addressed the impact of the Medicare documentation requirements on satisfaction with teaching. Teaching settings cost about one third more than non-teaching settings to operate. CONCLUSION: This review identifies many gaps in our knowledge of effective clinical teaching practices, and of learning environments in which that teaching takes place. The predominance of single-institution studies limits generalizability of current findings. A prioritized research agenda should be established and funded, focusing on improving the efficiency and effectiveness of teaching and learning in ambulatory settings.
Ambulatory Care↗
Evidence for longitudinal ambulatory care rotations: a review of the literature.
PURPOSE: Block ambulatory rotations and longitudinal ambulatory care experiences are now common in U.S. medical schools, but little is known about their efficacy. Through a structured review of the medical literature from 1966 through March 2000, the authors summarize the characteristics of, the evidence for, and the evaluation of longitudinal ambulatory care rotations. METHOD: The authors searched Medline using the terms "outpatients," "continuity of patient care," "ambulatory care," "mentors," "preceptorship," "graduate medical education," "curriculum," and "clinical clerkship" cross-matched to "medical students" and "internship and residency" for literature published from 1966 through March 2000. They narrowed the list to only articles containing empirical outcome data focusing on medical students' experiences in longitudinal ambulatory care rotations. Each study was scored to assess its strengths and weaknesses. RESULTS: Seven articles met the search criteria. The articles identified the benefits of longitudinal ambulatory care experiences, including developing effective patient interactions and understanding chronic diseases. There were little or no differences in the students' overall knowledge acquisition when those with longitudinal experiences were compared with those in block rotations. DISCUSSION: Although longitudinal ambulatory care experiences are now common in medical schools, evidence supporting their widespread implementation is sparse. Few studies employ rigorous methods to evaluate educational outcomes. Research to identify benefits and costs, improve the quality and consistency of the students' experiences, and develop other innovative ways of teaching and learning ambulatory care is needed.
Ambulatory Care↗