Separate and equitable promotion tracks for clinician-educators.
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Academic Medical Centers↗
Biomedical subjects
Debra A DaRosa
Publications and source records attributed to Debra A DaRosa.
Graduate surgical education redesign: reflections on curriculum theory and practice.
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Cognition↗
Evaluating and enhancing a women's health curriculum in an internal medicine residency program.
OBJECTIVE: Resident education in women's health is required but is often underemphasized. Our aim was to identify women's health topics with the most relevance to our graduates' practices and to determine how well they were prepared to address women's health issues. DESIGN: Postgraduate survey. SETTING: University-affiliated internal medicine residency program. PARTICIPANTS: Program graduates in general internal medicine practice. METHODS: A survey was drafted listing the 65 topics described in a published residency curriculum in women's health. Respondents indicated the extent to which each item was relevant to their practice and the adequacy of instruction received on a Likert-type scale of 1 (not relevant/inadequate) to 5 (highly relevant/adequate). RESULTS: The response rate was 86%. Many of the items were highly relevant to our graduates' practices. Learning needs were found in all areas as none of the topics were rated as "adequately" taught during residency. Many areas in the curriculum had low relevance scores. Few differences were seen in the perceived relevance of women's health problems or the adequacy of instruction received based on gender, practice type and setting, or amount of ambulatory training during residency. CONCLUSIONS: Use of this survey has allowed us to tailor and prioritize learning issues in women's health to meet the needs of our graduates. Increased time in ambulatory rotations alone may not be sufficient to prepare residents to provide comprehensive care in this field. Further study of the effectiveness of a dedicated curriculum in women's heath is needed.
Chicago↗
Developing an ethics curriculum for an internal medicine residency program: use of a needs assessment.
BACKGROUND: Residency programs are required to teach and evaluate trainees in the area of professionalism and medical ethics. Prior to developing a curriculum in this area, residents and fellows were surveyed to assess learning needs. DESCRIPTION: A case-based survey was developed based on published curricula. Residents and fellows were asked to describe their comfort level in 11 clinical scenarios on a Likert-type scale ranging from 1 (not at all comfortable) to 10 (extremely comfortable). EVALUATION: 151 surveys were returned for an overall response rate of 73%. Comfort levels ranged from a low of 3.1 to a high of 8.5 on the 10-point scale. Despite additional years of clinical training, fellows only reported an increased comfort level in 1 case. CONCLUSION: Learning needs exist in residents and fellows in the area of medical ethics. Use of a needs assessment was instrumental in planning and designing an ethics curriculum.
Attitude of Health Personnel↗
A learning prescription permits feedback on feedback.
BACKGROUND: Students consistently identified inadequate feedback as a deficiency in our third-year clerkship. METHODS: We asked students to solicit one faculty and one resident every 2 weeks for written feedback on a "feedback prescription pad." Each prescription requested four comments: two things the student did well and two things the student needs to improve. Students rated feedback using a five-point scale. A three-point categorization scheme was employed to assess the quality of feedback. RESULTS: Students' rating of feedback improved significantly compared with a previous time period (3.5 +/- 1.2 versus 2.6 +/- 1.2, P <0.01). Interrater reliability of our categorization scheme was high (kappa > or =0.75, P <0.01) and demonstrated that only 10% of comments were specific enough to qualify as effective feedback. CONCLUSIONS: Feedback prescription pads were a simple method to facilitate feedback. Although students appreciated feedback, most feedback was inadequate. Faculty development programs to enhance student feedback should be a priority of clinical medical education.
Clinical Clerkship↗
Facilitating academic institutional change: redefining scholarship.
BACKGROUND AND OBJECTIVES: Academic institutions are typically resistant to change. Redefining scholarship is an important issue for academic health care institutions. This study examines the change process at institutions that have attempted to change the definition of scholarship. METHODS: Five medical schools were identified that had recently redesigned their promotion and tenure systems based on expanded definitions of scholarship. Interviews were conducted with a key leader in this effort. The interviews were designed to identify the forces and barriers involved in change, activities designed to secure faculty "buy-in, "factors needed to sustain change, and advice that would help others who might be considering such an effort at their academic health centers. We organized the results of the interviews within a change leadership and management model. RESULTS: The responses to the survey questions fit well into the change model. Many of the responses were felt to be applicable to multiple stages of the change model. CONCLUSIONS: The leaders of change from the study institutions, either by intention or intuition, identified key factors of their change process that fit well with the study model. Change leaders should include plans that follow an established model for institutional change in their strategy to change the definition of scholarship at their institution.
Faculty, Medical↗
A critical evaluation of the morbidity and mortality conference.
BACKGROUND: This study was designed to evaluate the impact of changes made to our morbidity and mortality (M&M) conference. METHODS: A 23-item survey using corresponding Likert-type scales was created. Faculty and residents were asked to anonymously complete the surveys in June 1999. Based on this information, specific modifications were made to the conference. The same survey was administered to faculty and residents in the Fall of 2000. Analysis was performed using Student t tests. RESULTS: Postsurvey findings showed residents felt eight components improved significantly (P <0.05). Faculty noted nonsignificant improvement in nine survey items and decline in nine items (five unchanged). CONCLUSIONS: Changes in content and structure made to enhance our M&M conference's educational value resulted in significant improvements as perceived by the surgical residents. Interestingly, these changes had only minimal impact on faculty perceptions.
Clinical Competence↗
Residents seeking informed consent: Are they adequately knowledgeable?
PURPOSE: The purpose of this study was to determine the extent to which first-year surgical residents are prepared to obtain informed consent from patients. The study was designed to answer the following research questions: 1) Are first-year residents who are asked to obtain informed consent sufficiently knowledgeable about the risks, benefits, and alternatives of the procedures? 2) Can first-year residents accurately answer the questions patients may pose about these procedures? METHODS: First-year residents (n = 18) were asked to list the risks, benefits, and alternatives for open inguinal hernia repair, laparoscopic cholecystectomy, total thyroidectomy, esophagogastrectomy, and abdominal aortic aneurysm repair, assuming the procedures were elective on otherwise healthy individuals. Residents were also asked to answer questions that patients may pose about each of the procedures. The basic minimum risks, benefits, and alternatives to be listed and answers to the questions were validated by asking faculty representing general (n = 6) and vascular (n = 3) surgery to complete the questionnaires. RESULTS: Few residents were able to correctly list all risks, benefits, and alternatives of any of the procedures. Less than one-half of the questions that patients may ask about the procedures were correctly answered. CONCLUSIONS: Even though first-year residents are commonly obtaining consent for surgical procedures, many are unable to provide patients with the correct descriptions of the risks, benefits, and alternatives. Nor were they able to correctly answer common questions. Surgical faculty must take more time to educate first-year residents on the appropriate issues in informed consent for the procedures being performed.
Journal Article↗