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Biomedical subjects

Larry D Gruppen

Publications and source records attributed to Larry D Gruppen.

At least 19 recordsLinked to original sources
PubMed2006

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↗
PubMed2006

Teaching medical education principles and methods to faculty using an active learning approach: the University of Michigan Medical Education Scholars Program.

The Medical Education Scholars Program (MESP) at the University of Michigan Medical School was established in 1998 to develop educational leadership, improve teaching skills, and promote educational scholarship among medical school faculty. The Department of Medical Education designed and implemented the program. Eighty-one scholars have completed the MESP, with 15 more currently enrolled. While most scholars have been clinical faculty, some have been basic science faculty or from other allied health fields. The selection process emphasizes potential for contributing to the educational mission of the medical school. Each cohort is limited to two participants per department. The curriculum of the MESP is designed to provide an overview of a wide range of topics in education. It is divided into five broad domains: principles and theories of education, teaching methods, educational research methods, assessment and evaluation, and educational leadership. During the sessions, active learning of content is expected and encouraged. For instance, scholars share responsibility with the session presenters for planning and evaluating individual program sessions. To graduate, scholars are expected to attend the sessions regularly, and to make a final presentation of their project, which demonstrates near-completion or substantial progress toward that goal. Over its eight years, the MESP has evolved in response to environmental changes and ongoing evaluation of the program. Overall, the Medical Education Scholars Program has proven effective in developing faculty skills and educational leadership locally at the University of Michigan Medical School and nationally.

Adult↗
PubMed2006

Development of an evaluation of medical student competence in evidence-based medicine using a computer-based OSCE station.

BACKGROUND: Instruction in evidence-based medicine (EBM) has been widely incorporated into medical school curricula with little evidence of its effectiveness. Our goal was to create, implement, and validate a computer-based assessment tool that measured medical students' EBM skills. DESCRIPTION: As part of a required objective structured clinical examination, we developed a specific case scenario in which students (a) asked a structured clinical question using a standard framework, (b) generated effective MEDLINE search terms to answer a specific question, and (c) elected the most appropriate of 3 abstracts generated from a search justifying which best applies to the patient scenario. EVALUATION: Between the 3 blinded raters, there was very good interrater reliability with 84, 94, and 96% agreement on the scoring for each component, respectively (k = .64, .82, and .91, respectively). In addition, students found the station appropriately difficult for their level of training. CONCLUSIONS: This computer-based tool appears to measure several EBM skills independently and combines simple administration and scoring. Its generalizability to other cases and settings requires further study.

Clinical Competence↗
PubMed2005

Medical students self-reported work hours: perception versus reality.

OBJECTIVE: The objective of this study was to compare the students' actual work hours with their self-reported work hours during the obstetrics and gynecology clerkship, and to determine whether the number of hours worked correlate with the amount of "scut" reported or students' rating of the quality of the clerkship. STUDY DESIGN: Students self-reported work hours were compared against their actual scheduled hours over 2 different academic years. Pearson's correlation was performed to correlate the actual hours with the amount of reported "scut" work and the overall rating of the quality of the clerkship. RESULTS: The actual hours per week worked by students averaged 59 hours in 2003 and 48 hours in 2004. Students overestimated their work hours both years. Students who worked more hours rated the clerkship lower and the quality of the clerkship significantly improved from 2003 to 2004 (4.2 vs 3.8 P < .03). CONCLUSION: The majority of third-year students overestimate their work hours in obstetrics and gynecology. The rating of the overall quality of the clerkship increase significantly with fewer hours worked, and it is not affected by the amount of "scut" work.

Clinical Clerkship↗
PubMed2005

Initial use of a novel instrument to measure professionalism in surgical residents.

BACKGROUND: No universally accepted method to measure professionalism exists. We developed an instrument to measure specific aspects of professionalism in surgical residents. METHODS: Professionalism was deconstructed into 15 domains. Behavioral descriptors were determined for extreme and selected intermediate anchors. It became evident that residents could "go too far" in some professional behaviors. Therefore, although a 7-point continuous ordinal scale forms the framework, a score of 7 does not necessarily indicate the ideal. This characteristic minimizes the problem of inflated ratings. RESULTS: The instrument was utilized by attending faculty to evaluate residents and also by residents as a self-evaluation. Calculated from ordinal values, mean (SD) of the ratings across domains for faculty evaluations of residents was 4.95 (0.38) while mean for self-evaluations was 4.95 (0.39). Reliability was high (coefficient alpha 0.85). CONCLUSIONS: This instrument provides a means to measure professional behaviors during surgical residency. Repeated use will be required to thoroughly establish validity and reliability.

Accreditation↗
PubMed2005

Gender differences in the self-assessment of surgical residents.

BACKGROUND: Despite equivalent performance as assessed by objective external measures, women tend to underestimate their abilities compared with their male counterparts. METHODS: The difference in ordinal values from faculty and resident self-evaluations was calculated for each general and plastic surgery resident. Objective external performance measures were compared for female and male residents. RESULTS: Male and female residents performed equivalently. All residents underestimated their abilities compared with faculty assessment; however, general surgery residents did so to a greater degree (P < .05). Female residents demonstrated a greater degree of underestimation than did their male colleagues; however, this was not statistically significant. CONCLUSIONS: Although female resident surgeons are generally confident in their abilities, this may be in contrast to the self-perception of many female medical students. Consideration of gender differences in self-perception may be important when providing feedback to female students and residents.

Clinical Competence↗
PubMed2005

A controlled comparison study of the efficacy of training medical students in evidence-based medicine literature searching skills.

PURPOSE: Many educational programs seek to develop skills in evidence-based medicine (EBM). The authors examined the efficacy of teaching the EBM skill of efficiently searching the research literature. They compared students who received brief training in EBM searching skills with those who did not, and assessed the quality of literature searching one month after that training. METHOD: The authors used a nonrandomized control group study design to quantify the impact of a single, brief (two-hour) instructional intervention on EBM-based techniques for searching Medline for evidence related to a clinical problem provided to the students. Ninety-two fourth-year medical students (34 intervention, 58 control) at the University of Michigan participated in a four-week EBM elective between 2001 and 2003. The authors conducted a pre-intervention assessment of searching skills, followed by a repeat assessment one month after the intervention. Search quality was judged by medical librarians using a structured clinical scenario and scoring algorithm. RESULTS: Data for 30 intervention and 40 control students could be analyzed. Intervention students had fewer search errors and correspondingly higher quality searches than did control students. The educational intervention accounted for approximately 8% of the variance in both of these outcomes. The most common search errors were a lack of Medical Subject Headings (MeSH) explosion, missing MeSH terms, lack of appropriate limits, failure to search for best evidence, and inappropriate combination of all search concepts. CONCLUSIONS: This study provides evidence that a single, brief training session can have a marked beneficial effect on the quality of subsequent, short-term EBM literature searching performance outcomes.

Education, Medical, Undergraduate↗
PubMed2005

The prediction of professional behaviour.

OBJECTIVE: The purpose of this study was to establish outcome measures for professionalism in medical students and to identify predictors of these outcomes. DESIGN: Retrospective cohort study. SETTING: A US medical school. PARTICIPANTS: All students entering in 1995 and graduating within 5 years. MEASURES: Outcome measures included review board identification of professionalism problems and clerkship evaluations for items pertaining to professionalism. Pre-clinical predictor variables included material from the admissions application, completion of required course evaluations, students' self-reporting of immunisation compliance, students' performance on standardised patient (SP) exercises, and students' self-assessed performance on SP exercises. RESULTS: The outcome measures of clerkship professionalism scores were found to be highly reliable (alpha 0.88-0.96). No data from the admissions material was found to be predictive of professional behaviour in the clinical years. Using multivariate regression, failing to complete required course evaluations (B = 0.23) and failing to report immunisation compliance (B = 0.29) were significant predictors of unprofessional behaviour found by the review board in subsequent years. Immunisation non-compliance predicted low overall clerkship professional evaluation scores (B = - 0.34). Student self-assessment accuracy (SP score minus self-assessed score) (B = 0.03) and immunisation non-compliance (B = 0.54) predicted the internal medicine clerkship professionalism score. CONCLUSIONS: This study identifies a set of reliable, context-bound outcome measures in professionalism. Although we searched for predictors of behaviour in the admissions application and other domains commonly felt to be predictive of professionalism, we found significant predictors only in domains where students had had opportunities to demonstrate conscientious behaviour or humility in self-assessment.

Attitude of Health Personnel↗
PubMed2004

Teaching residents how to teach improves quality of clerkship.

OBJECTIVE: To evaluate the impact of a resident's teaching skills workshop on the ratings of the obstetrics and gynecology clerkship by third-year medical students. STUDY DESIGN: The 6-week obstetrics and gynecology clerkship at the University of Michigan is provided at 4 different sites including the University of Michigan Hospital. At the end of each rotation, medical students complete an evaluation form assessing various aspects of their learning experience, including the overall quality of clerkship. A workshop, "Teaching Residents How to Teach," was conducted at the University of Michigan Hospital, whereas the other 3 sites served as the control. Clerkship evaluations were compared before and after the workshop using Student t test. RESULTS: Students at the University of Michigan Hospital rated all items on the evaluation form higher after the teaching workshop. The overall quality of the clerkship at the University of Michigan Hospital improved ( P = .05), whereas the other sites remained stable. CONCLUSIONS: A "Teaching the Residents How to Teach" workshop improves the overall quality of the clerkship.

Clinical Clerkship↗
PubMed2004

Assessing residents' competencies at baseline: identifying the gaps.

PURPOSE: Entering residents have variable medical school experiences and differing knowledge and skill levels. To structure curricula, enhance patient safety, and begin to meet accreditation requirements, baseline assessment of individual resident's knowledge and skills is needed. To this end, in 2001 the University of Michigan Health System created the Postgraduate Orientation Assessment (POA), an eight-station, objective structured clinical examination for incoming residents. METHOD: The POA, administered at orientation, included items addressing critical laboratory values, cross-cultural communication, evidence-based medicine, radio-graphic image interpretation, informed consent, pain assessment and management, aseptic technique, and system compliance such as fire safety. The POA assessed many of the skills needed by interns in their initial months of training when supervision by senior physicians might not be present. RESULTS: In 2002, 132 interns from 14 different specialties and 59 different schools participated in the POA. The mean score was 74.8% (SD = 5.8). When scores were controlled for U.S. Medical Licensing Examination scores, there were no significant differences in performance across specialties. There were differences between University of Michigan Medical School graduates and those from other institutions (p <.001). Eighty-one percent of the residents would recommend the POA. CONCLUSIONS: The POA provides a feasible format to measure initial knowledge and skills and identify learning needs. Orientation is an effective time to identify important gaps in learning between medical school and residency. This is the first step in a continuing evaluation of the Accreditation Council for Graduate Medical Education's general competencies.

Accreditation↗
PubMed2004

The Department of Medical Education at the University of Michigan Medical School: a case study in medical education research productivity.

The Department of Medical Education (DME) at the University of Michigan Medical School has a strong and sustained history of contributing to medical education research. The author identifies several dimensions that contribute to this productivity: (1) the quality of department faculty and the complementary areas of expertise they possess; (2) a critical mass of educational scholars, both within and outside the DME; (3) extensive collaborations of DME faculty with colleagues in other departments on educational innovation; (4) the departmental status of the DME; (5) the separation of the DME from the administration of the curriculum; (6) the need to balance the missions of research and educational support of the medical school; (7) the research-intensive nature of the larger University of Michigan environment; (8) the complex challenge of funding the educational scholarship mission; and (9) the importance of maintaining visibility within the institution. Factors that will affect the health of future educational scholarship include (1) the response to the Accreditation Council for Graduate Medical Education's definition of resident competencies and similar initiatives; (2) the growth of opportunities for advanced training in educational scholarship and the corresponding expansion of medical school faculty with greater interest and skills in educational research; (3) an emerging emphasis on the importance of behavioral science in medical care; (4) demands on the clinical productivity of collaborating faculty; and (5) the paucity of funding for medical education research.

Accreditation↗
PubMed2004

The physical examination of patients with abdominal pain: the long-term effect of adding standardized patients and small-group feedback to a lecture presentation.

BACKGROUND: One of the most effective methods for teaching physical diagnosis may be standardized patient instructors. PURPOSE: To determine if a lecture plus standardized patient instructors with small-group sessions is more effective than a lecture alone for teaching the evaluation of patients with abdominal pain. METHODS: Control (class of 2001) and intervention (class of 2002) groups both attended a lecture on the abdominal examination. The intervention group then underwent an exercise with standardized patient instructors and a review session with surgical faculty. An evaluation 18 months later used standardized patient instructors to complete evaluations assessing history-taking and physical examination skills. RESULTS: The intervention group performed significantly better than the control group on both the history and the physical examination subscales. CONCLUSION: It is possible to have an important, measurable, and lasting effect on physical examination skills by adding standardized patient instructors and small-group discussion to a lecture presentation.

Abdominal Pain↗
PubMed2004

Relationship between symptoms and health-related quality of life in patients treated for hypertension.

STUDY OBJECTIVE: To determine the relationship between symptoms and health-related quality of life (HRQOL) in patients receiving drug therapy for hypertension. DESIGN: Cross-sectional survey. SETTING: Outpatient general medicine and university-based hypertension clinics. PATIENTS: All patients prescribed one or more antihypertensive drugs seen during a 6-month period in the clinics. INTERVENTION: Data were obtained from a mailed questionnaire and medical records. MEASUREMENTS AND MAIN RESULTS: Symptoms were measured by a symptom count and total symptom distress. Two scores derived from the Short Form-36 (SF-36)--the Physical Component Summary (PCS) and the Mental Component Summary (MCS)--were used to assess HRQOL. Responses were received from 125 of 220 patients (56.8%). Mean +/- SD values were 8.8 +/- 7.8 for symptom count, 31.6 +/- 46.2 for total symptom distress, 48.7 +/- 9.3 for PCS, and 51.6 +/- 10.1 for MCS. Higher symptom counts and symptom distress scores were strongly associated with lower HRQOL scores in multivariate models, with standardized coefficients from -0.62 to -0.41. These were greater in magnitude than any other predictor, including demographic information (age, sex, race, education level, income), disease variables (blood pressure, years of hypertension), and drug treatment (number of antihypertensive drugs and duration of regimen). Model-adjusted R2 values were 0.22-0.41. CONCLUSION: Symptoms have a greater impact on HRQOL than patient characteristics, blood pressure, or drug-related factors. Among patients receiving drug therapy for hypertension, detailed review of symptoms may yield important information for assessing and improving HRQOL.

Aged↗
PubMed2003

A longitudinal study of self-assessment accuracy.

AIM: Although studies have examined medical students' ability to self-assess their performance, there are few longitudinal studies that document the stability of self-assessment accuracy over time. This study compares actual and estimated examination performance for three classes during their first 3 years of medical school. METHODS: Students assessed their performance on classroom examinations and objective structured clinical examination (OSCE) stations. Each self-assessment was then contrasted with their actual performance using idiographic (within-subject) methods to define three measures of self-assessment accuracy: bias (arithmetic differences of actual and estimated scores), deviation (absolute differences of actual and estimated scores), and covariation (correlation of actual and estimated scores). These measures were computed for four intervals over the course of 3 years. Multivariate analyses of variance and correlational analyses were used to evaluate the stability of these measures. RESULTS: Self-assessment accuracy measures were relatively stable over the first 2 years of medical school with a decease occurring in the third year. However, the correlational analyses indicated that the stability of self-assessment accuracy was comparable to the stability of actual performance over this same period. CONCLUSION: The apparent decline in accuracy in the third year may reflect the transition from familiar classroom-based examinations to the substantially different clinical examination tasks of the third year OSCE. However, the stability of self-assessment accuracy compares favorably with the stability of actual performance over this period. These results suggest that self-assessment accuracy is a relatively stable individual characteristic that may be influenced by task familiarity.

Chi-Square Distribution↗
PubMed2003

Impact of a veterans affairs continuity clinic on resident competencies in women's health.

BACKGROUND: Education in women's health is now considered a core curricular component during residency training in Internal Medicine. There is potential for insufficient training in women's health for residents with a continuity clinic based at a Veterans Affairs (VA) hospital. OBJECTIVE: To determine the impact of a 3-year continuity clinic based at a VA hospital on residents' self-reported competencies in women's health. DESIGN: Cross sectional survey using an internal website. SETTING: University-based residency program in Ann Arbor, Michigan. MEASUREMENTS AND MAIN RESULTS: Comparison of residents with a VA clinic with residents with non-VA clinics (university and community) in self-reported competencies in knowledge base, counseling, and physical exam skills in the area of women's health. Responses were obtained from 66% (n = 72) of eligible residents. When compared to residents with either a university hospital- or community-based clinic site, VA-based residents reported less confidence in the majority of competencies surveyed. Clinic site had the strongest impact in the knowledge base domain, accounting for between 17% and 33% of the variance in each specific competency. For estimated number of Pap smears and breast exams done in the prior year, VA-based residents reported doing, on average, less than 5 of each per year while non-VA residents reported doing between 11 and 20 of each exam. CONCLUSIONS: Our data suggest that despite other clinical opportunities in women's health during ambulatory rotations, regular clinical experiences in women's health in the continuity clinic setting are necessary to improve education in this area.

Adult↗
PubMed2003

Faculty development for educational leadership and scholarship.

The Medical Education Scholars Program (MESP) at the University of Michigan Medical School is designed to develop leaders in medical education. The program's goals are to enable faculty to provide curriculum direction, improved teaching, educational research, and development, and institutional leadership at all levels of medical education. This one-year program uses a variety of educational methods and provides a broad curriculum in educational theory, assessment and evaluation, research design and methods, teaching-skills development, and educational leadership. Faculty are admitted on a competitive basis and one half-day per week of release time is funded as part of the program. Salient outcomes of the program (promotions, educational research and development, curriculum leadership, and educational scholarship) were measured in a pre- and post-program design in which each scholar acted as his or her own control. There were major increases in promotions and educational awards, new educational responsibilities, and new educational programs. A particularly important outcome was the emergence of educational scholarship in the professional portfolios of the program scholars in the form of peer-reviewed presentations and publications and educational grant funding. A cost-outcome analysis indicates that these multi-year outcomes were obtained from a one-time investment of approximately $21,000 per graduating scholar. This evaluation indicates that intensive faculty development programs can have measurable impacts on the careers of the participants and the institutional environment.

Curriculum↗
PubMed2003

Lecture versus Web tutorial for pharmacy students' learning of MDI technique.

OBJECTIVE: To compare pharmacy students' acquired knowledge and ability to assess metered-dose inhaler (MDI) technique after a traditional lecture versus a Web-based MDI technique tutorial. METHODS: All 42 third-year PharmD students completed a baseline MDI technique knowledge test and were then randomized into 1 of 3 groups. The Web group completed the tutorial on the college dispensing laboratory computers; the lecture group participated in the MDI technique excerpt of the asthma therapeutics lecture; and the control group participated in a 15-minute discussion of participants' hobbies. Afterward, participants in each group completed an identical MDI technique knowledge posttest. Students then observed a standardized mock patient perform MDI technique, documenting steps that were conducted incorrectly. MDI technique knowledge test and MDI technique evaluation test scores were compared between groups using repeated measures ANOVA. RESULTS: There was no significant difference in the baseline MDI technique knowledge test scores between groups. The post-MDI technique knowledge test scores for the Web and lecture groups did not differ significantly (p = 0.38), and both were significantly different from the control group (p < 0.001). MDI technique knowledge scores increased significantly for the Web and lecture groups from pre- to post-assessment, but did not change for the control group. A 2-way repeated measures ANOVA analysis demonstrated no significant interaction of subject and group characteristics. The MDI technique evaluation scores for the Web and lecture groups were not significantly different (p = 0.50), and both were significantly different from the control group (p </= 0.001). CONCLUSIONS: The Web-based MDI technique tutorial was as effective as the standard lecture format in pharmacy students acquiring knowledge of MDI technique and in evaluating a mock-patient exhibiting incorrect MDI technique. Further testing is required to assess the longitudinal effect of the program.

Curriculum↗