American medical education 100 years after the Flexner report.
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Biomedical Research↗
Biomedical subjects
Molly Cooke
Publications and source records attributed to Molly Cooke.
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↗
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↗
When the time comes to talk about HIV: factors associated with diagnostic disclosure and emotional distress in HIV-infected children.
OBJECTIVE: To determine factors related to the timing and probability of nondisclosure of HIV status to perinatally HIV-infected children, and to explore factors associated with emotional distress in HIV-infected children. METHODS: This is a cross-sectional study of 51 HIV-infected children based on medical records, parent interviews, and child assessments. RESULTS: 1) Probability of earlier age of disclosure is associated with higher child IQ (p =.04) and more family expressiveness (p =.01); 2) controlling for child age, disclosure status at time of study is associated with major life events, but not with medical status; and 3) factors associated with increased parent-rated anxiety in HIV-infected children in univariate analyses are: HIV disclosure (p =.04), other major life events (p =.001), higher medication dose frequency ( p=.01), and child age (p =.01). Increased depression is associated only with more medication doses (p =.02). CONCLUSION: These data indicate that higher child IQ and greater family expressiveness increase the probability of earlier diagnostic disclosure to HIV-infected children. Factors associated with emotional distress highlight important areas of clinical attention. These data suggest that diagnostic disclosure may not necessarily minimize emotional distress, indicating the need for further evaluation of the appropriate timing and type of disclosure for pediatric HIV.
Adolescent↗
The Academies Collaborative: sharing a new model for medical education.
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California↗
The UCSF Academy of Medical Educators.
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Adult↗
Intersessions: covering the bases in the clinical year.
OBJECTIVE: At most medical schools students spend the core clerkship year entirely in clinical settings, geographically dispersed, and assigned to separate teams. Because of the immediacy of experiential learning in the clinical environment, this year is often the highlight of medical school. However, the intensity of the experience and the dispersion of students poses serious challenges to student well being and professional development, and to meeting important educational objectives best taught in the clinical year but difficult to implement in competition with direct patient care. To address these challenges in a way that does not interfere with the clinical experiences, we developed and are implementing three one-week intersessions. These are designated weeks between clerkship rotations when all third-year students are "off rotations" and studying together in an integrative, collaborative and reflective manner. DESCRIPTION: We identified themes for the intersession course from several sources. In response to strong documentation by past students of isolation and insufficient opportunity to reflect on their experiences during the core clerkships we placed a high priority on students gathering together as a class and on professional development. Additionally, based on knowledge gaps identified in the AAMC Graduation Questionnaire and our commitment to integrating basic science teaching into the clinical year, we developed the following five themes: evidence-based medicine, ethics, health systems (quality; resource allocation), advances in science (recent advances that fundamentally shift clinical practice), and professional development. Each intersession week consists of 20 hours of structured contact time; 75% is devoted to small-group learning. The weeks rely heavily on student directed and collaborative learning to complete required readings and assignments. All sessions build on the clinical experiences students have had during clerkships and enhance the students' skills for upcoming rotations. DISCUSSION: In 1999-2000, we restructured the clinical core year into eight-week modules allowing us to gather the entire class, in between clerkships, for intersessions. We phased in two intersession weeks in 2000-2001 and are implementing three intersession weeks in 2001-2002 (October, February, and June). In the evaluations of the first year's intersessions students valued the opportunity to gather together, to process their clinical experience, and to utilize their clinical experience to drive learning in important, clinically relevant areas that are not consistently taught in the clerkships. Evaluations from the first intersession of the second cycle further underscore the preference for learning experiences that are highly relevant to the clinical year (e.g., practicing efficient search strategies to quickly answer clinical questions, utilizing systematic reviews, discussing ethics cases from the students' experiences) and the benefits of faculty facilitated small-group discussions over lecture time. The advances in science sessions are most effective when they focus on advances in diseases that students are likely to have encountered. In our next phase, we will use Web-based interfaces to collect cases from students on clerkships and to promote discussion of topics in anticipation of the next intersession. As we continue to refine intersessions, our experience so far provides good evidence to support intersessions as a successful curricular innovation.
Clinical Clerkship↗