Medical Education Online™Manuscripts organized by VolumeVolume 13, 2008 |
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Effects of Using Human Patient Simulator (HPS) versus a CD-ROM on Cognition and Critical Thinking
Don Johnson, PhD*, Amanda Flagg, MSN, PhD(c)†, Theresa L. Dremsa, PhD‡
*US Army Graduate Program in Anesthesia Nursing
Fort Sam Houston
San Antonio, Texas USA
†School of Nursing
University of Texas Health Science Center
San Antonio, Texas USA
‡United States Air Force Retired
San Antonio, Texas USA
Abstract
Background: Very little prospective randomized experimental research exists on the use of simulation as a teaching method, and no studies have compared the two strategies of using the HPS and a CD-ROM. In addition, no researchers have investigated the effects of simulation on various levels of cognition, specifically lower-level and higher-level cognition or critical thinking.
Objectives: A prospective pretest-posttest experimental mixed design (within and between) was used to determine if there were statistically significant differences in HPS and CD-ROM educational strategies in lower-level, higher-level cognition and critical thinking.
Results: A repeated measures multivariate analysis of variance (RMANOVA) with LSD post-hoc tests were used to analyze the data. There were no significant differences between the HPS and CD-ROM groups on lower-level cognition scores. The HPS group did significantly better than the CD-ROM group on higher-level cognition and critical thinking scores.
Conclusion: This study demonstrated that the choice of teaching strategies for lower-level cognition does not make a statistically significant difference in outcome. However, the HPS is superior to using CD-ROM and should be considered as the choice in teaching.
Keywords: simulation, teaching strategies, cognition, critical thinking
The Use of Professionalism Scenarios in the Medical School Interview Process: Faculty and Interviewee Perceptions
James Kleshinski, MD*, Constance Shriner, PhD†, Sadik A. Khuder, PhD‡
*Associate Professor of Medicine
Associate Dean for Admissions
The University of Toledo College of Medicine
†Assistant Professor of Family Medicine
Associate Dean for Faculty Development and Curriculum Evaluation
The University of Toledo College of Medicine
‡Professor of Medicine and Public Health
Director of Epidemiology, Northwest Ohio Consortium for Public Health
The University of Toledo College of Medicine
Abstract
Purpose: The purpose of this study was to determine the impact of professionalism scenarios on the medical school admissions process from applicant and faculty perspectives. Specifically, do completing professionalism scenarios as part of the medical school interview process have an impact on both the interviewee’s and the faculty’s perception of the process and outcome?
Method: Ninety-one faculty interviewed 199 applicants from January 2007 through April 2007 at The University of Toledo College of Medicine. All applicants were asked one standard professionalism scenario in each of their two interviews. A total of six scenarios were used for the entire interviewing season in rotation every two months. A survey was administered by an admissions office staff member to both the interviewed applicants as well as faculty who conducted interviews about how these scenarios impacted their interview experience.
Results: Asking applicants to respond to professionalism scenarios during the interview was described as having a positive influence on their interview experience. This was also associated with leaving an impression on the applicant about what our institution values in its students and contributed an element of personal reflection about what will be expected of them in the medical profession. Applicants more often reported that asking questions about professionalism was an important aspect of the interview than did faculty. Overall, there was an association between the interviewer’s perception of the applicant’s response and the interviewer’s assessment of professionalism.
Conclusions: Professionalism scenarios can be a worthwhile tool for use in the admissions process. The interview process should encourage participation from faculty who value this as an important component in the evaluation of an applicant. Determinants of faculty perception of the role of assessing professionalism in the interview process should be investigated in future research.
A focus Group Study of Medical Students’ Views of an Integrated Complementary and Alternative Medicine (CAM) Curriculum: Students Teaching Teachers
Désirée Lie, M.D., MSEd., Johanna Shapiro, Ph.D., Sarah Pardee, BA, Wadie Najm, M.D., MSEd.
Department of Family Medicine
University of California, Irvine
Orange, CA USA
Abstract
Background: Student views of new curricula can shape training outcomes. This qualitative study elicited student opinions of CAM instruction to examine and distill best strategies.
Methods: 49 second, third and fourth year students participated in focus groups using a predefined question route. Interviews were audio taped and transcribed.
Results: Students successfully differentiated CAM curricula from other academic content and were supportive of a longitudinal integrated approach. They had positive disposition toward CAM use for themselves but this did not necessarily translate into patient recommendations. They agreed that goals of the CAM curriculum should center on awareness of patient use and evidence and information relevant to clinical practice. They advocated a case-based, hands-on, experiential strategy vs lectures. Students proposed greater institutional commitment to strengthen curricular effectiveness. The majority did not intend to practice CAM modalities but valued skills to assess them. Patient-centeredness was recognized. As training progressed, students exhibited a growing tendency to evaluate CAM efficacy, and therefore value, exclusively according to evidence.
Conclusions: In-depth student input allowed examination of the effectiveness of a CAM curriculum,
permitting improvement and assessment of program effectiveness.
Keywords: Curriculum assessment, Complementary and Alternative Medicine (CAM), focus groups, medical students, qualitative.
Perceived Benefits and Barriers to Family Planning Education among Third Year Medical Students
Kimberly G. Smith, MD, MS*, Melissa L. Gilliam, MD, MPH*,
Mathieu Leboeuf, MD, MPH, FRCSC†, Amy Neustadt, MPH*, Debra Stulberg, MD, MA*
*Department of Obstetrics and Gynecology
University of Chicago
Chicago, IL 60637
†Department of Obstetrics and Gynaecology
Laval University
Québec City, Québec, Canada.
Abstract
Purpose: The purpose of the current study is to explore third- year medical students’ interest in learning about family planning, exposure to family planning (contraception and abortion) and perceived barriers and benefits to family planning education in their obstetrics and gynecology rotation.
Method: We conducted four focus groups with 27 third-year medical students near the end of their rotation in obstetrics and gynecology.
Results: Students desired education in family planning but perceived limited exposure during their rotation. Most students were aware of abortion but lacked factual information and abortion procedural skills. They felt systemic and faculty-related barriers contributed to limited exposure. Students discussed issues such as lack of time for coverage of contraception and abortion in the curricula and rotation itself. Perceived benefits of clinical instruction in family planning included increased knowledge of contraceptive management and abortion the ability to care for and relate to patients, opportunity for values clarification, and positive changes in attitudes towards family planning.
Conclusions: Medical students who desire full education in family planning during their obstetrics and gynecology rotation may face barriers to obtaining that education. Given that many medical students will eventually care for reproductive-age women, greater promotion of opportunities for exposure to family planning within obstetrics and gynecology rotations is warranted.
Keywords: Medical student education; Professionalism; Family planning; Contraception; Abortion
Resident Physician Attitudes and Competence About Obesity Treatment: Need for Improved Education
Nichola J. Davis M.D., M.S., § Himani Shishodia, M.D,† Bizath Taqui, M.D.,* Claudia Dumfeh, B.S.,§ Judith Wylie-Rosett, Ed.D., R.D. §
†St. Luke’s Roosevelt
New York, New York, USA
*Temple University Hospital
Philadelphia, Pennsylvania, USA
§Albert Einstein College of Medicine
Montefiore Medical Center
Bronx, New York, USA
Abstract
Background: Obesity is a common problem in primary care, but little is known about Internal Medicine residents’ attitudes towards obesity treatment.
Objective: To describe resident attitudes about obesity treatment.
Methods: Cross-sectional survey of 101 Internal Medicine residents in Philadelphia, PA, and Bronx, NY. Responses to 18 items on a Likert scale assessed resident attitudes. Weight loss goals were assessed with open-ended questions to a clinical scenario. ANOVA with trend analysis compared questionnaire responses to resident postgraduate year (PGY) level. Associations between clinic site, PGY level, and dichotomized Likert responses were tested with chi-square analysis.
Results: 19% of residents felt competent in prescribing weight loss programs. Few residents (18%) considered the current recommendations of a 5-10% reduction in body weight to be successful in an obese hypothetical patient. Third-year residents reported greater feelings of negativity towards obese patients than first- and second year residents (p<.05)
Conclusions: Resident physicians do not feel competent in treating obesity and have unrealistic weight loss goals; third-year residents had more negative attitudes about obese patients compared to residents in their 1st or 2nd year of training. These areas are targets for further resident education about obesity management.
Keywords: obesity, resident education, treatment
Resident Front Office Experience: A Systems-Based Practice Activity
Gary Sutkin*, MD, MBA and Christine K. Aronoff, MD†
*Department of Obstetrics, Gynecology, and Reproductive Sciences
University of Pittsburgh
Pittsburgh, PA, USA
†Department of Obstetrics and Gynecology
Texas Tech University Health Sciences Center
Lubbock, Texas, USA
Abstract:
Purpose: We set out to create and evaluate a systems-based practice experience designed to introduce
residents to front office responsibilities and stimulate suggestions for front office improvements.
Methods: On two occasions in 2002 and 2006, each resident in the Obstetrics and Gynecology Department was trained by a front office staff member for one day. The residents completed pre- and post-experience surveys, answered open-ended questions about their experience, and volunteered
suggestions for improving the front office staff, and were evaluated by their precepting staff member.
Results: All but two of 23 particpating residents participated enthusiastically. These residents perceived experiencing the staff as vital to the success of the practice, reported an increased sense of appreciation for the training of staff personnel, and were evaluated favorably.
Conclusion: This program gave our residents an appreciation for the training and responsibilities of pivotal office staff and an opportunity to suggest improvements. This program also satisfied ACGME resident education requirements regarding systems-based practice.
Keywords: resident education, front office, systems-based practice
A Pilot Study Exploring Gender Differences in Residents’ Strategies for Establishing Mentoring Relationships
Megan C. McNamara, M.D., MSc*, Melissa A. McNeil, M.D., M.P.H.*., Judy Chang, M.D., M.P.H.†
*Division of General Internal Medicine
University of Pittsburgh
Pennsylvania. Montefiore University Hospital
Suite 933W, 200 Lothrop Street
Pittsburgh, PA, 15213
†Department of Obstetrics, Gynecology, and Reproductive Sciences
University of Pittsburgh
Magee Women’s Hospital
300 Halket Street
Pittsburgh, PA, 15213
Abstract
Background Mentoring is important throughout a physician’s career and has been noted to be particularly important during residency training. Other studies suggest that women may experience difficulty in finding mentors.
Purpose This study explored gender-specific differences in residents’ mentoring experiences.
Methods The authors conducted two focus groups at the University of Pittsburgh in July, 2004. One group was composed of 12 female residents; the other was composed of nine male residents. Discussions were audiotaped and transcribed. Two investigators coded the transcripts and identified emerging themes.
Results Residents of both genders cited multiple barriers to mentoring. Men´s strategies for finding
mentors were more numerous than women´s and included identifying mentors through research,
similar interests, friendship, and networking. Female strategies were limited and included identifying mentors through “word of mouth” and work experiences. Women described more passive
approaches for finding a mentor than men.
Conclusions Female residents may lack strategies and initiatives for finding mentors. Residency programs should create opportunities for residents to develop mentoring relationships, with special attention paid to gender differences.
Keywords: Residents, mentoring, gender
Perceptions of Students in Different Phases of Medical Education of Educational Environment: Ankara University Faculty of Medicine
M. Demirören, Ö. Palaoglu, S. Kemahli, F.Özyurda, I.H. Ayhan
Faculty of Medicine
Department of Medical Education and Informatics
Ankara University
Ankara, Turkey
Abstract: The present study was undertaken to identify the perceptions of students about their educational environment in a newly restructured curriculum. The Turkish version of the DREEM questionnaire (total score: 200) was used to diagnose the strengths and weaknesses of the curriculum which is known to be a major determinant of educational environment. Five hundred fifty three students (years 1, 3, 5) voluntarily replied to the questionnaire. The mean DREEM score was found to be 117.63 (58.8%). The mean scores for the whole DREEM questionnaire and the five essential domains were found to be significantly different in different phases of medical education. The scores were found to be highest (123.65) for year 3 students and lowest (109.39) for year 5 students. The results are the first data of a curriculum reform obtained from the students about the educational environment and give important feedback to curriculum planners and change managers of the faculty for necessary improvement.
Keywords: educational environment, DREEM, medical education, PBL
Assessing Medical Students’, Residents’, and the Public’s Perceptions of the Uses of Personal Digital Assistants
Pradip D. Patel, MD*, Ruth B. Greenberg, PhD†, Karen Hughes Miller, PhD†, Mary B. Carter, MD, PhD†, Craig H. Ziegler, MS†
*Department of Pediatrics
University of Louisville School of Medicine
Louisville KY, USA
†Office of Medical Education
University of Louisville School of Medicine
Louisville, KY, USA
Abstract : Although medical schools are encouraging the use of personal digital assistants (PDAs), there have been few investigations of attitudes toward their use by students or residents and only one investigation of the public’s attitude toward their use by physicians. In 2006, the University of Louisville School of Medicine surveyed 121 third- and fourth-year medical students, 53 residents, and 51 members of the non-medical public about their attitudes toward PDAs. Students were using either the Palm i705 or the Dell Axim X50v; residents were using devices they selected themselves (referred to in the study generically as PDAs). Three survey instruments were designed to investigate attitudes of (a) third- and fourth-year medical students on clinical rotations, (b) Internal Medicine and Pediatrics residents, and (c) volunteer members of the public found in the waiting rooms of three university practice clinics. Both residents and medical students found their devices useful, with more residents (46.8%) than students (16.2%) (p<0.001) rating PDAs “very useful.” While students and residents generally agreed that PDAs improved the quality of their learning, residents’ responses were significantly higher (p<0.05) than students’. Residents also responded more positively than students that PDAs made them more effective as clinicians. Although members of the public were generally supportive of PDA use, they appeared to have some misconceptions about how and why physicians were using them. The next phase of research will be to refine the research questions and survey instruments in collaboration with another medical school.
Keywords: medical students, residents, public perception, handheld wireless devices, personal digital assistants (PDAs), standardized patients
Evaluating Attitudes of First-Year Residents to Shared Decision Making
Jon G. Caldwell, D.O.
Department of Psychiatry
University of California at Davis
Davis, California USA
Abstract
Objective - Shared decision making (SDM) is recognized as an ideal model of patient-physician interaction, yet clinical application occurs infrequently. The current study evaluated attitudes of first-year residents to identify potential barriers and opportunities regarding SDM.
Methods - A total of 70 residents attending orientation at the University of Utah completed a questionnaire that elicited their understanding of SDM, perceptions about the importance of SDM, confidence in utilizing SDM, and reasons for lacking confidence.
Results - Most residents reported no prior SDM education (N=42, 60%) or training (N=46, 66%), yet 67 (96%) of them could recognize it in a clinical vignette. Using a Likert scale, the majority of residents (91% to 99%) attributed importance to SDM principles, and most (79% to 90%) indicated confidence in applying them. Lack of training was reported as a barrier by 40 (57%) residents.
Conclusions - A minority of residents reported formal education or training in SDM, yet the vast majority recognized and valued the model. A large percentage of residents expressed confidence in their abilities to incorporate SDM into patient care, but many also identified a need for more education and training.
Keywords: Decision Making, Interviews/methods, Patient Participation/methods, Physician-Patient Relations, Patient Participation/psychology, Physician’s Role/psychology, Communication, Physicians, Education, Training, Internship and Residency, Internship, Medical Residency
Revising the Tool for Assessing Cultural Competence Training (TACCT) for curriculum evaluation: Findings derived from seven US schools and expert consensus
Désirée A. Lie, MD, MSEd*, John Boker, PhD*, Sonia Crandall, PhD, MS†, Christopher N. DeGannes, MD, FACP‡, Donna Elliott, MD, EdD§, Paula Henderson, MD||, Cheryl Kodjo, MD, MPH¶, and Lynn Seng, MSEd**
*University of California, Irvine School of Medicine
Orange, California, USA
†Wake Forest University School of Medicine
Winston-Salem, North Carolina, USA
‡Howard University College of Medicine
Washington, DC, USA
§Keck School of Medicine at the University of Southern California
Los Angeles, California, USA
||David Geffen School of Medicine at the University of California, Los Angeles
Los Angeles, California, USA
¶University of Rochester School of Medicine
Rochester, New York, USA
**University of Pennsylvania School of Medicine
Philadelphia, Pennsylvania, USA
Abstract
Background: The 67-item TACCT currently used for needs assessment has potential for evaluating evolving cultural competence (CC) curricula.
Purpose: To validate a shortened, more practical TACCT measure.
Methods: The 67-item TACCT was administered to students and course directors at US schools. Course directors and students reported which of 67 TACCT items were taught. Intraclass correlation coefficients (ICC) examined faculty-student agreement. Under-addressed content was identified. A new and shortened TACCT configuration was proposed and validated with expert educator input.
Results: Across-school faculty and student response rates ranged from 75% to 100%. Aggregate ICC was 0.90 (95% CI: 0.84, 0.94) for the 67-item TACCT, demonstrating faculty-student agreement. Experts agreed on reduction from 67 to 42 items and domain revision from five to six domains to match under-addressed content. Item analysis showed high internal consistency for all 6 new domains and the total revised 42-item TACCT.
Conclusions: A shorter, more practical TACCT measure is valid and reliable and focuses on under-addressed CC content. Use for curricular evaluation is suggested.
Keywords: cultural competence, curriculum tool, evaluation, validation
Does Gender Predict Medical Students’ Stress in Mansoura, Egypt?
Mostafa Amr , MD*, Abdel Hady El Gilany, MD†, Aly El-Hawary, MD‡
*Department of Psychiatry, Faculty of Medicine
Mansoura University, Egypt
†Department of Community Medicine, Faculty of Medicine
Mansoura University, Egypt
‡Department of Community Medicine, Faculty of Medicine
Zagazig University, Egypt
Abstract
Background: Medical education is perceived as being stressful with negative effects on students’ mental health. However, few studies have addressed the influence of gender on stress in medical students.
Aim: To compare male and female medical students in Egypt on sources of stress, perception of stress, anxiety, depression, physical symptomatology, and personality profile.
Methods: Data were collected through an anonymous self-administered questionnaire covering socio-demographic data, stressors, perceived stress scale, physical wellbeing factors, the Hospital Anxiety and Depression scale as well as neuroticism and extraversion subscales of the Eysenck Personality Questionnaire.
Results: Stressors were reported by 94.5% of the total sample with equal gender proportions. Univariate analysis indicated that female students scored higher than males on depression and neuroticism scales while male and female medical students were similar on level of perceived stress, number of stressors, clinical anxiety, physical well-being factors and the extraversion scale. Multivariate logistic regression revealed that the independent predictors of a high stress level were the presence of more than five stressors, clinical anxiety and depression, and increased scores on the global sickness index and on the extraversion and neuroticism sub-scales.
Conclusion: Despite there being no significant difference in perceived stress according to gender, females were less likely to cite relationship problems with teachers and substance abuse as sources of stress. Moreover, females scored significantly higher than males on depression and neuroticism scales.
Keywords: gender, medical student, stress, depression, anxiety.