PURPOSE:

To test educational methods that continue communication training into the fourth year of medical school.

METHOD:

The authors disseminated and evaluated an advanced communication elective in seven U.S. medical schools between 2007 and 2009; a total of 9 faculty and 22 fourth-year students participated. The elective emphasized peer learning, practice with real patients, direct observation, and applications of video technology. The authors used qualitative and quantitative survey methods and video review to evaluate the experience of students and faculty.

RESULTS:

Students reported that the elective was better than most medical school clerkships they had experienced. Their self-confidence in time management and in the use of nine communication skills improved significantly. The most valued course components were video review, repeated practice with real patients, and peer observation. Analysis of student videos with real patients and in role-plays showed that some skills (e.g., agenda setting, understanding the patient perspective) were more frequently demonstrated than others (e.g., exploring family and cultural values, communication while using the electronic health record). Faculty highly valued this learner-centered model and reported that their self-awareness and communication skills grew as teachers and as clinicians.

CONCLUSIONS:

Learner-centered methods such as peer observation and video review and editing may strengthen communication training and reinforce skills introduced earlier in medical education. The course design may counteract a "hidden curriculum" that devalues respectful interactions with trainees and patients. Future research should assess the impact of course elements on skill retention, attitudes for lifelong learning, and patients' health outcomes.

PURPOSE:

To describe community leaders' perceptions regarding the impact of a fully distributed undergraduate medical education program on a small, medically underserved host community.

METHOD:

The authors conducted semistructured interviews in 2007 with 23 community leaders representing, collectively, the education, health, economic, media, and political sectors. They reinterviewed six participants from a pilot study (2005) and recruited new participants using purposeful and snowball sampling. The authors employed analytic induction to organize content thematically, using the sectors as a framework, and they used open coding to identify new themes. The authors reanalyzed transcripts to identify program outcomes (e.g., increased research capacity) and construct a list of quantifiable indicators (e.g., number of grants and publications).

RESULTS:

Participants reported their perspectives on the current and anticipated impact of the program on education, health services, the economy, media, and politics. Perceptions of impact were overwhelmingly positive (e.g., increased physician recruitment), though some were negative (e.g., strains on health resources). The authors identified new outcomes and confirmed outcomes described in 2005. They identified 16 quantifiable indicators of impact, which they judged to be plausible and measureable.

CONCLUSIONS:

Participants perceive that the regional undergraduate medical education program in their community has broad, local impacts. Findings suggest that early observed outcomes have been maintained and may be expanding. Results may be applicable to medical education programs with distributed or regional sites in similar rural, remote, and/or underserved regions. The areas of impact, outcomes, and quantifiable indicators identified will be of interest to future researchers and evaluators.

In the last decade, electronic medical record (EMR) use in academic medical centers has increased. Although many have lauded the clinical and operational benefits of EMRs, few have considered the effect these systems have on medical education. The authors review what has been documented about the effect of EMR use on medical learners through the lens of the Accreditation Council for Graduate Medical Education's six core competencies for medical education. They examine acknowledged benefits and educational risks to use of EMRs, consider factors that promote their successful use when implemented in academic environments, and identify areas of future research and optimization of EMRs' role in medical education.

PURPOSE:

To explore methods to assess standardized patient (SP) performance over time so as to sustain objective performance in a high-stakes clinical skills examination and to inform quality assurance.

METHOD:

The authors selected data from the United States Medical Licensing Examination-Step 2 Clinical Skills to assess the relative usefulness of the classical measurement and common factor models in determining the difficulty and discrimination of SP-medical case pairs (SP-cases) on communication scores over time. The common factor model is an alternative to the classical measurement model and can be used to calibrate SP-case parameters. The sample comprised 88 SP-case combinations in test administrations throughout the year 2010. The authors constructed four time segments from scoring cohorts; computed, for each method, difficulty and discrimination parameters for each SP-case within each time segment; and then compared the efficacy of each. They also compared qualitative SP-case performance standards established through video monitoring to the common factor model for relative usefulness in identifying SP-case outliers.

RESULTS:

SP-case difficulty parameters produced by the classical measurement and common factor models were similarly useful for SP performance evaluation over time. The SP-case discrimination parameters produced by the common factor model appeared to capture more variation in performance.

CONCLUSIONS:

Although either method is equally useful for assessing SP-case difficulty, the common factor model is more sensitive to fluctuations in SP-case discrimination and could be an additionally useful source of information to identify outliers and to direct quality assurance resources for routine SP evaluation.

PURPOSE:

To examine the relationship between maintenance of certification (MOC) and the clinical knowledge demonstrated by family physicians as they move further away from formal training.

METHOD:

Performances of 10,801 examinees-2,440 seeking initial certification; 8,361 seeking MOC-on the summer 2009 American Board of Family Medicine (ABFM) certification examination were compared across 30 cohorts that represented recent residency program graduates and already-certified family physician diplomates with varying years of clinical experience. Experience was defined as the time in years since the year of initial certification. This study employed a natural-groups, cross-sectional design; however, it was used to draw longitudinal inferences.

RESULTS:

Family physicians who maintained certification performed better than recent graduates. They increased their examination scores by almost 17 points each successive time that they took the exam, with scores reaching their highest point 28 to 31 years after initial certification. Multiple comparison analyses confirmed that the trend was significant; however, subanalyses revealed that this trend remained significant only for U.S. medical graduates (USMGs) but not international medical graduates. Those family physicians that did not maintain their certification performed significantly worse than recent graduates.

CONCLUSIONS:

The findings suggest that ABFM diplomates who are USMGs and maintain their certification perform better on the ABFM certification examination with additional years of experience until approximately 30 years after residency training.

PURPOSE:

The Marshall University Family Medicine Residency (MUFMR) implemented its rural track (RT) in 1994 to help achieve its mission of producing primary care physicians for practice in rural areas and West Virginia. This study examined the impact of the RT on the program's training outcomes and assessed the academic equivalence of the RT and traditional track (TT) curricula.

METHOD:

The authors analyzed academic outcomes (in-training examination [ITE] scores, board certification rates) and practice outcomes (location and type following graduation) for the 174 MUFMR graduates who entered the program from 1984 through 2006. They compared RT and TT graduates who entered after RT implementation (1994-2006) with each other and with graduates who entered during the decade before implementation (1984-1993).

RESULTS:

There were differences between the 12 RT and 94 TT graduates in rural practice up on graduation (RT: 83% versus TT: 40%; P < .01) and practice in West Virginia (RT 83% versus TT 68%; P = .34). RT and TT graduates had similar mean increases in ITE scores and board certification rates. The 106 post-implementation graduates had a significantly higher rate of West Virginia practice than did the 68 pre-implementation graduates (70% versus 52%; P = .02).

CONCLUSIONS:

RT development was associated with a substantial increase in MUFMR graduates practicing in West Virginia. RT graduates were more likely than TT graduates to practice in rural areas and in the state up on graduation. RT graduates seem to advance academically as well as their TT counterparts.

PURPOSE:

To explore (1) whether an instructional model based on principles of cognitive apprenticeship fits with the practice of experienced clinical teachers and (2) which factors influence clinical teaching during clerkships from an environmental, teacher, and student level as perceived by the clinical teachers themselves. The model was designed to apply directly to teaching behaviors of clinical teachers and consists of three phases, advocating teaching behaviors such as modeling, creating a safe learning environment, coaching, knowledge articulation, and exploration.

METHOD:

A purposive sample of 17 experienced clinical teachers from five different disciplines and four different teaching hospitals took part in semistructured individual interviews. Two researchers independently performed a thematic analysis of the interview transcripts. Coding was discussed within the research team until consensus was reached.

RESULTS:

All participants recognized the theoretical model as a structured picture of the practice of teaching activities during both regular and senior clerkships. According to participants, modeling and creating a safe learning environment were fundamental to the learning process of both regular and senior clerkship students. Division of teaching responsibilities, longer rotations, and proactive behavior of teachers and students ensured that teachers were able to apply all steps in the model.

CONCLUSIONS:

The theoretical model can offer valuable guidance in structuring clinical teaching activities and offers suggestions for the design of effective clerkships.

PURPOSE:

To summarize the tool characteristics, sources of validity evidence, methodological quality, and reporting quality for studies of technology-enhanced simulation-based assessments for health professions learners.

METHOD:

The authors conducted a systematic review, searching MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Scopus, key journals, and previous reviews through May 2011. They selected original research in any language evaluating simulation-based assessment of practicing and student physicians, nurses, and other health professionals. Reviewers working in duplicate evaluated validity evidence using Messick's five-source framework; methodological quality using the Medical Education Research Study Quality Instrument and the revised Quality Assessment of Diagnostic Accuracy Studies; and reporting quality using the Standards for Reporting Diagnostic Accuracy and Guidelines for Reporting Reliability and Agreement Studies.

RESULTS:

Of 417 studies, 350 (84%) involved physicians at some stage in training. Most focused on procedural skills, including minimally invasive surgery (N = 142), open surgery (81), and endoscopy (67). Common elements of validity evidence included relations with trainee experience (N = 306), content (142), relations with other measures (128), and interrater reliability (124). Of the 217 studies reporting more than one element of evidence, most were judged as having high or unclear risk of bias due to selective sampling (N = 192) or test procedures (132). Only 64% proposed a plan for interpreting the evidence to be presented (validity argument).

CONCLUSIONS:

Validity evidence for simulation-based assessments is sparse and is concentrated within specific specialties, tools, and sources of validity evidence. The methodological and reporting quality of assessment studies leaves much room for improvement.

PURPOSE:

To determine which resources residents use at the point-of-care (POC) for decision making, the drivers for selection of these resources, and how residents use Google/Google Scholar to answer clinical questions at the POC.

METHOD:

In January 2012, 299 residents from three internal medicine residencies were sent an electronic survey regarding resources used for POC decision making. Resource use frequency and factors influencing choice were determined using descriptive statistics. Binary logistic regression analysis was performed to determine relationships between the independent variables.

RESULTS:

A total of 157 residents (56%) responded; similar numbers responded at each level of training. Residents most frequently reported using UpToDate and Google at the POC at least daily (85% and 63%, respectively), with speed and trust in the quality of information being the primary drivers of selection. Google, used by 68% of residents, was used primarily to locate Web sites and general information about diseases, whereas Google Scholar, used by 30% of residents, tended to be used for treatment and management decisions or locating a journal article.

CONCLUSIONS:

The findings suggest that internal medicine residents use UpToDate most frequently, followed by consultation with faculty and the search engines Google and Google Scholar; speed, trust, and portability are the biggest drivers for resource selection; and time and information overload appear to be the biggest barriers to resources such as Ovid MEDLINE. Residents frequently used Google and may benefit from further training in information management skills.

PURPOSE:

The authors conducted a systematic review of the published literature on social media use in medical education to answer two questions: (1) How have interventions using social media tools affected outcomes of satisfaction, knowledge, attitudes, and skills for physicians and physicians-in-training? and (2) What challenges and opportunities specific to social media have educators encountered in implementing these interventions?

METHOD:

The authors searched the MEDLINE, CINAHL, ERIC, Embase, PsycINFO, ProQuest, Cochrane Library, Web of Science, and Scopus databases (from the start of each through September 12, 2011) using keywords related to social media and medical education. Two authors independently reviewed the search results to select peer-reviewed, English-language articles discussing social media use in educational interventions at any level of physician training. They assessed study quality using the Medical Education Research Study Quality Instrument.

RESULTS:

Fourteen studies met inclusion criteria. Interventions using social media tools were associated with improved knowledge (e.g., exam scores), attitudes (e.g., empathy), and skills (e.g., reflective writing). The most commonly reported opportunities related to incorporating social media tools were promoting learner engagement (71% of studies), feedback (57%), and collaboration and professional development (both 36%). The most commonly cited challenges were technical issues (43%), variable learner participation (43%), and privacy/security concerns (29%). Studies were generally of low to moderate quality; there was only one randomized controlled trial.

CONCLUSIONS:

Social media use in medical education is an emerging field of scholarship that merits further investigation. Educators face challenges in adapting new technologies, but they also have opportunities for innovation.