Anne Walling

The fourth year of medical education: a literature review.

Purpose To identify expert recommendations and examples of programs that could be incorporated into curricular renewal of the fourth year of medical school. Method In 2009, the authors searched the relevant literature published from 1974 to 2009 using PubMed; they then searched bibliographies and related articles. They consulted clerkship and residency program directors at their institution and accessed recommendations from national organizations. Results Of the 66 publications reviewed, 40 focused on aspects of fourth-year education and 26 included the fourth year in general reviews. Long-standing concerns included clarifying the purpose of the year, the optimal type and organization of courses, and academic quality of courses. Specific concerns included excessive focus on securing residency positions (“preresidency syndrome”), uncertainty about the optimal ratio of required and elective courses, and grade inflation. Conclusions Despite representing a substantial proportion of the student experience, the fourth year has received significantly less attention than other phases of the curriculum. The authors conclude that goals for the year should be clarified, reflect the mission of the school, and be designed to both complete the medical school experience and facilitate the transition to residency. Schools should decide the types of courses and organization of the year based on these goals. Organizational strategies for the fourth year should incorporate the requirements of the United States Medical Licensing Examination examinations and the residency application process. Fourth-year curricula and their constituent courses should be well designed and stringently evaluated to ensure educational goals are met and appropriate grades awarded.

The Epidemiology Of Bacterial Meningitis

Background: The incidence by age and causative organism of bacterial meningitis are not known on a community basis. Methods: The epidemiology of bacterial meningitis in a metropolitan county was studied by identifying all cases admitted to a hospital from 1983 through 1987. Results: The overall incidence of bacterial meningitis was 5 per 100,000 person-years, but numbers of cases ranged from 40 per 100,000 for children younger than 5 years to 1.0 per 100,000 in adults aged between 16 and 64 years. No significant excesses of cases were found in male patients or in blacks. The predominant causative organism varied with age. Overall, Haemophilus influenzae was the most common causative organism, but 32 percent of cases were due to Streptococcus pneumoniae. Case fatality rates were high for S. pneumoniae (12.5 percent) and very high for the small number of elderly patients suffering from bacterial meningitis. Conclusions: Significant declines have occurred in the last decade in the incidence of bacterial meningitis in children, particularly in those younger than 5 years, and in disease caused by H. influenzae and group B streptococcus.

Maximizing the Use of a Web-Based Teaching Skills Curriculum for Community-based Volunteer Faculty

Background: The University of Kansas School of Medicine in Wichita created an Internet‐based faculty development curriculum for community‐based faculty. Because relatively few physicians use Internet‐based continuing medical education (CME), the most cost‐effective methods of encouraging use need to be identified. Method: Five interventions intended to increase use of the curriculum were assessed. The number of times the CME curriculum Webpages were accessed was correlated with the interventions. Results: Demonstrating the Website to faculty at a semiannual meeting elicited the most Website “hits.” Electronic mail and flyers also appeared to be effective in stimulating interest in the Website. Only four community‐based faculty applied for CME credit for completing the curricular modules. Findings: Multiple modalities should be used in advertising and stimulating interest in an Internet‐based faculty development curriculum. Demonstrating the Website to faculty at a meeting appeared to achieve the greatest return. Offering CME credit was not helpful in stimulating interest.

An unusual cause of hip pain in a child.

In this perplexing case, a child with signs of apparent hip pain was treated for a sewing needle embedded in the sole of the foot. The diagnosis of foreign body easily could have been missed, because the external signs were minimal and the clinical findings indicated hip disease. However, the childs extreme distress seemed inconsistent with the initial normal findings. Only reexamination and looking beyond the obvious led to the diagnosis.

On the Origins of Perceptions: Student Perceptions of Active Learning and Their Implications for Educational Reform

ABSTRACT This Conversation Starters article presents a selected research abstract from the 2016 Association of American Medical Colleges Central Region Group on Educational Affairs annual spring meeting. The abstract is paired with the integrative commentary of three experts who shared their thoughts stimulated by the study. These thoughts highlight the value of exploring what drives student perceptions of active learning in order to reform medical education.

Post-tenure Review at U.S. Medical Schools.

Purpose To assess post-tenure review policies at U.S. medical schools by examining how prevalent post-tenure review is, what models of post-tenure review are employed, and what outcomes result from post-tenure review processes. Method In late 2014, a Web-based survey was sent to the associate dean for faculty affairs (or equivalent) at each U.S. medical school accredited by the Liaison Committee on Medical Education (N = 141). The survey addressed elements of post-tenure review policies, including whether a policy was in place, the frequency of the review, and the review outcomes. Descriptive statistics were calculated. Results Of the 94 responding schools with a tenure system, 39 (41%) had an established post-tenure review policy. Although these policies showed great variability across schools in duration, having been in place from 1 to 50 years, 12 (31%) were established within the last 5 years. The outcomes of post-tenure review also varied. Superior performance ratings generally resulted in notations in the faculty member’s personnel file and notifications to school leadership. Conversely, when a faculty member received an unsatisfactory rating, a remediation or development plan was sometimes required. Conclusions At least 40% of medical schools with a tenure system have post-tenure review, and it is becoming more common. These findings about the prevalence and use of post-tenure review across institutions can assist medical school leaders as they strive to shape policies to facilitate faculty engagement and productivity. They also can provide the foundation for future evaluative studies on the effectiveness, outcomes, and impact of post-tenure review.

The Future of Academic Promotion for Clinicians

With little current momentum for change in academic promotion, individual schools are likely to continue developing the number and type of tracks for clinicians and to seek adjustments to improve the efficiency of the system. Movements to align regular faculty assessments, faculty development, and academic promotion have the potential to reengage clinical faculty members and increase the perceived value of promotion, but criteria for promotion must be related to faculty roles and activities. Ongoing changes raise basic questions about the definition of a faculty member, eligibility for academic promotion, the definition and role of scholarship, and the use of tenure-based concepts and systems for a predominantly non-tenured and very heterogeneous faculty.

Applying for Academic Promotion: Why? When? What?

Why? Appropriate motivation is essential to preparing the optimal application for academic promotion. Recognition of the potential benefits of a successful promotion for individuals, colleagues, programs, and others can enhance motivation for promotion. When? Ideally, application should be made when the chance of success is high as the applicant can document meeting all expectations for the requested promotion. Some institutions require or recommend application for promotion after a specified number of years in grade. Tenure-track appointments have deadlines for promotion and regulations about altering the tenure clock. What? The documentation required for promotion usually includes curriculum vitae (CV), internal and external assessments, and other information. Formats for documentation and timelines for submission vary among schools but are strictly enforced.

How the System for Academic Promotion Works

The process for academic promotion, including establishing the criteria for each academic rank and track, is governed by formal policies and procedures that should be strictly enforced, to protect applicants, reviewers, and the institution. The process differs by school but usually involves review at several levels in the institution. Reviews are conducted by both committees and senior administrators. Evidence of achievements are assessed from several perspectives including peers from other disciplines and external reviewers to facilitate a balanced and unbiased assessment. Each applicant must be assured a fair, objective, and thorough review. At each stage, the outcome must be supported by well-documented evidence. The final decision may take months and require approval from the governing board or highest administrative levels of the parent university. Applicants generally have the right of appeal, but the basis of appeals may be restricted to demonstrating flaws in the process, rather than the merits of decisions. The associate dean for faculty affairs (or equivalent) is responsible for the functioning and integrity of the process. Recommended best practices stress clarity and consistency in standards, procedures, and decisions, objectivity and candor in evaluations, and professional behavior by all involved in the promotion process.

The Participants in the Academic Promotion Process: Roles and Responsibilities

The process for academic promotion involves several individuals and committees both within the applicant’s academic department and in other units of the medical school. Understanding the roles, responsibilities, and limitations of the different individuals and groups involved helps applicants to access resources, direct questions to the most appropriate individuals, and prepare materials more effectively and efficiently.