Casey B. White

A qualitative exploration of how the conflict between the formal and informal curriculum influences student values and behaviors.

Purpose The third-year students at one medical school told the authors that values core to patient-centered care were impossible to practice in clerkships, in a culture where supervisors role modeled behaviors in direct conflict with patient-centered care. As they developed a new medical student curriculum, the authors designed the Family Centered Experience (FCE) to help students achieve developmental goals and understand the importance of and provide a foundation for patient-centered care. Method The authors solicited members of the first cohort to complete the FCE (the class of 2007) to participate in this focus-group-based study halfway through the third year. They explored the influence of the FCE on students’ experiences in the third-year clerkships, and how conflicts between the two learning experiences shaped these students’ values and behaviors. Results Students reported that during clerkships they experienced strong feelings of powerlessness and conflict between what they had learned about patient-centered care in the first two years and what they saw role modeled in the third year. Based on students’ comments, the authors categorized students into one of three groups: those whose patient-centered values were maintained, compromised, or transformed. Conclusions Students revealed that their conflict was connected to feelings of powerlessness, along with exacerbating factors including limited time, concerns about expectations for their behavior, and pessimism about change. Role modeling had a significant influence on consequences related to students’ patient-centered values.

Why are medical students ‘checking out’ of active learning in a new curriculum?

The University of Virginia School of Medicine recently transformed its pre‐clerkship medical education programme to emphasise student engagement and active learning in the classroom. As in other medical schools, many students are opting out of attending class and others are inattentive while in class. We sought to understand why, especially with a new student‐centred curriculum, so many students were still opting to learn on their own outside of class or to disengage from educational activities while in class.

Use of interactive theater for faculty development in multicultural medical education

Background: The development of critical consciousness, anchored in principles of social justice, is an essential component of medical education. Aim: In order to assist faculty instructors in facilitating small-group discussions on potentially contentious issues involving race, gender, sexual orientation, and socioeconomic class, a faculty development workshop was created. Methods: The workshop used ‘Forum Theater’ techniques in which the audience was directly involved in determining the course of a simulated classroom discussion and conflict. We assessed the workshops impact on the instructors’ attitudes regarding facilitation of small-group discussions through two surveys: one to gauge immediate impressions, and another, 9–15 months later, to assess impact over time. Results: Immediately after the workshop, participants reported that the topics covered in the sketch and in the discussion were highly relevant. In the follow-up survey, the instructors agreed that the workshop had raised their awareness of the classroom experiences of minorities and women and had offered strategies for addressing destructive classroom dynamics. 72% reported that the workshop led to changes in their behavior as facilitators. Differences in responses according to gender were observed. Conclusions: A workshop using interactive theater was effective in training faculty to facilitate small-group discussions about multicultural issues. This approach emphasizes and models the need to foster critical consciousness in medical education.

Remediating students' failed OSCE performances at one school: The effects of self-assessment, reflection, and feedback

Purpose To investigate whether and how use of an online remediation system requiring reflective review of performance and self-assessment influenced students’ performance on objective structured clinical examination (OSCE) station repeats (subsequent to failure on the first attempt) and their self-assessments of their performance (between the first and second attempts). Method Fourth-year medical students’ performances on seven OSCE stations were videotaped at University of Michigan Medical School in 2006. Failing students took the exam again; remediation included self-assessment and review, plus faculty guidance for failures that were greater than one standard error of measurement of the distribution. A total of 1,171 possible observations of students’ actual performance and performance self-assessments were analyzed using independent and dependent t tests and within-subjects ANOVA. Results Results indicate statistically significant changes in students’ performance between first and second attempts and statistically significant improvements in self-assessment between first and second attempts. No significant changes were found between self-assessed and faculty-guided remediation. Conclusions This study provides evidence that OSCE remediation combining review, reflection, and self-assessment has a salutary effect on (subsequent) performance and self-assessment of performance.

What is appropriate to post on social media? Ratings from students, faculty members and the public

The purpose of this study was to ascertain what medical students, doctors and the public felt was unprofessional for medical students, as future doctors, to post on a social media site, Facebook®. The significance of this is that unprofessional content reflects poorly on a student, which in turn can significantly affect a patients confidence in that students clinical abilities.

Pass–fail grading: laying the foundation for self-regulated learning

Traditionally, medical schools have tended to make assumptions that students will “automatically” engage in self-education effectively after graduation and subsequent training in residency and fellowships. In reality, the majority of medical graduates out in practice feel unprepared for learning on their own. Many medical schools are now adopting strategies and pedagogies to help students become self-regulating learners. Along with these changes in practices and pedagogy, many schools are eliminating a cornerstone of extrinsic motivation: discriminating grades. To study the effects of the switch from discriminating to pass–fail grading in the second year of medical school, we compared internal and external assessments and evaluations for a second-year class with a discriminating grading scale (Honors, High Pass, Pass, Fail) and for a second-year class with a pass–fail grading scale. Of the measures we compared (MCATs, GPAs, means on second-year examinations, USMLE Step 1 scores, residency placement, in which there were no statistically significant changes), the only statistically significant decreases (lower performance with pass fail) were found in two of the second-year courses. Performance in one other course also improved significantly. Pass–fail grading can meet several important intended outcomes, including “leveling the playing field” for incoming students with different academic backgrounds, reducing competition and fostering collaboration among members of a class, more time for extracurricular interests and personal activities. Pass–fail grading also reduces competition and supports collaboration, and fosters intrinsic motivation, which is key to self-regulated, lifelong learning.

The difficulty of sustaining curricular reforms: a study of "drift" at one school.

In 1997, five years after a major curricular reform at the University of Michigan Medical School, the authors revisited the Goals for Medical Education (written by faculty to guide the reform process) to identify factors that had facilitated or hindered their achievement. By reviewing responses to identical questionnaires circulated to faculty in 1993 and again in 1997, they learned that considerably more lectures were being used to deliver curricular content in the first-year curriculum than the faculty thought was ideal, and that less social science, humanities, and ethics material was being presented in the first year than the faculty thought was ideal. The authors also learned that consensus between faculty basic scientists and faculty clinicians about the content that would make up an ideal first-year curriculum had diverged since adoption of the new curriculum. Movement toward decreasing the amounts of social sciences, humanities, and ethics in the first year of medical school was particularly pronounced among the basic scientists, who felt this material was being taught prematurely and at the expense of essential basic science content. In contrast, by 1997 much closer agreement had developed between the two groups regarding time they would allocate for lectures; this agreement unfortunately reflected a stagnation in the adoption of active learning methods. Movement toward increasing the amount of time for lectures in the first-year curriculum was particularly pronounced among the clinicians, who reported feeling more and more pressured to bring in clinical revenues. Based on faculty comments and the schools experience with centralized governance and centralized funding, the authors propose a direct linkage between institutional funding to departments and the teaching effort of faculty in the departments, and sufficient, centralized funding to relieve pressure on faculty and to foster educational creativity. They maintain that this may be the most effective way to guarantee ongoing innovation, support interdisciplinary teaching, and subsequently move the curriculum and teachers completely away from content that is isolated within traditional department structures. At the same time they acknowledge that changing faculty attitudes presents a challenge.

Exploring agent physicality and social presence for medical team training

Mixed reality and 3D user interface technologies have increased the immersion, presence, and physicality of user interactions. These technologies can also increase the physicality of embodied conversational agents (ECAs) by making the ECAs occupy and interact with the physical space. We propose that increasing the physicality of an ECA can increase the ECAs social presence, that is, the feeling that the ECA is a real person. In this paper, we examine existing research and formalize the idea of ECA physicality. We also explored the relationship between physicality and social presence by conducting two user studies (n 18 and n 29). Both user studies took place in a medical team training context and involved virtual human ECAs as fellow team members. The first studys results suggested that increasing physicality increased social presence and elicited more realistic behavior. The second studys results suggested that individual dimensions of physicality affect social presence to different extents.

The impact of facilitation of small-group discussions of psychosocial topics in medicine on faculty growth and development.

Purpose To use qualitative analysis of interview transcripts with clinician–educators who facilitate small-group discussions on psychosocial themes—including doctoring—to answer the question, “What impact does facilitating small-group discussions of the patient’s experience with chronic illness, the doctor–patient relationship, and doctoring have on faculty instructors’ attitudes regarding their roles as clinicians and teachers?” Method In 2006, in-depth, face-to-face interviews using an open-ended question format were conducted with individual faculty small-group instructors teaching in the Family Centered Experience and Longitudinal Case Studies courses at the University of Michigan Medical School. Interview transcripts were analyzed using grounded theory methodology to identify emerging themes. Accuracy of interpretations and saturation of themes was confirmed by repeated contextual reading of the transcripts. Results Several major thematic codes emerged from the data. Facilitation of small-group discussions of psychosocial topics and doctoring fostered reflective approaches to patient care and teaching; enhanced interpersonal relationships between facilitators and their students, colleagues, and patients; and acted as a source of fulfillment and renewal among faculty facilitators. Conclusions Small-group teaching of the art of doctoring may stimulate personal and professional growth among faculty facilitators and renewed interest in teaching and patient care.

Is video review of patient encounters an effective tool for medical student learning? A review of the literature

Purpose To determine if video review of student performance during patient encounters is an effective tool for medical student learning. Methods Multiple bibliographic databases that include medical, general health care, education, psychology, and behavioral science literature were searched for the following terms: medical students, medical education, undergraduate medical education, education, self-assessment, self-evaluation, self-appraisal, feedback, videotape, video recording, televised, and DVD. The authors examined all abstracts resulting from this search and reviewed the full text of the relevant articles as well as additional articles identified in the reference lists of the relevant articles. Studies were classified by year of student (preclinical or clinical) and study design (controlled or non-controlled). Results A total of 67 articles met the final search criteria and were fully reviewed. Most studies were non-controlled and performed in the clinical years. Although the studies were quite variable in quality, design, and outcomes, in general video recording of performance and subsequent review by students with expert feedback had positive outcomes in improving feedback and ultimate performance. Video review with self-assessment alone was not found to be generally effective, but when linked with expert feedback it was superior to traditional feedback alone. Conclusion There are many methods for integrating effective use of video-captured performance into a program of learning. We recommend combining student self-assessment with feedback from faculty or other trained individuals for maximum effectiveness. We also recommend additional research in this area.