Christopher B. White

Multi-institutional development and utilization of a computer-assisted learning program for the pediatrics clerkship: The CLIPP project

Computer-assisted instruction (CAI) holds significant promise for meeting the current challenges of medical education by providing consistent and quality teaching materials regardless of training site. The Computer-assisted Learning in Pediatrics Project (CLIPP) was created over three years (2000–2003) to meet this potential through multi-institutional development of interactive Internet-based patient simulations that comprehensively teach the North American core pediatrics clerkship curriculum. Project development adhered to four objectives: (1) comprehensive coverage of the core curriculum; (2) uniform approach to CAI pedagogy; (3) multi-institutional development by educators; and (4) extensive evaluation by users. Pediatrics clerkship directors from 30 institutions worked in teams to develop a series of 31 patient case simulations. An iterative process of case content and pedagogy development, case authoring, peer review, and pilot-testing ensured that the needs of clerkship directors and medical students were met. Fifty medical schools in the United States and Canada are presently using CLIPP. More than 8,000 students have completed over 98,000 case sessions, with an average of 2,000 case sessions completed per week at this time. Each CLIPP case has been completed by more than 3,000 students. The current cost of CLIPP development is approximately

Tracking development of clinical reasoning ability across five medical schools using a progress test.

70 per student user, or

Students Assigned to Community Practices for Their Pediatric Clerkship Perform as Well or Better on Written Examinations As Students Assigned to Academic Medical Centers

6 per case session. The project’s success demonstrates that multi-institutional development and implementation of a peer-reviewed comprehensive CAI learning program by medical educators is feasible and provides a useful model for other organizations to develop similar programs. Although CAI development is both time-consuming and costly, the initial investment decreases significantly with broad use over time.

The State of Undergraduate Pediatric Medical Education in North America: The COMSEP Survey

Purpose Little is known about the acquisition of clinical reasoning skills in medical school, the development of clinical reasoning over the medical curriculum as a whole, and the impact of various curricular methodologies on these skills. This study investigated (1) whether there are differences in clinical reasoning skills between learners at different years of medical school, and (2) whether there are differences in performance between students at schools with various curricular methodologies. Method Students (n = 2,394) who had completed zero to three years of medical school at five U.S. medical schools participated in a cross-sectional study in 2008. Students took the same diagnostic pattern recognition (DPR) and clinical data interpretation (CDI) tests. Percent correct scores were used to determine performance differences. Data from all schools and students at all levels were aggregated for further analysis. Results Student performance increased substantially as a result of each year of training. Gains in DPR and CDI performance during the third year of medical school were not as great as in previous years across the five schools. CDI performance and performance gains were lower than DPR performance and gains. Performance gains attributable to training at each of the participating medical schools were more similar than different. Conclusions Years of training accounted for most of the variation in DPR and CDI performance. As a rule, students at higher training levels performed better on both tests, though the expected larger gains during the third year of medical school did not materialize.

Innovations in medical education: The medical college of Georgia school of medicine experience

Background: Medical schools are increasingly using community practice sites (CPS) for clerkship training. Purposes: We compared the test performance of all students assigned to CPS with all students trained at an academic medical center (AMC) for their pediatric clerkship for the past 5 years. Methods: Baseline comparability of both groups was established by the group mean scores on 1st and 2nd year medical school grade point average (GPA) and the United States Medical Licensing Examination (USMLE) Step 1 and Step 2. Performance outcome was compared by group mean scores on a written clerkship exam and the National Board of Medical Examiners Pediatric Subject Examination. Results: There was no statistical difference between the two groups with regard to GPA or USMLE scores. Standardized test performance results: N Written Exam p-Value NBME score p-Value CPS 173 87.1% .003 74.2 .382 AMC 698 85.1% 74.8 Conclusion: The CPS-trained students performed as well or better on standardized written tests compared with AMC-trained students. Community pediatric practices can provide a quality clerkship experience for junior medical students.

A Child With a Swollen, Painful Wrist and Elevated Inflammatory Markers

Background/Purpose: One mission of all academic medical centers is the education of medical students. The resources allocated to the oversight of this mission vary. The status of pediatric undergraduate medical education and the role of the pediatric clerkship director (PCD) was published in 1995. We sought to provide an updated description by surveying current North American PCDs. Methods: A survey was designed by members of the Council on Medical Student Education in Pediatrics and administered via the Internet. Results: Eighty-four percent of U.S. PCDs (110/131) and 50% of Canadian PCDs (8/16) completed the survey. Significant differences compared with 1995 include (a) more clerkship directors are assistant professors, women, and generalists; (b) clerkship directors have more time for clerkship activities but less than they perceive that they need; and (c) traditional scholarship is even more difficult to accomplish than in the past. Conclusion: The position of PCD is perceived to be a legitimate career track, but most PCDs hold lower academic rank and have less traditional scholarly activity than PCDs did 10 years ago. Although PCDs have more time (40% now vs. 28% in 1995), they still feel that it is not adequate, needing almost 50% of their total time to adequately do their job.

Toward hypothesis-driven medical education research: task force report from the Millennium Conference 2007 on educational research.

Picture two community-based physicians instructing seven student apprentices in two borrowed rooms in the City Hospital of Augusta, GA (http://www.mcg.edu/history/index. asp). That was the setting when the Georgia state governor signed a charter for a state medical academy in 1828. The original curriculum consisted of a 1-year lecture series. Two more physicians joined the faculty, the curriculum expanded to 2 years, and, in 1833, the first four graduates were awarded medical degrees. Two years later, the young medical school moved from the City Hospital into a separate building. During the succeeding years, the school had several name and location changes (Fig. 1A). Its fortunes waxed and waned, and it even closed for 4 years while students and faculty served in the Civil War. After the war, it reopened and ultimately became a department and then a unit of the University System of Georgia. By its 100th anniversary, the school’s curriculum had expanded to 4 years, comprising 2 years of basic sciences and 2 years of clinical sciences. By the middle of the 20th century, the school had adopted its present name, The Medical College of Georgia (MCG), and had its own teaching hospital. Today, 175 years after MCG’s founding, the picture is different. MCG now is the health sciences university for the state of Georgia. It comprises five schools (allied health, basic sciences, dentistry, medicine, and nursing) located on an urban campus with more than 80 buildings. The nearly 600 faculty members in the five schools teach approximately 2,000 students, 720 of whom are medical students. Although the external structure of the medical school curriculum seems similar in its emphasis on basic sciences during the first 2 years followed by 2 years of clinical training, medical education at MCG has changed dramatically. Today, education at MCG is designed to prepare students to provide health care in an era of rapidly changing technology and fiscal constraints while emphasizing state-of-the-art clinical knowledge, continued learning skills, early clinical experience, assessment of competence, and professionalism. This article describes some of the recent curriculum changes and how they affect students, communities, and faculty members.

Core clerkship directors: their current resources and the rewards of the role.

reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page A 6-year-old previously healthy female presented with a history of right wrist swelling and pain. Her symptoms began 2 days prior to presentation shortly after someone stepped on her wrist. After the initial incident, she felt moderate pain. The following day, the pain worsened, and she developed redness and swelling of the joint with a subjective fever. On physical exam in the emergency department, the patient was febrile at 39.4°C and tachycardic with a heart rate of 140 bpm. Her wrist was swollen, erythematous, and tender to palpation. Exquisite pain was elicited by motion, and there was limited range of motion of the joint. Laboratory studies revealed elevated erythrocyte sedimen-tation rate (ESR) at 40 mm/h and C-reactive protein (CRP) at 13.5 mg/dL, and blood cultures were drawn. Orthopedic Surgery was urgently consulted and performed a joint aspiration in the emergency department, extracting frankly purulent fluid from the joint. Gram stain of the fluid demonstrated gram-positive cocci with numerous neutrophils, and the fluid was sent for culture. She was admitted to the hospital, and treatment with intravenous (IV) clindamycin was begun. The following day, Orthopedic Surgery performed an arthrotomy in the operating room. On incision of the joint capsule, seropurulent fluid was expressed, and the joint space was copiously irrigated. She continued to receive IV clindamycin after surgery. On the first postoperative day, repeat ESR was 85 mm/h, and CRP was 11 mg/dL. She was afebrile, and her pain was well controlled by acetaminophen. Within 48 hours of admission, the joint aspiration fluid culture was positive for Streptococcus pyogenes, and within 72 hours, the blood culture was positive for Streptococcus pyogenes. Infectious Disease was consulted, and the antibiotic regi-men was switched from IV clindamycin to IV cefazolin. On the third postoperative day, Orthopedic Surgery performed a repeat arthrotomy for reassessment of the joint. On entry into the joint capsule, there was no return of fluid, and the joint was irrigated and closed. The patient continued to receive IV cefazolin. Serial ESR and CRP levels trended downward. A repeat blood culture performed 2 days after admission showed no growth after 48 hours. The patient was discharged on the sixth day of admission with a 3-week course of oral cephalexin. On outpatient follow-up with Infectious Disease, her ESR and …