Dario M. Torre

Concept maps in medical education: an analytical literature review

Medical Education 2010: 44: 440–448

Learning/feedback activities and high-quality teaching: perceptions of third-year medical students during an inpatient rotation.

Purpose To identify specific learning activities (and teaching methods) that students associate with high-quality teaching in the inpatient setting. Method For ten months in 2003–04, 170 third-year medical students recorded data on learning/feedback activities and teaching quality via personal digital assistants during the inpatient portion of a required two-month medicine clerkship at four sites affiliated with the Medical College of Wisconsin. Univariate and multivariate analyses were performed to assess the association between learning/feedback activities and students’ perceptions of high-quality teaching. Results A total of 2,671 teaching encounters were rated by 170 students during their required inpatient medicine rotations. Bedside teaching was reported in almost two-thirds of teaching/learning encounters. Feedback on case presentation and differential diagnosis were the inpatient feedback activities most often provided by faculty. The univariate analysis revealed that students’ perceptions of high-quality teaching was associated with receiving mini-lectures, developing short presentations on relevant inpatient topics, bedside teaching, case-based conferences, learning electrocardiogram and chest X-ray interpretation, teaching with other team members present (p <. 001), and receiving feedback on history and physical examination, on case presentation, at the bedside, on differential diagnosis, and on daily progress notes. Results from the regression analysis revealed that giving mini-lectures on inpatient topics, teaching electrocardiogram and chest X-ray interpretation, providing feedback on case presentation, and at the bedside were predictors of overall high-quality teaching. Conclusions Aspects of feedback, giving mini-lectures, and learning test-interpretation skills were the learning and feedback activities associated with students’ perceptions of high-quality teaching. In an increasingly time-pressured inpatient environment, clinical educators should understand which activities students value.

A qualitative evaluation of medical student learning with concept maps

Purpose and Aims: The purpose of this study was to investigate the ways in which the use of concept maps influenced the learning processes of third year internal medicine students in the context of medical education. Reported here are the qualitative results of this study. Methods: One–hundred thirty four medical students were taught to use concept mapping as a learning strategy at the beginning of their internal medicine rotations. Upon completion of the internal medicine rotation students were asked to evaluate how concept maps fostered the process of linking theoretical information to clinical practice. Additionally, students described how concept maps impacted their learning. Results: In this study, concept maps fostered a positive connection between theory and practice. Additionally, students described three major themes impacting their learning: concept mapping as a facilitator of knowledge integration and critical thinking, as a teaching methodology and finally, as a learning method. Conclusions: This study suggests concept maps may be an instructional method to foster the learning and thinking process of medical students.

Grade Inflation in the Internal Medicine Clerkship: A National Survey

Background: Grade inflation is a growing concern, but the degree to which it continues to exist in 3rd-year internal medicine (IM) clerkships is unknown. Purpose: The authors sought to determine the degree to which grade inflation is perceived to exist in IM clerkships in North American medical schools. Methods: A national survey of all Clerkship Directors in Internal Medicine members was administered in 2009. The authors assessed key aspects of grading. Results: Response rate was 64%. Fifty-five percent of respondents agreed that grade inflation exists in the Internal Medicine clerkship at their school. Seventy-eight percent reported it as a serious/somewhat serious problem, and 38% noted students have passed the IM clerkship at their school who should have failed. Conclusions: A majority of clerkship directors report that grade inflation still exists. In addition, many note students who passed despite the clerkship director believing they should have failed. Interventions should be developed to address both of these problems.

Twelve tips for teaching with concept maps in medical education

Background: Concept maps have been used as a learning tool in a variety of educational setting and provide an opportunity to explore learners’ knowledge structures and promote critical thinking and understanding. Concept mapping is an instructional strategy for individual and group learning that involves integration of knowledge and creation of meaning by relating concepts. Aims: The following tips outline an approach to foster meaningful learning using concept maps. Methods: A total of 12 tips on the use and applications of concept mapping based on the authors’ experiences and the available literature. Results: The 12 tips provide an overview of the theoretical framework and structure of concept maps, suggesting specific uses, and applications in medical education. Conclusions: We describe different types of concept maps based on learners’ task, and how they can be utilized in different educational settings. We provide ideas for educators to integrate this novel educational resource in their teaching and educational practices. Medical educators can utilize concept maps to detect students’ misunderstandings of concepts and to identify knowledge gaps that need to be corrected. Finally, we outline the potential role of concept maps as an assessment tool.

The prevalence and nature of postinterview communications between residency programs and applicants during the match.

Purpose To examine the frequency and nature of postinterview communications between programs and applicants during the National Resident Matching Program (NRMP) Main Residency Match. Method The authors surveyed senior medical students at seven U.S. medical schools about postinterview communications with residency programs during the 2010 Match and analyzed the data. Results The response rate was 68.2% (564/827). Among respondents, 86.4% reported communicating with residency programs. Most (59.9%) reported telling more than one program they would rank it highly; 1.1% reported telling more than one they would rank it first. Students reported that programs told them they would be “ranked to match” (34.6%), be “ranked highly” (52.8%), or “fit well” (76.2%). Almost one-fifth (18.6 %) reported feeling assured by a program that they would match there but did not despite ranking that program first; 23.4% reported altering their rank order list based on communications with programs. In multivariate analysis, applicants to more competitive specialties were less likely to report being told they would be “ranked to match” (relative risk [RR] 0.72, 95% confidence interval [CI] 0.52–0.99). Applicants were more likely to report being told that they would be “ranked to match” if they received honors in the specialty clerkship (RR 1.39, 95% CI 1.10–1.77) or were members of Alpha Omega Alpha (RR 1.72, 95% CI 1.37–2.17). Conclusions Reports of nonbinding communications with programs were frequent. Students should be advised to interpret any comments made by programs cautiously. Reported violations of the NRMP’s Match Participation Agreement were uncommon.

Reflective Writing in the Internal Medicine Clerkship: A National Survey of Clerkship Directors in Internal Medicine

Background and Purpose: Reflective writing programs have been implemented at many medical schools, but it is unclear to what extent and how they are structured. Methods: We surveyed the 107 Clerkship Directors of Internal Medicine member institutions on use of reflective writing assignments during the internal medicine clerkship. Results: Eighty-six of 107 (80%) institutional members completed the survey. Thirty-five percent reported having a reflective writing assignment, 48% did not, and 6% did not but were considering starting one within the next 2 years. Of the 30 assignments, most were partially structured (60%), involved small-group discussion (57%), and provided individual student feedback (73%). A minority (30%) contributed to the students’ grade. Respondents believed assignments contributed to students’ learning in multiple domains, most often Professionalism (97%) and Communication (77%). Conclusions: Although reflective writing programs were common, variability existed in their structure. Further research is needed to determine how best to implement them.

Training and assessment of CXR/basic radiology interpretation skills: results from the 2005 CDIM Survey.

Background: Despite published literature demonstrating deficiencies in chest radiograph (CXR)/basic radiology interpretation skills of 4th-year medical students, studies and subsequent curricula regarding the training needed to obtain these skills are lacking. Terms such as clinical exposure and radiology teaching have been used to describe the experience for these basic interpretive skills, but best practice methods of delivery, let alone common methods, have yet to be defined. Purpose: The objective is to describe the current methods of teaching and assessing CXR/basic radiology interpretation skills across institutions on the 3rd-year internal medicine (IM) clerkship. Methods: In 2005, the Clerkship Directors in Internal Medicine (CDIM), an international organization representing U.S. and Canadian medical schools, surveyed its institutional members. Twelve questions on the survey dealt with X-ray interpretation. Results: Eighty-eight of 109 members (81%) responded to the survey. Overall, 81% of respondents felt that CXR interpretation is an important clinical skill for medical students. Seventy-six percent indicated that instruction in these skills occurs on the IM clerkship. The most cited methods of instruction were lectures (56%) and teaching rounds (48%). Most schools spent on average of 2 to 4 hr during the IM clerkship on formal radiology instruction. Only 33% indicated that radiology interpretation skills are assessed during the clerkship. The most common assessment methods were written examination (19%) and OSCE (19%). Conclusion: Substantive data regarding attainment and assessment of CXR/basic radiology interpretation skills in the undergraduate curriculum are lacking. Our study provides preliminary descriptive data regarding CXR instruction and assessment on the 3rd-year IM clerkship.

Interprofessional education in the internal medicine clerkship: results from a national survey.

Purpose Growing data support interprofessional teams as an important part of medical education. This study describes attitudes, barriers, and practices regarding interprofessional education (IPE) in internal medicine (IM) clerkships in the United States and Canada. Method In 2009, a section on IPE was included on the Clerkship Directors in Internal Medicine annual survey. This section contained 23 multiple-choice questions exploring both core and subinternship experiences. Data were analyzed using descriptive statistics and Rasch analysis. Results Sixty-nine of 107 institutional members responded to the survey (64% response rate). Approximately 68% of responding clerkship directors believed that IPE is important to the practice of IM. However, only 57% believed that it should become a part of the undergraduate clinical curriculum. The three most significant barriers to IPE in the IM clerkship were scheduling alignment, time in the existing curriculum, and resources in time and money. Although more than half of respondents felt IPE should be included in the clinical curriculum, 81% indicated that there was no formal curriculum on IPE in their core IM clerkship, and 84% indicated that there was no formal curriculum during IM subinternship rotations at their institution. Conclusions There is limited penetration of IPE into one of the foundational clinical training episodes for medical students in Liaison Committee for Medical Education–accredited schools. This may be related to misperceptions of the relative value of these experiences and limitations of curricular time. Learning in and from successful models of interprofessional teams in clinical practice may help overcome these barriers.

Training and Assessment of ECG Interpretation Skills: Results From the 2005 CDIM Survey

Background: Despite published consensus-based statements on assessment of ECG interpretation skills, studies and curricula regarding the training needed to obtain basic ECG interpretation skills are lacking. These consensus statements have focused on attaining competency in ECG interpretation during postgraduate training; however, recommendations regarding assessment of competency in the undergraduate curriculum are not discussed. Purpose: The purpose is to describe the current methods of teaching and assessing ECG interpretation skills across institutions on the 3rd-year internal medicine (IM) clerkship. Method: In 2005, the Clerkship Directors in Internal Medicine surveyed its institutional members. Twelve questions on the survey dealt with ECG interpretation. Descriptive statistics, chi-square, and Mann–Whitney U were used for analysis. Results: Eighty-eight of 109 members (81%) responded to the survey. Overall, 89% of institutional respondents feel that ECG interpretation is an important clinical skill for medical students with 92% indicating that instruction occurs on the IM clerkship. Lectures (75%) and teaching rounds (44%) were the most cited methods of instruction. Most schools spend 1 to 6 hr during the IM clerkship on formal ECG instruction. Over 63% indicated that ECG interpretation skills are assessed during the clerkship. The most common assessment methods were written exam (40%) and OSCE (23%). Conclusions: Objective data regarding attainment and assessment of basic ECG interpretation competency in the undergraduate curriculum are lacking; our report provides preliminary descriptive data regarding ECG teaching and assessment on the 3rd-year IM clerkship. Further studies are needed to determine the ideal method of instruction and evaluation of this important clinical skill.