David T. Stern

Teaching the one-minute preceptor. A randomized controlled trial.

OBJECTIVE: The One-Minute Preceptor (OMP) model of faculty development is used widely to improve teaching, but its effect on teaching behavior has not been assessed. We aim to evaluate the effect of this intervention on residents’ teaching skills.DESIGN: Randomized controlled trial.SETTING: Inpatient teaching services at both a tertiary care hospital and a Veterans Administration Medical Center affiliated with a University Medical Center.PARTICIPANTS: Participants included 57 second- and third-year internal medicine residents that were randomized to the intervention group (n=28) or to the control group (n=29).INTERVENTION: The intervention was a 1-hour session incorporating lecture, group discussion, and role-play.MEASUREMENTS AND MAIN RESULTS: Primary outcome measures were resident self-report and learner ratings of resident performance of the OMP teaching behaviors. Residents assigned to the intervention group reported statistically significant changes in all behaviors (P<.05). Eighty-seven percent of residents rated the intervention as “useful or very useful” on a 1–5 point scale with a mean of 4.28. Student ratings of teacher performance showed improvements in all skills except “Teaching General Rules.” Learners of the residents in the intervention group reported increased motivation to do outside reading when compared to learners of the control residents. Ratings of overall teaching effectiveness were not significantly different between the 2 groups.CONCLUSIONS: The OMP model is a brief and easy-to-administer intervention that provides modest improvements in residents’ teaching skills.

The prediction of professional behaviour

Objective  The purpose of this study was to establish outcome measures for professionalism in medical students and to identify predictors of these outcomes.

Effect of a triage-based e-mail system on clinic resource use and patient and physician satisfaction in primary care: A randomized controlled trial

OBJECTIVES: E-mail communication between patients and their providers has diffused slowly in clinical practice. To address concerns about the use of this technology, we performed a randomized controlled trial of a triage-based e-mail system in primary care. DESIGN AND PATIENTS/PARTICIPANTS: Physicians in 2 university-affiliated primary care centers were randomized to a triage-based e-mail system promoted to their patients. E-mails from patients of intervention physicians were routed to a central account and parsed to the appropriate staff for response. Control group physicians and their patients did not have access to the system. We collected information on patient e-mail use, phone calls, and visit distribution by physician over the 10 months and performed physician and patient surveys to examine attitudes about communication. RESULTS: E-mail volume was greater for intervention versus control physicians (46 weekly e-mails per 100 scheduled visits vs 9 in the control group at the study midpoint; P<.01) but there were no between-group differences in phone volume (67 weekly phone calls per 100 scheduled visits vs 55 in the control group; P=.45) or rates of patient no-shows (5% in both groups; P=.77). Intervention physicians reported more favorable attitudes toward electronic communication than did control physicians but there were no differences in attitudes toward patient or staff communication in general. There were few between-group differences in patient attitudes toward electronic communication or communication in general. CONCLUSIONS: E-mail generated through a triage-based system did not appear to substitute for phone communication or to reduce visit no-shows in a primary care setting. Physicians’ attitudes toward electronic communication were improved, but physicians’ and patients’ attitudes toward general communication did not change. Growth of e-mail communication in primary care settings may not improve the efficiency of clinical care.

Medical students' views on peer assessment of professionalism.

BACKGROUND: Although peer assessment holds promise for assessing professionalism, reluctance and refusal to participate have been noted among learners and practicing physicians. Understanding the perspectives of potential participants may therefore be important in designing and implementing effective peer assessment.OBJECTIVE: To identify factors that, according to students themselves, will encourage or discourage participation in peer assessment.DESIGN: A qualitative study using grounded theory to interpret views shared during 16 focus groups that were conducted by leaders using a semi-structured guide.PARTICIPANTS: Sixty-one students in Years 1, 3, and 4 in 2 mid-western public medical schools.RESULTS: Three themes students say would promote or discourage peer assessment emerged: personal struggles with peer assessment, characteristics of the assessment system itself, and the environment in which the system operates. Students struggle with reporting an unprofessional peer lest they bring harm to the peer, themselves, or their clinic team or work group. Who receives the assessment and gives the peer feedback and whether it is formative or summative and anonymous, signed, or confidential are important system characteristics. Students’ views of characteristics promoting peer assessment were not unanimous. Receptivity to peer reports and close positive relationships among students and between students and faculty mark an environment conducive to peer assessment, students say.CONCLUSIONS: The study lays a foundation for creating acceptable peer assessment systems among students by soliciting their views. Merely introducing an assessment tool will not result in students’ willingness to assess each other.

Expanding the boundaries of medical education: Evidence for cross-cultural exchanges

Problem Statement and Background. Cross-cultural experiences are in increasing demand by both graduate and undergraduate medical students, yet the benefits of these experiences are not clearly established. Method. A review of the literature was conducted to identify articles on the outcomes of cross-cultural experiences. Themes were identified and categorized into domains. Results. Forty-two studies were found; 27 articles used qualitative methods, nine used quantitative methods, and six used both. Most (24) were from the nursing literature, 18 were from the medical literature. All studies reported positive outcomes along four domains: students’ professional development, students’ personal development, medical school benefits, and host population benefits. Conclusions. Studies reviewed were primarily case controlled or case series. Future research is needed that more clearly defines outcome measures and uses more rigorous methods. Although results suggest positive outcomes in all domains, additional research is needed before cross-cultural rotations can be supported based on evidence.

Ethics and Professionalism: What Does a Resident Need to Learn?

Training in ethics and professionalism is a fundamental component of residency education, yet there is little empirical information to guide curricula. The objective of this study is to describe empirically derived ethics objectives for ethics and professionalism training for multiple specialties. Study design is a thematic analysis of documents, semi-structured interviews, and focus groups conducted in a setting of an academic medical center, Veterans Administration, and community hospital training more than 1000 residents. Participants were 84 informants in 13 specialties including residents, program directors, faculty, practicing physicians, and ethics committees. Thematic analysis identified commonalities across informants and specialties. Resident and nonresident informants identified consent, interprofessional relationships, family interactions, communication skills, and end-of-life care as essential components of training. Nonresidents also emphasized formal ethics instruction, resource allocation, and self-monitoring, whereas residents emphasized the learning environment and resident-attending interactions. Conclusions are that empirically derived learning needs for ethics and professionalism included many topics, such as informed consent and resource allocation, relevant for most specialties, providing opportunities for shared curricula and resources.

Can There Be a Single System for Peer Assessment of Professionalism among Medical Students? A Multi-Institutional Study

Purpose Peer assessment is a valuable source of information about medical students’ professionalism. How best to facilitate peer assessment of students’ professional behavior remains to be answered, however. This report extends previous research through a multi-institutional study of students’ perspectives about system characteristics for peer assessment of professionalism. It examines whether students from different schools and year levels prefer different characteristics of peer assessment to assess each other candidly, or whether a single system can be designed. It then identifies the characteristics of the resulting preferred system(s). Method At the beginning of academic year 2004–2005, students (1,661 of 2,115; 78%) in years one through four at four schools replied to a survey about which peer assessment characteristics—related to, for example, who receives the assessment, its anonymity, and timing—would prevent or encourage their participation. Multivariate analysis of variance was used to detect differences among institutions and students from each year level. Results Students across year levels and schools generally agreed about the characteristics of peer assessment. They prefer a system that is 100% anonymous, provides immediate feedback, focuses on both unprofessional and professional behaviors, and uses peer assessment formatively while rewarding exemplary behavior and addressing serious repetitive professional lapses. The system, they emphasize, must be embedded in a supportive environment. Conclusions Students’ agreement about peer-assessment characteristics suggests that one system can be created to meet the majority of students’ preferences. Once implemented, the system should be monitored for student acceptability to maximize participation and to determine the formative and summative value of the process.

Using a Multimedia Tool to Improve Cardiac Auscultation Knowledge and Skills

AbstractOBJECTIVE: Today’s medical school graduates have significant deficits in physical examination skills. Medical educators have been searching for methods to effectively teach and maintain these skills in students. The objective of this study was to determine if an auscultation curriculum centered on a portable multimedia CD-ROM was effective in producing and maintaining significant gains in cardiac auscultatory skills. DESIGN: Controlled cohort study PARTICIPANTS: All 168 third-year medical students at 1 medical school in an academic medical center. INTERVENTIONS: Students were tested before and after exposure to 1 or more elements of the auscultation curriculum: teaching on ward/clinic rotations, CD-ROM comprehensive cases with follow-up seminars, and a CD-ROM 20-case miniseries. The primary outcome measures were student performance on a 10-item test of auscultation skill (listening and identifying heart sound characteristics) and a 30-item test of auscultation knowledge (factual questions about auscultation). A subset of students was tested for attenuation effects 9 or 12 months after the intervention. RESULTS: Compared with the control group (1 month clinical rotation alone), students who were also exposed to the CD-ROM 20-case miniseries had significant improvements in auscultation skills scores (P<.05), but not knowledge. Additional months of clerkship, comprehensive CD-ROM cases, and follow-up seminars increased auscultation knowledge beyond the miniseries alone (P<.05), but did not further improve auscultation skills. Students’ auscultation knowledge diminished one year after the intervention, but auscultation skills did not. CONCLUSION: In addition to the standard curriculum of ward and conference teaching, portable multimedia tools may help improve quality of physical examination skills.

The assessment of global minimum essential requirements in medical education

Using an international network of experts in medical education, the Institute for International Medical Education (IIME) developed the Global Minimum Essential Requirements (GMER) as a set of competence-based outcomes for graduating students. To establish a set of tools to evaluate these competences, the IIME then convened a Task Force of international experts on assessment that reviewed the GMER. After screening 75 potential assessment tools, they identified three that could be used most effectively. Of the 60 competences envisaged in the GMER, 36 can be assessed using a 150-item multiple-choice question (MCQ) examination, 15 by using a 15-station objective structured clinical examination (OSCE), and 17 by using a 15-item faculty observation form. In cooperation with eight leading medical schools in China, the MCQ, OSCE and Faculty Observation Form were developed to be used in an assessment program that is scheduled to be given to all seven-year students in October 2003.

Maximizing participation in peer assessment of professionalism: the students speak.

Background Medical students have unique information about peers’ professionalism but are reluctant to share it through peer assessment. Method Students (231 of 375; 62%) in one school replied to a survey about whether various characteristics of peer assessment (e.g., who receives the assessment, its anonymity, implications for the classmate) would prevent or encourage their participation. Results Sixty-six percent of the students agreed that there should be peer assessment of professionalism as long as the assessment reflected their preferences for how the assessment should take place. Some of their preferences included reporting unprofessional behavior to an impartial counselor, a 100% anonymous process, and having the classmate receive corrective instruction. Students across year levels generally agreed about the characteristics of peer assessment. Men and women disagreed about some characteristics. Conclusion Most students are willing to participate in peer assessment as long as their preferences are taken into consideration.