Douglas Myhre

Academic Performance of Longitudinal Integrated Clerkship Versus Rotation-based Clerkship Students: A Matched-cohort Study

Purpose Prior studies suggest that students on a longitudinal integrated clerkship (LIC) have comparable academic performance to those on a rotation-based clerkship (RBC); however, most of these studies did not adjust for preclerkship academic performance. The objective of this study was to compare the academic performance of LIC and RBC students matched on prior academic performance over a three-year period. Method Each LIC student in the University of Calgary classes of 2009, 2010, and 2011 (n = 34) was matched with four RBC students (n = 136) of similar prior academic performance. Knowledge and clinical skills performance between the streams was compared. Knowledge was evaluated by internal summative examinations and the Medical Council of Canada Part 1 licensing exam. Clinical skills were evaluated via in-training evaluation report (ITERs) and performance on the clerkship objective structured clinical examination (OSCE). Meta-analysis was used to compare knowledge evaluations and clinical performance for all core clerkship disciplines, and pooled effect sizes from the fixed-effect models were reported. Results Meta-analyses showed no statistically significant heterogeneity. There were no differences between LIC and RBC students on knowledge evaluations (pooled effect size 0.019; 95% confidence interval [−0.155, 0.152], P = .8), ITERs (pooled effect size −0.015 [−0.157, 0.127], P = .8), or mean OSCE ratings (67.9 [SD = 4.6] versus 68.6 [SD = 5.8], P = .5). Conclusions After matching on prior academic performance, LIC and RBC students at one school had comparable performance on summative evaluations of knowledge, clinical performance, and clinical skills over three years.

Comparing the Performance in Family Medicine Residencies of Graduates From Longitudinal Integrated Clerkships and Rotation-Based Clerkships

Purpose In 2008, the University of Calgary implemented a longitudinal integrated clerkship (LIC) called the Rural Integrated Community Clerkship (RICC), which places students in a rural community for 32 weeks. Research indicates that LIC students perform academically as well as or better than students completing rotation-based clerkships (RBCs). However, little is known about how LIC graduates perform in residency. This study compared residency program director ratings of RICC and RBC graduates. Method The performance of RICC and RBC graduates (2009–2011) was assessed using a rating form mailed to family medicine residency program directors at the end of graduates’ first postgraduate year. Because of sample size and confounding effects of discipline, only the performance of graduates training in family medicine was examined. Data were analyzed using factor analysis, ANOVA, and chi-square. Results Three hundred sixteen of 399 (80.8%) rating forms were returned. The instrument contained two factors (clinical acumen and human sensitivity) of acceptable reliability (≥0.90) plus an overall rating of performance. Of 124 (31.7%) students who matched to family medicine, 101 (81.5%) rating forms (RICC = 22/25; RBC = 79/99) were returned. Program directors rated the performance of RICC graduates to be at least equivalent to their RBC peers on both dimensions. On overall performance, 16/22 (72.7%) RICC graduates and 43/79 (54.4%) RBC graduates were rated as “stronger” or “much stronger” than most residents in the program, P = .30. Conclusions The performance of RICC graduates was at least equivalent to the performance of their RBC peers.

Exposure and attitudes toward interprofessional teams: a three-year prospective study of longitudinal integrated clerkship versus rotation-based clerkship students

Abstract This study explored exposure to, and attitudes toward, interprofessional (IP) teams between third-year longitudinal integrated clerkship (LIC) and traditional rotation-based clerkship (RBC) students at the University of Calgary medical school. Students completed a survey pre-post 32-week LIC or 6-week rural, regional or urban RBC family medicine rotations. Pre and post rotation surveys were completed by 213 (48%) students (LIC = 33/34; rural = 76/152; regional = 24/46; urban = 80/208). More LIC students (76%) reported participating on six or more IP teams than RBC students (rural = 38%; regional = 25%; urban = 21%). At pre rotation, the mean attitude to IP teams score of LIC and rural RBC students was high and did not differ. At post rotation, the mean attitude score of LIC students was significantly greater than the mean reported by rural RBC students. Only LIC students reported a significant pre-post rotation increase in attitude. Exposure to IP teams, possibly facilitated by a longer duration of rotation, appears to be an important factor in affecting attitude to IP teams.

Beyond bricks and mortar: a rural network approach to preclinical medical education

BackgroundCountries with expansive rural regions often experience an unequal distribution of physicians between rural and urban communities. A growing body of evidence suggests that the exposure to positive rural learning experiences has an influence on a physician’s choice of practice location. Capitalizing on this observation, many medical schools have developed approaches that integrate rural exposure into their curricula during clerkship. It is postulated that a preclinical rural exposure may also be effective. However, to proceed further in development, accreditation requirements must be considered. In this investigation, academic equivalence between a preclinical rural community based teaching method and the established education model was assessed.MethodTwo separate preclinical courses from the University of Calgary’s three year Undergraduate Medical program were taught at two different rural sites in 2010 (11 students) and 2012 (12 students). The same academic content was delivered in the pilot sites as in the main teaching centre. To ensure consistency of teaching skills, faculty development was provided at each pilot site. Academic equivalence between the rural based learners and a matched cohort at the main University of Calgary site was determined using course examination scores, and the quality of the experience was evaluated through learner feedback.ResultsIn both pilot courses there was no significant difference between examination scores of the rural distributed learners and the learners at the main University of Calgary site (p > 0.05). Feedback from the participating students demonstrated that the preceptors were very positively rated and, relative to the main site, the small group learning environment appeared to provide strengthened social support.ConclusionThese results suggest that community distributed education in pre-clerkship may offer academically equivalent training to existing traditional medical school curricula while also providing learners with positive rural social learning environments. The approach described may offer the potential to increase exposure to rural practice without the cost of constructing additional physical learning sites.

Specialty resident perceptions of the impact of a distributed education model on practice location intentions

Abstract Objectives: There is an increased focus internationally on the social mandate of postgraduate training programs. This study explores specialty residents’ perceptions of the impact of the University of Calgary’s (UC) distributed education rotations on their self-perceived likelihood of practice location, and if this effect is influenced by resident specialty or stage of program. Methods: Residents participating in the UC Distributed Royal College Initiative (DistRCI) between July 2010 and June 2013 completed an online survey following their rotation. Descriptive statistics and student’s t-test were employed to analyze quantitative survey data, and a constant comparative approach was used to analyze free text qualitative responses. Results: Residents indicated they were satisfied with the program (92%), and that the distributed rotations significantly increased their self-reported likelihood of practicing in smaller centers (p < 0.05). The findings suggest that the shift in attitude is independent of discipline, program year, and logistical experiences of living at the distributed sites, and is consistent across multiple cohorts over several academic years. Conclusion: The findings highlight the value of a distributed education program in contributing to future practice and career development, and its relevance in the social accountability of postgraduate programs.

Precepting at the time of a natural disaster

Natural disasters strike communities that have varied degrees of preparedness, both physical and psychological. Rural communities may be particularly vulnerable as they often do not have the infrastructure or resources to prepare in advance. The psychological impact of a natural disaster is amplified in learners who may be temporary members of the community and therefore cannot draw on personal support during the crisis. They may turn to their clinical preceptors for guidance.

Using a commitment-to-change strategy to assess faculty development

engagement, are limited by group size and time constraints. We trialled a novel teaching method that combined a popular teaching tool, ‘debate’, with a case-based, evidence-based format. The aim was to ensure learner engagement in a large group with emphasis on the clinical application of published evidence. What was done Two trainees were given the same clinical case to prepare 1 month ahead of the debate. The case chosen was suitable for both surgical and conservative treatments based on current accepted practice, so the debaters were assigned to argue opposite positions. Rules were specified that restricted the presentation format and time in order to encourage detailed literature review and audience participation. Each trainee was asked to summarise the case, management and relevant articles in 10 minutes using a maximum of five slides, and to allow 2 minutes for rebuttal. The debate outcome was judged by an audience vote for the more convincing speaker based on the quoted literature. We collected feedback using a 5-point Likert scale response on whether the debate met learner needs. Evaluation of results and impact There were 16 responders, of whom seven were medical officers and registrars, four were specialists and five did not specify their grade. A total of 87% found it a new and enjoyable style of learning and 75% wanted more of such sessions. Compared with a lecture, more than half the audience felt that the debate helped them to understand the literature better and to apply the evidence to actual patients. Compared with a regular journal club, 69% felt that it helped them to understand the topic better. This method engaged the interest of most of the participants, which is typically difficult on a Friday evening after work. We chose a controversial topic, vesico-ureteric reflux, because of marked variations in management worldwide. Prior to this session, several junior doctors were unaware of recently published landmark articles. The case was deliberately constructed to maximise the opportunity for debate using published evidence. Similarly, in other disciplines, suitable debate topics with conflicting evidence can be chosen. The structured format of the debate, with its arbitrary restrictions on time and the number of slides used, kept the debate succinct and lively. Overall, 94% of the audience agreed that the timing was just right. The preparatory work required of the organisers and debaters was substantially more than that required by the usual journal club. We do not think this format can replace lectures for global topic understanding, nor evidence-based journal clubs. It should be considered as an entertaining, educational alternative to regular journal clubs.

Attending to relationships: a necessary evolution in the clerkship

Faculties of medicine are working to increase social accountability in medical education (i.e. ‘to plan, implement and evaluate medical education programmes in relation to society’s primary health needs’). Partnering with communities, health professionals, the health delivery service and government to graduate physicians who are able to meet communities’ priority health needs is a response to the mandate. Rural medical education fosters these partnerships and RME programmes have been shown to influence students’ career choices and increase the numbers of generalists and rural clinicians.

A critical scoping review of the connections between social mission and medical school admissions: BEME Guide No. 47

Abstract Background: Despite a growing focus on the social accountability of medical schools, there has been no substantive review of admissions related to the social mission of medical schools. This paper reports on a critical scoping review of the connections between social mission and medical school admissions. Methods: Searches of seven bibliographic databases identified 1258 unique articles. After filtering for relevance, 71 articles were considered for final review. The results of the data extraction were synthesized using a combination of qualitative and quantitative techniques. Results: Five reviewers conducted 149 data extractions from 71 papers. Social missions tended to focus either on access and equity issues for applicants from underrepresented populations or on the career choices of medical graduates and how they meet particular social needs. The connection between social missions and admissions was often implied but rarely considered or evaluated directly. There was a notable absence of empirical evidence, with calls for reform or program descriptions far outweighing the number of papers based on empirical findings. Conclusions: Despite the move to social missions in medical education, there remains little direct connection between missions and admissions and little evidence reflecting the efficacy or impacts of making this connection.