G. Dodd Denton

Effect of Electronic Versus Print Format and Different Reading Resources on Knowledge Acquisition in the Third-Year Medicine Clerkship

Background: Many medical students have access to electronic and print resources. It is not known if the format or the choice of resources effects knowledge acquisition over an entire clerkship. Purpose: To determine if the format (electronic or print) or choice of reading materials is associated with knowledge acquisition during the 3-year internal medicine clerkship. Methods: This was a prospective cohort study. During the last week of the clerkship, students took the National Board of Medical Examiners (NBME) exam and completed a survey ranking the reading materials used. Results: One hundred and fourteen 3rd-year internal medicine clerkship students participated. The most commonly reported resources were UpToDate® (99%), a review or question book (93%), and Harrisons Principles of Internal Medicine (82%). Multivariate analysis showed a significant beneficial effect of any use of Harrisons (linear regression, p <. 04, absolute difference 3 points, SD = 1.4) on NBME score. The format of the most important resource-electronic (61%) or print (39%)-did not predict the NBME score, p >. 80. Conclusions: The format (electronic or print) of resources did not appear to effect NBME score in the medicine clerkship. A secondary analysis showed the use of Harrisons textbook was associated with improved knowledge acquisition.

End-of-life and palliative care curricula in internal medicine clerkships: A report on the presence, value and design of curricula as rated by clerkship directors

Purpose End-of-life and palliative care (EOL/PC) education is a necessary component of undergraduate medical education. The extent of EOL/PC education in internal medicine (IM) clerkships is unknown. The purpose of this national study was to investigate the presence of formal EOL/PC curricula within IM clerkships; the value placed by IM clerkship directors on this type of curricula; curricular design and implementation strategies; and related barriers and resources. Method The Clerkship Directors in Internal Medicine conducted its annual survey of its institutional members in April 2012. The authors analyzed responses to survey items pertaining to formal EOL/PC curriculum and content using descriptive statistics. The authors used qualitative techniques to analyze free-text responses. Results The response rate was 77.0% (94/122). Of those responding, 75.8% (69/91) believed such training should occur in the IM clerkship, and 43.6% (41/94) reported formal curricula in EOL/PC. Multiple instructional modalities were used to deliver this content, with the majority of programs dedicating four or more hours to the curriculum. Curricula covered a wide range of topics, and student assessment tools were varied. Most felt that students valued this education. The qualitative analysis revealed differences in the values clerkship directors placed on teaching EOL/PC within the IM clerkship. Conclusions Although many IM clerkship directors have implemented formal curricula in EOL/PC, a substantial gap remains between those who have implemented and those who believe it belongs in the clerkship. Time, faculty, cost, and competing demands are the main barriers to implementation.

Ethical issues in the care of transgender patients

A young man, JT, arrives at the clinic to establish care. The front desk staff is confused because his gender is listed as female in the chart. After several minutes of discussion, your assistant walks out and calls for “Ms T.” When you walk into the room, he is clearly upset with the process. Transgender describes a person whose gender identity differs from the sex assigned at birth. Gender identity is a persons inherent sense of being female, male, or an alternative gender.1 To adequately treat gender nonconforming patients, healthcare providers should recognize that not all patients fit into a binary gender description. In Louisiana, transgender people represent approximately 0.6% of the population, or 20,900 people.2 Transgender individuals experience a high degree of homelessness, violence, abuse, and hate crimes.3 Furthermore, transgender individuals have a suicide attempt rate of 41% that far surpasses the national average of 4.6%.4 In addition, transgender individuals battle extensive healthcare disparities, but aligning the treatment of transgender patients with the ethical principles of autonomy, nonmaleficence, benefice, and justice can help eliminate these disparities.