Gretchen Guiton

Medical school curricular reform: fourth-year colleges improve access to career mentoring and overall satisfaction.

Despite the trend toward curricular reform in the preclinical and core clerkship years, the fourth year of medical school is commonly unstructured, allowing students to take multiple “audition electives” in preparation for residency. Students struggle to identify mentors in their intended specialty in time to plan a well-rounded elective schedule and to prepare adequately for residency selection. The authors described the impact that an innovative fourth-year curriculum, the “College Program” at the David Geffen School of Medicine at the University of California–Los Angeles, which focuses on mentoring and required curricular components, has had on student perceptions of access to career mentors and overall satisfaction with the fourth-year experience. Pre- and postintervention cohorts participated in a 25-question telephone survey about their experience with mentors and overall satisfaction with their fourth year in 2001 and 2003. The Association of American Medical Colleges Graduation Questionnaire was analyzed as a secondary outcome measure, and responses were compared with those of national peers. Data were analyzed using two tailed t tests. Students in the intervention group reported a higher degree of satisfaction with accessibility to mentors and the impact they had on their educational experiences and careers than the preintervention cohort. Despite initial concerns that student freedom was going to be compromised, the students who participated in the College curriculum reported increased satisfaction with an intense foundations course, longitudinal experiences in the clinical setting, and scholarly projects during their senior year. Fourth-year students in the College Program were more likely to identify and develop better relationships with faculty mentors than their preintervention counterparts. They indicated excellent residency preparedness, and their overall impression of the fourth year was favorable.

Student body diversity: Relationship to medical students' experiences and attitudes

Background Multiple studies of undergraduate college students have demonstrated the effects of cross-cultural interaction and exposure to diverse ideas on a variety of educational outcomes. The current study was designed to extend this work into medical education, examining student body diversity and school-supported cross-cultural experiences on students’ attitudes about diversity. Method Four-hundred forty-one rising fourth-year medical students from three schools with differing levels of student body diversity completed a 55-item questionnaire on their background, experiences, and attitudes related to cross-cultural diversity. Results Medical students’ attitudes about culture and health and their perspectives on societal issues related to diversity were influenced by their medical school experiences. Informal instructional interactions seem to have been most influential in shaping these beliefs. Discussion The opportunity for students from diverse backgrounds to interact as part of the curriculum is an important means of promoting positive attitudes toward diversity in educational and social environments.

Impact of participation in a community-based intimate partner violence prevention program on medical students: A multi-center study

BackgroundPhysicians are generally poorly trained to recognize, treat or refer adolescents at risk for intimate partner violence (IPV). Participation in community programs may improve medical students’ knowledge, skills, and attitudes about IPV prevention.ObjectiveTo determine whether the experience of serving as educators in a community-based adolescent IPV prevention program improves medical students’ knowledge, skills, and attitudes toward victims of IPV, beyond that of didactic training.ParticipantsOne hundred and seventeen students attending 4 medical schools.DesignStudents were randomly assigned to didactic training in adolescent IPV prevention with or without participation as educators in a community-based adolescent IPV prevention program. Students assigned to didactic training alone served as community educators after the study was completed.MeasurementKnowledge, self-assessment of skills and attitudes about intimate partner violence and future plans to pursue outreach work.ResultsThe baseline mean knowledge score of 10.25 improved to 21.64 after didactic training (p ≤ .001). Medical students in the “didactic plus outreach” group demonstrated higher levels of confidence in their ability to address issues of intimate partner violence, (mean = 41.91) than did students in the “didactic only” group (mean = 38.94) after controlling for initial levels of confidence (p ≤ .002).ConclusionsExperience as educators in a community-based program to prevent adolescent IPV improved medical students’ confidence and attitudes in recognizing and taking action in situations of adolescent IPV, whereas participation in didactic training alone significantly improved students’ knowledge.

Using fresh tissue dissection to teach human anatomy in the clinical years.

Purpose. Gross anatomy is taught in medical school with textbooks, cadaver dissection, plastic models, and multimedia illustration, but all lack the reality of color and texture that is possible with fresh tissue dissection. The authors studied the use of fresh tissue dissection of the thorax and abdomen of the rat to teach human anatomy. Method. In a half-day exercise, 52 fourth-year medical students paired off and completed an exercise to dissect in less than three hours the thorax and abdomen of a euthanized rat. Observation of organs was augmented by active manipulation such as passing a tube down the esophagus, cannulating the trachea and inflating the lungs, injecting dye in the kidney to trace the ureter and bladder, and pulling the testis through the inguinal canal. Comparison of the rat and human was emphasized to enhance the education. The exercise ended with practice suturing fresh tissue. Results. Students rated the exercise to teach anatomy as 4.9 positive on a 5.0 (high) scale. The significant positive structures (p < .05) for texture were heart, liver, lungs and trachea; for color they were lungs and spleen; for location and size they were adrenal gland and urinary bladder; and for function they were adrenal gland and esophagus. Conclusion. Fresh tissue dissection of the thorax and abdomen of the rat is a valuable tool for human anatomy education. The dissonances in human and rat anatomy enhance abstraction and transfer of knowledge. Active manipulation of organs promotes retention of knowledge, and suturing provides a “clinical” context. Fresh tissue dissection is an efficient innovative method to provide a global review of anatomy of the thorax and abdomen during the busy clinical years of medical education.

Effective Feedback Strategies for Teaching in Pediatric and Adolescent Gynecology

The clinical setting of pediatric and adolescent gynecology poses complex tasks for the physician with its numerous procedures and the communication demands of interacting with an adolescent and/or guardian. Needless to say, teaching within this setting is highly demanding. Regardless of the level of learner or the professional role (e.g., nurse, medical student, resident, physician assistant) represented, clinical teaching requires that the instructor provide feedback in ways that benefit the student. Recent research on feedback suggests a more complex understanding of feedback than in the past. This article highlights key research and its implication for effective feedback by presenting a three part framework; know your learner, understand what is to be learned, and plan for improvement.

Integrating Case Topics in Medical School Curriculum to Enhance Multiple Skill Learning: Using Fetal Alcohol Spectrum Disorders as an Exemplary Case

ObjectivesThis article describes the use of fetal alcohol spectrum disorders (FASDs) as a theme to connect the learning of basic neurosciences with clinical applications across the age span within a systems-based, integrated curricular structure that emphasizes problem-based learning.MethodsIn collaboration with the Centers for Disease Control and Prevention (CDC) and the National Organization on Fetal Alcohol Syndrome, the Western Regional Training Center for Fetal Alcohol Exposure at UCLA developed and integrated educational materials on FASDs into the curriculum for first-year medical students.ResultsQuantitative and qualitative evaluations suggested materials were effective in enhancing student knowledge and skills related to FASDs, as well as embryology, brain development, substance abuse developmental psychopathology and medical ethics.ConclusionThe use of a unifying theme integrating basic science and clinical information and skills is effective for medical student training in the prevention and treatment of common medical problems.

The relationship between student anonymity and responses from two medical schools on the Association of American Medical Colleges' Graduation Questionnaire

Since the Association of American Medical Colleges (AAMC) began collecting data from graduating medical students in 1978, numerous studies have been published using data from the AAMC Graduation Questionnaire (GQ). Investigators have used the GQ to understand graduate career decisions and specialty choices or cited data from the GQ to document curricular deficiencies and evaluate outcomes. Medical schools often use the annual school report of their own GQ data to inform curricular discussions and stimulate change. Recently data have been made available online to supplement paper reports with graphic illustrations of multiple-year comparisons. In addition, the data can be purchased from the AAMC for analysis as SPSS data sets. When completing the questionnaire, students are asked for their permission to release their names so that their GQ responses can be merged with existing school data. This allows for a powerful curricular evaluation tool. For example, students’ GQ responses to questions about their preparation for practice can be merged with data from alumni who reflect on their medical school preparation. Do students selecting different careers evaluate the adequacy of curricular topics differently? Questions such as these can help schools better understand the quality and effectiveness of their curricula. Providing respondent anonymity or confidentiality is a characteristic method of survey data collection. Texts typically describe anonymity as the total separation of responses and respondents, whereas confidentiality allows the researcher to link responses to a respondent, (e.g. through name, unique identification), but the researcher promises not to do so in any way that would make an individual respondent identifiable. For example, confidential data allow the researcher to match an individual’s response on the GQ to data collected by the American Medical Association (AMA) Physician Profile through unique identifiers or respondent names, whereas anonymous data include no association between responses and respondents, rendering such a linkage impossible. Both these methods are advocated to increase response rates and improve honesty and accuracy in responding—especially to sensitive questions. However, confidentiality is considered less successful in this regard. Furthermore, those concerned with the protection of human subjects promote anonymity, while demanding confidentiality as a minimum standard. Anonymity places a number of restrictions on researchers. Anonymity severely limits the researcher’s ability to follow up and to ensure a representative response rate. In addition, it makes linking data, especially data collected at different times and in different settings, nearly impossible. For medical schools, the latter difficulty is the most problematic. Here we ask whether the perceived benefits of anonymity—particularly honesty in responding—warrant the limited use of results. Studies of the effects of anonymity versus confidentiality on responses have been contradictory. Most studies of anonymity have concluded that ensuring anonymity does not influence response rate. A review of 214 studies by Heberlein and Baumgartner found no benefit in the percentage responding when anonymous procedures were used. In terms of anonymity affecting subjects’ responses on a survey, 90% of respondents in a mail study self-identified by putting their return addresses on the envelope, yet their responses were comparable to the responses of those maintaining anonymity. Another study examining the effects of setting (home versus work) and anonymity (identifier versus no identifier) on teachers’ response rate, rapidity of response, and response about unions found no effect due to either the anonymity or the setting condition. Conversely, in another study, investigators compared college students’ satisfaction with counseling services after they had completed treatment. The 25% of the respondents who elected to self-identify reported higher levels of treatment satisfaction than did those remaining anonymous. In the medical education context, a recent study examined any biasing effects of non-response in a sample of 508 residents. Residents were asked to permit follow-up evaluations of their performances. Those granting permission had significantly higher mean scores on the Medical College Admission Test and higher medical school GPAs, indicating a clear source of nonresponse bias. Anonymity and response bias in surveys have always been a concern to investigators. In this study, we examined the scores of students who did and did not agree to release their names for the GQ survey to test whether GQ scores vary between the two groups of students, thereby introducing bias.

Intimate partner violence in the medical school curriculum: approaches and lessons learned.

The UCLA curriculum model educates students about intimate partner violence by integrating the topic into existing preclinical and clinical course work and offering elective experiences for interested students. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Medical Student Performance on an Adolescent Medicine Examination

PURPOSE To examine the performance of third-year medical students on an adolescent medicine clinical practice examination. METHODS The participants were third-year medical students (2010 [n = 145] and 2011 [n = 134]) at the University of Colorado School of Medicine. Student performance on adolescent contraceptive management was measured in three domains following Accreditation Council for Graduate Medical Education (ACGME) competencies in professionalism, communication, and history-taking skills. RESULTS With regard to professionalism and communication skills, students performed very well, scoring >95% correct in both years. Students demonstrated relatively poorer performance in history-taking competency in 2010 and 2011 (66% and 67% correct, respectively). CONCLUSION In the adolescent Objective Structured Clinical Examination case, third-year medical students demonstrated extremely high performance in communication and professionalism skills. However, performance was lower for history-taking skill in contraceptive management.

Responding to the challenges of teaching cultural competency

Context and setting This study evaluates the effectiveness of a 2.5-hour introductory session on culture, health and illness delivered to Year 1 medical students. It examines the effectiveness of this session on students’ attitudes and compares it with that of prior efforts. The primary goal was to introduce the notion of culture and explore the interaction of cultures in a medical encounter. The session attempted to help students understand that both the patient and the doctor have a culture. A second objective was to provide a tool to help students to explore medically relevant aspects of a patient’s culture. Why the idea was necessary The need to include cultural competency education throughout medical school is widely accepted. However, introducing this topic in the context of the basic science curriculum presents many challenges. Student apathy and resistance are primary challenges that are gaining wider acknowledgement. This session attempted to overcome such resistance through student leadership and a focus on the clinical encounter. What was done During an interactive session in the Foundations of Doctoring course, upper-level students and a clinician jointly introduced the notion of culture to 156 Year 1 students (in groups of 50+). Each group then viewed a video of a medical situation involving culture and discussed their impressions of the doctor and family portrayed. The students were encouraged to reflect on the situation, the family’s culture, the medical culture and the interactions between the two cultures. Under the upper-level students’ leadership, group members then explored their own individual culture with a peer using structured dyads. Finally, the clinician and an upper-level student demonstrated the use of anthropologically oriented interviewing techniques in a role-play of a medical interview which the students then practised with their peers. Students completed the 15-item Health Beliefs Attitude Survey before and after participating in the session. A paired t-test was conducted for each attitudinal factor documented in the literature: whether the doctor should elicit a patient’s perspective, and whether knowing the patient’s perspective affects the quality of care the doctor provides. Evaluation of results and impact Students’ attitudes increased significantly (P = 0.001) on both factors resulting in large (d = 0.66) and moderate (d = 0.44) effect sizes for care and elicit, respectively. These results are remarkable when compared with those of prior studies with medical students in which attitudes declined or increased only on care. Asked to evaluate whether the session ‘advanced my understanding of the impact of culture on communication issues’, students rated the session significantly more highly than in the previous prior year (t = 3.4385, P £ 0.0007). We felt that the utilisation of upper-level students along with clinicians as instructors and the provision of opportunities to relate to culture personally and in a medical situation and to practise skills to address culture appeared to reduce resistance and improve students’ attitudes towards addressing cross-cultural communication in medicine.