Heather-Lyn Haley

Results of a survey on the use of standardized patients to teach and evaluate clinical skills

In 1989, a survey was sent to each U.S. and Canadian medical school requesting information about how standardized patients are used for teaching and evaluating clinical skills, and 95% of the schools responded. Although there was widespread use of standardized patients throughout the curricula, the role and training of these patients varied markedly within a given school as well as across schools. One outcome of this survey is the development of a network to share resources, protocols, and training material to enhance the development of this educational strategy.

Comparison of blogged and written reflections in two medicine clerkships

Medical Education 2011: 45: 166–175

Community preceptors' views of their identities as teachers

Purpose Community physicians are increasingly being recruited to teach medical students and residents, yet there has been little research about how they think of themselves as teachers or what factors contribute to “teacher identity.” Physicians who think of themselves as teachers may be more likely to enjoy teaching, to teach more, and to be recognized by students and other faculty as good teachers. Identifying factors that enhance teacher identity may be helpful for the recruitment and retention of high-quality community faculty. Method Thirty-five experienced community preceptors were audiotaped in five structured focus groups in April 2001, answering a series of questions about their teacher identity. Responses were qualitatively analyzed for evidence of themes. Results “Feeling intrinsic satisfaction” was the most common theme that emerged from the tapes. Preceptors also identified that “having knowledge and skill about teaching” and “belonging to a group of teacher” enhanced their roles as teachers. “Being a physician means being a teacher,” “feeling a responsibility to teach medicine,” and “sharing clinical expertise” also emerged as important themes. Although a group of participants were interested in “receiving rewards for teaching,” rewards did not need to be financial compensation. For some, genuine recognition for their efforts by the medical school, particularly in the form of faculty development opportunities, constituted reward and recognition for teaching. Conclusions Community physicians described a variety of factors that contribute to their identity as teachers. Faculty development programs offer opportunities to strengthen teacher identity and foster relationships between teaching programs and community-based faculty.

Developing Culturally Competent Community Faculty: A Model Program

The Liaison Committee on Medical Education recently set standards for cultural diversity training as part of the medical school curriculum. To the authors’ knowledge, this is the first description of a faculty-development program designed to develop the capacity of the clinical faculty to integrate culture and advocacy education into clinical training. The paper describes the first two years of the development of an ongoing cultural competence curriculum that has been integrated into the training of community preceptors from 13 medical schools in New England and New York. The training, entitled “Teaching the Culture of the Community,” consists of four 2.5-hour modules that include interactive lectures and small-group role-play exercises on cultural needs assessment, patient-centered interviewing, feedback on cultural issues and use of the community to enhance cultural understanding. The 137 participants in the first two years of the program (1999–00 and 2000–01) reported a high level of acceptance of the curriculum. In the second year, the program began to document participants’ self-reported “intention to change” in relation to the cultural competence curriculum. Many participants reported plans to change aspects of their clinical care and their teaching practices. Intentions to change were most frequently expressed in the context of content on effective communication skills. In summary, cultural competency training has been successfully integrated into an existing faculty-development program for community-based preceptors.

Between two worlds: a multi-institutional qualitative analysis of students' reflections on joining the medical profession.

BACKGROUNDRecent changes in healthcare system and training mandates have altered the clinical learning environment. We incorporated reflective writing into Internal Medicine clerkships (IMcs) in multiple institutions so students could consider the impact of clerkship experiences on their personal and professional development. We analyzed student reflections to inform curricula and support learning.METHODSWe qualitatively analyzed the reflections of students at 3 US medical schools during IMcs (N = 292) to identify themes, tone, and reflective quality using an iterative approach. Chi-square tests assessed differences between these factors and across institutions.FINDINGSStudents openly described powerful experiences. Major themes focused on 4 categories: personal issues (PI), professional development (PD), relational issues (RI), and medical care (MC). Each major theme was represented at each institution, although with significant variability between institutions in many of the subcategories including student role (PI), development-as-a-physician (PD), professionalism (PD) (p < 0.001). Students used positive tones to describe student role, development-as-a-physician and physician–patient relationship (PD) (p < 0.01–0.001), and negative tones for quality and safety (MC) (p < 0.05). Only 4% of writings coded as professionalism had a positive tone. Students employed a “reporting” voice in writing about clinical problem-solving, healthcare systems, and quality/safety (MC).DISCUSSIONReflection is considered important to professional development. Our analysis suggests that students at 3 institutions reflect on similar experiences. Theme variability across institutions implies curricula should be tailored to local culture. Reflective quality analysis suggests students are better equipped to reflect on certain experiences over others, which may impact learning. Student reflections can function as a mirror for our organizations, offer institutional feedback for support and improvement, and inform curricula for learners and faculty.

Modern Moulage: Evaluating the Use of 3-Dimensional Prosthetic Mimics in a Dermatology Teaching Program for Second-Year Medical Students

OBJECTIVES To evaluate the effectiveness of a teaching method that uses 3-dimensional (3D) silicone-based prosthetic mimics of common serious lesions and eruptions and to compare learning outcomes with those achieved through the conventional method of lectures with 2-dimensional (2D) images. DESIGN Prospective and comparative. SETTING University of Massachusetts Medical School. PARTICIPANTS Ninety second-year medical students. INTERVENTION A 1-hour teaching intervention using a lecture with 2D images (2D group) or using 3D prosthetic mimics of lesions and eruptions (3D group). MAIN OUTCOME MEASURES Mean scores in the domains of morphology, lesion and rash recognition, lesion and rash management, and overall performance assessed at baseline, immediately after, and 3 months after each groups respective teaching intervention. RESULTS Immediately after the teaching intervention, the 3D group had significantly higher mean percentage scores than did the 2D group for overall performance (71 vs 65, P = .03), lesion recognition (65 vs 56, P = .02), and rash management (80 vs 67, P = .01). Three months later, the 3D group still had significantly higher mean percentage scores than did the 2D group for lesion recognition (47 vs 40, P = .03). The 3D group better recognized lesions at 3 months compared with at baseline, whereas the 2D group was no better at recognizing lesions at 3 months compared with at baseline. CONCLUSIONS Despite limited curricular time, the novel teaching method using 3D prosthetic mimics of lesions and eruptions improves immediate and long-term learning outcomes, in particular, lesion recognition. It is also a preferred teaching format among second-year medical students.

The video-based test of communication skills: description, development, and preliminary findings

Background: The importance of assessing physician–patient communication skills is widely recognized, but assessment methods are limited. Objective structured clinical examinations are time-consuming and resource intensive. For practicing physicians, patient surveys may be useful, but these also require substantial resources. Clearly, it would be advantageous to develop alternative or supplemental methods for assessing communication skills of medical students, residents, and physicians. Description: The Video-based Test of Communication Skills (VTCS) is an innovative, computer-administered test, consisting of 20 very short video vignettes. In each vignette, a patient makes a statement or asks a question. The examinee responds verbally, as if it was a real encounter and he or she were the physician. Responses are recorded for later scoring. Test administration takes approximately 1 h. Evaluation: Generalizability studies were conducted, and scores for two groups of physicians predicted to differ in their communication skills were compared. Preliminary results are encouraging; the estimated g coefficient for the communication score for 20-vignette test (scored by five raters) is 0.79; g for the personal/affective score under the same conditions is 0.62. Differences between physicians were in the predicted direction, with physicians considered “at risk” for communication difficulties scoring lower than those not so identified. Conclusions: The VTCS is a short, portable test of communication skills. Results reported here suggest that scores reflect differences in skill levels and are generalizable. However, these findings are based on very small sample sizes and must be considered preliminary. Additional work is required before it will be possible to argue confidently that this test in particular, and this approach to testing communication skills in general, is valuable and likely to make a substantial contribution to assessment in medical education.

A Human Factors Curriculum for Surgical Clerkship Students

HYPOTHESIS Early introduction of a full-day human factors training experience into the surgical clerkship curriculum will teach effective communication skills and strategies to gain professional satisfaction from a career in surgery. DESIGN In pilot 1, which took place between July 1, 2007, and December 31, 2008, 50 students received training and 50 did not; all received testing at the end of the rotation for comparison of control vs intervention group performance. In pilot 2, a total of 50 students were trained and received testing before and after rotation to examine individual change over time. SETTING University of Massachusetts Medical School. PARTICIPANTS A total of 148 third-year medical students in required 12-week surgical clerkship rotations. INTERVENTIONS Full-day training with lecture and small-group exercises, cotaught by surgeons and educators, with focus on empathetic communication, time management, and teamwork skills. MAIN OUTCOME MEASURES Empathetic communication skill, teamwork, and patient safety attitudes and self-reported use of time management strategies. RESULTS Empathy scores were not higher for trained vs untrained groups in pilot 1 but improved from 2.32 to 3.45 on a 5-point scale (P < .001) in pilot 2. Students also were more likely to ask for the nurses perspective and to seek agreement on an action plan after team communication training (pilot 1, f = 7.52, P = .007; pilot 2, t = 2.65, P = .01). Results were mixed for work-life balance, with some trained groups scoring significantly lower than untrained groups in pilot 1 and no significant improvement shown in pilot 2. CONCLUSIONS The significant increase in student-patient communication scores suggests that a brief focused presentation followed by simulation of difficult patient encounters can be successful. A video demonstration can improve interdisciplinary teamwork.

Correctional Health Curriculum Enhancement Through Focus Groups

Background: Little has been published describing curricular experiences in correctional health (CH). Purposes: Our goal is to articulate a curriculum cognizant of the special needs of the correctional health care worker. Methods: We conducted focus groups with nurses, nurse practitioners, physician assistants, and physicians focused on content crucial to prepare competent medical professionals committed to careers in correctional health. Results: Six main themes emerged from the data, which were used to confirm and add to the growing curriculum on correctional health used in our universitys correctional health electives. The themes are (a) characteristics of the population being served; (b) prevalent conditions requiring clinical expertise; (c) public health opportunities in correctional facilities; (d) ethical considerations; (e) medical-legal issues; and (d) the CH system, structure, and administration. Conclusions: The successful provision of health care in correctional settings requires specialized knowledge, skills, and awareness not typically available in other health care training settings.

Initial testing of an instrument to measure teacher identity in physicians

Background: A previous study described 7 elements of teacher identity: intrinsic satisfaction from teaching, knowledge and skill about teaching, belonging to a community of teachers, receiving rewards for teaching, believing that being a doctor means being a teacher, feeling a responsibility to teach, and sharing clinical expertise. Purpose: To conduct the initial testing of an instrument to measure the 7 elements of teacher identity in clinical educators and to consider the potential applications of such an instrument. Methods: A 37-item questionnaire was mailed to 153 preceptors of preclinical students. Categories reflected the elements of teacher identity listed here. Demographic data were collected. Means, alphas, ANOVAs, and paired t tests were calculated. Results: Of 153 preceptors, 127 (83%) completed the questionnaire. Cronbachs alpha for the overall scale and several subscales were high. Salaried physicians and those who had completed a faculty development program scored significantly higher on several subscales than physicians who volunteered to teach or who did not have faculty development. Conclusions: This study provides preliminary evidence that teacher identity can be measured and that preceptors do not respond as a homogeneous group. Assessing teacher identity may be helpful to medical schools looking to identify and support physicians who teach.