Jessica Muller

Lessons learned about integrating a medical school curriculum: perceptions of students, faculty and curriculum leaders

Objective  Recent educational reform in US medical schools has created integrated curricular structures. This study investigated how stakeholders in a newly integrated curriculum – students, course directors and curriculum leaders – define integration and perceive its successes and challenges during its first year.

Promoting Research in Medical Education at the University of California, San Francisco, School of Medicine

Over the past seven years, educational innovations and scholarship have flourished at the University of California, San Francisco, (UCSF) School of Medicine. Prior to 1998, there was no infrastructure to support educational research and yet a few faculty members published in medical education journals and were active in national professional associations. With the initiation of curriculum reform in 1998, a great deal of excitement about education was generated and innovative new educational programs were envisioned. These changes became opportunities for educational scholarship. With the development of an Office of Medical Education in 1997 and the Haile T. Debas Academy of Medical Educators in 2001, the infrastructure was in place to expand educational research and the scholarship of teaching. The components of this support include educational leadership, faculty development, the Teaching Scholars Program, the Office of Educational Research and Development, the Academy, a Fellowship in Medical Education Research, collaborative research, and extramural grants. As a result of these investments, the number of UCSF faculty members who are involved in educational research has increased significantly. There has been a four-fold increase in peer-reviewed articles published in medical education journals and a greater increase in the publication of educational abstracts, editorials, chapters, and books, plus presentations at U.S. professional association meetings. In this article, the authors describe the changes that have occurred at UCSF to achieve these results.

Complementary and alternative medicine for menopause: a qualitative analysis of women's decision making.

BackgroundWhile almost half of women use complementary and alternative medicine (CAM) during their menopause, almost no literature explores why women choose CAM for menopausal symptoms. Clinician–patient conversations about CAM can be unsatisfactory, and exploration of women’s choices may benefit communication.ObjectiveThe objective of this study was to describe women’s choices to use CAM for menopausal health issues.DesignThis is a qualitative study utilizing semi-structured interviews.ParticipantsConvenience sample of 44 menopausal women ages 45 to 60 recruited in two primary care clinics. Both users and non-users of CAM were included.ApproachTranscripts of semi-structured interviews were analyzed for themes that were refined through comparison of labeled text.Main resultsFour themes emerged in decisions to use CAM: (1) valuing CAM as “natural”, although the meaning of “natural” varied greatly, (2) perceiving menopause as marking a change in life stage, (3) seeking information about menopause generated from personal intuition and other women’s experiences, and (4) describing experiences before menopause of using CAM and allopathic medication in patterns similar to current use (patterned responses).ConclusionWomen’s decisions about using CAM during menopause can be understood through their perspectives on menopause and overall health. Increased clinician awareness of these themes may promote supportive discussions about CAM during counseling for menopause.

Reflections-on-action: medical students' accounts of their implicit beliefs and strategies in the context of one-to-one clinical teaching.

No abstract available.

Impact of an information retrieval and management curriculum on medical student citations.

Background Increasingly, schools have integrated evidence-based medicine into their curricula. Most efforts focus on critical appraisal of literature rather than information retrieval and management (IRAM) skills. We implemented two versions of an IRAM curriculum (workshop alone and workshop with librarian visit) and evaluated their effectiveness. Method First-year medical students in a problem-based learning course researched six learning issues (LIs). We compared the number and completeness of LI citations of students receiving a Workshop/Librarian or a Workshop intervention with those of a control group. Results A total of 2,415 LIs containing 6,717 citations from 429 students were scored. Among the Workshop/Librarian, Workshop, and control groups, respectively, the percentage of LIs without citations was 9.3%, 11.0%, and 14.0%, the percentage of citations with complete documentation was 64.9%, 61.0%, and 29.4%, and the frequency of citing primary articles was 24.7%, 13.2%, and 18.8% (P < .05). Conclusions An IRAM curriculum that includes a workshop plus librarian participation produced the best student citation habits.

Practical teaching How to lead effective group discussions

A n animated group discussion can stimulate thinking, promote deep engagement with subject matter, overcome misunderstandings and motivate learning. This is possible, in part, because learners in effective small groups are actively involved in the process of learning: articulating what they know, wrestling with the limits of their understanding, and engaging with others while seeking solutions to a problem. Small groups give learners the opportunity to share experiences and observations, ask questions, get feedback, and learn from their peers. Their active role in the learning process allows them to take more responsibility for their own learning. Because learners work together, group discussions can also foster collaborative and interactive skills, which is good preparation for future team work.

Perceived self-efficacy for performing key physician-faculty functions--a baseline assessment of participants in a one-year faculty development program.

In 1990, the Department of Family and Community Medicine at the University of California San Francisco (UCSF) established the Northern California Faculty Development Program (NCFDP) to address the needs of family physicians holding full-time faculty positions devoted to teaching, curriculum planning, program leadership, and patient care. Program participants are sponsored by the family medicine departments of three medical schools—University of California, San Francisco (UCSF), University of California, Davis (UCD), and Stanford University (SU). Approximately ten faculty members participate annually in the program’s one-year, parttime comprehensive faculty development curriculum. In 1995, the NCFDP directors developed a Faculty self-efficacy Scale (FacSES) to identify entering participants’ specific faculty development needs and provide a baseline for evaluating educational outcomes using self-efficacy measures. The concept of self-efficacy, which is concerned with people’s beliefs in their capabilities to carry out tasks within relevant personal and professional domains, has been demonstrated to predict performance of those tasks in real-world situations. The Faculty Self-efficacy Scale has now been administered to NCFDP participants annually since 1995, at the beginning and end of the year. While there have been reports describing faculty members’ perceived self-efficacy for carrying out general classroom and nursing-education functions, we are aware of no published report documenting physician–faculty members’ perceived self-efficacy for performing key medical education functions. The purpose of this paper is to: (1) report on participants’ baseline composite self-efficacy scores for the entire scale and for specific areas of professional function, and (2) describe how four independent variables—faculty type, length of time as faculty, age, and gender—affect participants’ self-efficacy scores. The use of the FacSES as an evaluation tool to assess change over time in participants’ perceived self-efficacy will be discussed in a future publication.

Introducing physical examination practice into problem-based learning.

lead small-group discussions with medical students. Why the idea was necessary Because of the high volume of faculty staff needed to teach in this new curriculum, recruitment and retention required attention. Thus, the training of faculty, many of whom were inexperienced with the specialised skill set required to lead PBL small groups, implied that a comprehensive, faculty training programme was vital to obtaining and maintaining knowledgeable PBL faculty. Before 2006, an introductory workshop, lasting a few hours, was the only formal training opportunity afforded to PBL faculty. Further, student evaluations indicated that faculty members were struggling with several aspects of the PBL process: they were perceived as providing insufficient feedback, giving copious lectures, and not supporting a multidisciplinary perspective. Thus we concluded that more regularly scheduled faculty PBL training was needed to address the skills, concepts and problems that arise in the course of the teaching experience. What was done Regular opportunities – before, during and after teaching – for training, discussion and collaboration with fellow PBL faculty were designed and implemented as needs assessments were conducted:

What did we learn about the impact on university-based faculty?

Meeting the objectives and requirements of the Interdisciplinary Generalist Curriculum (IGC) Project had positive and negative effects on the university-based basic science and clinical faculty, which have been divided into four categories: boundary issues, collaboration, teaching, and development. The specific experiences of two schools, the University of California, San Francisco, School of Medicine and the Joan C. Edwards School of Medicine at Marshall University, are compared against the experiences of the ten schools as documented in the IGC Project external evaluation teams final report. Boundary issues regarded as negative effects of the IGC Project included perceived encroachment on the time devoted to basic science education, loss of the unique identity of the university-based faculty as academicians, and reduced prominence of subspecialist clinical faculty. Effects of the IGC Project in the other areas were, for the most part, positive. The increased collaboration yielded a net benefit to the university-based faculty at large. The clinical faculty experienced more opportunities to teach. Introduction of teacher development programs were of benefit to both clinical and basic science faculty. The other arm of development, professional development, was evidenced by increased stature and promotions of IGC faculty directors. In conclusion, changes within the university-based faculty occurred in stages as faculty realized that the design of the IGC Project enhanced the educational experience of the students.