Joel Purkiss

Use of interactive theater for faculty development in multicultural medical education

Background: The development of critical consciousness, anchored in principles of social justice, is an essential component of medical education. Aim: In order to assist faculty instructors in facilitating small-group discussions on potentially contentious issues involving race, gender, sexual orientation, and socioeconomic class, a faculty development workshop was created. Methods: The workshop used ‘Forum Theater’ techniques in which the audience was directly involved in determining the course of a simulated classroom discussion and conflict. We assessed the workshops impact on the instructors’ attitudes regarding facilitation of small-group discussions through two surveys: one to gauge immediate impressions, and another, 9–15 months later, to assess impact over time. Results: Immediately after the workshop, participants reported that the topics covered in the sketch and in the discussion were highly relevant. In the follow-up survey, the instructors agreed that the workshop had raised their awareness of the classroom experiences of minorities and women and had offered strategies for addressing destructive classroom dynamics. 72% reported that the workshop led to changes in their behavior as facilitators. Differences in responses according to gender were observed. Conclusions: A workshop using interactive theater was effective in training faculty to facilitate small-group discussions about multicultural issues. This approach emphasizes and models the need to foster critical consciousness in medical education.

What is appropriate to post on social media? Ratings from students, faculty members and the public

The purpose of this study was to ascertain what medical students, doctors and the public felt was unprofessional for medical students, as future doctors, to post on a social media site, Facebook®. The significance of this is that unprofessional content reflects poorly on a student, which in turn can significantly affect a patients confidence in that students clinical abilities.

Preference of Interactive Electronic Versus Traditional Learning Resources by University of Michigan Medical Students during the First Year Histology Component

Histology or microanatomy is an integral component of most first year medical curricula. As histology is heavily based on the review and analysis of images, modern educational resources are increasingly used for teaching this subject. These novel didactic approaches often supplement more traditional offerings of the material, such as lectures and laboratory sessions. After completion of their M1 histology component, University of Michigan medical students participated in a voluntary survey about their study habits and their use of various histology learning resources and how this usage changed over time. The data presented in this analysis demonstrate a strong preference of these students for studying histology with electronic rather than traditional learning resources. In particular, students’ use of scheduled didactic opportunities decreased over the progression of the course. Students also exhibited a strong inclination to study histology individually rather than in study groups. These reported insights in students’ preferences suggest a need to develop and update educational tools for teaching this very visual subject.

Standardized Patient Instructor (SPI) interactions are a viable way to teach medical students about health behavior counseling

OBJECTIVES We explored comfort levels of third-year medical (M3) students through two health behavior counseling (HBC) interactions with Standardized Patient Instructors (SPIs) in tobacco cessation (TCC) and nutrition and physical activity (NPA). METHODS Nearly 200 M3s participated in two SPI HBC interactions; including a role-play interview and subsequent feedback session on performance. Students completed a 5-point Likert scale evaluation measuring pre- and post-comfort level on two HBC sessions. RESULTS Both interactions resulted in statistically significant increases in students pre- and post-interaction comfort levels. A paired-sample t-test revealed a mean increase of 0.91 for TCC (t = 14.01, df = 197, p<0.001), and a mean increase of 0.69 for NPA (t = 12.65, df = 198, p<0.001). CONCLUSION The use of SPIs is a viable approach to exposing medical students and future doctors to health behavior counseling, and increasing comfort level with such skills. The SPI experience ensures that HBC opportunities are available and contain meaningful feedback on performance. PRACTICE IMPLICATIONS Encouraging patient behavior modification is a skill that can be developed during undergraduate medical training. Combining HBC with SPI sessions and traditional learning approaches could prove effective in a curriculum intended to teach students strategies that improve patient health behavior.

Learning histology – dental and medical students' study strategies

PURPOSE Histology, the science of cells and tissues at the microscopic level, is an integral component of most dental and medical curricula and is often taught using both traditional and novel computer-based didactic approaches. The purpose of this study was to analyse the strategies used by dental and medical students when studying this very visual and challenging subject. METHODS Data were collected from 75 dental and 143 medical students, who had almost identical histology learning resources at their disposal. RESULTS When compared with their medical counterparts, dental students view histology as a more difficult subject and as less relevant for their future career. Whereas dental students, who are required to attend class unlike medical students, made more use of in-classroom learning opportunities, they did not take as much advantage of out-of-classroom resources. In addition, dental students reported a significantly higher tendency than medical students to work together, rather than to study alone. DISCUSSION Small differences in the dental versus the medical learning environment associate with several observed differences in learning strategies that are adopted by dental and medical students. CONCLUSIONS These differences should be considered when teaching the subject of histology to dental or to medical students.

Study Behaviors and USMLE Step 1 Performance: Implications of a Student Self-Directed Parallel Curriculum

Purpose To determine medical students’ study behaviors when preparing for the United States Medical Licensing Examination (USMLE) Step 1, and how these behaviors are associated with Step 1 scores when controlling for likely covariates. Method The authors distributed a study-behaviors survey in 2014 and 2015 at their institution to two cohorts of medical students who had recently taken Step 1. Demographic and academic data were linked to responses. Descriptive statistics, bivariate correlations, and multiple linear regression analyses were performed. Results Of 332 medical students, 274 (82.5%) participated. Most students (n = 211; 77.0%) began studying for Step 1 during their preclinical curriculum, increasing their intensity during a protected study period during which they averaged 11.0 hours studying per day (standard deviation [SD] 2.1) over a period of 35.3 days (SD 6.2). Students used numerous third-party resources, including reading an exam-specific 700-page review book on average 2.1 times (SD 0.8) and completing an average of 3,597 practice multiple-choice questions (SD 1,611). Initiating study prior to the designated study period, increased review book usage, and attempting more practice questions were all associated with higher Step 1 scores, even when controlling for Medical College Admission Test scores, preclinical exam performance, and self-identified score goal (adjusted R 2 = 0.56, P < .001). Conclusions Medical students at one public institution engaged in a self-directed, “parallel” Step 1 curriculum using third-party study resources. Several study behaviors were associated with improved USMLE Step 1 performance, informing both institutional- and student-directed preparation for this high-stakes exam.

Online learning applied to a course on rational therapeutics: an international comparison between final year students of two medical schools

Poor prescribing is probably the most common cause of preventable medication errors and many of these events involve junior doctors. In 2009, an electronic problem‐based therapeutics course developed at the University of Michigan Medical School (UMMS) was translated and adapted for use at the University of Zagreb Medical School (UZMS).

Course evaluation respondents: are ‘low‐performing retaliators’ really over‐represented?

bystander cardiopulmonary resuscitation (CPR) is independently associated with improvement in survival. Therefore, it is critical that parents of highrisk infants receive training to respond to such an emergency. We investigated whether a medical student-led initiative could provide basic life support (BLS) training to parents in a manner that also benefited students. What was tried? In 2008, we developed the Paediatric Emergency Response Initiative (PERI), which provides BLS training to parents with infants prior to the infant’s discharge from a children’s hospital. The PERI recruited medical students in Years 1 and 2 to become American Heart Association (AHA)certified BLS instructors. Once trained, studentinstructors taught BLS courses to parents twice weekly in the hospital using manikins and a video-based AHA training module. Following institutional review board approval, we administered an anonymous questionnaire in 2010 to medical students who had participated in the PERI. This questionnaire asked students to rate components of the PERI using a scale of 1–10, on which 1 = not helpful ⁄ definitely no and 10 = very helpful ⁄ definitely yes. Instructors who coordinated this study were excluded. The response rate for the questionnaire was 87% (34 ⁄ 39). What lessons were learned? The PERI has now been piloted for 4 years with 56 medical student-instructors and three sets of leaders. Additionally, over 300 parents have received BLS training through the initiative. Initial start-up costs totalled US

Improving medical students' competence at breast examination

820. Subsequent expenses for educational materials and student-instructor training totalled US

Assessing the Feasibility and Construct Validity of Cross-Cultural Care Competency with the Script Concordance Test

600 annually and were supported by the nursing department and the medical school. Questionnaire results showed that medical student-instructors had positive perceptions of the PERI. Interestingly, student-instructors who joined in 2010 rated the PERI’s contribution to their medical education more highly (mean rating: 7.8) than students who had joined the programme earlier (mean ratings: 6.3 in 2008 and 7.3 in 2009). This trend continued as student-instructors indicated that participation in the PERI had improved their confidence in interacting with parents (mean ratings: 6.9 in 2008, 7.6 in 2009 and 8.0 in 2010). Recently recruited student-instructors were also more likely to recommend the PERI to classmates (mean ratings: 7.3 in 2008, 8.2 in 2009 and 8.5 in 2010), which probably reflects continual operational improvements. When asked how the PERI aided their development as medical students, the most common responses indicated that the PERI helped student-instructors to develop confidence in communicating with patients and performing CPR. One student wrote: ‘[The] PERI has helped...my understanding of CPR [and provided] a glimpse at the kinds of things parents deal with when they are in the hospital with a sick child.’ Another student commented: ‘[Participation in the PERI] was an opportunity to give back to the patient community in a way that I could not with my limited clinical skills.’ We estimate that student-instructors commit approximately 2–4 hours per month to PERI training. It appears that this commitment, although minimal, discourages three or four students each year from continuing participation, which underscores the importance of defining clear expectations upon recruitment. Based on questionnaire feedback and our successes in securing funding and recruiting leadership and student-instructors, we believe the PERI is a sustainable means of providing BLS training to parents that also benefits medical studentinstructors.