Luann Wilkerson

Educational Innovations in Academic Medicine and Environmental Trends

Fifteen educational innovations in academic medicine are described in relation to 5 environmental trends. The first trend, demands for increased clinical productivity, has diminished the learning environment, necessitating new organizational structures to support teaching, such as academies of medical educators, mission-based management, and faculty development. The second trend is multidisciplinary approaches to science and education. This is stimulating the growth of multidisciplinary curricular design and oversight along with integrated curricular structures. Third, the science of learning advocates the use of case-based, active learning methods; learning communities such as societies and colleges; and instructional technology. Fourth, shifting views of health and disease are encouraging the addition of new content in the curriculum. In response, theme committees are weaving content across the curriculum, new courses are being inserted into curricula, and community-based education is providing learning experiences outside of academic medical centers. Fifth, calls for accountability are leading to new forms of performance assessment using objective structured clinical exams, clinical examination exercises, simulators, and comprehensive assessment programs. These innovations are transforming medical education.

The Impact of the Changing Health Care Environment on the Health and Well-Being of Faculty at Four Medical Schools

Purpose Increased pressure for clinical and research productivity and decreased control over the work environment have been reported to have adverse impacts on academic faculty in limited studies. The authors examined whether work-related stressors in academic medicine negatively affected the physical and mental health, as well as life and job satisfaction, of academic medical school faculty. Method A 136-item self-administered anonymous questionnaire modified from a small 1984 study was distributed to 3,519 academic faculty at four U.S. medical schools following institutional review board approval at each school. Validated scales measuring depression, anxiety, work strain, and job and life satisfaction; a checklist of common physical and mental health symptoms; and questions about the impact of institutional financial stability, colleague attrition, and other work-related perceptions were used. Responses were analyzed by sex, academic rank, age, marital status, faculty discipline, and medical school. Results Responses were received from 1,951 full-time academic physicians and basic science faculty, a 54.3% response rate. Twenty percent of faculty, almost equal by sex, had significant levels of depressive symptoms, with higher levels in younger faculty. Perception of financial instability was associated with greater levels of work strain, depression, and anxiety. Significant numbers of faculty acknowledged that work-related strain negatively affected their mental health and job satisfaction, but not life satisfaction or physical health. Specialties were differentially affected. Conclusions High levels of depression, anxiety, and job dissatisfaction—especially in younger faculty—raise concerns about the well-being of academic faculty and its impact on trainees and patient care. Increased awareness of these stressors should guide faculty support and development programs to ensure productive, stable faculty.

Teaching when time is limited.

Teaching in small increments of time during patient care can provide powerful learning experiences for trainees. This article explores the ways that clinical teachers might do this in a time efficient way

Documentation Systems for Educators Seeking Academic Promotion in U.S. Medical Schools

Purpose. To explore the state and use of teaching portfolios in promotion and tenure in U.S. medical schools. Method. A two-phase qualitative study using a Web-based search procedure and telephone interviews was conducted. The first phase assessed the penetration of teaching portfolio-like systems in U.S. medical schools using a keyword search of medical school Web sites. The second phase examined the current use of teaching portfolios in 16 U.S. medical schools that reported their use in a survey in 1992. The individual designated as having primary responsibility for faculty appointments/promotions was contacted to participate in a 30–60 minute interview. Results. The Phase 1 search of U.S. medical schools’ Web sites revealed that 76 medical schools have Web-based access to information on documenting educational activities for promotion. A total of 16 of 17 medical schools responded to Phase 2. All 16 continued to use a portfolio-like system in 2003. Two documentation categories, honors/awards and philosophy/personal statement regarding education, were included by six more of these schools than used these categories in 1992. Dissemination of work to colleagues is now a key inclusion at 15 of the Phase 2 schools. The most common type of evidence used to document education was learner and/or peer ratings with infrequent use of outcome measures and internal/external review. Conclusions. The number of medical schools whose promotion packets include portfolio-like documentation associated with a faculty members excellence in education has increased by more than 400% in just over ten years. Among early-responder schools the types of documentation categories have increased, but students’ ratings of teaching remain the primary evidence used to document the quality or outcomes of the educational efforts reported.

The resident as teacher during work rounds.

The resident is a central figure in the education of medical students and other residents. In order to examine the ways in which residents fulfill their teaching responsibilities, the authors observed 14 first- and second-year internal medicine residents as they reviewed a total of 158 cases during work rounds. Inpatient work rounds were selected for study because in this setting an attending faculty member is not present and the resident bears total responsibility for initiating any teaching that occurs. The results of the study indicated that the most frequently observed teaching behaviors were associated with patient care at the bedside: providing a model of appropriate interaction with patients and verifying clinical findings. Away from the bedside, the residents frequently used brief lectures to teach. The least frequently observed teaching behaviors involved referring to the literature, giving feedback, demonstrating techniques and procedures, and asking questions. Following these observations, the authors initiated a course on clinical teaching for residents.

Impact of the University of California, Los Angeles/Charles R. Drew University Medical Education Program on medical students' intentions to practice in underserved areas.

Purpose To estimate the impact of a U.S. inner-city medical education program on medical school graduates’ intentions to practice in underserved communities. Method The authors conducted an analysis of secondary data on 1,088 medical students who graduated from either the joint University of California, Los Angeles/Charles R. Drew University Medical Education Program (UCLA/Drew) or the UCLA School of Medicine between 1996 and 2002. Intention to practice in underserved communities was measured using students’ responses to questionnaires administered at matriculation and graduation for program improvement by the Association of American Medical Colleges. Multivariate logistic regression analysis was used to compare the odds of intending to practice in underserved communities among UCLA/Drew students with those of their counterparts in the UCLA School of Medicine. Results Compared with students in the UCLA School of Medicine, UCLA/Drew students had greater adjusted odds of reporting intention to work in underserved communities at graduation, greater odds of maintaining or increasing such intentions between matriculation and graduation, and lower odds of decreased intention to work in underserved communities between matriculation and graduation. Conclusions Training in the UCLA/Drew program was independently associated with intention to practice medicine in underserved communities, suggesting that a medical education program can have a positive effect on students’ goals to practice in underserved areas.

No content without context: Integrating basic, clinical, and social sciences in a pre-clerkship curriculum

Background: The basic science curricula in medical schools ultimately succeed or fail at the bedside when students must draw on their pre-clerkship experiences as they learn to form nuanced clinical decisions. Given this expectation, learning context becomes as decisive as content in determining students’ recall and application. Aims: Using the pre-clerkship medical curriculum at the University of California, Los Angeles, as an example, we illustrate how traditional biomedical sciences can be integrated with clinical sciences in a comprehensive foundational curriculum following curricular design features and teaching methods based on learning principles from cognitive psychology and education. Methods: Multiple planning teams of faculty and students collaborated in the design of the Human Biology and Disease (HB&D) curriculum. Broad participation, careful selection of course chairs, the assistance of educational consultants, ongoing oversight structures, and faculty development were used to develop and sustain the curriculum. Results: The resulting HB&D curriculum features an interdisciplinary spiral block structure including interactive lecture formats, integrative formative and summative examinations, self- and peer-taught laboratories, and problem-based learning with innovative variations. Conclusion: Our fully integrated, spiral, pre-clerkship curriculum built on repeating interdisciplinary blocks and longitudinal threads has yielded encouraging results as well as some specific innovations that other schools or individual teachers may find valuable to adapt for use in their own settings.

Assessing physical examination skills of senior medical students: knowing how versus knowing when.

Purpose. Literature has documented a lack of physical examination proficiency among medical students. To investigate UCLA medical students’ physical examination proficiency, this study compared their performance on a multiple-station Clinical Performance Examination (CPX) focused on clinical cases with that on a thorough physical examination objective structured clinical examination (OSCE) of the same organ systems. Method. One hundred sixty-three beginning fourth-year students participated in the study. Four organ systems were included in both the CPX and OSCE. Pearson’s correlation coefficients and paired-sample t-tests were conducted to determine the correlations between and differences in the two tests. Results. The physical examination scores on the CPX were significantly (p < .001) lower both by organ subscale and in total than those on the OSCE. Correlation coefficients between the two tests were negligible. Conclusions. The study suggests that fourth-year medical students may demonstrate competency in directed examination of organ systems while being unable to correctly apply those examination skills to the work-up of clinical cases.

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.

Using “standardized students” to teach a learner-centered approach to ambulatory precepting

No abstract available.