Molly Blackley Jackson

Impact of a Pre-Clinical Clinical Skills Curriculum on Student Performance in Third-Year Clerkships

ABSTRACTBACKGROUNDResearch on the outcomes of pre-clinical curricula for clinical skills development is needed to assess their influence on medical student performance in clerkships.OBJECTIVETo better understand the impact of a clinical-skills curriculum in the pre-clinical setting on student performance.DESIGNWe conducted a non-randomized, retrospective, pre-post review of student performance evaluations from 3rd-year clerkships, before and after implementation of a clinical-skills curriculum, the Colleges (2001–2007).MAIN RESULTSComparisons of clerkship performance data revealed statistically significant differences favoring the post-Colleges group in the Internal Medicine clerkship for 9 of 12 clinical-skills domains, including Technical Communication Skills (p < 0.023, effect size 0.16), Procedural Skills (p < 0.031, effect size 0.17), Communication Skills (p < 0.003, effect size 0.21), Patient Relationships (p < 0.003, effect size 0.21), Professional Relationships (p < 0.021, effect size 0.17), Educational Attitudes (p < 0.001, effect size 0.24), Initiative and Interest (p < 0.032, effect size 0.15), Attendance and Participation (p < 0.007, effect size 0.19), and Dependability (p < 0.008, effect size 0.19). Statistically significant differences were identified favoring the post-Colleges group in technical communication skills for three of six basic clerkships (Internal Medicine, Surgery, and Pediatrics).CONCLUSIONSImplementation of a pre-clinical fundamental skills curriculum appears to be associated with improved clerkship performance in the 3rd year of medical school, particularly in the Internal Medicine clerkship. Similar curricula, focused on teaching clinical skills in small groups at the bedside with personalized mentoring from faculty members, may improve student performance. Continued efforts are needed to understand how to best prepare students for clinical clerkships and how to evaluate outcomes of similar pre-clinical skills programs.

Ready or not? Expectations of faculty and medical students for clinical skills preparation for clerkships

Abstract Background : Preclerkship clinical-skills training has received increasing attention as a foundational preparation for clerkships. Expectations among medical students and faculty regarding the clinical skills and level of skill mastery needed for starting clerkships are unknown. Medical students, faculty teaching in the preclinical setting, and clinical clerkship faculty may have differing expectations of students entering clerkships. If students’ expectations differ from faculty expectations, students may experience anxiety. Alternately, congruent expectations among students and faculty may facilitate integrated and seamless student transitions to clerkships. Aims : To assess the congruence of expectations among preclerkship faculty, clerkship faculty, and medical students for the clinical skills and appropriate level of clinical-skills preparation needed to begin clerkships. Methods : Investigators surveyed preclinical faculty, clerkship faculty, and medical students early in their basic clerkships at a North American medical school that focuses on preclerkship clinical-skills development. Survey questions assessed expectations for the appropriate level of preparation in basic and advanced clinical skills for students entering clerkships. Results : Preclinical faculty and students had higher expectations than clerkship faculty for degree of preparation in most basic skills. Students had higher expectations than both faculty groups for advanced skills preparation. Conclusions : Preclinical faculty, clerkship faculty, and medical students appear to have different expectations of clinical-skills training needed for clerkships. As American medical schools increasingly introduce clinical-skills training prior to clerkships, more attention to alignment, communication, and integration between preclinical and clerkship faculty will be important to establish common curricular agendas and increase integration of student learning. Clarification of skills expectations may also alleviate student anxiety about clerkships and enhance their learning.

What are the benefits of early patient contact? - A comparison of three preclinical patient contact settings

BackgroundDespite increasing attention to providing preclinical medical students with early patient experiences, little is known about associated outcomes for students. The authors compared three early patient experiences at a large American medical school where all preclinical students complete preceptorships and weekly bedside clinical-skills training and about half complete clinical, community-based summer immersion experiences. The authors asked, what are the relative outcomes and important educational components for students?MethodsMedical students completed surveys at end of second year 2009–2011. In 2009, students compared/contrasted two of three approaches; responses framed later survey questions. In 2010 and 2011, students rated all three experiences in relevant areas (e.g., developing comfort in clinical setting). Investigators performed qualitative and quantitative analyses.ResultsStudents rated bedside training more highly for developing comfort with clinical settings, one-on-one clinical-skills training, feedback, active clinical experience, quality of clinical training, and learning to be part of a team. They rated community clinical immersion and preceptorships more highly for understanding the life/practice of a physician and career/specialty decisions.ConclusionsPreclinical students received different benefits from the different experiences. Medical schools should define objectives of early clinical experiences and offer options accordingly. A combination of experiences may help students achieve clinical and team comfort, clinical skills, an understanding of physicians’ lives/practices, and broad exposure for career decisions.

From Cheerleader to Coach: The Developmental Progression of Bedside Teachers in Giving Feedback to Early Learners.

Background Medical students learn clinical skills at the bedside from teaching clinicians, who often learn to teach by teaching. Little is known about the process of becoming an effective clinical teacher. Understanding how teaching skills and approaches change with experience may help tailor faculty development for new teachers. Focusing on giving feedback to early learners, the authors asked: What is the developmental progression of clinician–teachers as they learn to give clinical skills feedback to medical students? Method This qualitative study included longitudinal interviews with clinician–teachers over five years in a new clinical skills teaching program for preclinical medical students. Techniques derived from grounded theory were used for initial analyses. The current study focused on one theme identified in initial analyses: giving feedback to students. Transcript passages were organized by interview year, coded, and discussed in year clusters; thematic codes were compared and emergent codes developed. Results Themes related to giving feedback demonstrated a dyadic structure: characteristic of less experienced teachers versus characteristic of experienced teachers. Seven dominant dyadic themes emerged, including teacher as cheerleader versus coach, concern about student fragility versus understanding resilience, and focus on creating a safe environment versus challenging students within a safe environment. Conclusions With consistent teaching, clinical teachers demonstrated progress in giving feedback to students in multiple areas, including understanding students’ developmental trajectory and needs, developing tools and strategies, and adopting a dynamic, challenging, inclusive team approach. Ongoing teaching opportunities with targeted faculty development may help improve clinician–teachers’ feedback skills and approaches.

Cardiovascular Risk Stratification

Perioperative cardiovascular complications pose serious risk to patients, especially those with underlying cardiac disease. The degree of risk varies widely depending on medical comorbidities and type of surgery. A careful medical evaluation before surgery can help inform a discussion of risk for patients and providers, and suggest management to mitigate risk.

How to Teach Beginning Students in the Clinical Setting

Early clinical experiences are increasingly emphasized in medical school curricula. These experiences help students develop clinical skills, professional identity, and comfort in the clinical environment. To effectively teach beginning medical students, supervising physicians can maximize the effectiveness of shadowing experiences, teach digestible clinical pearls, engage patients and other members of the healthcare team as teachers, and arrange time for student-driven inquiry, investigation, and reflection.

Obstructive sleep apnea and obesity hypoventilation syndrome

Sleep-disordered breathing affects approximately 20 % of adults and is even more common among patients preparing for surgery. 7 % of adults have moderate or severe obstructive sleep apnea (OSA). A small subset of these patients suffer from obesity hypoventilation syndrome (OHS), defined as awake hypoventilation in the setting of obesity and sleep-disordered breathing. The prevalence of OHS is 0.15–0.3 % in adults, but up to 8 % in patients preparing for bariatric surgery.

The Preoperative Evaluation

The “pre-op” remains a common and important role for the medical consultant. A good preoperative evaluation provides a baseline for the patient’s preoperative state, identifies perioperative risks for the patient and surgical team, makes recommendations to help mitigate that risk, and serves as a starting point for postoperative management of a patient’s medical conditions.

Ischemic Heart Disease

History of ischemic heart disease is a significant risk factor for perioperative cardiac complications, including postoperative myocardial infarction, heart failure, arrhythmia, cardiac arrest, and death. A careful history and physical exam in patients with ischemic heart disease, including prior infarction and/or extent of coronary artery disease (CAD), is crucial prior to surgery to better assess and communicate risk to the patient and surgeon and to suggest management that may mitigate risk perioperatively.