Patrick D. Bridge

A pilot study of comprehensive ultrasound education at the Wayne State University School of Medicine: A pioneer year review

Objective. Ultrasound is a versatile diagnostic modality used in a variety of medical fields. Wayne State University School of Medicine (WSUSOM) is one of the first medical schools in the United States to integrate an ultrasound curriculum through both basic science courses and clinical clerkships. Methods. In 2006, 25 portable ultrasound units were donated to WSUSOM. First‐year medical students were provided an ultrasound curriculum consisting of 6 organ‐system sessions that addressed the basics of ultrasound techniques, anatomy, and procedural skills. After the last session, students were administered 2 anonymous and voluntary evaluations. The first assessed their overall experience with the ultrasound curriculum, and the second assessed their technical skills in applying ultrasound techniques. Results. Eighty‐three percent of students agreed or strongly agreed that their experience with ultrasound education was positive. On the summative evaluation, nearly 91% of students agreed or strongly agreed that they would benefit from continued ultrasound education throughout their 4 years of medical school. Student performance on the technical assessment was also very positive, with mean class performance of 87%. Conclusions. As residency programs adopt ultrasound training, medical school faculty should consider incorporating ultrasound education into their curriculum. Portable ultrasound has the potential to be used in many different settings, including rural practice sites and sporting events. The WSUSOM committees pilot ultrasound curriculum will continue to use student feedback to enhance the ultrasound experience, helping students prepare for challenges that they will face in the future.

Increasing physicians' awareness of the impact of statistics on research outcomes: Comparative power of the t-test and Wilcoxon Rank-Sum test in small samples applied research

To effectively evaluate medical literature, practicing physicians and medical researchers must understand the impact of statistical tests on research outcomes. Applying inefficient statistics not only increases the need for resources, but more importantly increases the probability of committing a Type I or Type II error. The t-test is one of the most prevalent tests used in the medical field and is the uniformally most powerful unbiased test (UMPU) under normal curve theory. But does it maintain its UMPU properties when assumptions of normality are violated? A Monte Carlo investigation evaluates the comparative power of the independent samples t-test and its nonparametric counterpart, the Wilcoxon Rank-Sum (WRS) test, to violations from population normality, using three commonly occurring distributions and small sample sizes. The t-test was more powerful under relatively symmetric distributions, although the magnitude of the differences was moderate. Under distributions with extreme skews, the WRS held large power advantages. When distributions consist of heavier tails or extreme skews, the WRS should be the test of choice. In turn, when population characteristics are unknown, the WRS is recommended, based on the magnitude of these power differences in extreme skews, and the modest variation in symmetric distributions.

The Effectiveness of Streaming Video on Medical Student Learning: A Case Study

Abstract Information technology helps meet today’s medical students’ needs by providing multiple curriculum delivery methods. Video streaming is an e-learning technology that uses the Internet to deliver curriculum while giving the student control of the content’s delivery. There have been few studies conducted on the effectiveness of streaming video in medical schools. A 5-year retrospective study was conducted using three groups of students (n = 1736) to determine if the availability of streaming video in Years 1-2 of the basic science curriculum affected overall Step 1 scores for first-time test-takers. The results demonstrated a positive effect on program outcomes as streaming video became more readily available to students. Based on these findings, streaming video technology seems to be a viable tool to complement in-class delivery methods, to accommodate the needs of medical students, and to provide options for meeting the challenges of delivering the undergraduate medical curriculum. Further studies need to be conducted to continue validating the effectiveness of streaming video technology.

Measurement practices: methods for developing content-valid student examinations

Measurement experts generally agree that a systematic approach to test construction will probably result in an instrument with sound psychometric properties. One fundamental method is called the blueprint approach to test construction. A test blueprint is a tool used in the process for generating content-valid exams by linking the subject matter delivered during instruction and the items appearing on the test. Unfortunately, this procedure as well as other educational measurement practices is often overlooked. A survey of curriculum administrators at 144 United States and international medical schools was conducted to assess the importance and prevalence of test blueprinting in their school. Although most found test blueprinting to be very important, few require the practice. The purpose of this paper is to review the fundamental principals associated with achieving a high level of content validity when developing tests for students. The short-term efforts necessary to develop and integrate measurement theory into practice will lead to long-term gains for students, faculty and academic institutions.

Wireless Handheld Computers in the Undergraduate Medical Curriculum

Abstract Wayne State University Medical School has implemented wireless handheld computers or PocketPCs (PPCs) into all four years of the undergraduate curriculum. A transition from a passive to an interactive learning environment in the classroom, as well as administrative solutions for monitoring patient encounter data by students in their clinical rotations was fostered by this educational technology. Implementation of the wireless devices into the curriculum will be described in this report. This will include the technical specifications and justification for the required device, as well as a detailed discussion of the different applications used for educational and administrative purposes by the preclinical and clinical students. Outcomes from the educational and administrative aspects of the project will also be presented in this report.

Retention of medical genetics knowledge and skills by medical students.

Purpose: To determine whether specific knowledge and skills medical students acquire after completing a Year 1 genetics course are retained at the end of Year 3.Methods: A genetics case was developed for an observed structured clinical exam at the end of Year 3. The case involved a pregnant patient who underwent population screening for cystic fibrosis and is identified as a carrier of a common mutation. Students performance in completing eight essential genetic tasks taught in Year 1 was assessed by their ability to apply these concepts in the Year 3 observed structured clinical exam.Results: A total of 212 students were included in the study. Performance on the essential tasks revealed that students were better able to discuss inheritance pattern (73.1%). Students were less likely to calculate and discuss fetal risk (25%), discuss the option of prenatal diagnosis if the father is a carrier (25%), and ask about a family history of cystic fibrosis (36.8%). Only half (50%) explained the test result and implications to the patient. There was no correlation between individual student exam scores in Year 1 and the eight essential genetics tasks scores assessed in the observed structured clinical exam (r = 0.003, P ≤ 0.67).Conclusion: Third year medical students do not retain medical genetics knowledge and skills learned in the first year of medical school. Medical schools need to integrate genetics curriculum through the continuum of the 4 years of medical school.

Incorporating Active Learning Into a Psychiatry Clerkship: Does It Make a Difference?

ObjectiveMedical students’ satisfaction with the psychiatry clerkship, sense of preparedness for an institutional Objective Structured Clinical Exam (OSCE), expressed likelihood of choosing psychiatry as a specialty, and National Board of Medical Examiners (NBME) psychiatry shelf-examination scores were compared after a curriculum based on Active Learning (AL) techniques was introduced.MethodsIn consecutive academic years, two groups of students were compared after completing a 1-month psychiatry clerkship. The first group (N=108) received traditional lectures, and the second (N=102) was taught via AL. Participants were surveyed regarding satisfaction, sense of preparedness for an institutional OSCE, and expressed likelihood of choosing psychiatry as a specialty. NBME psychiatry shelf-examination scores were analyzed; independent-samples t-tests were used to evaluate the data.ResultsSatisfaction and sense of preparedness for the institutional OSCE increased with AL techniques. NBME scores were not significantly different between groups. Professed likelihood of choosing psychiatry as a specialty did not increase with the interventional curriculum.ConclusionWe confirmed findings from previous studies that student satisfaction improves with active learning (AL). Sense of preparedness for the OSCE examination improved with AL, as well. NBME psychiatry exam scores and professed interest in psychiatry as a specialty were not different from those taught in a traditional format.

Evaluation of a preparatory community-based prostate health education program.

BACKGROUND Medical organizations are divided on the issue of screening for prostate cancer, yet there is agreement that men should be educated about prostate health. Shared decision making involves patients and practitioners in this process, yet some men need preparatory education prior to the physician encounter. This study assessed the effectiveness of a community prostate health awareness program, focusing on men at risk for prostate cancer. METHODS Participants were given a pretest and a posttest to assess knowledge gains and impact on short-term intentions to address their prostate health. RESULTS There was a statistically significant increase in knowledge. Short-term intentions increased for those participants meeting the inclusion criteria. DISCUSSION Community outreach programs remain an excellent vehicle to educate the public and complement the efforts of health care providers.

Effectiveness of an occupational and environmental medicine curriculum as indicated by evaluation of medical student performance on an objective structured clinical examination.

Medical students must learn to recognize occupational and environmental-related illness. An occupational and environmental medicine curriculum can achieve this goal. The curriculum must be evaluated to ensure that medical students are learning to recognize exposure-related health conditions and to evaluate if this ability correlates with medical interviewing skills. A case, formatted for an Objective Structured Clinical Examination (OSCE), was developed to evaluate student performance on an exposure-related clinical problem. The OSCE results were analyzed to identify the areas that differentiated the students who recognized an exposure-related medical condition from those who did not. We conclude that an OSCE is an effective curriculum evaluation tool to assess whether a core occupational and environmental-related curriculum is contributing to student learning in exposure history-taking and associated clinical reasoning skills.

Incorporating Geographic Information Systems (GIS) into Program Evaluation: Lessons from a Rural Medicine Initiative

Purpose: To address the shortage of physicians practicing in rural areas of Michigan, the Wayne State University School of Medicine developed an integrated rural core curriculum to interest students in rural practice careers. Here we focus on the evaluation strategy used to determine the extent to which students in the new rural medicine interest group who self-identified as selecting a rural clerkship or externship did secure a clinical training experience in a rural setting. Methods: Three measures of rurality were compared to determine whether students were placed in rural training settings: (1) the percentage of the county living in rural areas; (2) a county-level dichotomous measure of rural/nonrural; and (3) a dichotomous measure based on urban area boundaries within the county. Practice address and geographic data were integrated into geographic information systems software, which we used to map out rural characteristics of Michigan counties through a process called thematic mapping; this shows characteristic variation by color-shading geographic features. In addition, reference maps were created showing the boundaries of urban areas and metropolitan/micropolitan areas. Once these processes were completed, we overlaid the practice location on the contextual-level geographic features to produce a visual representation of the relationship between student placement and rural areas throughout the state. Results: The outcome of student placement in rural practices varied by the definition of rural. We concluded that, although students were not placed in the most rural areas of Michigan, they received clerkship or externship training near rural areas or in semirural areas. Conclusion: This process evaluation had a direct impact on program management by highlighting gaps in preceptor recruitment. A greater effort is being made to recruit physicians for more rural areas of the state rather than urban and semirural areas. Geographic information systems mapping also defined levels of ruralism for students to help them make informed selections of training sties. This is especially important for students who are not sure about a rural experience and might be discouraged by placement in a remote rural area.