Paul F. Wimmers

Influence of clerkship experiences on clinical competence

Background  Clerkship experiences are considered crucial for the development of clinical competence. Yet whether there is a direct relationship between the nature and volume of patient encounters and learning outcomes is far from clear. Some evidence in the literature points towards the importance of clinical supervision on student learning, but the relationship between clinical supervision, patient encounters and student competence remains unclear.

The impact of case specificity and generalisable skills on clinical performance: a correlated traits−correlated methods approach

Context  The finding of case or content specificity in medical problem solving moved the focus of research away from generalisable skills towards the importance of content knowledge. However, controversy about the content dependency of clinical performance and the generalisability of skills remains.

Inducing expertise effects in clinical case recall

Background  This study was directed at illuminating a well known phenomenon in the medical expertise literature, the ‘intermediate effect’ in clinical case recall. This robust phenomenon consists of the finding that medical students of intermediate levels of expertise outperform both experts and novices in clinical case recall after diagnosing cases. It deals in particular with the findings of some researchers who have reported a monotonically increasing recall with level of expertise.

Relationship between medical student perceptions of mistreatment and mistreatment sensitivity

Background: National statistics reveal that efforts to reduce medical student mistreatment have been largely ineffective. Some hypothesize that as supervisors gain skills in professionalism, medical students become more sensitive. Aims: The purpose of this study was to determine if medical student perceptions of mistreatment are correlated with mistreatment sensitivity. Method: At the end of their third year, 175 medical students completed an Abuse Sensitivity Questionnaire, focused on student assessment of hypothetical scenarios which might be perceived as abusive, and the annual Well-Being Survey, which includes measurement of incident rates of mistreatment. It was hypothesized that those students who identified the scenarios as abusive would also be more likely to perceive that they had been mistreated. Results: Student perceptions of mistreatment were not statistically correlated with individuals responses to the scenarios or to a statistically derived abuse sensitivity variable. There were no differences in abuse sensitivity by student age or ethnicity. Women were more likely than men to consider it “harsh” to be called incompetent during rounds (p < 0.0005). Conclusion: This study provides preliminary evidence that challenges the hypothesis that medical students who perceive mistreatment by their superiors are simply more sensitive.

Clinical competence understood through the construct validity of three clerkship assessments.

Medical Education 2011: 45: 849–857

Two perspectives on the effects of a curriculum change: student experience and the United States medical licensing examination, step 1.

Background Students’ perceptions of curricular experience and study effort were compared for a traditional and a new integrative, interdisciplinary curriculum at a single institution. United States Medical Licensing Exam (USMLE) Step 1 scores were examined for subgroup interactions. Method Medical students from four cohorts completed an educational goals survey and USMLE Step 1. Analysis included subgroup performance based on admissions data. Results Students rated the new curriculum as more helpful in achieving educational goals. USMLE Step 1 was significantly higher for students in the lowest quartile of MCAT scores in the new compared with the previous curriculum. Conclusions To understand the outcomes of a large-scale curricular intervention, interactions of curriculum and aptitude should be examined.

A New Approach to Learning How to Teach: medical students as instructional designers

Abstract As students at the David Geffen School of Medicine at UCLA, the student authors were given the opportunity to develop their own creative projects which would be used to teach future medical students. They chose their own topics, planned and researched their projects, and then implemented the projects in interactive digital Adobe Flash files. In the first project they created interactive case-based radiology teaching files. In the second project they integrated photographic images into the existing illustrative anatomy files. Students in subsequent years have learned from these files on computers both at home and in the schools anatomy lab. The experience of creating the files served as an opportunity for hands-on learning for the student authors, both of the material and of the practice of teaching. In this paper they describe why they undertook these projects, what exactly they did, and the impact their creation had on them. The projects demonstrate that student-driven educational materials are both possible and beneficial. Furthermore, their experience has allowed them to conclude that faculty at other medical schools should consider providing students with opportunities to develop their own creative projects that contribute to the curriculum.

Clinical clerkship timing revisited: Support for non-uniform sequencing

Background: The logistical necessity of students taking required clinical clerkship rotations in non-uniform sequences may have significant consequences on performance. Aims: To investigate (1) the impact of previous clinical clerkship experience and the national licensing examination (USMLE Step 1) rankings on end-of-clerkship overall skills assessments and (2) the effect of clinical clerkship order on end-of-year objective structured clinical examination (OSCE) performance. Method: The core clinical phase of UCLA consists at six clinical clerkships during a 48-week continuum. The clerkships are structured in two different tracks with different rotation order. Clinical performance scores were analyzed for 124 year-3 students in the two different tracks. Results: Performance, as reviewed on a standardized clinical clerkship evaluation form by faculty and residents, improved significantly across the clinical year, regardless of track suggesting an accumulated advantage of previous experiences. There were no significant differences between tracks on the OSCE. Conclusions: Overall clinical skills are more directly impacted by the time-of-year and not order whereas knowledge of specific specialties may be impacted by the order rotations that are taken. While this may not be obvious to students, perhaps we should share these results for their use in tracking their personal growth in clinical skills.

Instruction and Assessment of Competencies: Two Sides of the Same Coin

Six core competencies, as defined by the Accreditation Council for Graduate Medical Education (ACGME), offer a conceptual framework to address the knowledge and skills needed by students in training and doctors to perform competently. The question of interest for educators is “how” residents perceive they acquire proficiency in the core competencies. An annual survey was sent to all residents at UCLA from 2007 to 2010. Survey questions asked trainees across various programs about the helpfulness of specific predefined learning activities in acquiring the competencies. Responses from 1378 PGY1-3 residents in 12 ACGME-accredited residency programs were analyzed. Patient care activities and observation of attendants and peers were listed as the two most helpful learning activities for acquiring all six core competencies. The findings reinforce the importance of learning from role models during patient care activities and the heterogeneity of learning activities needed for acquiring all the competencies. The fact that competencies are multidimensional and interconnected makes it highly unlikely that a single approach to teaching or assessment will be sufficient for their acquisition. Hence, multiple methods for teaching and learning are necessary for the acquisition of the competencies.

Assessing Competence in Medical Humanism: Development and Validation of the ICARE Scale for Assessing Humanistic Patient Care

Although the human dimensions of health care have been incorporated into medical education, how students perform in those areas remains unclear. One potential reason is the lack of reliable and valid instruments to assess humanistic performance in medical trainees. This study developed and examined a 15-item, 5-point Likert scale designed to assess medical students’ performance in Integrity, Compassion, Altruism, Respect, and Empathy (ICARE). Fifty medical students’ videotaped performance in an Objective Structured Clinical Examination (OSCE) station were rated by three investigators. Cronbach’s alpha, intraclass correlation (ICC), and the generalizability (G) study were conducted for reliability examination. To examine validity, factor analysis was conducted to explore the latent structure of the scale, and the correlations of the scale scores with four external criterion measures were calculated. Psychometric findings provided support for internal consistency, inter-rater and reproducibility reliability as well as construct validity of the scale scores. Criterion-related validity remains to be further investigated. The mean scores for the scale (3.74) and subscales (ranging from 3.44 to 4.08) showed room for the students to grow. The mean scores on the Respect and Integrity subscales were significantly (p < 0.05–0.001) higher than those of the other subscales. Students’ humanistic performance in a simulated clinical setting appeared to differ from their self-perceived patient-centeredness and empathy. While patient-centeredness and professionalism have received good attention in medical education, resulting in better student performances in those areas in the study, compassion and altruism remain in need of greater emphasis.