Paul George

Incorporating iPads into a preclinical curriculum: A pilot study

Background: The incorporation of technology into medical education is critical for learners. Little is known about the effect of integrating iPad technology into undergraduate medical education. Aims: We introduced iPads into the first-year curriculum in 2011–2012. We aimed to evaluate students’ use of, and attitudes toward, the iPad. Methods: We administered two surveys to students during the 2011–2012 academic year. Additionally, we conducted focus groups to further evaluate the effectiveness of iPad integration into the curriculum. Results: Survey data reflect mixed attitudes toward the use of the iPad in the preclinical curriculum. While a vast majority of students agree “the iPad has value in the medical curriculum” (79% in the first survey; 65% in the second survey), there was a decrease over time in the view that “the iPad is a positive addition to the curriculum” (75% in the first survey; 49% in the second survey). Focus group data indicate students appreciate certain aspects of iPad use in the curriculum, including improved curriculum interactivity, but the majority believe it cannot replace printed handouts at this time. Discussion: The iPad provides some benefits in undergraduate medical education. More studies are necessary to determine how the iPad is best incorporated into medical education.

Introducing technology into medical education: Two pilot studies

OBJECTIVES Educators are integrating new technology into medical curriculum. The impact of newer technology on educational outcomes remains unclear. We aimed to determine if two pilot interventions, (1) introducing iPads into problem-based learning (PBL) sessions and (2) online tutoring would improve the educational experience of our learners. METHODS We voluntarily assigned 26 second-year medical students to iPad-based PBL sessions. Five students were assigned to Skype for exam remediation. We performed a mixed-method evaluation to determine efficacy. RESULTS Pilot 1: Seventeen students completed a survey following their use of an iPad during the second-year PBL curriculum. Students noted the iPad allows for researching information in real time, annotating lecture notes, and viewing sharper images. Data indicate that iPads have value in medical education and are a positive addition to the curriculum. Pilot 2: Students agreed that online tutoring is at least or more effective than in-person tutoring. CONCLUSIONS In our pilot studies, students experienced that iPads and Skype are beneficial in medical education and can be successfully employed in areas such as PBL and remediation. PRACTICE IMPLICATIONS Educators should continue to further examine innovative opportunities for introducing technology into medical education.

Race Matters? Examining and Rethinking Race Portrayal in Preclinical Medical Education.

Critical examination of “health disparities” is gaining consideration in medical schools across the United States, often as elective curricula that supplement required education. However, there is disconnect between discussions of race and disparities in these curricula and in core science courses. Specifically, required preclinical science lecturers often operationalize race as a biological concept, framing racialized disparities as inherent in bodies. A three- and five-month sampling of lecture slides at the authors’ medical school demonstrated that race was almost always presented as a biological risk factor. This presentation of race as an essential component of epidemiology, risk, diagnosis, and treatment without social context is problematic, as a broad body of literature supports that race is not a robust biological category. The authors opine that current preclinical medical curricula inaccurately employ race as a definitive medical category without context, which may perpetuate misunderstanding of race as a bioscientific datum, increase bias among student–doctors, and ultimately contribute to worse patient outcomes. At the authors’ institution, students approached the medical school administration with a letter addressing the current use of race, urging reform. The administration was receptive to proposals for further analysis of race in medical education and created a taskforce to examine curricular reform. Curricular changes were made as part of the construction of a longitudinal race-in-medicine curriculum. The authors seek to use their initiatives and this article to spark critical discussion on how to use teaching of race to work against racial inequality in health care.

Implementation of interprofessional education (IPE) in 16 U.S. medical schools: Common practices, barriers and facilitators

BACKGROUND Enhanced patient outcomes and accreditation criteria have led schools to integrate interprofessional education (IPE). While several studies describe IPE curricula at individual institutions, few examine practices across multiple institutions. PURPOSE To examine the IPE integration at different institutions and determine gaps where there is potential for improvement. METHOD In this mixed methods study, we obtained survey results from 16 U.S. medical schools, 14 of which reported IPE activities. RESULTS The most common collaboration was between medical and nursing schools (93%). The prevalent format was shared curriculum, often including integrated modules (57%). Small group activities represented the majority (64%) of event settings, and simulation-based learning, games and role-play (71%) were the most utilized learning methods. Thirteen schools (81.3%) reported teaching IPE competencies, but significant variation existed. Gaps and barriers in the study include limitations of using a convenience sample, limited qualitative analysis, and survey by self-report. CONCLUSIONS Most IPE activities focused on the physician role. Implementation challenges included scheduling, logistics and financial support. A need for effective faculty development as well as measures to examine the link between IPE learning outcomes and patient outcomes were identified.

The Integrated Skin Exam film: An educational intervention to promote early detection of melanoma by medical students

BACKGROUND Knowledge of the skin cancer examination (SCE) and its practice remain relevant competency gaps among medical students. OBJECTIVE We elaborate on a method of SCE known as the Integrated Skin Exam and discuss the development of an instructional film that illustrates its principles. We assess the tools effect on knowledge, attitudes, and perceptions related to the SCE. METHODS Second-year students among 8 randomized schools viewed the film and completed pre-post questionnaires. RESULTS After viewing The Integrated Skin Exam film, students demonstrated improved melanoma knowledge, including identification of high-risk demographic groups (61% vs 42.9%, P < .001), high-risk anatomic sites in women (88.6% vs 46.5%, P < .001) and men (92.1% vs 34.8%, P < .001), and the ABCDEs of melanoma (98.4% vs 91.2%, P < .001). Students demonstrated increased confidence in the SCE (66.93% vs 16.40%, P < .001) and augmented intentions to practice it (99.05% vs 13.9%, P < .001). A greater proportion (70.4% vs 41.9%, P < .001) of students thought less than 3 minutes were required to integrate SCE into the routine examination. LIMITATIONS Longitudinal impact of the film was not assessed. CONCLUSION The Integrated Skin Exam film introduces an integrated approach to the SCE that addresses knowledge gaps, mitigates perceived barriers, and augments intention related to practice of the SCE.

Role Modeling and Regional Health Care Intensity: U.S. Medical Student Attitudes Toward and Experiences with Cost-Conscious Care

Purpose To examine medical student attitudes toward cost-conscious care and whether regional health care intensity is associated with reported exposure to physician role-modeling behaviors related to cost-conscious care. Method Students at 10 U.S. medical schools were surveyed in 2015. Thirty-five items assessed attitudes toward, perceived barriers to and consequences of, and observed physician role-modeling behaviors related to cost-conscious care (using scales for cost-conscious and potentially wasteful behaviors; Cronbach alphas of 0.82 and 0.81, respectively). Regional health care intensity was measured using Dartmouth Atlas End-of-Life Chronic Illness Care data: ratio of physician visits per decedent compared with the U.S. average, ratio of specialty to primary care physician visits per decedent, and hospital care intensity index. Results Of 5,992 students invited, 3,395 (57%) responded. Ninety percent (2,640/2,932) agreed physicians have a responsibility to contain costs. However, 48% (1,1416/2,960) thought ordering a test is easier than explaining why it is unnecessary, and 58% (1,685/2,928) agreed ordering fewer tests will increase the risk of malpractice litigation. In adjusted linear regression analyses, students in higher-health-care-intensity regions reported observing significantly fewer cost-conscious role-modeling behaviors: For each one-unit increase in the three health care intensity measures, scores on the 21-point cost-conscious role-modeling scale decreased by 4.4 (SE 0.7), 3.2 (0.6), and 3.9 (0.6) points, respectively (all P < .001). Conclusions Medical students endorse barriers to cost-conscious care and encounter conflicting role-modeling behaviors, which are related to regional health care intensity. Enhancing role modeling in the learning environment may help prepare future physicians to address health care costs.

A 5-year experience with an elective scholarly concentrations program

Problem Programs that encourage scholarly activities beyond the core curriculum and traditional biomedical research are now commonplace among US medical schools. Few studies have generated outcome data for these programs. The goal of the present study was to address this gap. Intervention The Scholarly Concentration (SC) Program, established in 2006 at the Warren Alpert Medical School of Brown University, is a 4-year elective program that not only encourages students to pursue scholarly work that may include traditional biomedical research but also seeks to broaden students’ focus to include less traditional areas. We compared characteristics and academic performance of SC students and non-SC students for the graduating classes of 2010–2014. Context Approximately one-third of our students opt to complete an SC during their 4-year undergraduate medical education. Because this program is additional to the regular MD curriculum, we sought to investigate whether SC students sustained the academic achievement of non-SC students while at the same time producing scholarly work as part of the program. Outcome Over 5 years, 35% of students elected to enter the program and approximately 81% of these students completed the program. The parameters that were similar for both SC and non-SC students were age at matriculation, admission route, proportion of undergraduate science majors, and number of undergraduate science courses. Most academic indicators, including United States Medical Licensing Examinations scores, were similar for the two groups; however, SC students achieved more honors in the six core clerkships and were more likely to be inducted into the medical schools two honor societies. Residency specialties selected by graduates in the two groups were similar. SC students published an average of 1.3 peer-reviewed manuscripts per student, higher than the 0.8 manuscripts per non-SC student (p=0.013). Conclusions An elective, interdisciplinary scholarly program with a focus beyond traditional biomedical research offers students the opportunity to expand the scope of their medical education without an untoward effect on academic performance or residency placement.Problem Programs that encourage scholarly activities beyond the core curriculum and traditional biomedical research are now commonplace among US medical schools. Few studies have generated outcome data for these programs. The goal of the present study was to address this gap. Intervention The Scholarly Concentration (SC) Program, established in 2006 at the Warren Alpert Medical School of Brown University, is a 4-year elective program that not only encourages students to pursue scholarly work that may include traditional biomedical research but also seeks to broaden students’ focus to include less traditional areas. We compared characteristics and academic performance of SC students and non-SC students for the graduating classes of 2010–2014. Context Approximately one-third of our students opt to complete an SC during their 4-year undergraduate medical education. Because this program is additional to the regular MD curriculum, we sought to investigate whether SC students sustained the academic achievement of non-SC students while at the same time producing scholarly work as part of the program. Outcome Over 5 years, 35% of students elected to enter the program and approximately 81% of these students completed the program. The parameters that were similar for both SC and non-SC students were age at matriculation, admission route, proportion of undergraduate science majors, and number of undergraduate science courses. Most academic indicators, including United States Medical Licensing Examinations scores, were similar for the two groups; however, SC students achieved more honors in the six core clerkships and were more likely to be inducted into the medical schools two honor societies. Residency specialties selected by graduates in the two groups were similar. SC students published an average of 1.3 peer-reviewed manuscripts per student, higher than the 0.8 manuscripts per non-SC student (p=0.013). Conclusions An elective, interdisciplinary scholarly program with a focus beyond traditional biomedical research offers students the opportunity to expand the scope of their medical education without an untoward effect on academic performance or residency placement.

A Cross-Sectional Analysis of Perceptions of Interprofessional Education in Medical Students

Background and Objectives: With the recent paradigm shift in medicine away from traditional hierarchies and patient-physician dyads, there is increased interest in training students to work interprofessionally. A primary focus for improving collaboration in health care is increasing exposure to formalized interprofessional education (IPE) across health professions during training. This study focuses on the effect of formal and informal curricula on medical student attitudes toward IPE. Methods: A cross-sectional survey of all undergraduate medical students was conducted using the Readiness for Interprofessional Learning Scale (RIPLS). Results: Throughout all years of medical school, students agreed with the importance of interprofessional education. Fourth-year medical students had higher total RIPLS scores (64.29 versus 61.0; p=0.007), as well as higher scores on multiple individual RIPLS questions than first-year students. Conclusions: Medical students become more enthusiastic about IPE as their training progresses. Both formal and informal educational opportunities contribute to this effect.

When Race Matters on the Wards: Talking About Racial Health Disparities and Racism in the Clinical Setting

Introduction There is a growing body of literature illustrating the negative impact of racial bias on clinical care. Despite the growing evidence, medical schools have been slow to make necessary curricular changes. Most attempts to educate on racial health disparities focus on transferring knowledge and do not foster the development of skills to understand ones own bias or address bias and racism in the clinical setting. To address this, we developed a small-group, case-based curriculum for rising third-year medical students. Methods This session was designed to be delivered in concurrently run, 1-hour small-group sessions, with each small group ideally comprising no more than 10 students and one facilitator. The curriculum was integrated into an existing 3-week clerkship preparation course for 122 students during the 2015–2016 academic year. The session materials include a facilitators guide and three cases for discussion. Results The session was evaluated using a 6-point Likert scale (1 = poor, 6 = exceptional). Students rated this session overall a 4.28 out of 6 (N = 79). Qualitative feedback varied, with the most common theme focusing on the need for more time to discuss this topic. Discussion Though one session before starting clinical clerkships is not enough to maintain the practice of sustained critical thinking regarding bias and racism in clinical medicine, this session is a starting point for curriculum developers looking to use an evidence-based approach to racial bias in clinical care.

The Association Between Premedical Curricular and Admission Requirements and Medical School Performance and Residency Placement: A Study of Two Admission Routes.

Purpose The curricular elements of undergraduate premedical education are the subject of an ongoing debate. The Warren Alpert Medical School of Brown University (AMS) matriculates students via the traditional premedical route (TPM) and an eight-year baccalaureate/MD program—the Program in Liberal Medical Education (PLME)—which provides students with a broad and liberal education. Using the juxtaposition of these two admission routes, the authors aimed to determine whether there is an association between highly distinct premedical curricular and admission requirements and medical school performance and residency placement. Method The cohorts studied included all of the PLME (n = 295) and TPM (n = 215) students who graduated from the AMS between 2010 and 2015. Outcome variables consisted of multiple measures of medical school performance, including standardized multiple-choice examination scores and honors grades, and residency placement. The authors employed unadjusted tests of averages and proportions (independent t tests and chi-square tests) to compare variables. Results The TPM students attained marginally, but statistically significantly, higher average scores on standardized multiple-choice examinations than their PLME counterparts. The number of undergraduate premedical science courses completed by PLME students accounted for less than 4% of the variance in key metrics of medical school performance. The residency placement record of the PLME and TPM cohorts proved comparable. Conclusions These findings suggest that the association between medical school performance and residency placement and undergraduate premedical curricular and admission requirements is weak. Further study is needed to determine the optimal premedical preparation of students.