Paula T. Ross

A qualitative exploration of how the conflict between the formal and informal curriculum influences student values and behaviors.

Purpose The third-year students at one medical school told the authors that values core to patient-centered care were impossible to practice in clerkships, in a culture where supervisors role modeled behaviors in direct conflict with patient-centered care. As they developed a new medical student curriculum, the authors designed the Family Centered Experience (FCE) to help students achieve developmental goals and understand the importance of and provide a foundation for patient-centered care. Method The authors solicited members of the first cohort to complete the FCE (the class of 2007) to participate in this focus-group-based study halfway through the third year. They explored the influence of the FCE on students’ experiences in the third-year clerkships, and how conflicts between the two learning experiences shaped these students’ values and behaviors. Results Students reported that during clerkships they experienced strong feelings of powerlessness and conflict between what they had learned about patient-centered care in the first two years and what they saw role modeled in the third year. Based on students’ comments, the authors categorized students into one of three groups: those whose patient-centered values were maintained, compromised, or transformed. Conclusions Students revealed that their conflict was connected to feelings of powerlessness, along with exacerbating factors including limited time, concerns about expectations for their behavior, and pessimism about change. Role modeling had a significant influence on consequences related to students’ patient-centered values.

Use of interactive theater for faculty development in multicultural medical education

Background: The development of critical consciousness, anchored in principles of social justice, is an essential component of medical education. Aim: In order to assist faculty instructors in facilitating small-group discussions on potentially contentious issues involving race, gender, sexual orientation, and socioeconomic class, a faculty development workshop was created. Methods: The workshop used ‘Forum Theater’ techniques in which the audience was directly involved in determining the course of a simulated classroom discussion and conflict. We assessed the workshops impact on the instructors’ attitudes regarding facilitation of small-group discussions through two surveys: one to gauge immediate impressions, and another, 9–15 months later, to assess impact over time. Results: Immediately after the workshop, participants reported that the topics covered in the sketch and in the discussion were highly relevant. In the follow-up survey, the instructors agreed that the workshop had raised their awareness of the classroom experiences of minorities and women and had offered strategies for addressing destructive classroom dynamics. 72% reported that the workshop led to changes in their behavior as facilitators. Differences in responses according to gender were observed. Conclusions: A workshop using interactive theater was effective in training faculty to facilitate small-group discussions about multicultural issues. This approach emphasizes and models the need to foster critical consciousness in medical education.

Diabetes stories: use of patient narratives of diabetes to teach patient-centered care

A critical component to instituting compassionate, patient-centered diabetes care is the training of health care providers. Our institution developed the Family Centered Experience (FCE), a comprehensive 2-year preclinical program based on longitudinal conversations with patients about living with chronic illness. The goal of the FCE is to explore the experience of illness from the patient’s perspective and ultimately to incorporate this perspective in clinical practice. In this qualitative study, we wished to investigate the impact of “diabetes stories”—the stories of FCE volunteers with diabetes—on medical students’ understanding of diabetes and its management. Individual interviews were conducted with medical students who had worked with a volunteer with diabetes to answer the questions: “in what ways was learning through these ‘diabetes stories’ different from that acquired through lectures and textbooks,” and “how did these stories impact the students’ understanding of diabetes and its care?” Thematic analysis of the transcribed interviews was performed using Grounded Theory. Several major themes emerged: There was more to diabetes than the “scientific” knowledge acquired through lectures; the stories challenged students’ assumptions about having or working with people with diabetes and allowed students to see the world through the perspective of someone with diabetes, and the stories motivated students’ development as physicians and influenced their general perspectives of doctoring and medicine. First-person narratives of living with diabetes allow for learning in affective, experiential, and cognitive dimensions, stimulate self reflection and perspective-taking, and enhance growth through the challenging of previous assumptions, beliefs, and perspectives. This type of learning is transformative and may result in a shift in students’ perspectives towards more open, inclusive attitudes towards patient-centered diabetes care.

Remediating students' failed OSCE performances at one school: The effects of self-assessment, reflection, and feedback

Purpose To investigate whether and how use of an online remediation system requiring reflective review of performance and self-assessment influenced students’ performance on objective structured clinical examination (OSCE) station repeats (subsequent to failure on the first attempt) and their self-assessments of their performance (between the first and second attempts). Method Fourth-year medical students’ performances on seven OSCE stations were videotaped at University of Michigan Medical School in 2006. Failing students took the exam again; remediation included self-assessment and review, plus faculty guidance for failures that were greater than one standard error of measurement of the distribution. A total of 1,171 possible observations of students’ actual performance and performance self-assessments were analyzed using independent and dependent t tests and within-subjects ANOVA. Results Results indicate statistically significant changes in students’ performance between first and second attempts and statistically significant improvements in self-assessment between first and second attempts. No significant changes were found between self-assessed and faculty-guided remediation. Conclusions This study provides evidence that OSCE remediation combining review, reflection, and self-assessment has a salutary effect on (subsequent) performance and self-assessment of performance.

The impact of facilitation of small-group discussions of psychosocial topics in medicine on faculty growth and development.

Purpose To use qualitative analysis of interview transcripts with clinician–educators who facilitate small-group discussions on psychosocial themes—including doctoring—to answer the question, “What impact does facilitating small-group discussions of the patient’s experience with chronic illness, the doctor–patient relationship, and doctoring have on faculty instructors’ attitudes regarding their roles as clinicians and teachers?” Method In 2006, in-depth, face-to-face interviews using an open-ended question format were conducted with individual faculty small-group instructors teaching in the Family Centered Experience and Longitudinal Case Studies courses at the University of Michigan Medical School. Interview transcripts were analyzed using grounded theory methodology to identify emerging themes. Accuracy of interpretations and saturation of themes was confirmed by repeated contextual reading of the transcripts. Results Several major thematic codes emerged from the data. Facilitation of small-group discussions of psychosocial topics and doctoring fostered reflective approaches to patient care and teaching; enhanced interpersonal relationships between facilitators and their students, colleagues, and patients; and acted as a source of fulfillment and renewal among faculty facilitators. Conclusions Small-group teaching of the art of doctoring may stimulate personal and professional growth among faculty facilitators and renewed interest in teaching and patient care.

A strategy for improving health disparities education in medicine.

IntroductionA health disparities curriculum that uses evidence-based knowledge rooted in pedagogic theory is needed to educate health care providers to meet the needs of an increasingly diverse U.S. population.DescriptionThe Health Disparities Education: Beyond Cultural Competency Precourse, along with its accompanying Train the Trainer Guide: Health Disparities Education (2008), developed by the Society of General Internal Medicine (SGIM) Disparities Task Force (DTF), is a comprehensive tool to facilitate developing, implementing and evaluating health disparities education. The curriculum includes five modules highlighting several fundamental concepts in health disparities, suggestions for teaching about health disparities in a wide range of settings and strategies for curriculum evaluation. The modules are Disparities Foundations, Teaching Disparities in the Clinical Setting, Disparities Beyond the Clinical Setting, Teaching about Disparities Through Community Involvement, and Curriculum Evaluation.EvaluationAll five modules were delivered as a precourse at the 31st Annual SGIM Annual Meeting in Pittsburgh, PA and received the “Best Precourse Award”. This award is given to the most highly rated precourse based on participant evaluations. The modules have also been adapted into a web-based guide that has been downloaded at least 59 times.ConclusionUltimately, the modules are designed to develop a professional commitment to eliminating racial and ethnic disparities in health care quality, promote an understanding of the role of health care providers in reducing health care disparities through comprehensive education and training, and provide a framework with which providers can address the causes of disparities in various educational settings.

Standardized Patient Instructor (SPI) interactions are a viable way to teach medical students about health behavior counseling

OBJECTIVES We explored comfort levels of third-year medical (M3) students through two health behavior counseling (HBC) interactions with Standardized Patient Instructors (SPIs) in tobacco cessation (TCC) and nutrition and physical activity (NPA). METHODS Nearly 200 M3s participated in two SPI HBC interactions; including a role-play interview and subsequent feedback session on performance. Students completed a 5-point Likert scale evaluation measuring pre- and post-comfort level on two HBC sessions. RESULTS Both interactions resulted in statistically significant increases in students pre- and post-interaction comfort levels. A paired-sample t-test revealed a mean increase of 0.91 for TCC (t = 14.01, df = 197, p<0.001), and a mean increase of 0.69 for NPA (t = 12.65, df = 198, p<0.001). CONCLUSION The use of SPIs is a viable approach to exposing medical students and future doctors to health behavior counseling, and increasing comfort level with such skills. The SPI experience ensures that HBC opportunities are available and contain meaningful feedback on performance. PRACTICE IMPLICATIONS Encouraging patient behavior modification is a skill that can be developed during undergraduate medical training. Combining HBC with SPI sessions and traditional learning approaches could prove effective in a curriculum intended to teach students strategies that improve patient health behavior.

Understanding the medical marriage: Physicians and their partners share strategies for success

Purpose Physicians and their spouses experience challenges to their relationships, some of which are shared with the general population and others of which are unique to the field of medicine. Trainees and junior faculty members remain curious about how they will balance their careers alongside marriage and family obligations. This study explores the challenges and strengths of dual- and single-physician relationships. Method In 2009, using appreciative inquiry as a theoretical framework, the authors conducted in-depth qualitative interviews with 25 individuals: 12 women and 13 men; 10 from dual-physician and 15 from single-physician relationships. A phenomenological analytic approach was used to arrive at the final themes. Results Four themes emerged during the interviews: “We rely on mutual support in our relationships,” “We recognize the important roles of each family member,” “We have shared values,” and “We acknowledge the benefit of being a physician to our relationships.” Conclusions These findings illustrate that physicians identify strategies to navigate the difficult aspects of their lives. Learn ing from others’ best practices can assist in managing personal relationships and work–life balance. These data can also be useful when counseling physicians on successful relationship strategies. As systems are developed that improve wellness and focus on role models for work–life balance, it will be important for this topic to be integrated into formal curricula across the continuum of medical education.

Faculty reflections on the implementation of socio‐cultural eportfolio assessment tool

Electronic portfolios (eportfolios) are increasingly used to assess student development. The degree to which faculty in North American medical schools are confident in their ability to evaluate such materials and their perceptions of the utility of eportfolios are unclear. Thirteen medical educators developed skills necessary to critically assess students’ reflective essays. Qualitative methods were used to explore faculty experiences with a socio‐cultural eportfolio. Despite self‐perceptions of being novice users, faculty were willing to engage with the eportfolio and assume an unfamiliar role in guiding medical students’ personal reflections. Additionally, we uncovered unique faculty expectations regarding the quality of students’ essays and their thoughts about the utility of an eportfolio as an assessment tool. Our findings indicate that given adequate time and training, faculty will use an eportfolio. They believe it is an effective method for both longitudinal assessment of student learning and achieving curricular objectives. Our findings also illustrate the numerous unintended ethical challenges faculty encounter as they engage in student assessment.

Using film in multicultural and social justice faculty development: Scenes from Crash†

&NA; We designed a faculty development workshop integrating scene excerpts from the Academy Award‐winning movie Crash and active learning methods to encourage faculty participation and generate participant dialogue. The aims of this workshop were to enhance awareness of issues related to teaching in a multicultural classroom; stimulate discussion on teaching and learning about potentially contentious issues linked to race, ethnicity, religion, gender, geographical origin, and class; and expose faculty to the use of multimedia to facilitate discussion on topics of diversity and social justice. Twenty‐five faculty attended 3 workshops in various venues, 18 of whom completed workshop evaluations. The workshop evaluation revealed that all participants believed that the scene excerpts and discussions helped them to reflect on their own attitudes toward race and diversity and felt better prepared to effectively facilitate classroom discussions on similar issues. This workshop is a useful tool for helping faculty to develop the skills and confidence to facilitate, manage, and stimulate discussions on controversial issues in multicultural education that may otherwise be avoided due to lack of expertise or experience.