Richard Dollase

AMEE guide No. 14: Outcome-based education: Part 2-Planning, implementing and evaluating a competency-based curriculum

In September, 1996, Brown University School of Medicine inaugurated a new competency-based curriculum, known as MD2000, which defines a comprehensive set of competency requirements that all graduates are expected to attain. The medical students entering in 1996 and thereafter are required to demonstrate mastery in nine abilities as well as a comprehensive knowledge base as a requirement for graduation. Faculty use performance-based methods to determine if students have attained competence. We describe in this article the reasons why we developed the new curriculum, how we planned and structured it, and the significance we anticipate the curricular innovation will have on medical education.

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.

Developing a Peer-Mentor Program for Medical Students

Background: Doctoring is a 2-year preclinical course designed to teach medical students fundamental clinical skills. Purpose: We designed, implemented, and evaluated an innovative and cost-effective peer-mentoring program embedded within Doctoring. Our Teaching Academy (TA) included a formal orientation for teaching “Fellows.” Methods: During academic years 2008–09 and 2009–10, 2nd-year students were systematically selected by course faculty and then trained as TA Fellows to peer-mentor 1st-year students. Both TA Fellows and 1st-year medical students completed anonymous written surveys. Results: Peer-mentors reported a significant increase of confidence in their ability to provide feedback (p < .001). First-year students reported a significant increase of confidence in their ability to conduct a medical interview and perform a physical exam (p < .001 for each). Conclusions: Student participation in a formal peer-mentor program embedded within a clinical skills course significantly increased, for both teachers and learners, confidence in their skills. Our program is easily transferrable to other courses and institutions.

Assessing medical students for non-traditional competencies

Assessing medical student competence in non-traditional domains can be challenging. Conventional methods of assessment are generally unsatisfactory. The authors discuss the approach taken at the Brown Medical School, USA to assess students at the beginner, intermediate, and advanced levels in the social and community contexts of health care – one of the nine abilities that comprise Browns competency-based curriculum. At the beginner level, faculty use weekly field notes written by students about their experiences in community practice placements as the means for assessment. At the intermediate level, faculty assess students based on their completion of a project focused on a community health problem. At the advanced level, a screening process is used in which students first meet individually with a member of the assessment committee who determines if the students efforts appear to meet the expected standards. If success seemed likely, then the student was encouraged to appear before the whole committee. The authors discuss the common use of subjective judgments at all three levels and the importance of diverse perspectives in achieving a consensus. Allowing students wide latitude in expressing themselves and their accomplishments helps to ensure success.

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.

Access to treatment for opioid use disorders: Medical student preparation

The current opioid epidemic requires new approaches to increasing access to treatment for patients with opioid use disorders and to improve availability of medication assisted treatment. We propose a model where medical students complete the necessary training to be eligible for the waiver to prescribe opioid medications to treat these disorders by the time of medical school graduation. This plan would increase the number of Drug Abuse Treatment Act of 2000 (DATA 2000) waivered physicians who could gain additional experience in treating substance use disorders during residency and provide the access to clinical care needed for individuals suffering with opioid use disorder. (Am J Addict 2017;26:316-318).

Designing Interprofessional Education Curriculum Using Multiple Conceptual Frameworks

Full implementation of the Affordable Care Act and the projected physician and nurse shortages, will require that health care providers work effectively in teams. To achieve this goal, education about team work must start at the student level. We describe how we used educational conceptual frameworks such as Kotter’s 8-step Change Model, Kern’s 6-step approach to designing curriculum, and Miller’s Pyramid of Assessment to develop our curriculum. This approach to interprofessional curriculum development is adaptable and transferable to other health professions schools.

The importance of quality improvement education for medical students.

tional responses before (when the code blue was announced overhead), during and after the event. The facilitator from spiritual care used the focused conversation method as a model for reflection upon which trainees could subsequently draw to provide a framework for conversations immediately after future code blues. What lessons were learned? A survey conducted 2 weeks after the session revealed that 81% of respondents felt more comfortable discussing their emotions following a code blue, 88% felt better prepared to deal with the stress and emotions associated with code blues, and 94% felt that they were more likely to debrief immediately following a code blue in the future. In the supportive environment of our debriefing session, trainees were comfortable in sharing a range of emotions related to code blues. Although many trainees were saddened or upset by them, some described feelings of detachment or indifference following a cardiac arrest. This was associated with guilt or a feeling that something may be wrong with them. In the follow-up survey, one trainee stated that it was helpful to know that he was not alone in feeling this way. Whereas the expression of emotions by practitioners is often undermined by medical education’s hidden curriculum, we learned that our trainees are engaged and fulfilled by these reflective activities when they are legitimised in the formal curriculum.

Substance Use Disorder Training Workshop for Future Interprofessional Health Care Providers

Introduction Rates of substance use disorders, including opioid misuse, continue to rise despite national initiatives. Because of this, health professional schools from Rhode Island joined together to design and implement a single-day interprofessional education workshop on substance use disorder training. Methods This workshop consists of four sessions. The first is a patient panel featuring both patients recovering from substance use disorders and their health care providers. Next is a naloxone administration training session. This is followed by a standardized patient session featuring an individual who requires nonopioid options for chronic pain treatment and in which health professional students work together to take a history, perform a physical examination, and develop a treatment plan. Finally, the last session is a complex paper-based case study focusing on a homeless individual with diverse medical problems requiring multifaceted care. Results A total of 540 students from a variety of health care professions participated in the workshop. Students were asked to evaluate each component of the workshop, as well as the workshop overall, on a 6-point Likert scale (1 = poor, 6 = outstanding). Students rated the overall workshop at 76% (4.54 out of 6), and the sessions received ratings ranging from 67% (4.01 out of 6 for the case study) to 83% (4.96 out of 6 for the patient/provider panel). Discussion This curriculum can be adapted and implemented at other medical schools to provide opportunities for future health care professionals to learn how to work effectively in interprofessional teams to manage substance use disorders.