Richard T. Kasuya

Using standardized patients to assess the geriatrics medicine skills of medical students, internal medicine residents, and geriatrics medicine fellows.

Purpose. Medical schools and residency programs are placing additional emphasis on including clinical geriatrics competencies within their curricula. An eight-station, Geriatric Medicine Standardized Patient Examination (GSPX) was studied as a method to assess bedside geriatrics clinical skills over the continuum of medical education from medical school through residency and fellowship training. Method. The GSPX was administered to 39 medical students, 49 internal medicine residents, and 11 geriatrics medicine fellows in 2001–02. Reliability of standardized patient (SP) checklists and rating scales used to assess examinees’ performance was measured by Cronbachs alpha. Validity was measured by surveying the examinees’ assessment of fairness, individual case length, difficulty, and believability, and by faculty standard setting for each level of trainee. Results. Reliability was high (α = .89). All levels of examinees found the SPs to be believable, station lengths to be adequate, and rated the GSPX as a fair assessment. Students rated the cases as more difficult. Previous experience with similar real patients increased significantly with level of training (Pearson’s r = .48, p < .0001). Faculty set passing scores that increased from students to residents to fellows. However, GSPX scores decreased with level of training (r = −.25, p = .01). Conclusion. The GSPX is a reliable measure of geriatrics medicine skills with adequate face validity for examinees at all levels. However, GSPX scores did not increase with level of training, suggesting that a single form of the examination cannot be used across the continuum of training. Potential modifications to the GSPX that might provide more discrimination between levels of training are currently being explored.

Smoking Cessation Counseling Training for Pediatric Residents in the Continuity Clinic Setting

OBJECTIVE To determine the effectiveness of a clinic-based smoking cessation counseling curriculum on pediatric resident confidence, knowledge, counseling skills, and provision of counseling. METHODS Twenty-six residents at a pediatric residency program completed a new smoking cessation counseling curriculum as part of continuity clinic training. We assigned residents to 2 groups (study group, n = 12 vs control group, n = 14) on the basis of clinic site. We used a quasi-experimental, crossover design with pre- and posttests for each group. Control-group residents served as an initial control before the intervention crossover. Residents were tested at baseline and at completion of each groups intervention. Standardized patients measured resident provision of counseling and quality of counseling during resident continuity clinic. Knowledge and confidence were measured by a written exam and self-administered survey. Analysis of variance with a mixed design assessed overall group differences and group performances over time. RESULTS There were no baseline differences between groups. Across time, there were significant differences between study-group and control-group residents for confidence (F [2, 48] = 11.82; P <.01), knowledge (F [2, 48] = 6.24; P <.01), and provision of counseling (F [2, 48] = 3.60, P <.05) but not counseling skills (F [2, 48] = 2.44; P <.10). After each groups intervention, their confidence, knowledge, counseling skills, and inclusion of counseling increased significantly (P <.01 for all). CONCLUSIONS Our findings suggest that a clinic-based curriculum in smoking cessation counseling can significantly increase knowledge, confidence, counseling skills, and provision of counseling. Future research should evaluate the long-term impact of such curricula on resident counseling behavior and patient outcomes.

A retreat on leadership skills for residents.

Objective: It is widely acknowledged that residents must develop their leadership skills. The ACGME Residency Review Committee guidelines state that residency programs should include ‘‘assignments during which residents learn to work with other members of the health-care team and to become leaders in the organization and management of patient care.’’ With this consideration in mind, we developed a three-year curriculum in leadership skills for residents, the goals being that residents should be able to appreciate and practice principles of personal effectiveness, effectively manage resident ward teams, and be able to appreciate and practice principles of effective leadership. Most of this curriculum is delivered in either annual resident orientation sessions or annual resident retreats, with a stepwise emphasis of our three goals across the three years of training. We describe a component of this curriculum, a half-day retreat for interns entitled ‘‘Leadership Skills for Residents.’’ Description: As part of our leadership-skills curriculum, a one-day, six-hour retreat for interns was held prior to the start of their second year of training. It was divided between the themes of teaching and leadership. Small-group tasks and discussions were integrated with large-group introductions and summaries by the retreat faculty. Themes and activities related to leadership were brainstorming the qualities of stellar upper-level residents (setting personal vision), brainstorming the qualities of stellar interns (understanding their constituency), leadership vs. management, building a team, practical negotiation skills, providing effective feedback, and problem-solving as a team leader. Instructional methods included facilitated active discussions, panel sessions with more experienced residents, working through scenarios, and role-playing. Discussion: All the participants completed entry and exit questionnaires responding to items using a four-point Likert scale (4 = strongly agree to 1 = strongly disagree). They reported increased confidence in their abilities to lead a ward team (p = .0002) and fulfill their responsibilities as upperlevel residents (p = .0002), and having identified qualities they aspired to as upper-level residents (p = .0014). They also reported that as a result of the retreat they better appreciated their roles as team leader and manager (mean = 3.76, SD .44) and felt better prepared to deal with the challenges of being upper-level residents (mean = 3.65, SD .61). The participants also believed that they would use what they learned at this retreat as upper-level residents (mean = 3.88, SD .33). We are now in the process of finalizing a followup questionnaire to all retreat participants to assess whether these findings are sustained over the first six months of their PGY2 training. We are planning to further develop our three-year longitudinal curriculum in leadership skills for residents. We currently address issues of personal effectiveness at our intern orientation sessions (developing personal mission statements, etc.). We are planning another retreat for PGY2s moving into their PGY3 training that emphasizes higherorder leadership skills (e.g., ‘‘leading beyond the ward team’’). We hope that these efforts will help prepare our residents to respond to the leadership challenges they will encounter. Inquiries: Richard T. Kasuya, MD, University of Hawaii Internal Medicine Residency Program, 1356 Lusitana Street #716, Honolulu, HI 96813.

Implementing an online curriculum management database in a problem-based learning curriculum.

Managing a medical school curriculum is a difficult challenge. The body of knowledge is large, diverse, and changing. Continuous oversight is required to ensure the proper balance of learning opportunities, to eliminate redundancies, and to fill in gaps. Within the context of the integrated problem-based learning curriculum at the University of Hawaii John A. Burns School of Medicine (JABSOM), the authors describe a 2003 transition from a paper-based method of curriculum tracking to an online international database. The tool chosen, the Curriculum Management and Information Tool (CurrMIT®), allows for myriad ways of entering data and structuring the curriculum, but presents unique challenges as well. The authors describe how this new tool was implemented at JABSOM, which included initial data entry by course directors, who provided close scrutiny of course content and took the opportunity to more closely align course objectives with course content. A keyword meta-data strategy was adopted to tag each curriculum element. Despite some difficulties, the resulting ease and accuracy of report generation has produced significant benefit to course directors and to the curriculum oversight committee, and has allowed even further improvement in the educational process. This strategy has been successfully adopted and adapted by other institutions.

University of Hawaii at Mãnoa John A. Burns School of Medicine.

The JABSOM Office of Medical Education (OME) was established in 1989 to support the medical student education program. Currently, the office supports 14 professionals. Most of the faculty members assigned to the office have split assignments between the OME and their home department. The role of the office is to oversee and coordinate the required courses in the first two years of the curriculum and selected (primarily interdepartmental) courses in the third and fourth years. The OME also supports the activities of the JABSOM curriculum committee and provides an array of faculty development opportunities for the school.

Introducing educational interventions for first year medical students in the area of cancer clinical trials: impact on attitudes and confidence.

Background. This study tested the feasibility and efficacy of a multi-faceted educational intervention designed to increase medical students’ confidence in discussing cancer clinical trials with patients. Method. First year students were provided with written resources, problem-based learning scenarios, and an optional practicum. Results. Pre/Post results indicated significant increases in confidence levels; however, these results were tempered with declines in attitudes related to clinical trials. Conclusions. Integrating clinical trials education into existing medical school curriculum is both feasible and desirable. This intervention was successful in increasing students’ confidence levels in discussing clinical trials with patients and deserves continued study.Background. This study tested the feasibility and efficacy of a multi-faceted educational intervention designed to increase medical students’ confidence in discussing cancer clinical trials with patients. Method. First year students were provided with written resources, problem-based learning scenarios, and an optional practicum. Results. Pre/Post results indicated significant increases in confidence levels; however, these results were tempered with declines in attitudes related to clinical trials. Conclusions. Integrating clinical trials education into existing medical school curriculum is both feasible and desirable. This intervention was successful in increasing students’ confidence levels in discussing clinical trials with patients and deserves continued study.

Medical education in paradise: another facet of Hawaii

Hawaii is synonymous with paradise in the minds of many. Few know that it is also an environment where high quality medical education is thriving. This paper outlines medical education initiatives beginning with native Hawaiian healers of centuries ago, and continuing to present-day efforts to support top-notch multicultural United States medical education across the continuum of training. The undergraduate medical education program has as its core community-based problem-based learning. The community basis of training is continued in graduate medical education, with resident doctors in the various programs rotating through different clinical experiences at various hospitals and clinics. Continuing medical education is provided by nationally accredited entities, within the local context. Educational outreach activities extend into primary and secondary schools, homeless shelters, neighbouring islands, and to countries throughout the Pacific. Challenges facing the medical education community in Hawaii are similar to those faced elsewhere and include incorporating more technology to improve efficiency, strengthening the vertical integration of the training continuum, better meeting the needs of the state, and paying for it all. Readers are invited to join in addressing these challenges to further the realisation of medical education in paradise as a paradise of medical education.

University of Hawaii John A. Burns School of Medicine.

Graduates of the University of Hawaii John A. Burns School of Medicine are life-long learners. They apply their knowledge of biological and clinical sciences, demonstrate a deep appreciation for their community, and communicate effectively in the care of their patients, particularly the peoples of Hawaii and the Pacific Basin. They practice medicine with the highest professional standards while maintaining their personal health and well-being. All medical students at JABSOM must demonstrate achievement of these objectives prior to graduation.