Sheila M. Crow

Perspective: Guidelines for Reporting Team-Based Learning Activities in the Medical and Health Sciences Education Literature

Medical and health sciences educators are increasingly employing team-based learning (TBL) in their teaching activities. TBL is a comprehensive strategy for developing and using self-managed learning teams that has created a fertile area for medical education scholarship. However, because this method can be implemented in a variety of ways, published reports about TBL may be difficult to understand, critique, replicate, or compare unless authors fully describe their interventions. The authors of this article offer a conceptual model and propose a set of guidelines for standardizing the way that the results of TBL implementations are reported and critiqued. They identify and articulate the seven core design elements that underlie the TBL method and relate them to educational principles that maximize student engagement and learning within teams. The guidelines underscore important principles relevant to many forms of small-group learning. The authors suggest that following these guidelines when writing articles about TBL implementations should help standardize descriptive information in the medical and health sciences education literature about the essential aspects of TBL activities and allow authors and reviewers to successfully replicate TBL implementations and draw meaningful conclusions about observed outcomes.

State Efforts to Identify Maltreated Children with Disabilities: A Follow-Up Study

Child abuse and neglect state liaison officers representing 50 states and 7 U.S. territories were surveyed regarding data collection procedures, accuracy of reporting, state assistance to local agencies, and training for child welfare workers in the area of maltreated children with disabilities. The current study is a replication of a similar survey conducted by Camblin in 1982. Results indicate that (a) more states provided assistance to local child welfare agencies than was reported in 1982, (b) the number of states that routinely collected disability information in child maltreatment cases had declined, (c) seven states documented specific disabilities in children, (d) two states reported on the number of children disabled as a result of abuse, (e) fewer states reported having accurate information on the incidence of disabled children reported for maltreatment, and (f) seven states required training in disabilities for child welfare workers, with an average of four hours required. Implications of the results for identifying and serving maltreated children with disabilities are discussed and recommendations for child welfare agencies are presented.

Meeting the Family: Promoting Humanism in Gross Anatomy

Background: Human dissection commonly occurs early in the undergraduate medical school curriculum, thus presenting an immediate opportunity for educators to teach and encourage humanistic qualities of respect, empathy, and compassion. Purpose: The purpose of this study was to measure the impact of the Donor Luncheon, a unique program in which medical students meet the families of the anatomical donor prior to dissection in the anatomy course at the University of Oklahoma College of Medicine. Methods: Students were randomized into groups of 8 to attend the luncheon and either met with family of the donor or attended the luncheon with no donor family present. A questionnaire measured students’ attitudes at 2 weeks, 6 weeks, and at the conclusion of the anatomy course. Results: Factor analysis revealed 5 scales. Analysis revealed statistically significant differences across time for Donor as Person, Dissection Process, and Donor as Patient and statistically significant differences between groups for Donor as Person and Donor as Patient. Conclusions: These results suggest that this program can provide students with the opportunity to maintain more humanistic attitudes at the beginning of their medical education career.

Enhancing humanism through gross anatomy: a pre-course intervention.

Context and setting At the University of Oklahoma College of Medicine, we designed a luncheon where the families of anatomy donors are invited to meet the students who will dissect the bodies of their relatives before the anatomy course begins. The luncheon was specifically designed so that the families of donors lunched with and became acquainted with the very students assigned to dissect their family member. Why the idea was necessary It is well documented that a certain dark humour is associated with gross anatomy classes in medical schools. We felt that meeting the families of donors and hearing their life narratives before beginning dissection would increase the level of professionalism in the anatomy laboratory. We also felt it would increase student empathy for the diseased donor’s suffering during life as the students went about the dissection. What was done A freshman class of medical students was randomised into groups of students who participated in the donor luncheon experience and students who did not. Families of donors to the anatomy programme were invited to a luncheon sponsored by the College of Medicine. They were asked to bring pictures and the life stories of the donors to share with the students. This luncheon took place during orientation in Year 1 of medical school. The idea was to personalise the donor so that the first patient the students encountered would have a name, a life story and thus a psychosocial history. We hypothesised that the experience of meeting the donor’s family and learning the donor’s life story would create empathy for the donor and his or her family. It was also hypothesised that less dark humour and cadaver tricks would be used by students who met with the families of donors. The students and families became acquainted and the families shared stories about their donor members over lunch. Evaluation of results and impact Evaluation was carried out using questionnaires in order to compare the 2 groups of students. Those exposed to the families of anatomy donors were more likely to think about the donor’s family during the gross anatomy course (a measure of empathic understanding) and were less likely to quit thinking of the donor as a human being and detach from the process. Both these findings were statistically significant. Interestingly, the group exposed to donor families approached the gross anatomy experience more intellectually than emotionally, compared with the non-exposed group. One student who participated in a cadaver trick was exposed for this behaviour in a 360-degree professionalism evaluation used during the course. This behaviour was seen as unprofessional by fellow students. In summary, we believe our results affirm that a programme such as the anatomy donor luncheon offered at the University of Oklahoma College of Medicine provides an ideal opportunity to teach and encourage humanistic qualities of respect, empathy and compassion.

Obstetrics and gynecology clerkship for males and females: similar curriculum, different outcomes?

Objective To determine if performance differences exist between male and female students on a 6-week obstetrics and gynecology (Ob/Gyn) clerkship and to evaluate potential variables that might underlie any observed variations. Study Design Final clerkship grades and component scores (clinical evaluations, objective structured clinical examination [OSCE], oral examination, and National Board of Medical Examiners [NBME] subject examination) from July 2007 to June 2010 were matched by student and analyzed by gender. Basic science grade point average (GPA) and initial United States Medical Licensing Exam (USMLE) Step 1 scores were used to establish students’ baseline medical knowledge. On a post-clerkship questionnaire, a subset of students reported the numbers of procedures they performed during the clerkship; students also completed online pre- and post-clerkship questionnaires reflecting their self-assessed confidence in womens health clinical skills. Results Scores were analyzed for 136 women and 220 men. Final clerkship grades were significantly higher for females than for males (89.05 vs. 87.34, p=0.0004, η 2=0.08). Specifically, females outscored males on the OSCE, oral, and NBME subject examination portions of the clerkship but not clinical evaluations. Males reported completing fewer breast examinations (p=0.001, η 2=0.14). Pre-clerkship, males were significantly less confident than females in womens health clinical skills (p<0.01) but reached similar levels upon completion of the clerkship. No gender differences were detected for basic science GPA and USMLE Step 1 scores. Conclusion Student gender is associated with final grades on an Ob/Gyn clerkship. Further research regarding these differences should be explored.

Changing the culture of a medical school by orienting students and faculty toward community medicine.

Oklahoma’s health status has been ranked among the worst in the country. In 1972, the University of Oklahoma established the Tulsa branch of its College of Medicine (COM) to expand the physician workforce for northeastern Oklahoma and to provide care for the uninsured patients of the area. In 2008, the Tulsa branch launched a distinct educational track, the University of Oklahoma COM’s School of Community Medicine (SCM), to prepare providers equipped and committed to addressing prevalent health disparities. The authors describe the Tulsa branch’s Summer Institute (SI), a signature program of the SCM, and how it is part of SCM’s process of institutional transformation to align its education, service, and research missions toward improving the health status of the entire region. The SI is a weeklong, prematriculation immersion experience in community medicine. It brings entering medical and physician assistant students together with students and faculty from other disciplines to develop a shared culture of community medicine. The SI uses an unconventional curriculum, based on Scharmer’s Theory U, which emphasizes appreciative inquiry, critical thinking, and collaborative problem solving. Also, the curriculum includes Professional Meaning conversations, small-group sessions to facilitate the integration of students’ observations into their professional identities and commitments. Development of prototypes of a better health care system enables participants to learn by doing and to bring community medicine to life. The authors describe these and other curricular elements of the SI, present early evaluation data, and discuss the curriculum’s incremental evolution. A longitudinal outcomes evaluation is under way.

Providing context for a medical school basic science curriculum: The importance of the humanities

Abstract Introduction: To increase students’ understanding of what it means to be a physician and engage in the everyday practice of medicine, a humanities program was implemented into the preclinical curriculum of the medical school curriculum. The purpose of our study was to determine how medical students’ views of being a doctor evolved after participating in a required humanities course. Methods: Medical students completing a 16-clock hour humanities course from 10 courses were asked to respond to an open-ended reflection question regarding changes, if any, of their views of being a doctor. The constant comparative method was used for coding; triangulation and a variety of techniques were used to provide evidence of validity of the analysis. Results: A majority of first- and second-year medical students (rr = 70%) replied, resulting in 100 pages of text. A meta-theme of Contextualizing the Purpose of Medicine and three subthemes: the importance of Treating Patients Rather than a Disease, Understanding Observation Skills are Important, and Recognizing that Doctors are Fallible emerged from the data. Conclusions: Results suggest that requiring humanities as part of the required preclinical curriculum can have a positive influence on medical students and act as a bridge to contextualize the purpose of medicine.

A Teaching Oath: A Commitment to Medical Students’ Learning and Development

Background: There are several oaths and affirmations that are integrated into the academic customs of the health sciences, such as the Hippocratic Oath and the Ethical Affirmation for Scientists. What current oaths do not communicate is that teaching and learning are the foundation of the professions. Summary: We articulated an oath to punctuate the important role of teaching and to emphasize that educating students is not a marginal responsibility but an important duty. The goal of this oath is to include all educators who contribute to teaching medical students, including basic science and clinical faculty, residents, nurses, and healthcare providers. This oath is also designed to be concise, allowing for a public declaration during ceremonies that call attention to teaching and learning. Conclusions: Publically declaring the Teaching Oath is an opportunity to clarify the highest standards of teaching and to energize educators to fulfill the promise of a dynamic learning community.