Shou Ling Leong

Integrating Web-based computer cases into a required clerkship: development and evaluation.

Purpose To evaluate a five-year experience (1995–2000) developing and integrating computer cases into a required clerkship. Method In Study 1, 54 volunteer students were randomly assigned to study articles, a paper case, or a computer case on low back pain/kidney stones. Students were given an exam immediately after the exercise and one week later. In Study 2, 325 clerkship students were asked to select and complete two computer cases or to prepare assignments on unrelated topics. Among the cases offered were two test cases on low back pain/kidney stones and pneumonia. Questions specific to the computer test cases (CC) and other noncomputer cases (NCC) were in the final exam. Exam scores related to CC questions and NCC questions were compared between the groups of students who did and did not complete the computer cases. Students also rated the computer cases on a questionnaire. Results In Study 1, reading articles required the most time and received the most negative comments. The students who completed the computer case scored the best on the exam one week later. In Study 2, the students who completed the two computer cases scored significantly higher on the CC questions than did students who studied only one or none of the computer cases (p < .001). There was no difference among groups for the NCC scores (p = .76). Students rated the computer cases with a mean of 6 on a seven-point scale (7 = strongly agree). Conclusion Computer cases are effective learning tools, are well-received by students, and can be successfully integrated into existing clerkships.

A collaborative model for developing and maintaining virtual patients for medical education

There is great interest in using computer-assisted instruction in medical education, but getting computer-assisted instruction materials used broadly is difficult to achieve. We describe a successful model for the development and maintenance of a specific type of computer-assisted instruction – virtual patients – in medical education. The collaborative models seven key components are described and compared to other models of diffusion of innovation and curriculum development. The collaborative development model that began in one medical discipline is now extended to two additional disciplines, through partnerships with their respective clerkship director organizations. We believe that the ability to achieve broad use of virtual patients, and to transition the programs from successfully relying on grant funding to financially self-sustaining, resulted directly from the collaborative development and maintenance process. This process can be used in other learning environments and for the development of other types of computer-assisted instruction programs.

Tobacco world: evaluation of a tobacco cessation training program for third-year medical students.

Background Training in tobacco cessation counseling is deficient in medical schools. Tobacco World, a tobacco cessation training program, was implemented in a family medicine clerkship and subsequently evaluated. Method In the pilot year, students were assigned to either standard clerkship training (comparison group) or a group that also received Tobacco World training (intervention group). All students received intervention training in the second year of the study. A 35-item questionnaire was administered before and after the four-week clerkship to assess knowledge, attitude, and confidence regarding tobacco cessation counseling. Results Intervention training was highly rated. Students in the intervention group from both years demonstrated significant improvements in some key measurements of knowledge, attitude, confidence, and increased frequency of tobacco cessation counseling. Conclusions This smoking cessation training program addresses an underrepresented area of medical school education and has the potential to translate into improved smoking cessation counseling by future physicians.

Frequency and negative impact of medical student mistreatment based on specialty choice: a longitudinal study.

Purpose According to responses to the Association of American Medical Colleges’ Medical School Graduation Questionnaire, 17% to 20% of medical students report mistreatment. This study examined the longitudinal nature of medical student mistreatment based on specialty choice. Method From 2003 to 2010, the authors surveyed all medical students at one institution at the end of their third year, assessing the frequency and impact of any mistreatment based on specialty choice. They analyzed quantitative data on the frequency, impact, sources, and trends over time and qualitative data from students’ open-ended responses and compared data by specialty interest (primary care versus subspecialty). Results Of the 1,059 students sent the survey, 801 (76%) responded. Mistreatment based on specialty choice was common. The frequency and impact of such mistreatment were tightly correlated (Pearson r = 0.8, P < .001). The nature of mistreatment differed between students interested in primary care and those interested in a subspecialty, occurred more commonly on specific clerkships, and originated most often from resident physicians. Students perceived that teaching opportunities and evaluations were negatively affected by their specialty choice. An association was found between the theme of respect and students reconsidering their specialty choice. These patterns of mistreatment were stable over the study period, despite several professionalism initiatives. Conclusions Mistreatment based on specialty choice is a distinct and common phenomenon perpetuated by faculty, residents, and peers. More research is needed to explore the potential hidden curriculum drivers of these findings and to develop interventions specifically targeting this type of mistreatment.

Three-Year MD Programs: Perspectives From the Consortium of Accelerated Medical Pathway Programs (CAMPP)

In the last decade, there has been renewed interest in three-year MD pathway programs. In 2015, with support from the Josiah Macy Jr., Foundation, eight North American medical schools with three-year accelerated medical pathway programs formed the Consortium of Accelerated Medical Pathway Programs (CAMPP). The schools are two campuses of the Medical College of Wisconsin; McMaster University Michael G. DeGroote School of Medicine; Mercer University School of Medicine; New York University School of Medicine; Penn State College of Medicine; Texas Tech University Health Sciences Center School of Medicine; University of California, Davis School of Medicine; and University of Louisville School of Medicine. These programs vary in size and medical specialty focus but all include the reduction of student debt from savings in tuition costs. Each school’s mission to create a three-year pathway program differs; common themes include the ability to train physicians to practice in underserved areas or to allow students for whom the choice of specialty is known to progress more quickly. Compared with McMaster, these programs are small, but most capitalize on training and assessing competency across the undergraduate medical education–graduate medical education continuum and include conditional acceptance into an affiliated residency program. This article includes an overview of each CAMPP school with attention to admissions, curriculum, financial support, and regulatory challenges associated with the design of an accelerated pathway program. These programs are relatively new, with a small number of graduates; this article outlines opportunities and challenges for schools considering the development of accelerated programs.

fmCASES: Collaborative Development of Online Cases to Address Educational Needs.

Family medicine educators are realizing their dream: a set of online cases to teach the core curriculum of the family medicine clerkship, fulfilling the goal of a 10-year journey. In 1998, 65 STFM members met to discuss sharing of Web-based curricular materials. As education becomes more competency-based, educators needed to find ways to meet the Liaison Committee for Medical Education’s (LCME) ED-2 and ED-8 standards. Clerkship directors need to ensure there are comparable educational experiences and evaluation methods across all instructional sites (ED-8) and that each clerkship specify the numbers of patients (since revised), as well as the major disease states/conditions that all students must encounter in order to achieve the course’s learning objectives (ED-2). If a student does not encounter patients with a particular clinical condition, the student should be able to remedy the gap by a simulated experience. ED-2 is especially challenging for family medicine since most clerkships use a decentralized model with many sites, making standardization problematic. Leong et al have shown that computer-assisted online cases are effective learning tools and can be successfully integrated into clerkship.1 A task force was charged to explore using computer cases to address these requirements and to enhance learning for the students. A group of educators with the common vision of collaborative development of high quality online cases that would meet the educational needs of both STFM educators and students formally established the STFM Group on Online Cases in 2006. These cases are designed to teach the national curriculum defined by STFM and provide the resource for clerkship directors to meet LCME standards. The goal is to develop a product that is: high quality, meeting national standards, peer reviewed, and current serving the needs of STFM educators and medical students responsive to end users affordable sustainable a system to recognize and reward participation providing scholarship and academic productivity for writers and reviewers publishing a case

Roadmap for creating an accelerated three-year medical education program

ABSTRACT Medical education is undergoing significant transformation. Many medical schools are moving away from the concept of seat time to competency-based education and introducing flexibility in the curriculum that allows individualization. In response to rising student debt and the anticipated physician shortage, 35% of US medical schools are considering the development of accelerated pathways. The roadmap described in this paper is grounded in the experiences of the Consortium of Accelerated Medical Pathway Programs (CAMPP) members in the development, implementation, and evaluation of one type of accelerated pathway: the three-year MD program. Strategies include developing a mission that guides curricular development – meeting regulatory requirements, attaining institutional buy-in and resources necessary to support the programs, including student assessment and mentoring – and program evaluation. Accelerated programs offer opportunities to innovate and integrate a mission benefitting students and the public. Abbreviations: CAMPP: Consortium of accelerated medical pathway programs; GME: Graduate medical education; LCME: Liaison committee on medical education; NRMP: National residency matching program; UME: Undergraduate medical education