Steven A. Lieberman

Toward Defining the Foundation of the MD Degree: Core Entrustable Professional Activities for Entering Residency.

Currently, no standard defines the clinical skills that medical students must demonstrate upon graduation. The Liaison Committee on Medical Education bases its standards on required subject matter and student experiences rather than on observable educational outcomes. The absence of such established outcomes for MD graduates contributes to the gap between program directors’ expectations and new residents’ performance. In response, in 2013, the Association of American Medical Colleges convened a panel of experts from undergraduate and graduate medical education to define the professional activities that every resident should be able to do without direct supervision on day one of residency, regardless of specialty. Using a conceptual framework of entrustable professional activities (EPAs), this Drafting Panel reviewed the literature and sought input from the health professions education community. The result of this process was the publication of 13 core EPAs for entering residency in 2014. Each EPA includes a description, a list of key functions, links to critical competencies and milestones, and narrative descriptions of expected behaviors and clinical vignettes for both novice learners and learners ready for entrustment. The medical education community has already begun to develop the curricula, assessment tools, faculty development resources, and pathways to entrustment for each of the 13 EPAs. Adoption of these core EPAs could significantly narrow the gap between program directors’ expectations and new residents’ performance, enhancing patient safety and increasing residents’, educators’, and patients’ confidence in the care these learners provide in the first months of their residency training.

Medical student perception of the academic environment: a prospective comparison of traditional and problem-based curricula.

No abstract available.

Functional consequences of the somatopause and its treatment

The decline in the function of the growth hormone-releasing hormone, growth hormone, insulin-like growth factor (GHRH-GH-IGF) axis has been termed the somatopause. Many of the catabolic sequelae seen in normal aging has been attributed to this decrease in circulating GH and IGF-I. In order to provide hormone replacement therapy for the somatopause, elderly subjects have been treated with GH, IGF-I, or both hormones together. Whereas numerous beneficial effects on body composition, strength, and quality of life have been reported in some studies, other studies have reported only marginal functional imporvements. Moreover, it is clear that both hormones can cause significant morbidity.

The impact of structured student debates on critical thinking and informatics skills of second-year medical students.

Among its many facets, the field of medical informatics encompasses the use of technology to access and manage scientific information. The Association of American Medical Colleges (AAMC), through the Medical Informatics Objectives of the Medical School Objectives Project (MSOP) has identified five informatics-related roles of the physician and has established objectives for each of these roles. The lifelong learning role incorporates skills relating to information retrieval, evaluation, and reconciliation. Without activities specifically targeting these skills, it is an act of faith that students will graduate with adequate preparation in these areas. To explicitly address these curricular goals, second-year students in Endocrinology and Reproduction Course at the University of Texas Medical Branch in Galveston were required to participate in debates on controversial topics in these fields. This exercise provided a structured task for developing and improving skills in literature searching, critical thinking, including evaluation of the quality of studies, reconciling results of conflicting studies, teamwork, formal presentation and communication, and spontaneous scholarly discussion. A search of the Medline database produced only one article describing the use of student debates for acquiring content and developing critical thinking and communication skills in health science education. The paper describes a first-year pharmacy curriculum that incorporated debates on socioeconomic topics relevant to pharmacy practice. While these debates required critical analysis of issues, the primary focus was on content rather than cognitive or informatics-related skills. Published accounts of debates in a college chemistry course and business school provide qualitative descriptions of the beneficial effects of such exercises on critical thinking, updating knowledge, and communication skills. In a more quantitative approach, Allen et al. conducted a meta-analysis of the impact of formal instruction in communication skills (including debates) on critical thinking ability. Such training resulted in 44% increase in scores on tests of critical thinking. Compared with training in other communication skills, participation in ‘‘forensics’’ (i.e., competitive debates) produced the greatest improvement, although the differences did not achieve statistical significance. Finally, Johnson et al. performed a meta-analysis of the effects of a method they call ‘‘academic controversy’’ on a variety of cognitive outcomes. This method, which shares many features of the debates described in the current report, has produced ‘‘increased achievement and retention, higher-quality problem-solving and decision-making, more frequent creative insight, more thorough exchange of expertise, and greater task involvement’’ by students. The current report describes the implementation of structured debates and the evaluation by students and faculty of the degree to which the informatics objectives were accomplished. Method

Effects of comprehensive educational reforms on academic success in a diverse student body

Medical Education 2010: 44: 1232–1240

Introduction of patient video clips into computer-based testing: effects on item statistics and reliability estimates.

Purpose. Using patient video clips to evaluate examinees’ skills in interpreting physical examination findings is possible with computer-based testing, but the psychometric properties of video-based questions are unknown. Method. We developed parallel test questions incorporating video clips or text descriptions of abnormal neurologic findings and administered them to 106 fourth-year medical students finishing their Neurology Clerkship. Results. Overall, video-based questions had comparable difficulty and discrimination compared to analogous text-based questions. Preliminary studies indicated similar reliability with text- and video-based questions. Conclusions. The inclusion of patient video clips in computer-based testing is feasible from technical, practical, and psychometric perspectives. Further study is needed to gather validity evidence for this novel question format.

Growth hormone therapy in the elderly: Implications for the aging brain

Growth hormone (GH) secretion declines during normal aging, resulting in lower serum insulin-like growth factor (IGF)-I levels. It has been proposed that many of the catabolic changes seen in normal aging, including osteoporosis and muscle atrophy, are in part caused by the decreased action of the GH-IGF-I axis. In addition, patients with GH deficiency have increased overall cardiovascular mortality. Several investigators have initiated GH treatment for elderly patients with relative hyposomatotropinemia. Initial reports suggest that GH can increase muscle mass, improve exercise tolerance, increase REM sleep and cause an enhanced sense of well-being. The basis for neuropsychiatric changes during GH therapy may be due to a direct CNS action of GH itself, to the increased IGF-I secretion which GH elicits, or to enhanced functioning of peripheral organ systems. Long-term studies will determine whether GH or IGF-I can exert a neurotrophic action in the aging brain.

Growth hormone deficiency in adults: Characteristics and response to growth hormone replacement

Despite adequate adrenal, gonadal, and thyroid hormone replacement, many adults with hypopituitarism have a recognizable syndrome of weakness and diminished sense of well-being, accompanied by alterations in metabolism and body composition, as well as increased mortality. Short-term treatment with human growth hormone improves many of these abnormalities, but a clear improvement in functional status has yet to be demonstrated. Until such an effect is shown, the use of growth hormone replacement in adults with hypopituitarism remains investigational.

Integrating Geriatric Content into a Medical School Curriculum: Description of a Successful Model.

Abstract Most medical school curricula do not equip students with adequate attitudes, knowledge and skills to care for elderly populations. We describe an effective geriatric curricular infusion model compatible with preserving the overall curricula schema. Course and clerkship directors, staff and faculty from the Office of Educational Development, Center on Aging, curriculum committee and Associate/Assistant Deans of Education, and faculty from the schools of medicine, nursing, and allied health collaborated in the effort. Each of these components and institutional financial commitment were critical to successful basic science and clinical geriatric content infusion addressing the American Geriatric Society (AGS) Core Competencies. Delivery modalities included problem-based learning cases, lectures, standardized patient portrayals for teaching and assessment, and experiential activities with elderly. Assessments were conducted and outcomes tracked in several ways, including: (1) annual course reviews, focus groups, and student evaluations; (2) mandatory geriatrics 4th year graduation competency exam; and, (3) AAMC Graduation Questionnaire responses. Initial data indicate that student knowledge and competencies have increased with increasing exposure in the desired areas, and support infusion as a viable approach to enhancing gerontology and geriatric curricular content.

Cognitive benefits of problem-based learning: do they persist through clinical training?

The use of problem-based learning (PBL) is increasing in preclinical medical education. In comparison with students in traditional lecture-based curricula, students completing two-year PBL curricula report favorable changes in cognitive behaviors, specifically decreased reliance on rote memorization and greater reflection on the material they learn and how they learn. Students also report increased relevance of and greater satisfaction with their learning experience. Improved teamwork, an expected consequence of the small-group PBL environment, has been indirectly studied by assessing students’ relations with their peers, with mixed results in several studies. Of course, preclinical education represents only the first two years of medical training, which typically spans seven to ten years. It is not clear whether benefits derived from preclinical curriculum changes persist through the undergraduate clinical years, not to mention postgraduate training. We undertook the present study to examine whether differences in cognitive behaviors and intellectual satisfaction resulting from traditional and PBL preclinical curricula persisted through a common clinical curriculum.