Susan Baillie

An Innovative Program to Augment Community Preceptors' Practice and Teaching Skills

Medical students currently interface more and more with community-based physicians, many of whom have little training or experience as educators. They also start their ambulatory experiences from the beginning of their medical school training, not just at the clerkship year. This has prompted substantial literature on the need for improved faculty development for community preceptors, which is widely believed to be inadequate at present. The authors describe a novel program, designed to augment community preceptor teaching skills and practice behaviors, focusing on topics relating to humanism, communication, and psychosocial issues common in primary care. The program was conducted for four years beginning in 1999 and organized around acknowledged attributes of successful adult learning, and used case-based, small-group sessions, where individual community preceptors were each asked to “teach” a series of standardized students, in front of the group, regarding issues raised by a number of hypothetical patient cases. The standardized students had in turn been trained by the authors to interact with the participating faculty in a defined manner. The small-group sessions were led by community “opinion leaders” who had been chosen for this role by the participants, and who themselves first underwent training by the authors to familiarize them with core concepts felt to be essential to the program. At the conclusion of the entire process, surveys of the opinion leaders, the other community preceptor participants, and the standardized students suggested that the program did stimulate significant changes in attitude and behavior, although further research is needed to confirm this.

Relationship between medical student perceptions of mistreatment and mistreatment sensitivity

Background: National statistics reveal that efforts to reduce medical student mistreatment have been largely ineffective. Some hypothesize that as supervisors gain skills in professionalism, medical students become more sensitive. Aims: The purpose of this study was to determine if medical student perceptions of mistreatment are correlated with mistreatment sensitivity. Method: At the end of their third year, 175 medical students completed an Abuse Sensitivity Questionnaire, focused on student assessment of hypothetical scenarios which might be perceived as abusive, and the annual Well-Being Survey, which includes measurement of incident rates of mistreatment. It was hypothesized that those students who identified the scenarios as abusive would also be more likely to perceive that they had been mistreated. Results: Student perceptions of mistreatment were not statistically correlated with individuals responses to the scenarios or to a statistically derived abuse sensitivity variable. There were no differences in abuse sensitivity by student age or ethnicity. Women were more likely than men to consider it “harsh” to be called incompetent during rounds (p < 0.0005). Conclusion: This study provides preliminary evidence that challenges the hypothesis that medical students who perceive mistreatment by their superiors are simply more sensitive.

Integrating Case Topics in Medical School Curriculum to Enhance Multiple Skill Learning: Using Fetal Alcohol Spectrum Disorders as an Exemplary Case

ObjectivesThis article describes the use of fetal alcohol spectrum disorders (FASDs) as a theme to connect the learning of basic neurosciences with clinical applications across the age span within a systems-based, integrated curricular structure that emphasizes problem-based learning.MethodsIn collaboration with the Centers for Disease Control and Prevention (CDC) and the National Organization on Fetal Alcohol Syndrome, the Western Regional Training Center for Fetal Alcohol Exposure at UCLA developed and integrated educational materials on FASDs into the curriculum for first-year medical students.ResultsQuantitative and qualitative evaluations suggested materials were effective in enhancing student knowledge and skills related to FASDs, as well as embryology, brain development, substance abuse developmental psychopathology and medical ethics.ConclusionThe use of a unifying theme integrating basic science and clinical information and skills is effective for medical student training in the prevention and treatment of common medical problems.

Educating Health Professionals about Fetal Alcohol Spectrum Disorders

Abstract Prenatal exposure to alcohol is a leading preventable cause of birth defects and developmental disabilities. Individuals exposed to alcohol during fetal development can have physical, mental, behavioral, and learning disabilities, with lifelong implications. These conditions are known as fetal alcohol spectrum disorders (FASDs). Health care professionals play a crucial role in identifying women at risk for an alcohol-exposed pregnancy and in identifying the effects of prenatal alcohol exposure among individuals. The Centers for Disease Control and Preventions National Center on Birth Defects and Developmental Disabilities has funded four universities as FASD Regional Training Centers (RTCs). The RTCs, in collaboration with the CDC and the National Organization on Fetal Alcohol Syndrome, are developing, implementing, and evaluating educational curricula for medical and allied health students and practitioners and seeking to have the curricula incorporated into training programs at each grantees university or college, into other schools throughout the region, and into the credentialing requirements of professional boards. This article highlights some of the innovative training approaches that the RTCs are implementing to increase knowledge regarding FASDs and the ability of health professionals to identify, treat, and prevent these conditions.

Chaplain Rounds: A Chance for Medical Students to Reflect on Spirituality in Patient-Centered Care

ObjectiveThis study assesses the perceived impact of a required half-day with a hospital chaplain for first-year medical students, using a qualitative analysis of their written reflections.MethodsStudents shadowed chaplains at the UCLA hospital with the stated goal of increasing their awareness and understanding of the spiritual aspects of health care and the role of the chaplain in patient care. Participation in the rounds and a short written reflection on their experience with the chaplain were required as part of the first-year Doctoring course.ResultsThe qualitative analysis of reflections from 166 students using grounded theory yielded four themes: (1) the importance of spiritual care, (2) the chaplain’s role in the clinical setting, (3) personal introspection, and (4) doctors and compassion.ConclusionsGoing on hospital rounds with a chaplain helps medical students understand the importance of spirituality in medicine and positively influences student perceptions of chaplains and their work.

Instruction and Assessment of Competencies: Two Sides of the Same Coin

Six core competencies, as defined by the Accreditation Council for Graduate Medical Education (ACGME), offer a conceptual framework to address the knowledge and skills needed by students in training and doctors to perform competently. The question of interest for educators is “how” residents perceive they acquire proficiency in the core competencies. An annual survey was sent to all residents at UCLA from 2007 to 2010. Survey questions asked trainees across various programs about the helpfulness of specific predefined learning activities in acquiring the competencies. Responses from 1378 PGY1-3 residents in 12 ACGME-accredited residency programs were analyzed. Patient care activities and observation of attendants and peers were listed as the two most helpful learning activities for acquiring all six core competencies. The findings reinforce the importance of learning from role models during patient care activities and the heterogeneity of learning activities needed for acquiring all the competencies. The fact that competencies are multidimensional and interconnected makes it highly unlikely that a single approach to teaching or assessment will be sufficient for their acquisition. Hence, multiple methods for teaching and learning are necessary for the acquisition of the competencies.

Teaching pre-clerkship clinical skills via clinical exposure.

Context and setting Clinical skills development has increasingly become a leading objective of pre-clerkship medical education. Authentic patient care experiences foster desired clinical competencies, generate enthusiasm about learning, and facilitate passage into clerkships. At our institution, an integrated, problem-orientated curriculum includes doctoring and clinical skills threads woven across the first 2 years. Within this context, we describe 2 innovative paediatrics clinical skills workshops designed to expose Year 1 and 2 medical students to clinical education objectives in a practice-based environment. Why the idea was necessary Pre-clerkship education offers medical students limited opportunities to observe or practise patient care in a clinical environment. However, students need to be situated in a clinical context to comprehend the complexity of competencies applied in patient care. The workshops in paediatric clinical care were designed to overcome the limitations of pre-clinical education and explicitly address clinical education objectives. What was done The workshops introduced students to essential skills of paediatric clinical care and provided opportunities for:

Using Fetal Alcohol Syndrome as an integrating curricular theme

Context: In 2003, UCLA introduced a new, systemsbased, integrated curricular structure for first year medical students. The curriculum emphasises small group and independent learning, limiting lectures to 10 h per week. A problem-based learning (PBL) case presents the clinical theme of each week, and provides the framework for incorporating the basic science learning. The exemplary case: In an integrated curriculum organised around a clinical case, the ideal case simultaneously serves as an exemplar that assists students in integrating their knowledge, while teaching them about commonly encountered diseases. Fetal Alcohol Syndrome (FAS) was chosen as a commonly encountered clinical disorder, which was able to carry teaching about the basic sciences of embryology, neuroanatomy and brain development, and epidemiology, as well as other important clinical topics such as ethics and law, counselling, and health behaviour. During the portion of the curriculum covering the neurosciences, a week was designed to address ‘Nurture or Nature’ using FAS as an exemplar clinical case. A PBL case began the week with a webadministered presentation of a school-aged child with physical features and learning and behaviour problems potentially attributable to a number of prenatal (including alcohol, cocaine, and nicotine exposure) and postnatal factors. An evidence-based portion of PBL required students to investigate the literature to either research a related learning issue or to defend or refute the position that ‘It is safe for a woman to drink a little during pregnancy’. The PBL case ended with a discussion of the impact of fetal alcohol exposure on child development and ‘hands-on’ practice screening a child for FAS, including conducting a facial dysmorphology exam to assess physical features associated with prenatal alcohol exposure. In another exercise, small groups of students worked with a standardised patient case learning to screen adolescents for alcohol and drug use and practising a brief intervention to reduce binge drinking. A portion of a Law and Order television episode in which a woman is prosecuted for drinking while pregnant facilitated students’ consideration of legal and ethical issues as they formed juries and wrestled with a verdict. Evaluation: Results of assessments and course evaluations by the 146 students completing the FAS elements of the curriculum suggest increased awareness, knowledge and appreciation of the potential damage alcohol causes to the developing embryo and fetus and the consequences of FAS to the family and broader society. On a quiz testing knowledge of alcohol’s effect on the fetus, students completing the embryology lab had a mean score of 5.65 (maximum 1⁄4 6) and rated the lab’s effectiveness as 4.11 (maximum 1⁄4 5). Students attained a mean score of 4.31 (maximum 1⁄4 5) on the FAS items in the weekly quiz. Students’ end of course evaluations yielded mean ratings of 3.7 and 3.6 on the FAS-related PBL and standardised patient cases, respectively, using a 5-point scale (1 1⁄4 not effective; 5 1⁄4 very effective). These rating compared favourably to ratings of other first year cases in the curriculum.