RESUMO
Given gaps in both identifying and providing targeted interventions to struggling learners, the purpose of this study is to both improve rapid identification and to improve individualized academic advising for learners using this visual representation of performance. Across three graduating classes, individual growth curves were calculated for each student on National Board of Medical Examiners customized assessments during the pre-clerkship period using their deviation from the class average at each assessment point. These deviation scores were cumulatively summed over time and were regressed onto the sequence of exams. We analyzed the difference between the regression slopes of those students placed on Academic Probation (AP) versus not, as well as differences in slopes based on the timing of when a struggling learner was placed on AP to explore learner trajectory after identification. Students on AP had an average growth slope of - 6.06 compared to + 0.89 for those not on AP. Findings also suggested that students who were placed on AP early during pre-clerkship showed significant improvement (positive changes in trajectory) compared to students identified later in the curriculum. Our findings suggest that earlier academic probation and intervention with struggling learners may have a positive effect on academic trajectory. Future research can better explore how academic trajectory monitoring and performance review can be regularly used in advising sessions with students.
Assuntos
Estágio Clínico , Educação de Graduação em Medicina , Estudantes de Medicina , Currículo , Avaliação Educacional , HumanosRESUMO
Construct: The definition of clinical reasoning may vary among health profession educators. However, for the purpose of this paper, clinical reasoning is defined as the cognitive processes that are involved in the steps of information gathering, problem representation, generating a differential diagnosis, providing a diagnostic justification to arrive at a leading diagnosis, and formulating diagnostic and management plans. Background: Expert performance in clinical reasoning is essential for success as a physician, and has been difficult for clerkship directors to observe and quantify in a way that fosters the instruction and assessment of clinical reasoning. The purpose of this study was to gather validity evidence for the Multistep exam (MSX) format used by our medicine clerkship to assess analytical clinical reasoning abilities; we did this by examining the relationship between scores on the MSX and other external measures of clinical reasoning abilities. This analysis used dual process theory as the main theoretical framework of clinical reasoning, as well as aspects of Kane's validity framework to guide the selection of validity evidence for the investigation. We hypothesized that there would be an association between the MSX (a three-step clinical reasoning tool developed locally), and the USMLE Step 2 CS, as they share similar concepts in assessing the clinical reasoning of students. We examined the relationship between overall scores on the MSX and the Step 2 CS Integrated Clinical Encounter (ICE) score, in which the student articulates their reasoning for simulated patient cases, while controlling for examinee's internal medicine clerkship performance measures such as the NBME subject exam score and the Medicine clerkship OSCE score. Approach: A total 477 of 487 (97.9%) medical students, representing the graduating classes of 2015, 2016, 2017, who took the MSX at the end of each medicine clerkship (2012-2016), and Step 2 CS (2013-2017) were included in this study. Correlation analysis and multiple linear regression analysis were used to examine the impact of the primary explanatory variables of interest (MSX) onto the outcome variable (ICE score) when controlling for baseline variables (Medicine OSCE and NBME Medicine subject exam). Findings: The overall MSX score had a significant, positive correlation with the Step 2 CS ICE score (r = .26, P < .01). The overall MSX score was a significant predictor of Step 2 CS ICE score (ß = .19, P < .001), explaining an additional 4% of the variance of ICE beyond the NBME Medicine subject score and the Medicine OSCE score (Adjusted R2 = 13%). Conclusion: The stepwise format of the MSX provides a tool to observe clinical reasoning performance, which can be used in an assessment system to provide feedback to students on their analytical clinical reasoning. Future studies should focus on gaining additional validity evidence across different learners and multiple medical schools.
Assuntos
Estágio Clínico/normas , Currículo/normas , Educação de Graduação em Medicina/métodos , Avaliação Educacional/estatística & dados numéricos , Medicina Interna/educação , Estudantes de Medicina/estatística & dados numéricos , Competência Clínica , Feminino , Humanos , Masculino , Estados UnidosRESUMO
There has been increased attention to and emphasis on competency-based medical education and the transformation from highly supervised medical students towards independent, entrustable physicians. We explored how program directors (PDs) justify decisions about whether they would trust finishing Post Graduate Year 1 (PGY1) residents to care for the PD or a loved one. Using an end of year survey with validity evidence, we assessed PDs' responses (Yes, No, Not Sure) and written comments about this entrustment decision for USUHS medical students from graduating classes of 2013-2015 (PGY1). We performed a qualitative inductive content analysis to identify themes in how PDs justified their decisions as well as descriptive statistics and a contingency table analysis to examine associations between trust decisions and election to membership in Alpha Omega Alpha (AOA), or conversely, referral to the Student Promotions Committee (SPC) for remediation. Qualitative analyses revealed five themes related to this trust decision about medical residents: personal, interpersonal, knowledge, competence, and developmental. Neither AOA status, nor SPC referral status was significantly associated with the trust measure, overall, but positive trust decisions were significantly higher among those elected to AOA than in those who were not. Positive trust decisions were significantly associated with AOA status but negative trust decisions were not significantly associated with referral to the SPC. This study offers insights into what attributes may underpin trust decisions by PDs. Our findings suggest that PDs' frequent use of personal and interpersonal characteristics to justify trust decisions contrasts with the use of clinical and knowledge based assessments during undergraduate medical education (UME), and emphasize the importance of critical intrinsic abilities.
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Docentes de Medicina , Família , Internato e Residência , Estudantes de Medicina , Confiança , Humanos , Análise Multivariada , Aprendizado Social , Inquéritos e QuestionáriosRESUMO
Theory: We used two theoretical frameworks for this study: a) experiential learning, whereby learners construct new knowledge based on prior experience, and learning grows out of a continuous process of reconstructing experience, and b) deliberate practice, whereby the use of testing (test-enhanced learning) promotes learning and produces better long-term retention. Hypothesis: We hypothesized that moving the USMLE Step 1 exam to follow the clerkship year would provide students with a context for basic science learning that may enhance exam performance. We also hypothesized that examination performance variables, specifically National Board of Medical Examiners (NBME) Customized Basic Science Examinations and NBME subject examinations in clinical disciplines would account for a moderate to large amount of the variance in Step 1 scores. Thus we examined predictors of USMLE Step 1 scores when taken after the core clerkship year. Method: In 2011, we revised our medical school curriculum and moved the timing of Step 1 to follow the clerkship year. We performed descriptive statistics, an ANCOVA to compare Step 1 mean scores for three graduating classes of medical students before and after the curriculum changes, and stepwise linear regression to investigate the association between independent variables and the primary outcome measure after curriculum changes. Results: 993 students took the Step 1 exam, which included graduating classes before (2012-2014, N = 491) and after (2015-2017, N = 502) the curriculum change. Step 1 scores increased significantly following curricular revision (mean 218, SD 18.2, vs. 228, SD 16.7, p < 0.01) after controlling for MCAT and undergraduate GPA. Overall, 66.4% of the variance in Step 1 scores after the clerkship year was explained by: the mean score on fourteen pre-clerkship customized NBME exams (p < 0.01, 57.0% R2); performance on the surgery NBME subject exam (p < 0.01, 3.0% R2); the pediatrics NBME subject exam (p < 0.01, 2.0% R2); the Comprehensive Basic Science Self-Assessment (p < .01, 2.0% R2) ; the internal medicine NBME subject exam (p < 0.01, 0.03% R2), pre-clerkship Integrated Clinical Skills score (p < 0.01, 0.05% R2), and the pre-matriculation MCAT (p < 0.01, 0.01% R2). Conclusion: In our institution, nearly two-thirds of the variance in performance on Step 1 taken after the clerkship year was explained mainly by pre-clerkship variables, with a smaller contribution emanating from clerkship measures. Further study is needed to uncover the specific aspects of the clerkship experience that might contribute to success on high stakes licensing exam performance.
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Estágio Clínico/normas , Currículo/normas , Educação de Graduação em Medicina/normas , Avaliação Educacional/normas , Logro , Feminino , Humanos , Licenciamento em Medicina , Masculino , Faculdades de Medicina/organização & administração , Estudantes de Medicina/estatística & dados numéricos , Estados UnidosRESUMO
BACKGROUND: Face-to-face formal evaluation sessions between clerkship directors and faculty can facilitate the collection of trainee performance data and provide frame-of-reference training for faculty. OBJECTIVE: We hypothesized that ambulatory faculty who attended evaluation sessions at least once in an academic year (attendees) would use the Reporter-Interpreter-Manager/Educator (RIME) terminology more appropriately than faculty who did not attend evaluation sessions (non-attendees). DESIGN: Investigators conducted a retrospective cohort study using the narrative assessments of ambulatory internal medicine clerkship students during the 2008-2009 academic year. PARTICIPANTS: The study included assessments of 49 clerkship medical students, which comprised 293 individual teacher narratives. MAIN MEASURES: Single-teacher written and transcribed verbal comments about student performance were masked and reviewed by a panel of experts who, by consensus, (1) determined whether RIME was used, (2) counted the number of RIME utterances, and (3) assigned a grade based on the comments. Analysis included descriptive statistics and Pearson correlation coefficients. KEY RESULTS: The authors reviewed 293 individual teacher narratives regarding the performance of 49 students. Attendees explicitly used RIME more frequently than non-attendees (69.8 vs. 40.4 %; p < 0.0001). Grades recommended by attendees correlated more strongly with grades assigned by experts than grades recommended by non-attendees (r = 0.72; 95 % CI (0.65, 0.78) vs. 0.47; 95 % CI (0.26, 0.64); p = 0.005). Grade recommendations from individual attendees and non-attendees each correlated significantly with overall student clerkship clinical performance [r = 0.63; 95 % CI (0.54, 0.71) vs. 0.52 (0.36, 0.66), respectively], although the difference between the groups was not statistically significant (p = 0.21). CONCLUSIONS: On an ambulatory clerkship, teachers who attended evaluation sessions used RIME terminology more frequently and provided more accurate grade recommendations than teachers who did not attend. Formal evaluation sessions may provide frame-of-reference training for the RIME framework, a method that improves the validity and reliability of workplace assessment.
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Estágio Clínico , Competência Clínica , Avaliação Educacional/métodos , Docentes de Medicina , Medicina Interna/educação , Adulto , Educação de Graduação em Medicina , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVES: The primary objectives of this study were to examine the regulatory processes of medical students as they completed a diagnostic reasoning task and to examine whether the strategic quality of these regulatory processes were related to short-term and longer-term medical education outcomes. METHODS: A self-regulated learning (SRL) microanalytic assessment was administered to 71 second-year medical students while they read a clinical case and worked to formulate the most probable diagnosis. Verbal responses to open-ended questions targeting forethought and performance phase processes of a cyclical model of SRL were recorded verbatim and subsequently coded using a framework from prior research. Descriptive statistics and hierarchical linear regression models were used to examine the relationships between the SRL processes and several outcomes. RESULTS: Most participants (90%) reported focusing on specific diagnostic reasoning strategies during the task (metacognitive monitoring), but only about one-third of students referenced these strategies (e.g. identifying symptoms, integration) in relation to their task goals and plans for completing the task. After accounting for prior undergraduate achievement and verbal reasoning ability, strategic planning explained significant additional variance in course grade (ΔR(2 ) = 0.15, p < 0.01), second-year grade point average (ΔR(2) = 0.14, p < 0.01), United States Medical Licensing Examination Step 1 score (ΔR(2) = 0.08, p < 0.05) and National Board of Medical Examiner subject examination score in internal medicine (ΔR(2) = 0.10, p < 0.05). CONCLUSIONS: These findings suggest that most students in the formative stages of learning diagnostic reasoning skills are aware of and think about at least one key diagnostic reasoning process or strategy while solving a clinical case, but a substantially smaller percentage set goals or develop plans that incorporate such strategies. Given that students who developed more strategic plans achieved better outcomes, the potential importance of forethought regulatory processes is underscored.
Assuntos
Competência Clínica/estatística & dados numéricos , Educação de Graduação em Medicina , Aprendizagem , Autoavaliação (Psicologia) , Estudantes de Medicina/psicologia , Adulto , Diagnóstico , Feminino , Objetivos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Análise de Regressão , Controles Informais da Sociedade , Pensamento/fisiologiaRESUMO
BACKGROUND: Competency-based medical education increasingly recognizes the importance of observation, feedback, and reflection for trainee development. Although bedside rounds provide opportunities for authentic workplace-based implementation of feedback and team-based reflection strategies, this relationship has not been well described. The authors sought to understand the content and timing of feedback and team-based reflection provided by bedside teachers in the context of patient-centered bedside rounds. METHODS: The authors conducted a thematic analysis qualitative study using transcripts from audio-recorded, semi-structured telephone interviews with internal medicine attending physicians (n= 34) identified as respected bedside teachers from 10 academic US institutions (2010-2011). RESULTS: Half of the respondents (50%) were associate/full professors, with an average of 14 years of academic experience. In the context of bedside encounters, bedside teachers reported providing feedback on history-taking, physical-examination, and case-presentation skills, patient-centered communication, clinical decision-making, leadership, teaching skills, and professionalism. Positive feedback about physical-exam skills or clinical decision-making occurred during encounters, positive or constructive team-based feedback occurred immediately following encounters, and individualized constructive feedback occurred in one-on-one settings following rounding sessions. Compared to less frequent, emotionally-charged events, bedside teachers initiated team-based reflection on commonplace "teachable moments" related to patient characteristics or emotions, trainee actions and emotions, and attending physician role modeling. CONCLUSIONS: Bedside teachers use bedside rounds as a workplace-based method to provide assessment, feedback, and reflection, which are aligned with the goals of competency-based medical education. Embedded in patient-centered activities, clinical teachers should be encouraged to incorporate these content- and timing-related feedback and reflection strategies into their bedside teaching.
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Educação Baseada em Competências , Docentes de Medicina , Retroalimentação , Internato e Residência , Adulto , Atitude do Pessoal de Saúde , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Assistência Centrada no Paciente , Estados UnidosRESUMO
Background: Teaching medical students the skills required to acquire, interpret, apply, and communicate clinical information is an integral part of medical education. A crucial aspect of this process involves providing students with feedback regarding the quality of their free-text clinical notes. Objective: The goal of this study was to assess the ability of ChatGPT 3.5, a large language model, to score medical students' free-text history and physical notes. Methods: This is a single-institution, retrospective study. Standardized patients learned a prespecified clinical case and, acting as the patient, interacted with medical students. Each student wrote a free-text history and physical note of their interaction. The students' notes were scored independently by the standardized patients and ChatGPT using a prespecified scoring rubric that consisted of 85 case elements. The measure of accuracy was percent correct. Results: The study population consisted of 168 first-year medical students. There was a total of 14,280 scores. The ChatGPT incorrect scoring rate was 1.0%, and the standardized patient incorrect scoring rate was 7.2%. The ChatGPT error rate was 86%, lower than the standardized patient error rate. The ChatGPT mean incorrect scoring rate of 12 (SD 11) was significantly lower than the standardized patient mean incorrect scoring rate of 85 (SD 74; P=.002). Conclusions: ChatGPT demonstrated a significantly lower error rate compared to standardized patients. This is the first study to assess the ability of a generative pretrained transformer (GPT) program to score medical students' standardized patient-based free-text clinical notes. It is expected that, in the near future, large language models will provide real-time feedback to practicing physicians regarding their free-text notes. GPT artificial intelligence programs represent an important advance in medical education and medical practice.
Assuntos
Estudantes de Medicina , Humanos , Estudos Retrospectivos , Educação de Graduação em Medicina/métodos , Avaliação Educacional/métodos , Idioma , Anamnese/métodos , Anamnese/normas , Competência Clínica/normas , MasculinoRESUMO
PURPOSE: Competency-based medical education (CBME) represents a shift to a paradigm with shared definitions, explicit outcomes, and assessments of competence. The groundwork has been laid to ensure all learners achieve the desired outcomes along the medical education continuum using the principles of CBME. However, this continuum spans the major transition from undergraduate medical education (UME) to graduate medical education (GME) that is also evolving. This study explores the experiences of medical educators working to use CBME assessments in the context of the UME-GME transition and their perspectives on the existing challenges. METHOD: This study used a constructivist-oriented qualitative methodology. In-depth, semistructured interviews of UME and GME leaders in CBME were performed between February 2019 and January 2020 via Zoom. When possible, each interviewee was interviewed by 2 team members, one with UME and one with GME experience, which allowed follow-up questions to be pursued that reflected the perspectives of both UME and GME educators more fully. A multistep iterative process of thematic analysis was used to analyze the transcripts and identify patterns across interviews. RESULTS: The 9 interviewees represented a broad swath of UME and GME leadership positions, though most had an internal medicine training background. Analysis identified 4 overarching themes: mistrust (a trust chasm exists between UME and GME); misaligned goals (the residency selection process is antithetical to CBME); inadequate communication (communication regarding competence is infrequent, often unidirectional, and lacks a shared language); and inflexible timeframes (current training timeframes do not account for individual learners' competency trajectories). CONCLUSIONS: Despite the mutual desire and commitment to move to CBME across the continuum, mistrust, misaligned goals, inadequate communication, and inflexible timeframes confound such efforts of individual schools and programs. If current efforts to improve the UME-GME transition address the themes identified, educators may be more successful implementing CBME along the continuum.
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Educação de Graduação em Medicina , Educação Médica , Internato e Residência , Humanos , Educação de Graduação em Medicina/métodos , Competência Clínica , Educação de Pós-Graduação em Medicina , Educação Baseada em Competências/métodosRESUMO
BACKGROUND: Medical educators believe bedside rounds are effective for the delivery of patient-centered care, and are necessary in helping trainees acquire competence in clinical care. Although recommendations for bedside rounds have been reported, a recent, systematic assessment of strategies used by current-day bedside teachers was needed to advance knowledge of this teaching method. OBJECTIVE: To identify and understand bedside teachers' 1) preparatory steps, 2) patient selection, and 3) role allocation during the process of bedside rounds. DESIGN: A qualitative inductive thematic analysis using transcripts from audio-recorded, semi-structured telephone interviews. PARTICIPANTS: Internal medicine physicians (n = 34) who perform bedside rounds from ten academic US institutions (2010-2011). APPROACH: A purposive sampling strategy was utilized to identify physicians who were active inpatient attending physicians and met specific inclusion criteria for "bedside rounds." A total of 34 interviews were completed, and each was recorded and transcribed verbatim. A thematic analysis extracted key themes pertaining to the three objectives. KEY RESULTS: Most respondents (51 %) were associate or full professors, with an average of 14 years of academic experience. Attending physicians prepared using trainee-specific, patient-specific and disease-specific information, while also mentally preparing for bedside rounds. They sought trainee buy-in and learning objectives, reviewed expectations and methods to ensure patient comfort, and provided early guidance with bedside encounters. Patients were selected if they required immediate care, were new to the service, or had a high educational value, while patients were deferred if unavailable, unwilling, or unable to communicate. The team members' roles during bedside rounds varied, with trainees being given graduated autonomy with increased experience. CONCLUSIONS: Bedside teachers' methods for preparation, patient selection, and role allocation during bedside rounds enhance trainees' education within the workplace. Strategies used by experienced bedside teachers can be used for faculty development efforts aimed at promoting this activity.
Assuntos
Centros Médicos Acadêmicos , Educação Médica/métodos , Medicina Interna/educação , Corpo Clínico Hospitalar/educação , Visitas de Preceptoria/métodos , Humanos , Internato e Residência/métodos , Seleção de Pacientes , Assistência Centrada no Paciente , Papel do Médico , Relações Médico-Paciente , Pesquisa Qualitativa , Estados UnidosRESUMO
BACKGROUND: Residency work hour restrictions in 2003 changed medical student participation in overnight call. PURPOSES: The goal is to compare experiences, attitudes, and skills between medical students who did and did not participate in overnight call. METHODS: Using a retrospective cohort design, all students at one medical school received a survey at the end of their 3rd-year internal medicine clerkship. Students at 3 clerkship sites were required to take overnight call, and students at 2 sites were not. RESULTS: One hundred four of 167 (62%) students participated. Sixty-one of 104 (59%) took overnight call. Overnight call students reported improved team relationships and were able to evaluate more unstable "cross-cover" patients. Students who took overnight call were more likely to state it was worthwhile (58% vs. 34%; p = .034). Overnight call led to fatigue and the perception of interference with didactics. CONCLUSIONS: Overnight call within the internal medicine clerkship has positive and negative effects. With new residency work hour restrictions, schools may consider innovative ways to preserve the positive experiences while working to minimize fatigue and interference with learning.
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Plantão Médico , Estágio Clínico , Competência Clínica , Medicina Interna/educação , Estudantes de Medicina/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Effective written communication is a core competency for medical students, but it is unclear whether or how this skill is evaluated in clinical clerkships. PURPOSE: This study identifies current requirements and practices regarding required written work during internal medicine clerkships. METHODS: In 2010, Clerkship Directors of Internal Medicine (CDIM) surveyed its institutional members; one section asked questions about students' written work. RESULTS were compared to similar, unpublished CDIM 2001 survey questions. RESULTS: Requirements for student-written work were nearly universal (96% in 2001 and 100% in 2010). Only 23% used structured evaluation forms and 16% reported written work was weighted as a percentage of the final grade, although 72% of respondents reported that written work was "factored" into global ratings. CONCLUSIONS: Despite near universal requirements for student written work, structured evaluation was not commonly performed, raising concern about the validity of factoring these assessments into grades.
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Estágio Clínico , Medicina Interna/educação , Anamnese , Exame Físico , Adulto , Canadá , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados UnidosRESUMO
BACKGROUND: Bedside rounds have decreased on teaching services, raising concern about trainees' clinical skills and patient-physician relationships. PURPOSE: We sought to identify recognized bedside teachers' perceived value of bedside rounds to assist in the promotion of bedside rounds on teaching services. METHODS: Authors used a grounded theory, qualitative study design of telephone semistructured interviews with bedside teachers (n = 34) from 10 U.S. institutions (2010-2011). Main outcomes were characteristics of participants, themes pertaining to the perceived value of bedside rounds, and quotations highlighting each respective theme. RESULTS: The mean years in academic medicine was 13.7, and 51% were associate or full professors. Six main themes emerged: (a) skill development for learners (e.g., physical examination, communication, and clinical decision-making skills); (b) observation and feedback; (c) role-modeling; (d) team building among trainees, attending, and patient; (e) improved patient care delivery through combined clinical decision-making and team consensus; and (f) the culture of medicine as patient-centered care, which was embodied in all themes. CONCLUSIONS: Bedside teachers identify potential benefits of bedside rounds, many of which align with national calls to change our approach to medical education. The practice of bedside rounds enables activities essential to high-quality patient care and education.
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Atitude do Pessoal de Saúde , Visitas de Preceptoria/métodos , Centros Médicos Acadêmicos , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Masculino , Assistência Centrada no Paciente , Quartos de Pacientes , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Estados UnidosRESUMO
INTRODUCTION: Virtual patient cases (VPCs), a type of simulated, interactive electronic learning, are a potentially important tool for military health care providers in austere or pandemic settings to maintain skills but need more validation. Our military internal medicine clerkship is spread across military treatment facilities around the country and has 15 weekly live student lectures, but students randomly miss the first, second, or third 5 weeks due to their psychiatry clerkship. We hypothesized that VPCs would be an adequate replacement for lost lectures. MATERIALS AND METHODS: We compared live lectures to a web-based VPC and analyzed the academic outcomes of 734 students from 2015 to 2022. RESULTS: Using our end-of-clerkship Script Concordance Test (SCT) as the primary outcome, there was no significant difference in performance between the 2 learning methods (VPC, 63.9% correct; lectures 63.2%, P = .27). After controlling for gender, baseline knowledge, and the total number of VPCs completed, there was still not a statistically significant difference between teaching methods (F(1,728) = 0.52, P = .47). There was also no significant differences in all other clerkship outcomes including National Board of Medical Examiner and Objective Structured Clinical Examination scores. CONCLUSION: VPCs appear noninferior at teaching clinical reasoning as measured by SCT. VPCs might be substituted for traditional, live lectures in clerkships when time or other resources are limited, in austere environments such as military deployments, or during conditions limiting interpersonal contact such as pandemics but are not a complete substitution for in-person learning.
Assuntos
Estágio Clínico , Treinamento por Simulação , Estudantes de Medicina , Humanos , Estágio Clínico/métodos , Estudantes , Aprendizagem , Medicina Interna/educação , CurrículoRESUMO
Background Specialty-specific individualized learning plans (ILPs) have been promoted to improve the undergraduate to graduate medical education transition, yet few pilots have been described. Objective To create and report on the feasibility and acceptability of a pilot internal medicine (IM) ILP template. Methods The ILP was created by a group of diverse IM expert stakeholders and contained questions to stimulate self-reflection and collect self-reported readiness data from incoming interns. US IM residency programs were invited to pilot the ILP with interns in spring 2022. Data was used at the programs' discretion. The pilot was evaluated by a post-pilot survey of programs to elicit perceptions of the impact and value of the ILP and analyze anonymous ILP data from 3 institutions. Results Fifty-two IM residency programs agreed to participate with a survey response rate of 87% (45 of 52). Of responding programs, 89% (40 of 45) collected ILPs, thus we report on data from these 40 programs. A total of 995 interns enrolled with 782 completing ILPs (79%). One hundred eleven ILPs were analyzed (14%). Most programs found the ILP valuable to understand incoming interns' competencies (26 of 40, 65%) and areas for improvement (24 of 40, 60%) and thought it should continue (29 of 40, 73%). Programs estimated the ILP took interns 29.2±14.9 minutes and 21.6±10.3 minutes for faculty mentors to complete. The most common barrier was faculty mentor participation. Conclusions An ILP based on interns' self-reported data was feasible and valuable to IM residency programs in understanding interns' competencies and areas for improvement.
Assuntos
Internato e Residência , Humanos , Competência Clínica , Educação de Pós-Graduação em Medicina , Currículo , Avaliação Educacional/métodosRESUMO
Introduction: Self-regulated learning is a cyclical process of forethought, performance, and self-reflection that has been used as an assessment tool in medical education. No prior studies have evaluated SRL processes for answering multiple-choice questions (MCQs) and most evaluated one or two iterations of a non-MCQ task. SRL assessment during MCQs may elucidate reasons why learners are successful or not on these questions that are encountered repeatedly during medical education. Methods: Internal medicine clerkship students at three institutions participated in a SRL microanalytic protocol that targeted strategic planning, metacognitive monitoring, causal attributions, and adaptive inferences across seven MCQs. Responses were transcribed and coded according to previously published methods for microanalytic protocols. Results: Forty-four students participated. In the forethought phase, students commonly endorsed prioritizing relevant features as their diagnostic strategy (n = 20, 45%) but few mentioned higher-order diagnostic reasoning processes such as integrating clinical information (n = 5, 11%) or comparing/contrasting diagnoses (n = 0, 0%). However, in the performance phase, students' metacognitive processes included high frequencies of integration (n = 38, 86%) and comparing/contrasting (n = 24, 55%). In the self-reflection phase, 93% (n = 41) of students faulted their management reasoning and 84% (n = 37) made negative references to their abilities. Less than 10% (n = 4) of students indicated that they would adapt their diagnostic reasoning process for these questions. Discussion: This study describes in detail student self-regulatory processes during MCQs. We found that students engaged in higher-order diagnostic reasoning processes but were not explicit about it and seldom reflected critically on these processes after selecting an incorrect answer. Self-reflections focused almost exclusively on management reasoning and negative references to abilities which may decrease self-efficacy. Encouraging students to identify and evaluate diagnostic reasoning processes and make attributions to controllable factors may improve performance.
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Educação de Graduação em Medicina , Educação Médica , Estudantes de Medicina , Humanos , Estudantes de Medicina/psicologia , Educação de Graduação em Medicina/métodos , Aprendizagem , Avaliação Educacional/métodosRESUMO
This Guide reviews theories of science that have influenced the development of common educational evaluation models. Educators can be more confident when choosing an appropriate evaluation model if they first consider the model's theoretical basis against their program's complexity and their own evaluation needs. Reductionism, system theory, and (most recently) complexity theory have inspired the development of models commonly applied in evaluation studies today. This Guide describes experimental and quasi-experimental models, Kirkpatrick's four-level model, the Logic Model, and the CIPP (Context/Input/Process/Product) model in the context of the theories that influenced their development and that limit or support their ability to do what educators need. The goal of this Guide is for educators to become more competent and confident in being able to design educational program evaluations that support intentional program improvement while adequately documenting or describing the changes and outcomes-intended and unintended-associated with their programs.
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Modelos Educacionais , Avaliação de Programas e Projetos de Saúde/métodos , Modelos Lineares , Dinâmica não LinearRESUMO
This article was written to provide a brief history of the medical educational system in the USA, the current educational structure, and the current topics and challenges facing USA medical educators today. The USA is fortunate to have a robust educational system, with over 150 medical schools, thousands of graduate medical education programs, well-accepted standardized examinations throughout training, and many educational research programs. All levels of medical education, from curriculum reform in medical schools and the integration of competencies in graduate medical education, to the maintenance of certification in continuing medical education, have undergone rapid changes since the turn of the millennium. The intent of the changes has been to involve the patient sooner in the educational process, use better educational strategies, link educational processes more closely with educational outcomes, and focus on other skills besides knowledge. However, with the litany of changes have come increased regulation without (as of yet) clear evidence as to which of the changes will result in better physicians. In addition, the USA governmental debt crisis threatens the current educational structure. The next wave of changes in the USA medical system needs to focus on what particular educational strategies result in the best physicians and how to fund the system over the long term.