A PGY1 curriculum--meeting a need for changing times.

A systematic process is described that produced a PGY1 curriculum for the surgical residents at Medical College of Wisconsin. The process involved faculty and residents. Topics were selected based on the six general competencies. Objectives were developed for all topics. The curriculum was delivered to the residents while they were off clinical duty. This Protected Block Curriculum approach was chosen to facilitate the learning structure of the curriculum. Feedback was positive, learning objectives appeared to be achieved and the plan is to continue to develop the PGY1 curriculum in the same format.

Web-based curriculum. A practical and effective strategy for teaching women's health.

OBJECTIVE: To address the need for women's health education by designing, implementing, and evaluating a self-study, web-based women's health curriculum. DESIGN: Cohort of students enrolled in the ambulatory portion of the medicine clerkship with comparison group of students who had not yet completed this rotation. PARTICIPANTS/SETTING: Third- and fourth-year medical students on the required medicine clerkship (115 students completed the curriculum; 158 completed patient-related logs). INTERVENTION: Following an extensive needs assessment and formulation of competencies and objectives, we developed a web-based women's health curriculum completed during the ambulatory portion of the medicine clerkship. The modules were case based and included web links, references, and immediate feedback on posttesting. We discuss technical issues with implementation and maintenance. MEASUREMENTS AND MAIN RESULTS: We evaluated this curriculum using anonymous questionnaires, open-ended narrative comments, online multiple-choice tests, and personal digital assistant (PDA) logs of patient-related discussions of women's health. Students completing the curriculum valued learning women's health, preferred this self-directed learning over lecture, scored highly on knowledge tests, and were involved in more and higher-level discussions of women's health with faculty (P<.001). CONCLUSIONS: We present a model for the systematic design of a web-based women's health curriculum as part of a medicine clerkship. The web-based instruction resolved barriers associated with limited curriculum time and faculty availability, provided an accessible and standard curriculum, and met the needs of adult learners (with their motivation to learn topics they value and apply this knowledge in their daily work). We hypothesize that our web-based curriculum spurred students to later discuss these topics with faculty. Web-based learning may be particularly suited for women's health because of its multidisciplinary nature and need for vertical integration throughout medical school curricula.

Learning activities and high-quality teaching: perceptions of third-year IM clerkship students.

PURPOSE: To identify learning activities that students associate with high-quality teaching on a clinical rotation. METHOD: From July to December 2001, data on patient encounters, learning activities, and teaching quality were collected via personal hand-held computers from 82 medical students during a required third-year internal medicine (IM) clerkship at the Medical College of Wisconsin, Milwaukee. Univariate (chi-square test) and multivariate analysis (stepwise multiple logistic regression) were performed to assess the association between learning activities and students' perceptions of teaching quality during this rotation. RESULTS: A total of 1,839 patient encounters were recorded: 62% of these occurred in the inpatient setting and 38% in outpatient clinics. In 80% of all encounters, students reported that they gave an oral case presentation and proposed a plan; they reported receiving high-quality feedback after 64% of these presentations. Univariate analysis demonstrated that the students' perception of high-quality teaching was associated with being on an inpatient rotation, formulating an assessment, proposing a plan, presenting to the attending physician with other members of the team present, giving an oral case presentation, and receiving high-quality feedback (p <.01). Multivariate analysis demonstrated that receiving high-quality feedback (odds ratio [OR] 4.5; 95% CI 3.57-6.25) and proposing a plan (OR 2.3; 95% CI 1.4-3.9) were the two strongest predictors of high, overall teaching quality. CONCLUSION: Receiving high-quality feedback from faculty and proposing a plan were the learning activities most strongly associated with students' perception of high-quality teaching on a required third-year IM clerkship.

Meeting the Accreditation Council for Graduate Medical Education competencies using established residency training program assessment tools.

BACKGROUND: Most existing residency evaluation tools were constructed to evaluate the Accreditation Council for Graduate Medical Education (ACGME) competencies. METHODS: Before ACGME's six competency based assessment requirements for resident performance were developed, we created a residency evaluation tool with 5 domains important to successful surgical resident performance. Reliability was determined after 6 months of use. Factor analysis assessed whether the evaluation tool was a construct-valid measure of the ACGME competencies. RESULTS: Three hundred forty-three evaluations for 36 surgical residents were tested. The original evaluation tool was highly reliable with an overall reliability of 0.97. Factor analysis defined 4 new combinations of questions analogous to 4 of the ACGME competencies: professionalism (reliability 0.95), patient care (reliability 0.93), medical knowledge (reliability 0.92), and communication (reliability 0.92). The new competency clusters were correlated with each other to a moderate degree. CONCLUSIONS: Our locally developed tool demonstrated high reliability and construct validity for 4 of 6 ACGME competencies. The correlation between factors suggests overlap between competencies.

Outcomes results from the evaluation of the APA/HRSA Faculty Scholars Program.

BACKGROUND: The goal of the Ambulatory Pediatric Association/Health Resources and Services Administration National Faculty Development Scholars Program was to improve primary care education in the pediatric setting. The program evaluation focused on four stake-holder objectives: 1) increase the educational skills of community and generalist faculty; 2) create pediatric leadership focused on changing the culture within the medical community to support primary care education; 3) develop an infrastructure that supports sustained faculty development efforts at the local, regional, and national level; and 4) include content areas consistent with Health Resources and Services Administration contract requirements. METHODS: A multimethod evaluation plan, focused on the 107 completing scholars, was implemented utilizing six evaluation instruments. RESULTS: Key outcomes from both quantitative and qualitative outcome measures reveal that all evaluation objectives were achieved. Scholars presented 438 local workshops and 161 regional/national workshops focused on pediatric education with a combined attendance of 7939 participants. More than half of the scholars have now assumed a leadership position in education associated with program participation. Ninety-three percent of the scholars reported organizational/infrastructure changes associated with their program participation ranging from increased numbers of community teaching sites to specific resource allocations to support of faculty development. CONCLUSIONS: The outcomes of this evaluation reveal that the faculty development program achieved its objectives, with participants leading workshops, impacting faculty development infrastructure, advancing their own careers, and being strategically positioned in leadership roles with the skills to improve primary care education in the ambulatory setting.

The APA/HRSA Faculty Development Scholars Program: introduction to the supplement.

BACKGROUND: The purpose of this project was to improve pediatric primary care medical education by providing faculty development for full-time and community-based faculty who teach general pediatrics to medical students and/or residents in ambulatory pediatric community-based settings. Funding for the program came through an interagency agreement with the Health Resources and Services Administration (HRSA) and the Agency for Healthcare Research and Quality (AHRQ). METHODS: A train-the-trainer model was used to train 112 scholars who could teach skills to general pediatric faculty across the nation. The three scholar groups focused on community-based ambulatory teaching; educational scholarship; and executive leadership. RESULTS: Scholars felt well prepared to deliver faculty development programs in their home institutions and regions. They presented 599 workshops to 7989 participants during the course of the contract. More than 50% of scholars assumed positions of leadership, and most reported increased support for medical education in their local and regional environments. CONCLUSIONS: This national pediatric faculty development program pioneered in the development of a new training model and should guide training of new scholars and advanced and continuing training for those who complete a basic program.

Outcomes of a comprehensive faculty development program for local, full-time faculty.

BACKGROUND AND OBJECTIVES: Family medicine has a long history of using faculty development programs (FDPs). Recent evaluation reports of those programs highlight participant achievements in FDPs but underscore the need for stronger evaluations of those programs. This study examined the outcomes of a comprehensive, 2-year, within-institution FDP focused on participants' productivity and retention in academics. METHODS: Subjects were 30 full-time FDP completers (1993 through 1999). The curriculum included monthly seminars and mentor involvement to promote competence in education, research, writing, administration, professional academic skills, and technology. Projects were required in education, research, and administration. Four evaluation levels were examined: reactions, learning, behavior change, and results. Instruments included satisfaction surveys, validated competence measures, CV review, and attendance and retention records. Ten years of data from six training cohorts were analyzed. RESULTS: Reaction data showed 80% attendance and high program satisfaction. Learning outcomes revealed positive pre- to post-program changes in each curriculum area. Behavior changes included a pre- to postprogram tripling of institutional leadership positions. Yearly group averages of peer-reviewed publications increased from seven before the program to 26 after the FDP Results showed that 80% of participants were retained in academic careers through the 2-year post-program time frame. CONCLUSIONS: Significant, positive outcomes were found at all evaluation levels. This multi-level, longitudinal design may contribute to future FDP evaluations.

Graduate medical education at the Medical College of Wisconsin: new initiatives to respond to the changing residency training environment.

Nationally, Graduate Medical Education (GME) is facing a series of challenges. These include cutbacks in Medicare funding, major changes in accreditation standards requiring education in and assessment of "general (core) competencies," and reduction in housestaff work hours. GME at the Medical College of Wisconsin (MCW) is managed by a consortium called the Medical College of Wisconsin Affiliated Hospitals, Inc. (MCWAH), which is comprised of 13 health care institutions in Southeastern Wisconsin. The general competencies required by the Accreditation Council for Graduate Medical Education (ACGME) include six focal areas: (1) patient care; (2) medical knowledge; (3) professionalism; (4) interpersonal and communication skills; (5) practice-based learning and improvement; and (6) systems-based practice. Traditionally, the GME programs have focused on training and assessment specific to patient care and medical knowledge, but have limited emphasis on the other four. To address this gap, MCWAH has launched several initiatives to enhance teaching and assessment of the other four competencies. An on-line residency management system marketed by New Innovations of Toledo, Ohio is being used to provide a web-based residency management system, allowing the faculty and residents to evaluate one another at the end of each rotation. Faculty development programs for residency program directors have been initiated to ensure they have the knowledge and skills associated with teaching and assessing the core competencies. We are now piloting a 360-degree evaluation system to include evaluations of residents and faculty by co-workers and patients. The ACGME is in the process of mandating reduced duty hours for the housestaff. As a result, residents will have less time for direct patient care responsibilities with more intensive use of other education and training strategies to ensure that they become independent specialists. GME is undergoing a major paradigm change, and MCWAH remains on the cutting edge in responding to the challenges.

Personal digital assistants herald new approaches to teaching and evaluation in medical education.

Since its arrival in 1994, the personal digital assistant (PDA) has made significant inroads in the handheld industry, with 50% of physicians anticipated as users by 2005 due to its functionality as a point-of-care medical informatics tool. However, its use in medical education is less well documented. Since 1998, PDAs have been used at Medical College of Wisconsin (MCW) as both a teaching and an evaluation tool for medical student and resident education. This article highlights the use of the PDA in medical education and describes current applications for monitoring clinical experiences of students/residents, and teaching resources for hypertension, cardiac auscultation, and community health. MCW's experiences with the PDA as a real time teaching and data collection tool serves as a model for other medical schools and for our students who are educated in the importance of self-monitoring one's clinical experiences and the need for continuous improvement as future physicians.

Feasibility, reliability and user satisfaction with a PDA-based mini-CEX to evaluate the clinical skills of third-year medical students.

BACKGROUND: The mini-clinical evaluation exercise (mini-CEX) has been used to assess clinical skills of 3rd-year medical schools. However a PDA-based mini-CEX has not been developed or evaluated before. Our objective was to determine the feasibility, implementation, and user satisfaction with a PDA-based mini-CEX. DESCRIPTION: Third-year medical students at the Medical College of Wisconsin who rotated on their core clinical clerkship in internal medicine during the period of July 2004 to April 2005 (n = 177) were required to complete two PDA-based mini-CEXs that were supervised by a faculty member or senior resident. Descriptive statistics and sample t test with equal variances were performed to analyze PDA-based mini-CEX completion rates, satisfaction scores by overall user and by evaluator type. EVALUATION: During the 10-month study period, 354 PDA-based mini-CEX forms were collected (100% completion rate). Seventy-five percent (n = 267) of mini-CEXs occurred in the inpatient setting and 24% (n = 87) in the outpatient clinics. Students reported receiving feedback from their evaluator in 96% of these exercises. The most frequently evaluated competencies were humanism (90%), physical examination (90%), and overall clinical competence (90%). Third-year students were evaluated by residents in 58% (n = 205) of encounters and by faculty in 42% (n = 149). Residents rated students significantly higher than faculty (overall M = 7.6 vs. 7.1, respectively) in all clinical domains of the PDA-based form (p < .05). Satisfaction with the PDA based mini-CEX was high (scale = 1-9) for residents (8.1; SD = 1.5), faculty (7.4; SD = 1.5), and students (8.0; SD = 1.7). CONCLUSIONS: A PDA-based mini-CEX is a feasible tool to facilitate the direct observation of students' clinical skills. The PDA-based mini-CEX was highly rated by students and evaluators as a valuable technology-based tool to document direct supervision of clinical skills.

Competency-based strategies for injury control and prevention curriculums in undergraduate medical education.

Injury, including unintentional injury and intentional injury, is the leading cause of death in people aged

An Assessment of the Impact of Multimedia, Technology-Based Learning Tools on the Cardiac Auscultation Skills of Third-Year Medical Students.

BACKGROUND: Previous studies have shown that medical students and post-graduate trainees need to improve their proficiency in cardiac auscultation. Technologic advances have created new learner-centered opportunities to enhance proficiency in this important physical examination skill. OBJECTIVES: We sought to determine if technology-based, self-directed learning tools improved the cardiac auscultation skills of third-year medical students. METHODS: Sixteen (16) third-year medical (M3) students were exposed to three educational inter-ventions: a one-hour cardiac auscultation lecture that featured computer-generated heart sounds, a PDA-based heart sounds/murmur form and a web-based cardiac auscultation program. Thirteen (13) internal medicine (IM) residents who served as a comparison group attended a cardiac auscultation lecture identical in content and format to the student lecture. At the end of the study period, we evaluated the ability of both groups to accurately identify heart sounds and cardiac murmurs via a twelve-item performance-based examination utilizing computer-generated heart sounds. RESULTS: Following our teaching interventions, findingsM3 students correctly identified 80% of the computer-simulated heart sounds/murmurs while the comparison group of IM residents accurately detected 60% of the same cardiac findings (p<. 005). CONCLUSIONS: The combination of traditional lecture and multi-media, technology-based, self-directed learning tools appears to be an effective and efficient strategy for teaching and reinforcing cardiac auscultation skills to third year medical students.

Personal digital assistant for "real time" assessment of women's health in the clinical years.

OBJECTIVE: To assess in "real time" the degree to which women's health competencies are addressed in the clinical curriculum by using a personal digital assistant. STUDY DESIGN: Competencies for women's health were developed. Twelve students were supplied with a personal digital assistant, pre-loaded with a patient log system, for use in assessment of the inclusion of these competencies in the clinical arena. The students received instruction on completing the log for each patient for whom they were primarily responsible. RESULTS: There were 2690 total encounters. In clerkships other than obstetrics and gynecology, gender was discussed in 10% to 20% of encounters. Other than obstetrics and gynecology diagnostic categories, no more than 15% of diagnoses included gender discussion. CONCLUSION: Student recording of patient encounters reveals a minimal amount of women's health discussion in the clinical years; however, the personal digital assistant is an effective tool with which to monitor curriculum content in the clinical setting.

A longitudinal women's health curriculum: a multi-method, multiperspective needs assessment.

OBJECTIVES: To define critical competencies in women's health for medical student education and to assess the degree to which they are taught. STUDY DESIGN: A set of competencies in women's health was developed. A multi-method needs assessment was implemented. RESULTS: Faculty and student evaluations revealed no major areas of disagreement but did identify major deficits in the basic sciences including the physiologic influence of estrogen on nongynecologic organ systems and of androgen on various organ systems, nutrition, and alternative medicine and the difference between the sexes in disease processes, presentation, and treatment. In the clinical years, there are important deficits in the teaching of diseases unique to women, limited attention to psychosocial aspects of women's health, and no cohesive teaching of a gender-specific approach to clinical evaluation. CONCLUSION: In the medical school curriculum, gender's effect on disease is inadequately addressed. An integrated longitudinal approach to gender-specific medicine is needed.