Long Term Outcomes of a Curriculum on Care for the Underserved.

ACKNOWLEDGEMENTS: This work was funded by HRSA grants D16HP00067 and D08PE50097. BACKGROUND: Evaluations of curricula to enhance ability to care for the underserved are often limited to short-term medical student outcomes. PURPOSE: This study evaluates retention of short-term improvements in outcomes from post-curriculum to graduation. METHODS: Third-year students on 2003-2004 pediatric clerkships were randomized to a curriculum on caring for the underserved in one of three formats: established "readings only", faculty-led, or web-based. Outcomes (knowledge, attitudes, self-efficacy and clinical skills) were assessed at three timepoints-pre- and post-curriculum and at graduation. Analyses, from 2009-2010, included Fisher's exact test to assess the relationship of curriculum group with response patterns, demographics, and outcomes at graduation. Multivariate regression was used to model the longitudinal relationship between outcomes and curriculum groups, adjusting for prior clerkship experiences, baseline scores, and clustering by student. RESULTS: Of 137 students, 135 (99%) completed the pre-curriculum survey, 128 (93%) completed the post-curriculum survey and 88 (64%) completed the graduation survey. Post-curriculum improvements in self-efficacy and clinical skills seen among students receiving the faculty-led or web-based curricula were retained at graduation. At graduation, web-based curriculum students' self-efficacy was significantly greater for "establishing achievable goals with underserved families" compared to established curriculum students. With regard to skills relevant to caring for the underserved, few graduates had facilitated a referral to Women, Infants and Children (33%) or followed up to ensure a patient accessed a needed resource (56%). CONCLUSIONS: Self-efficacy and skills gained through web-based and faculty-led curricula were retained at graduation. Data from items at graduation support targeted curricular improvement.

Care of the underserved: faculty development needs assessment.

INTRODUCTION: Because role models are crucial to training physicians to care for the underserved, we examined pediatric faculty's knowledge, attitudes, self-efficacy, skills, and precepting behaviors regarding care for this population. METHODS: Faculty knowledge, attitudes, self-efficacy, and skills/precepting behaviors were surveyed. RESULTS: Fifty-five (65%) of 85 faculty responded. The mean (standard deviation) knowledge score was 5.9 (1.3) of 8 possible. More than one-third of faculty did not recognize the eligibility criteria, services, and outcomes associated with common resources serving the underserved. Overall attitudes toward underserved families were positive, mean 3.3 (0.3), as was mean self-efficacy, 3.0 (0.7). Self-efficacy was lowest for accessing community resources for underserved families, 2.4 (0.7). Although most faculty performed the surveyed skills, fewer than 50% reported, precepting of these same skills with students. Precepting was lowest for accessing public and community resources. CONCLUSIONS: Low rates of student precepting as well as specific knowledge and self-efficacy deficits highlight potential targets for faculty development.

Clinical skills and self-efficacy after a curriculum on care for the underserved.

BACKGROUND: Despite calls for medical school curricula that address care for the underserved, published evaluations of such curricula are few and often do not assess clinical skills. This study assesses the changes in self-efficacy and clinical skills resulting from faculty-led or web-based curricula on care for the underserved. METHODS: Third-year students on 6-week 2003-2004 pediatric clerkships were block-randomized to a curriculum on caring for the underserved in one of three formats: established (readings only), faculty-led, or web-based. Primary outcomes were pre- and post-curriculum changes in self-efficacy and clinical skills. ANCOVA was used to test differences among curriculum groups, adjusting for prior experiences with the underserved. Analyses were performed in 2007. RESULTS: A total of 138 students participated, with 121 (88%) completing both pre- and post-tests. Compared to the established-curriculum students, both faculty-led and web-based students improved their self-efficacy in establishing achievable goals with underserved families, while web-based students improved their self-efficacy around knowledge of community resources. Significantly more new skills were performed by both faculty-led (mean [SD]=3.3[1.8]) and web-based curriculum students (2.9[1.5]), compared to established-curriculum students (1.5[1.4]). Compared to established-curriculum students, more faculty-led and web-based students also reported new skills in locating resources to meet the needs of underserved patients and in following up on referrals to ensure that families accessed needed care. CONCLUSIONS: Web-based and faculty-led curricula improve medical student self-efficacy and clinical skills. Results from specific self-efficacy and skill items facilitate targeted curricular improvement.

Caring for the underserved: blending service learning and a web-based curriculum.

BACKGROUND: Recognition of health disparities among underserved individuals, whose demographic, geographic, or economic characteristics impede access to health-related services, has led to calls for the development of medical school curricula that address care for the underserved, but reports of the development and evaluation of such curricula are limited. METHODS: Two formats of a curriculum addressing care for the underserved were developed and implemented during the 6-week pediatric clerkship for third-year medical students during the 2003-2004 academic year. One format was faculty-led; the other was web-based. Skills for providing care to underserved families were taught through didactic, experiential, and service-learning curriculum components. Novel core curriculum elements included a screening tool for recognizing underserved patients and an independent clinical project through which students linked underserved families with community health resources. Analyses from 2004-2005 compared pre- and post-curriculum knowledge and attitudes of web-based students (n = 29) to those receiving either the faculty-led (n = 36) or the established "readings-only" curriculum (n = 35). Qualitative data from service learning projects were analyzed to assess clinical skills. RESULTS: Compared to students in the established curriculum, both web-based and faculty-led students demonstrated improved knowledge (p < 0.001) and attitudes (p < 0.05) about caring for the underserved. Both web-based and faculty-led students were successful in recognizing and addressing underserved health issues in the clinical setting. CONCLUSIONS: Faculty-led and web-based curricula can equally improve student knowledge, attitudes, and skills about caring for the underserved.