The Family Medicine Accelerated Track at Texas Tech University Health Sciences Center.

Meeting Texas' future health care needs will be challenging, including the goal for a physician workforce more balanced toward primary care. To help expand the primary care physician workforce, Texas Tech University Health Sciences Center (TTUHSC) School of Medicine developed the Family Medicine Accelerated Track (FMAT), a three-year curriculum that culminates in the MD degree and links medical students to family medicine residency programs at TTUHSC campuses in Lubbock, Amarillo, or the Permian Basin (Odessa and Midland). Twenty current family medicine residents are graduates of the FMAT program, and 30 medical students are enrolled in the program, which is charting a path for curricular innovation in medical education that will be increasingly competency-based.

Epistemology and uncertainty: a follow-up study with third-year medical students.

BACKGROUND AND OBJECTIVES: Prior research results indicate a relationship between medical epistemology (ie, how a physician organizes and prioritizes the biological and psychosocial data of a patient presentation) and stress reactions to uncertainty among primary care physicians. However, little is known about when this relationship forms. The purpose of this study was to begin answering this question by exploring the relationship between medical epistemology and stress reactions to uncertainty among a group of 89 third-year medical students from the class of 2010 of a three-campus state medical school located in the southwestern US. METHODS: Data from Likert-type measures of medical epistemology and stress reactions to uncertainty were extracted from course evaluation information that was collected at the start (T1) and end (T2) of a continuity clinic experience that spanned most of the students' third year. Using these data, the authors conducted a simple bivariate regression analysis to identify the relationship between medical epistemology and stress reactions to uncertainty (Model 1), and a multivariate regression analysis to test for the independent effect of medical epistemology on stress reactions to uncertainty while controlling for gender and specialty interest (Model 2). These two regression models were calculated for both the T1 and T2 data sets. RESULTS: The two regression models at T1 indicated no significant relationships between medical epistemology and stress reactions to uncertainty; however, the two regression models at T2 indicated that a biopsychosocial epistemology is associated with less stress reactions to uncertainty, and a biomedical epistemology is associated with more stress reactions to uncertainty. CONCLUSIONS: The third year is an opportune time for medical educators to help shape and develop students' medical epistemology and stress reactions to uncertainty.

Influence of community preceptor specialty and method of assignment in an early clinical experience course.

OBJECTIVES: Although early clinical experience courses are often the purview of family medicine faculty, students may receive training with community physicians from varying specialties. Little is known about the influence of preceptor specialty and method of assignment on students' performance and course satisfaction. METHODS: Second-year medical students spent one half day per month with a preceptor to practice clinical skills. Preceptors were either assigned randomly or assigned by student recruitment or specialty request. We analyzed whether preceptor specialty, method of assignment, and practice site (the independent variables) were associated with the dependent variables of course evaluation ratings and student performance on objective structured clinical examinations (OSCEs). RESULTS: Analyses found no differences in students' overall course satisfaction or OSCE scores and little difference in satisfaction with specific course components. There was a positive relationship between overall course rating and the rating of the preceptor experience and between the preceptor experience and more time spent in ambulatory clinics and direct patient interaction. CONCLUSIONS: Because students were equally satisfied and performed comparably regardless of specialty or matching method, early clinical exposure may be accomplished equally well using specialist or generalist physicians, potentially giving primary care educators greater latitude to focus their efforts on teaching students in clinical clerkships and those interested in primary care.