Faculty development on professionalism and medical ethics: the design, development and implementation of Objective Structured Teaching Exercises (OSTEs).

BACKGROUND: As students are expected to develop competency in professionalism and medical ethics, faculty are also expected to facilitate medical students' learning and understanding of these areas. One of the main challenges to success in this domain has been uncertainty of whether or not faculty know the content and the methods to teach and assess these competencies. AIM: We used the Objective Structured Teaching Exercise (OSTE) format as a faculty development tool to train and evaluate faculty on how to teach professionalism and medical ethics to students in clinical settings. METHODS: The process for the design, development and implementation of OSTEs consisted of five phases: (1) performing a literature review and student needs assessment, (2) developing the OSTE cases and performance checklists, (3) recruiting and training of standardized students, (4) conducting a mock training session and (5) organizing faculty development workshops using OSTEs. RESULTS: Twenty clinical faculty members participated in one of three half-day OSTE workshops offered. Faculty confidence and attitudes about teaching professionalism increased significantly (p < 0.05) from before participating in the workshop to afterwards. CONCLUSIONS: Faculty feedback were positive stating that the OSTE scenarios were reflective of issues they generally encounter while teaching medical students, the information and skills they learned from the workshop are important to them as clinical educators, and that the information and skills will likely have an impact on the way they teach professionalism and ethics in the future.

Failure to control an outbreak of multidrug-resistant Streptococcus pneumoniae in a long-term-care facility: emergence and ongoing transmission of a fluoroquinolone-resistant strain.

OBJECTIVES: To characterize risk factors associated with pneumococcal disease and asymptomatic colonization during an outbreak of multidrug-resistant Streptococcus pneumoniae (MDRSP) among AIDS patients in a long-term-care facility (LTCF), evaluate the efficacy of antimicrobial prophylaxis in eliminating MDRSP colonization, and describe the emergence of fluoroquinolone resistance in the MDRSP outbreak strain. DESIGN: Epidemiologic investigation based on chart review and characterization of SP strains by antimicrobial susceptibility testing and PFGE and prospective MDRSP surveillance. SETTING: An 80-bed AIDS-care unit in an LTCF PARTICIPANTS: Staff and residents on the unit. RESULTS: From April 1995 through January 1996, 7 cases of MDRSP occurred. A nasopharyngeal (NP) swab survey of all residents (n=65) and staff (n=70) detected asymptomatic colonization among 6 residents (9%), but no staff. Isolates were sensitive only to rifampin, ofloxacin, and vancomycin. A 7-day course of rifampin and ofloxacin was given to eliminate colonization among residents: NP swab surveys at 1, 4, and 10 weeks after prophylaxis identified 1 or more colonized residents at each follow-up with isolates showing resistance to one or both treatment drugs. Between 1996 and 1999, an additional 6 patients were diagnosed with fluoroquinolone-resistant (FQ-R) MDRSP infection, with PFGE results demonstrating that the outbreak strain had persisted 3 years after the initial outbreak was recognized. CONCLUSIONS: Chemoprophylaxis likely contributed to the development of a FQ-R outbreak strain that continued to be transmitted in the facility through 1999. Long-term control of future MDRSP outbreaks should rely primarily on vaccination and strict infection control measures.