Faculty Development in Basic Science Disciplines for Clinical Teachers: Results of a Cross-Cultural Workshop in the Dominican Republic.

BACKGROUND: Faculty development programs, studied both within the USA and internationally, have been shown to be helpful for enhancing scholarly and academic work for academic faculty in teaching institutions. This project investigates the impact of a well-studied faculty development program applied to basic science teachers in an academic medical center in the Dominican Republic. METHODS: A faculty cohort of physician educators in the Basic Sciences at Universidad Iberoamericana (UNIBE) School of Medicine in the Dominican Republic underwent training in the Stanford Faculty Development Center (SFDC) model of teaching through a sequence of seven workshops that were adapted for basic science content. A validated retrospective pre- and post-test instrument was used to measure study outcomes on specific teaching behaviors at the end of the workshops, at 3-month and at 12-month post-intervention. Thematic analysis of specific teaching techniques and barriers to their teaching were compiled. RESULTS: Fourteen faculty participants completed the study. All participants found the workshops valuable. Significant improvement in self-reported teaching abilities was seen comparing the mean pre-intervention scores of 106.21 (maximum score = 145, standard deviation [SD] = 12.70) with mean immediate post-intervention scores of 138.28 (SD = 6.12), the 3-month post-intervention scores of 129.79 (SD = 11.12) and the 1-year post-intervention scores of 131.86 (SD = 11.26). Several consistent themes were found among participants. CONCLUSIONS: Faculty development for improving teaching of basic science concepts by clinicians can be performed across the cultures of the USA and the Dominican Republic.

Cross-Cultural Interprofessional Faculty Development in Japan: Results of an Integrated Workshop for Clinical Teachers.

BACKGROUND: Faculty development programs, studied both home and abroad, have been shown to be helpful for enhancing the scholarly and academic work of nonacademic clinicians. Interprofessional education and faculty development efforts have been less well studied. This project investigated the effect of a well-studied faculty development program applied in an interprofessional fashion across health profession educators in medicine and nursing. METHODS: A faculty cohort of nurse and physician educators at The University of Tokyo underwent training in the Stanford Faculty Development Center (SFDC) model of clinical teaching through a sequence of 7 workshops. The workshops were performed in English with all materials translated into Japanese. A validated, retrospective pretest and posttest instrument was used to measure study outcomes on global assessment of teaching abilities and specific teaching behaviors (STBs) at 1 and 12 months after intervention. Successful completion of Commitment to Change statements were also assessed at 12 months. RESULTS: In total, 19 faculty participants completed the study. All participants found the workshops valuable. For global assessment, significant improvement in self-reported teaching abilities was seen comparing the mean pretest scores of 27.26 (maximum score = 55, standard deviation [SD] = 8.61) with mean scores at both 1 month (36.81, SD = 7.48, P < 0.001) and at 1 year (34.67, SD = 7.32, P < 0.001). For STBs, significant improvement was also seen comparing the mean group pretest score of 82.11 (maximum score = 145, SD = 15.72), to the posttest mean score of 111.11 (SD = 14.48, P < 0.001) and the 1-year mean score of 103.76 (SD = 12.87, P < 0.001). In total, 27/42 Commitment to Change statements were successfully completed at 1 year. CONCLUSIONS: Faculty development for improving clinical teaching can be performed across the cultures of medicine and nursing, as well as across the cultures of the United States and Japan.

Gold Humanism Honor Society Election and Academic Outcomes: A 10-Institution Study.

BACKGROUND AND OBJECTIVES: This study examines relationships among election to the Gold Humanism Honor Society (GHHS) and election to Alpha Omega Alpha (AOA), class rank, and residency selection to determine if GHHS members are more likely to select primary care residencies than students not elected to GHHS membership. METHODS: We evaluated five graduating classes (2006--2010) at 10 medical schools (n=5,481 students). Residency selections were grouped into primary care (family medicine, internal medicine, pediatrics, OB-GYN), surgery (including surgical specialties), or E-ROAD and other (including lifestyle practices-emergency medicine, radiology, ophthalmology, anesthesiology, and dermatology plus all other specialties, eg, neurology, pathology). RESULTS: A higher proportion of GHHS members were attracted to primary care compared to non-GHHS members (54.3% versus 44.5%). Additional comparisons between GHHS and non-GHHS members demonstrated that 33.1% of GHHS members matched into E-ROAD and other residencies, while 40.9% of non-GHHS went into one of these specialties. Fewer GHHS members chose general surgery or a surgical sub-specialty (12.6% versus 14.6%). More GHHS members were elected into AOA (30.3% versus 14.0%). Further, a far greater proportion of dual AOA/GHHS members elect family medicine residency versus AOA members not elected to GHHS. In addition, GHHS members had slightly higher mean scores on USMLE Step 1 and 2 CK (Clinical Knowledge) and mean class rank. CONCLUSIONS: This study demonstrates that students elected into the GHHS as an aggregate group tend to be academically higher achieving when compared to their non-GHHS peers and gravitate to a higher degree toward primary care and specifically to family medicine.

Lifestyle factors and primary care specialty selection: comparing 2012-2013 graduating and matriculating medical students' thoughts on specialty lifestyle.

PURPOSE: To compare how first-year (MS1) and fourth-year students (MS4) ascribe importance to lifestyle domains and specialty characteristics in specialty selection, and compare students' ratings with their primary care (PC) interest. METHOD: In March 2013, MS4s from 11 U.S. MD-granting medical schools were surveyed. Using a five-point Likert-type scale (1 = not important at all; 5 = extremely important), respondents rated the importance of 5 lifestyle domains and 21 specialty selection characteristics. One-way analysis of variance was used to assess differences by PC interest among MS4s. Using logistic regression, ratings from MS4s were compared with prior analyses of ratings by MS1s who matriculated to the same 11 schools in 2012. RESULTS: The response rate was 57% (965/1,701). MS4s, as compared with MS1s, rated as more important to good lifestyle: time off (4.3 versus 4.0), schedule control (4.2 versus 3.9), and financial compensation (3.4 versus 3.2). More MS4s than MS1s selected "time-off" (262/906 [30%] versus 136/969 [14%]) and "control of work schedule" (169/906 [19%] versus 146/969 [15%]) as the most important lifestyle domains. In both classes, PC interest was associated with higher ratings of working with the underserved and lower ratings of prestige and salary. CONCLUSIONS: In the 2012-2013 academic year, matriculating students and graduating students had similar perceptions of lifestyle and specialty characteristics associated with PC interest. Graduating students placed more importance on schedule control and time off than matriculating students. Specialties should consider addressing a perceived lack of schedule control or inadequate time off to attract students.

Cerebral venous thrombosis and "Dense Triangle Sign" on unenhanced head computed tomographic scan.

This case report describes a 21-year-old man with headache who was ultimately diagnosed as having cerebral venous thrombosis(CVT), a rare cause of headache in the emergency department that is sometimes lethal. However, correct diagnosis of CVT is often quite difficult because of a lack of findings in imaging studies. Unenhanced head computed tomography was completely normal in up to 39% of patients diagnosed as having CVT, but a subtle sign known as 'Dense Triangle Sign' was found in this case. This finding disappeared after anticoagulation therapy. Emergency physicians must know about this finding to diagnose this rare condition correctly.

Primary care, the ROAD less traveled: what first-year medical students want in a specialty.

PURPOSE: Medical students are increasingly choosing non-primary-care specialties. Students consider lifestyle in selecting their specialty, but how entering medical students perceive lifestyle is unknown. This study investigates how first-year students value or rate lifestyle domains and specialty-selection characteristics and whether their ratings vary by interest in primary care (PC). METHOD: During the 2012-2013 academic year, the authors conducted a cross-sectional survey of first-year medical students from 11 MD-granting medical schools. Using a five-point Likert-type scale (1 = not important at all; 5 = extremely important), respondents rated the importance of 5 domains of good lifestyle and 21 characteristics related to specialty selection. The authors classified students into five groups by PC interest and assessed differences by PC interest using one-way analysis of variance. RESULTS: Of 1,704 participants, 1,020 responded (60%). The option "type of work I am doing" was the highest-rated lifestyle domain (mean 4.8, standard deviation [SD] 0.6). "Being satisfied with the job" was the highest-rated specialty-selection characteristic (mean 4.7, SD 0.5). "Availability of practice locations in rural areas" was rated lowest (mean 2.0, SD 1.1). As PC interest decreased, the importance of "opportunities to work with underserved populations" also decreased, but importance of "average salary earned" increased (effect sizes of 0.98 and 0.94, respectively). CONCLUSIONS: First-year students valued enjoying work. The importance of financial compensation was inversely associated with interest in PC. Examining the determinants of enjoyable work may inform interventions to help students attain professional fulfillment in PC.

Improving clinical teaching in China: initial report of a multihospital pilot faculty development effort.

BACKGROUND: The study's purpose was to investigate whether or not a US-based faculty development program could be successfully used to improve the teaching skills of Chinese medical faculty. DESCRIPTION: The program, based on the Stanford Faculty Development Program (SFDP) model, was presented to 28 faculty teachers affiliated with Zhejiang University School of Medicine, Hangzhou, China. Outcomes included the attendees' satisfaction of the seminars and their ratings of self-reported teaching ability using a previously studied retrospective pre-post questionnaire. Paired mean scores of the retrospective pre-test were statistically compared to the means of the retrospective post-test for all respondents. EVALUATION: Twenty-eight teachers completed the survey. The seminars were rated highly and summative ratings of both global teaching performance and use of specific teaching behaviors were significantly improved between the retrospective pre- and post-test scores. CONCLUSION: We were able to demonstrate a positive effect of a Western-based faculty development course on the teaching skills of Chinese clinical medical teachers.

Neuroscience curriculum changes and outcomes: medical university of South Carolina, 2006 to 2010.

OBJECTIVES: To develop future neurologists and translational neuroscientists, we created a neurosciences pathway throughout our medical school curriculum that included early exposure to clinical neurosciences decision-making and added variety to the choices of later clinical neurosciences experiences. METHODS: Our curricular innovation had 3 parts: (1) integrating basic neurosciences content into an explicit clinical context in a College of Medicine (COM) first year of medical school; (2) expanding pathophysiological principles related to neurosciences in COM second year of medical school; and (3) creating a variety of 3-week clinical neurosciences selectives in COM third year of medical school and 4-week electives/externships for interested learners in COM fourth year of medical school. These new changes were evaluated (1) by comparing national standardized examinations including Neurology Subject examination scores for students choosing clinical neurosciences selectives; (2) by student satisfaction Graduate Questionnaires; and (3) by the total number of our graduates matching in US neurosciences disciplines. RESULTS: Students taking neuroscience selectives demonstrated a nonsignificant trend toward higher Step 2 Clinical Knowledge scores. The students' Neurology Subject examination scores were comparable with those scores reported nationally for other US COM third year of medical school students on 4-week rotations. Student-reported satisfaction in clinical neurology teaching improved from 43.9% (before) to 81.8% (after). The percentage of students matching into clinical neuroscience disciplines rose from 2% (before) to 6% (after). CONCLUSIONS: Our neurosciences curricular innovation increased graduating student satisfaction scores, had a mild positive impact on Step 2 Clinical Knowledge scores, and increased the number of students choosing careers in the clinical neurosciences. This model may be a consideration for other medical schools who wish to integrate neurosciences teaching throughout their curriculum.

Bullous dermatosis associated with vancomycin extravasation.

Cutaneous side effects related to vancomycin therapy have been reported including histamine-related reactions, linear IgA bullous dermatosis, Stevens-Johnson syndrome, maculopapular rash and drug rash with eosinophilia and systemic symptoms. In all instances, these reports were due to the systemic administration of vancomycin and subsequent immunological reactions to the medication. Drug extravasation into soft tissues can result in a variety of clinical outcomes usually related to physiochemical properties of the drug extravasated and its diluents or pharmacologic effects on the vasculature and tissue. The authors report a patient who experienced vancomycin extravasation that resulted in a localized bullous eruption resembling linear IgA bullous dermatosis, a phenomenon not previously described in the literature.

Developing a program to promote stress resilience and self-care in first-year medical students.

BACKGROUND: Facilitating stress resilience in future physicians is an important role of medical educators and administrators. We developed an extracurricular program and pilot tested the program on first year medical students. METHODS: Presentations on topics related to mental health, help-seeking, and stress resilience were presented (one topic per session). Attendance was voluntary. Attendees were requested to complete anonymous evaluations following each presentation. Primary outcome variables were rates of agreement that the presentation (1) was interesting, (2) provided valuable information, and (3) provided information relevant for the student's future practice as a physician. RESULTS: Each of the seven topics was attended on average by approximately half of the student body. Evaluations were very positive that presentations were interesting and provided information useful to maintaining balance during medical school (all had ≥85% rates of agreement). Evaluations by students were variable (41%-88% rates of agreement) on whether each presented information relevant for future practice. CONCLUSIONS: The results support that first-year medical students value explicit guidance on ways to bolster stress resilience and self-care during medical school. It is important to clarify with each presentation how the information is relevant to their future practice as a physician.