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2.
Rev. Fund. Educ. Méd. (Ed. impr.) ; 23(3): 151-154, mayo-jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193882

RESUMO

OBJETIVO: Conocer la opinión de los estudiantes de medicina que han realizado su rotación por el centro de salud en los últimos años, mediante el análisis de su opinión reflejada en la memoria de la estancia práctica que elaboran al final de su rotación en tercer y sexto curso. SUJETOS Y MÉTODOS: Se realizó un análisis documental de la opinión expresada por los estudiantes de medicina en la memoria de estancia práctica. Se analizaron un total de 15 memorias de estudiantes del Grado de Medicina de la Universidad Complutense de Madrid que han rotado por dos consultas de un centro de salud desde el año 2011 hasta 2019. RESULTADOS: Se han identificado seis categorías en las que se pueden agrupar las opiniones de los estudiantes de medicina sobre su rotación práctica en atención primaria: utilidad de la rotación para su formación, existencia de ideas preconcebidas sobre medicina de familia, grado de satisfacción de la rotación, duración de la rotación, aspectos positivos y negativos de la atención primaria y la medicina de familia, y relación con el tutor. CONCLUSIONES: La opinión del estudiante del grado de medicina sobre sus rotaciones en atención primaria es muy positiva sobre la utilidad y satisfacción con las rotaciones a pesar de su corta duración y la existencia de ideas preconcebidas negativas sobre la medicina de familia y la atención primaria. La rotación ha servido para conocer los aspectos conceptuales de la atención primaria y los valores de la medicina de familia


AIM: To know the opinion of medical students who have performed their rotation by the health center in recent years by analyzing their opinion reflected in the report of the practical stay they perform at the end of their rotation in third and sixth grades. SUBJECTS AND METHODS: A documentary analysis of the opinion expressed by medical students in the practical stay report was carried out. A total of 15 reports of Universidad Complutense de Madrid Medical Degree students who have rotated by two health primary care centers from 2011 to 2019. RESULTS: Six categories have been identified in which medical students' opinions on their practical rotation in primary care can be grouped: usefulness of rotation for their training; the existence of preconceived ideas on family medicine; the degree of rotation satisfaction; duration of rotation; positive and negative aspects of primary care and family medicine; and relationship with the tutor. CONCLUSION: The medical grade student's opinion of his or her rotations in primary care is very positive about the usefulness and satisfaction with rotations despite their short duration and the existence of negative preconceived ideas about the medicine of family and primary care. Rotation has served to understand the conceptual aspects of primary care and the values of family medicine


Assuntos
Humanos , Educação de Pós-Graduação em Medicina/métodos , Estágio Clínico/métodos , Atenção Primária à Saúde , Estágio Clínico/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Medicina de Família e Comunidade/educação
3.
J Grad Med Educ ; 12(2): 145-149, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32322345

RESUMO

Background: Two criteria that have been investigated for evaluating orthopedic surgery residency candidates are achieving an "honors" grade during a surgery clerkship and the total number of honors grades received in all clerkships. Unfortunately, the rate of honors grades given and the criteria for earning an honors grade differ between medical schools, making comparison of applicants from different medical schools difficult. Objective: We measured the rate of honors grades in clerkships at different medical schools in the United States to examine the utility of clerkship grades in evaluating orthopedic surgery residency applicants. Methods: Adequate data via the Electronic Residency Application Service were available for 86 of 142 Association of American Medical Colleges medical schools from the 2017 Match cycle. Descriptive statistics and Wilcoxon rank sum tests were performed to identify differences in grade distributions within each clerkship and in school ranking for research by U.S. News & World Report. Results: For the surgery clerkship, the median rate of honors grades given was 32.5% (range 5%-67%). There was a high rate of interinstitutional variability in all clerkships. We were unable to demonstrate a statistically significant relationship between research ranking and percentage honors grades given for individual clerkships. Conclusions: A standardized method for grading medical students during clinical clerkships does not exist, resulting in a high degree of interinstitutional variability. Surgery clerkship grades are an unreliable measure for comparing orthopedic surgery residency applicants from different medical schools. Standardized measures of applicant evaluation might be helpful in the future.


Assuntos
Estágio Clínico/normas , Educação de Graduação em Medicina/normas , Avaliação Educacional/estatística & dados numéricos , Estágio Clínico/estatística & dados numéricos , Educação de Graduação em Medicina/métodos , Avaliação Educacional/métodos , Avaliação Educacional/normas , Humanos , Internato e Residência/normas , Cirurgiões Ortopédicos/educação , Faculdades de Medicina/normas , Faculdades de Medicina/estatística & dados numéricos , Estudantes de Medicina , Estados Unidos
4.
BMJ Open Qual ; 9(1)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32169862

RESUMO

BACKGROUND: In recent years, Rutgers New Jersey Medical School Department of Family Medicine has integrated a quality assurance (QA) project as a required component of their 5-week medical student clerkship. This project requires each student to conduct a QA study at an assigned family practice and discuss the results with their preceptor. The aim of this study was to determine if sequential medical student QA projects impact physician readiness to improve guideline adherence over time. METHODS: A retrospective analysis of student reports was conducted to determine if physician readiness to improve compliance improved post implementation of the QA project using James Prochaska's Transtheoretical Model of Behavioral Change. Fisher's exact test or the χ2 test were used as applicable to compare the change in results. RESULTS: In academic year 2015-2016, there were 11 (6%) instances where physicians were precontemplating on change, 43 (24%) instances where physicians were contemplating, 101 (57%) instances where physicians were preparing to make change, 18 (10%) instances where physicians were acting, and 4 (2%) of instances where a physician were maintaining previous changes. The following year, the numbers were: 15 (8%), 38 (21%), 82 (46%), 34 (19%) and 11 (6%), respectively. There were increases of physicians in stages of precontemplation (p=0.047), action (p=0.02) and maintenance (p=0.047), a decrease in physicians that were in the stage of preparation (p=0.05) and no significant change in the instances they were in a stage of contemplation (p=0.60). CONCLUSION: Student QA projects appear to leverage physician readiness to improve guideline adherence. Future studies will determine if raising awareness through these clerkship projects results in practice behavioural change.


Assuntos
Medicina de Família e Comunidade/educação , Garantia da Qualidade dos Cuidados de Saúde/métodos , Estudantes de Medicina/psicologia , Estágio Clínico/métodos , Estágio Clínico/estatística & dados numéricos , Educação de Graduação em Medicina/métodos , Medicina de Família e Comunidade/métodos , Humanos , New Jersey , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Melhoria de Qualidade , Estudos Retrospectivos , Estudantes de Medicina/estatística & dados numéricos
5.
Acad Med ; 95(1): 111-121, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31365399

RESUMO

PURPOSE: To investigate the effect of a change in the United States Medical Licensing Examination Step 1 timing on Step 2 Clinical Knowledge (CK) scores, the effect of lag time on Step 2 CK performance, and the relationship of incoming Medical College Admission Test (MCAT) score to Step 2 CK performance pre and post change. METHOD: Four schools that moved Step 1 after core clerkships between academic years 2008-2009 and 2017-2018 were analyzed. Standard t tests were used to examine the change in Step 2 CK scores pre and post change. Tests of differences in proportions were used to evaluate whether Step 2 CK failure rates differed between curricular change groups. Linear regressions were used to examine the relationships between Step 2 CK performance, lag time and incoming MCAT score, and curricular change group. RESULTS: Step 2 CK performance did not change significantly (P = .20). Failure rates remained highly consistent (pre change: 1.83%; post change: 1.79%). The regression indicated that lag time had a significant effect on Step 2 CK performance, with scores declining with increasing lag time, with small but significant interaction effects between MCAT and Step 2 CK scores. Students with lower incoming MCAT scores tended to perform better on Step 2 CK when Step 1 was after clerkships. CONCLUSIONS: Moving Step 1 after core clerkships appears to have had no significant impact on Step 2 CK scores or failure rates, supporting the argument that such a change is noninferior to the traditional model. Students with lower MCAT scores benefit most from the change.


Assuntos
Estágio Clínico/estatística & dados numéricos , Competência Clínica/estatística & dados numéricos , Licenciamento em Medicina/tendências , Fracasso Acadêmico/tendências , Teste de Admissão Acadêmica/estatística & dados numéricos , Currículo/normas , Currículo/tendências , Feminino , Humanos , Conhecimento , Licenciamento em Medicina/estatística & dados numéricos , Modelos Lineares , Masculino , Estudantes de Medicina/classificação , Estudantes de Medicina/estatística & dados numéricos , Estados Unidos/epidemiologia
6.
Acad Med ; 95(3): 425-434, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31626000

RESUMO

PURPOSE: Infusing continuity of care into medical student clerkships may accelerate professional development, preserve patient-centered attitudes, and improve primary care training. However, prospective, randomized studies of longitudinal curricula are lacking. METHOD: All entering Northwestern University Feinberg School of Medicine students in 2015 and 2016 were randomized to the Education Centered Medical Home (ECMH), a 4-year, team-based primary care clerkship; or a mentored individual preceptorship (IP) for 2 years followed by a traditional 4-week primary care clerkship. Students were surveyed 4 times (baseline, M1, M2, and M3 year [through 2018]); surveys included the Maslach Burnout Inventory (MBI); the Communication, Curriculum, and Culture (C3) survey assessing the hidden curriculum; and the Attitudes Toward Health Care Teams (ATHCT) scale. The authors analyzed results using an intent-to-treat approach. RESULTS: Three hundred twenty-nine students were randomized; 316 (96%) participated in surveys. Seventy percent of all respondents would recommend the ECMH to incoming first-year students. ECMH students reported a more positive learning environment (overall quality, 4.4 ECMH vs 4.0 IP, P < .001), greater team-centered attitudes (ATHCT scale, 3.2 vs 3.0, P = .007), less exposure to negative aspects of the hidden curriculum (C3 scale, 4.6 vs 4.3, P < .001), and comparable medical knowledge acquisition. ECMH students established more continuity relationships with patients (2.2 vs 0.3, P < .001) and reported significantly higher professional efficacy (MBI-PE, 4.1 vs 3.9, P = .02). CONCLUSIONS: In this randomized medical education trial, the ECMH provided superior primary care training across multiple outcomes compared with a traditional clerkship-based model, including improved professional efficacy.


Assuntos
Estágio Clínico/métodos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Currículo , Educação de Graduação em Medicina/métodos , Preceptoria/métodos , Atenção Primária à Saúde/métodos , Estudantes de Medicina/psicologia , Chicago , Estágio Clínico/estatística & dados numéricos , Feminino , Humanos , Masculino , Modelos Educacionais , Grupo Associado , Preceptoria/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários
9.
PLoS One ; 14(8): e0221300, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31419265

RESUMO

Physicians currently spend as much as half of their day in front of the computer. The Electronic Health Record (EHR) has been associated with declining bedside skills and physician burnout. Medical student EHR use has not been well studied or characterized. However, student responsibilities for EHR documentation will likely increase as the Centers for Medicare and Medicaid Services (CMS) most recent provisions now allow student notes for billing which will likely increase the role of medical student use of the EHR over time. To gain a better understanding of how medical students use the EHR at our institution, we retrospectively analyzed 6,692,994 EHR interactions from 49 third-year clerkship medical students and their supervising physicians assigned to the inpatient medicine ward rotation between June 25 2015 and June 24 2016 at a tertiary academic medical center. Medical students spent 4.42 hours (37%) of each day at the on the EHR and 35 minutes logging in from home. Improved understanding of student EHR-use and the effects on well-being warrants further attention, especially as EHR use increases with early trainees.


Assuntos
Estágio Clínico/estatística & dados numéricos , Educação de Graduação em Medicina/métodos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Centros Médicos Acadêmicos/estatística & dados numéricos , Esgotamento Profissional/etiologia , Esgotamento Profissional/prevenção & controle , Educação de Graduação em Medicina/normas , Humanos , Estudos Retrospectivos , Estudantes de Medicina/psicologia , Estados Unidos
10.
Rural Remote Health ; 19(2): 4987, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31340654

RESUMO

INTRODUCTION: Access to medical services for rural communities is poorer than for metropolitan communities in many parts of the world. One of the strategies to improve rural medical workforce has been rural clinical placements for undergraduate medical students. This study explores the workforce outcomes of one model of such placements - the longitudinal integrated clerkship (LIC) - delivered in year 4, the penultimate year of the medical course, as part of the rural programs delivered by a medical school in Victoria, Australia. The LIC involved student supervision under a parallel consulting model with experienced rural generalist doctors for a whole year in small community rural general practices. METHODS: This study aimed to compare the work locations (regional or more rural), following registration as a medical practitioner, of medical students who had completed 1 year of the LIC, with, first, students who had other types of rural training of comparable duration elsewhere, and second, students who had no rural training. Study participants commenced their medical degree after 2004 and had graduated between 2008 and 2016 and thus were in postgraduate year 1-9 in 2017 when evaluated. Information about the student training location(s), and duration, type and timing of training, was prospectively collected from university administrative systems. The outcome of interest was the main work location in 2017, obtained from the Australian Health Practitioner Regulation Agency's public website. RESULTS: Students who had undertaken the year 4 LIC along with additional rural training in years 3 and/or 5 were more likely than all other groups to be working in smaller regional or rural towns, where workforce need is greatest (relative risk ratio (RRR) 5.62, 95% confidence interval (CI) 2.81-11.20, compared with those having metropolitan training only). Non-LIC training of similar duration in rural areas was also significantly associated, but more weakly, with smaller regional work location (RRR 2.99, 95%CI 1.87-4.77). Students whose only rural training was the year 4 LIC were not significantly associated with smaller regional work location (RRR 1.72, 95%CI 0.59-5.04). Overall, after accounting for both LIC and non-LIC rural training exposure, rural work after graduation was also consistently positively associated with rural background, being an international student and having a return of service obligation under a bonded program as a student. CONCLUSION: This study demonstrates the value of rural LICs, coupled with additional rural training, in contributing to improving Australia's medical workforce distribution. Whilst other evidence has already demonstrated positive educational outcomes for doctors who participate in rural LIC placements, this is the first known study of work location outcomes. The study provides evidence that expanding this model of rural undergraduate education may lead to a better geographically distributed medical workforce.


Assuntos
Estágio Clínico/estatística & dados numéricos , Educação de Graduação em Medicina , Área de Atuação Profissional , Serviços de Saúde Rural , Adulto , Feminino , Medicina Geral/educação , Mão de Obra em Saúde , Humanos , Modelos Logísticos , Masculino , População Rural , Vitória , Adulto Jovem
11.
BMC Med Educ ; 19(1): 219, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215430

RESUMO

BACKGROUND: Little is known regarding the psychometric properties of computerized long-menu formats in comparison to classic formats. We compared single-best-answer (Type A) and long-menu formats using identical question stems during the computer-based, summative, intermediate clinical-clerkship exams for nine disciplines. METHODS: In this randomised sequential trial, we assigned the examinees for every summative exam to either the Type A or long-menu format (four different experimental questions, otherwise identical). The primary outcome was the power of discrimination. The study was carried out at the Faculty of Medicine, University of Geneva, Switzerland, and included all the students enrolled for the exams that were part of the study. Examinees were surveyed about the long-menu format at the end of the trial. RESULTS: The trial was stopped for futility (p = 0.7948) after 22 exams including 88 experimental items. The long-menu format had a similar discriminatory power but was more difficult than the Type A format (71.45% vs 77.80%; p = 0.0001). Over half of the options (54.4%) chosen by the examinees in long-menu formats were not proposed as distractors in the Type A formats. Most examinees agreed that their reasoning strategy was different. CONCLUSIONS: In a non-selected population of examinees taking summative exams, long-menu questions have the same discriminatory power as classic Type A questions, but they are slightly more difficult. They are perceived to be closer to real practice, which could have a positive educational impact. We would recommend their use in the final years of the curriculum, within realistic key-feature problems, to assess clinical reasoning and patient management skills.


Assuntos
Comportamento de Escolha , Estágio Clínico/estatística & dados numéricos , Computadores , Educação de Graduação em Medicina/estatística & dados numéricos , Avaliação Educacional/métodos , Estudantes de Medicina , Humanos , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Psicometria , Reprodutibilidade dos Testes , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Suíça
12.
Acad Med ; 94(12): 1939-1945, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31219812

RESUMO

PURPOSE: The medical student performance evaluation (MSPE) summarizes a residency applicant's academic performance. Despite attempts to improve standardized clerkship grading, concerns regarding grade inflation and variability at United States medical schools persist. This study's aim was to describe current patterns of clerkship grading and applicant performance data provided in the MSPE. METHOD: The authors evaluated Electronic Residency Application Service data submitted to a single institution for the 2016-2017 Match cycle. Clerkship grading characteristics regarding grading tiers, school rank, location, and size were obtained. Data regarding methods for summative comparisons such as key word utilization were also extracted. Descriptive statistics were generated, and generalized linear modeling was performed. RESULTS: Data were available for 137/140 (98%) MD-granting U.S. medical schools. Pass/fail grading was most commonly used during the preclinical years (47.4%). A 4-tier system was most common for clerkship grading (31%); however, 19 different grading schemes were identified. A median of 34% of students received the highest clerkship grade (range, 5%-97%). Students attending a top 20 medical school were more likely to receive the highest grade compared with those attending lower-rated schools (40% vs 32%, P < .001). Seventy-three percent of schools ranked students, most commonly using descriptive adjectives. Thirty-two different adjectives were used. CONCLUSIONS: There is significant institutional variation in clinical grading practices and MSPE data. For core clerkships where most students received the highest grade, the ability to distinguish between applicants diminishes. A standardized approach to reporting clinical performance may allow for better comparison of residency applicants.


Assuntos
Estágio Clínico/normas , Educação de Graduação em Medicina/normas , Avaliação Educacional/estatística & dados numéricos , Faculdades de Medicina/normas , Estágio Clínico/estatística & dados numéricos , Educação de Graduação em Medicina/métodos , Educação de Graduação em Medicina/estatística & dados numéricos , Avaliação Educacional/métodos , Avaliação Educacional/normas , Feminino , Humanos , Masculino , Faculdades de Medicina/estatística & dados numéricos , Estados Unidos
13.
Med Teach ; 41(6): 703-710, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30907206

RESUMO

This paper evaluates rural work location outcomes of an Extended Rural Cohort (ERC) program in medical school. Students nominate a preference and are contracted to the program at entry to the medical course, involving 2-3 years continuous rural training. Data included 2412 graduates from a large university medical school cohort study. Regression modeling compared 2017 work location of ERC participants, by their level of preference for the ERC and students who had other (similar or shorter duration) rural training with a metropolitan-only trained group. Students who entered medicine with ERC as their first preference commonly had rural background (95.5%) compared with second or lower preferences (61.5% and 40.4%, respectively). Multivariate regression modeling identified ERC participants were more likely to work rurally (OR: 2.69-3.27, compared with metropolitan-trained), though higher odds were associated with lower preference for ERC. However, non-ERC students undertaking a similar duration rural training by opting for this "year by year" after course entry, had the strongest odds of rural work (OR: 4.62, 95%CI: 3.00-7.13) and work in smaller rural towns (RRR: 4.08, 95%CI: 2.36-7.06). The ERC attracts rural background students and increases rural work outcomes. However, students choosing a rural training path of equivalent duration after course entry may be more effective and improve rural workforce distribution.


Assuntos
Estágio Clínico/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Adulto , Austrália , Escolha da Profissão , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Área de Atuação Profissional , Fatores de Tempo , Adulto Jovem
14.
Acad Med ; 94(6): 775-780, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30768466

RESUMO

An increasing number of medical schools have moved away from traditional 2 + 2 curricular structures toward curricula that intentionally integrate basic, clinical, and health systems science, with the goal of graduating physicians who consistently apply their foundational knowledge to clinical practice to improve the care of patients and populations. These curricular reforms often include a shortened preclerkship phase with earlier introduction of learners into clinical environments. This has led schools to reconsider the optimal timing of United States Medical Licensing Examination Step 1. A number of schools have shifted the exam to the period immediately after core clerkships. Although this shift can provide pedagogical advantages, there are potential challenges that must be anticipated and proactively addressed. As more institutions consider making this change, key educational leaders from five schools that repositioned the Step 1 exam after core clerkships share strategies for mitigating some of the potential challenges associated with this approach. The authors describe six possible challenges: lack of readiness without consolidation of basic science knowledge prior to clerkships; risk that weaker students will not be identified and provided academic support early; clerkship or clinical shelf exam performance weaknesses; extension of Step 1 study time; an increase in student anxiety about residency specialty choices; and/or a reduced time frame to take and pass board exams. These potential challenges may be addressed using three main strategies: effective communication with all stakeholders; curricular design and assessments that facilitate integration of basic and clinical sciences; and proactive student coaching and advising.


Assuntos
Ansiedade/psicologia , Estágio Clínico/estatística & dados numéricos , Licenciamento em Medicina/estatística & dados numéricos , Estágio Clínico/normas , Competência Clínica/estatística & dados numéricos , Comunicação , Currículo/tendências , Avaliação Educacional/métodos , Avaliação Educacional/estatística & dados numéricos , Humanos , Internato e Residência , Licenciamento em Medicina/normas , Faculdades de Medicina/legislação & jurisprudência , Fatores de Tempo , Estados Unidos/epidemiologia
15.
Int J Radiat Oncol Biol Phys ; 104(1): 24-26, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30605753

RESUMO

PURPOSE: The purpose of this study was to assess national trends in fourth-year medical student radiation oncology clerkships over the past 6 academic years. Results demonstrate a national trend toward inclusion of structured didactics in radiation oncology clerkships coinciding with the implementation and expansion of the Radiation Oncology Education Collaborative Study Group (ROECSG) clerkship curriculum. However, over half of clerkship experiences continue to lack a structured didactic curriculum. Over the past 6 years, the ROECSG implemented and expanded upon a national standardized curriculum for the fourth-year medical student radiation oncology clerkship. This study hypothesized that this would lead to increased use of structured clerkship educational methods on a national level. METHODS AND MATERIALS: From 2013 to 2018, all applicants to a single United States radiation oncology residency program were sent an anonymous clerkship experience survey. The χ2 test was used for statistical analysis. RESULTS: Of 1183 students, 488 completed the survey (41.3% response rate); 1303 total clerkship experiences were described. From 2013 to 2018, there has been a significant increase in clerkships with lectures designed for medical students, from 28.3% of clerkships in 2013 to 43.2% in 2018 (P = .02). Students who received ≥1 formal lecture perceived greater postclerkship confidence in radiation oncology-related knowledge (P < .01) and overall confidence in their ability to function as a postgraduate year-2 resident (P = .02). CONCLUSIONS: These results demonstrate a national trend toward inclusion of structured didactics in radiation oncology clerkships coinciding with the expansion of the ROECSG curriculum and support the addition of structured didactics to the clerkship experience to provide medical students with foundational radiation oncology knowledge to function as residents.


Assuntos
Estágio Clínico/tendências , Radioterapia (Especialidade)/tendências , Adulto , Distribuição de Qui-Quadrado , Estágio Clínico/estatística & dados numéricos , Currículo , Feminino , Humanos , Masculino , Radioterapia (Especialidade)/educação , Autoavaliação , Inquéritos e Questionários/estatística & dados numéricos , Fatores de Tempo , Estados Unidos , Adulto Jovem
16.
West J Emerg Med ; 21(1): 78-84, 2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31913823

RESUMO

INTRODUCTION: E-learning is widely used in medical education. To maximize the potential of E-learning tools, every effort should be made to encourage adoption by optimizing usability. We created Learning Moment (LM), a web-based application that integrates principles of asynchronous learning and learning portfolios into a platform on which students can document and share learning experiences that occur during clinical work. We sought to evaluate the usability of LM and identify features that optimize adoption by users. METHODS: We implemented LM in August 2016 at a busy, urban, tertiary care emergency department that hosts an emergency medicine residency, robust third and fourth year medical student clerkships as well as a physician assistant student rotation. We conducted a single-center, mix-methods study using the System Usability Scale (SUS) questionnaire and qualitative interviews. We sent e-mail invitations with subsequent reminders to all students who rotated in our emergency medicine clerkship from August 2016 to April 2017 to complete the SUS questionnaire anonymously and to participate in qualitative interviews. We employed purposive sampling to recruit students who used LM during their rotation to participate in our qualitative interviews. We conducted semi-structured interviews with 13 participants (10 individual interviews and one 3-person group interview) between January and March 2017 using an ethnographic approach and utilized a general inductive method to analyze and code for potential themes. RESULTS: Thirty of the seventy students invited to participate completed the SUS questionnaire (Response rate of 42.8%). The mean SUS score is 80.9 (SD 18.2, 80% CI 76.5 - 85.3). The internal consistency of the responses achieved the Cronbach's Alpha of 0.95. The participants stressed the importance of the following in the adoption of LM: maximal simplicity and usability, compatibility with learning preferences, and department-wide acceptance and integration. CONCLUSION: The overall perceived usability of LM was high. Our qualitative data revealed important implications for future designers to maximize adoption: include target users in every step of the design and development process to maximize simplicity and usability; build features that cater to a diversity of learning preferences; involve the entire department and find ways to incorporate the tool into the educational infrastructure and daily workflow.


Assuntos
Estágio Clínico/estatística & dados numéricos , Instrução por Computador/estatística & dados numéricos , Educação a Distância/normas , Medicina de Emergência/educação , Internato e Residência , Atitude do Pessoal de Saúde , Instrução por Computador/normas , Educação a Distância/estatística & dados numéricos , Serviço Hospitalar de Emergência , Feminino , Humanos , Internet , Masculino , Satisfação Pessoal , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários
17.
Med Teach ; 41(2): 125-140, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30484351

RESUMO

BACKGROUND: Ingrained assumptions about clinical placements (clerkships) for health professions students pursuing primary basic qualifications might undermine best educational use of mobile devices. QUESTION: What works best for health professions students using mobile (hand-held) devices for educational support on clinical placements? METHODS: A Best Evidence Medical Education (BEME) effectiveness-review of "justification" complemented by "clarification" and "description" research searched: MEDLINE, Educational Resource Information Center, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Central, Scopus (1988-2016). Reviewer-pairs screened titles/abstracts. One pair coded, extracted, and synthesized evidence, working within the pragmatism paradigm. SUMMARY OF RESULTS: From screening 2279 abstracts, 49 articles met inclusion-criteria, counting four systematic reviews for context. The 45 articles of at least Kirkpatrick K2 primary research mostly contributed K3 (39/45, 86.7%), mixed methods (21/45, 46.7%), and S3-strength (just over one-half) evidence. Mobile devices particularly supported student: assessment; communication; clinical decision-making; logbook/notetaking; and accessing information (in about two-thirds). Informal and hidden curricula included: concerns about: disapproval; confidentiality and privacy; security;-distraction by social connectivity and busy clinical settings; and mixed messages about policy. DISCUSSION AND CONCLUSION: This idiosyncratic evidence-base of modest robustness suggested that mobile devices provide potentially powerful educational support on clinical placement, particularly with student transitions, metalearning, and care contribution. Explicit policy must tackle informal and hidden curricula though, addressing concerns about transgressions.


Assuntos
Estágio Clínico/estatística & dados numéricos , Computadores de Mão/estatística & dados numéricos , Pessoal de Saúde/educação , Estudantes de Ciências da Saúde/estatística & dados numéricos , Atitude do Pessoal de Saúde , Competência Clínica , Tomada de Decisão Clínica , Comunicação , Documentação , Prática Clínica Baseada em Evidências , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Mídias Sociais
18.
Acad Psychiatry ; 43(2): 151-156, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30091071

RESUMO

OBJECTIVE: This retrospective study compared faculty-selected evaluation scores with those mathematically calculated from behaviorally anchored assessments. METHODS: Data from 1036 psychiatry clerkship clinical evaluations (2012-2015) was reviewed. These clinical evaluations required faculty to assess clinical performance using 14 behaviorally anchored questions followed by a faculty-selected overall evaluation. An explicit rubric was included in the overall evaluation to assist the faculty in interpreting their 14 assessment responses. Using the same rubric, mathematically calculated evaluations of the same assessment responses were generated and compared to the faculty-selected evaluations. RESULTS: Comparison of faculty-selected to mathematically calculated evaluations revealed that while the two methods were reliably correlated (Cohen's kappa = 0.314, Pearson's coefficient = 0.658, p < 0.001), there was a notable difference in the results (t = 24.5, p < 0.0001). The average faculty-selected evaluation was 1.58 (SD = 0.61) with a mode of "1" or "outstanding," while the mathematically calculated evaluation had an average of 2.10 (SD = 0.90) with a mode of "3" or "satisfactory." 51.0% of the faculty-selected evaluations matched the mathematically calculated results: 46.1% were higher and 2.9% were lower. CONCLUSIONS: Clerkship clinical evaluation forms that require faculty to make an overall evaluation generate results that are significantly higher than what would have been assigned solely using behavioral anchored assessment questions. Focusing faculty attention on assessing specific behaviors rather than overall evaluations may reduce this inflation and improve validity. Clerkships may want to consider removing overall evaluation questions from their clinical evaluation tools.


Assuntos
Estágio Clínico/estatística & dados numéricos , Competência Clínica/estatística & dados numéricos , Avaliação Educacional/métodos , Docentes de Medicina , Educação de Graduação em Medicina/métodos , Humanos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estudantes de Medicina
19.
Clin Teach ; 16(2): 131-137, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29575707

RESUMO

BACKGROUND: Little is known on ambulatory clerkship students' use of an electronic medical record (EMR). We investigated students' use of recommended EMR tasks across different types of sites and studied the predictors of these recommended tasks. METHODS: Students documented how often they performed recommended EMR tasks and suggested improvements to enhance EMR use. We compared student performance of recommended tasks across different types of sites using χ2 tests and the Fisher's exact test. We performed regression analyses to investigate factors predicting students' performance of EMR tasks. Two faculty members read all of the suggested improvements and agreed on themes. RESULTS: From January 2014 to June 2015, 263 of 295 Family and Community Medicine Clerkship (FCMC) students (89.2%) were at sites that used an EMR. Of the 263 students, 68.4% typed their own note into the EMR, but only 31.2% entered orders and 27.8% entered prescriptions for their teacher to sign. Students' rating of the orientation to the EMR predicted their use of all EMR tasks. The number of years that the teaching site used an EMR predicted the students' use of some tasks. Suggested improvements included a better orientation to the EMR, more use of the EMR, and access to a computer and the EMR. Little is known on ambulatory clerkship students' use of an electronic medical record DISCUSSION: Many students did not perform recommended EMR tasks. To help more students learn EMR tasks, clinical teachers can offer students a detailed orientation to their EMR, provide them with access to a computer and the EMR, and give them the opportunity to perform recommended EMR tasks, including typing their own note and entering orders and prescriptions.


Assuntos
Estágio Clínico/estatística & dados numéricos , Registros Eletrônicos de Saúde/provisão & distribução , Estudantes de Medicina/estatística & dados numéricos , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Humanos , Aprendizagem , Fatores de Tempo
20.
Int J Med Educ ; 9: 255-261, 2018 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-30278431

RESUMO

Objectives: To determine if faculty perceive standardized oral examinations to be more objective and useful than the non-standardized format in assessing third-year medical students' learning on the obstetrics and gynecology rotation. Methods: Obstetrics and gynecology faculty at three teaching hospitals were sampled to complete a survey retrospectively comparing the standardized oral examination (SOE) and non-standardized or traditional oral examinations (TOE).  A Likert scale (0-5) was used to assess satisfaction, objectivity, and usefulness of SOE and TOE.  Wilcoxon signed rank test was performed to compare median Likert scale scores for each survey item. A Spearman's correlation coefficient was used to investigate the relationship between the perceived level of objectivity and SOE characteristics. For qualitative measures, content analysis was applied. Results: Sixty-six percent (n=25) of eligible faculty completed the survey. Faculty perceived the standardized oral examination as significantly more objective compared with the non-standardized (z=-3.15, p=0.002). Faculty also found SOE to be more useful in assessing overall clerkship performance (z=-2.0, p<0.05). All of the survey participants were willing to administer the standardized examination again.  Faculty reported strengths of the SOE to be uniformity, fairness, and ease of use. Major weaknesses reported included inflexibility and decreased ability to assess students' higher order reasoning skills. Conclusions: Faculty found standardized oral examinations to be more objective in assessing third-year medical students' clinical competency when compared with a non-standardized approach.  This finding can be meaningfully applied to medical education programs internationally.


Assuntos
Educação Médica , Avaliação Educacional , Docentes de Medicina/psicologia , Ginecologia/educação , Obstetrícia/educação , Percepção , Estudantes de Medicina , Estágio Clínico/normas , Estágio Clínico/estatística & dados numéricos , Competência Clínica , Educação Médica/métodos , Educação Médica/normas , Avaliação Educacional/métodos , Avaliação Educacional/normas , Ginecologia/normas , Humanos , Obstetrícia/normas , Projetos Piloto , Padrões de Referência , Estudantes de Medicina/psicologia , Inquéritos e Questionários , Comportamento Verbal/fisiologia
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