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1.
Acad Med ; 95(3): 417-424, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31577581

RESUMO

PURPOSE: To determine whether longitudinal student involvement improves patient satisfaction with care. METHOD: The authors conducted a satisfaction survey of patients followed by 10 University of Minnesota Medical School students enrolled in 2016-2017 in the Veterans Affairs Longitudinal Undergraduate Medical Education (VALUE) program, a longitudinal integrated clerkship at the Minneapolis Veterans Health Care System. Students were embedded in an ambulatory practice with primary preceptors who assigned students a panel of 14 to 32 patients to follow longitudinally in inpatient and outpatient settings. Control patients, matched on disease severity, were chosen from the preceptor's panel. Two to five months after the students completed the VALUE program, the authors conducted a phone survey of the VALUE and control patients using a validated, customized questionnaire. RESULTS: Results are reported from 97 VALUE patients (63% response rate) and 72 controls (47% response rate) who had similar baseline characteristics. Compared with control patients, VALUE patients reported greater satisfaction with explanations provided by their health care provider, their provider's knowledge of their personal history, and their provider's looking out for their best interests (P < .05). Patients in the VALUE panel selected the top category more often than control patients for overall satisfaction with their health care (65% vs 43%, P < .05). CONCLUSIONS: The results of this controlled trial demonstrate that VALUE student longitudinal participation in patient care improves patient satisfaction and patient-perceived quality of health care for VALUE patients compared with controls matched by primary care provider and disease severity. These findings may have implications outside the Veterans Administration population.


Assuntos
Estágio Clínico/métodos , Educação de Graduação em Medicina/organização & administração , Satisfação do Paciente/estatística & dados numéricos , Aprendizagem Baseada em Problemas/métodos , Veteranos/psicologia , Veteranos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota , Adulto Jovem
2.
Acad Med ; 95(3): 411-416, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31436627

RESUMO

PURPOSE: Longitudinal integrated clerkships (LICs) are a widely used method of delivering clerkship curricula. Although there is evidence that LICs work and core components of LIC training have been identified, there is insufficient understanding of which components are integral to why they work. To address this question, this research explored how students experienced the first year of an LIC program. The aim was to use participants' understanding of their learning experiences to identify potential mechanisms of the LIC curriculum model. METHOD: Thirty-two interviews were conducted with 13 University of Toronto students, 7 LIC and 6 block rotation students from the same site, from October 2014 to September 2015. A thematic analysis was performed iteratively to explore participants' understanding of their key learning experiences and outcomes. RESULTS: Participants in both cohorts described their key learning outcome as integration and application of knowledge during patient care. Experiences supporting this outcome were articulated as longitudinal variable practice and continuity of relationships with preceptors and patients. Critically, these experiences manifested differently for the 2 cohorts. For block students, these learning experiences appeared to reflect the informal curriculum, whereas for LIC students, learning experiences were better supported by the LIC formal curriculum. CONCLUSIONS: The results illustrate the importance of learning experiences that support longitudinality and continuity. By also emphasizing variability and knowledge integration, they align with literature on expert development. Notably, many of the learning experiences identified resulted from informal learning and thus support going beyond the formal curriculum when evaluating the effectiveness of curricula.


Assuntos
Estágio Clínico/métodos , Currículo , Educação de Graduação em Medicina/organização & administração , Aprendizagem Baseada em Problemas/métodos , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Ontário , Adulto Jovem
3.
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
4.
Int J Med Educ ; 10: 195-202, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31658442

RESUMO

Objectives: To evaluate the effectiveness of including interactive video-based patient cases in preparatory lectures on medical students' patient-centredness and attitudes towards psychiatry. Methods: This study was designed as a quasi-experimental intervention study. A preparatory lecture on diagnostic interviewing was given to 204 fourth-year medical students before a 4-week psychiatry clerkship. The students were divided into two groups. One group (n=102) received a preparatory lecture including an interactive video case portraying a doctor performing a diagnostic interview with a simulated patient (intervention group). The other group (n=102) received a conventional preparatory lecture using text-based instructional material (control group). We conducted a paired sample t-test to compare the students' confidence in exhibiting patient-centred communication and their attitudes towards psychiatry before receiving the preparatory lecture and after having completed a minimum of three weeks of clerkship training. Results: A total of 102 students, 51 in each group, completed a questionnaire at both measurement points. In the intervention group, we found a statistically significantly difference for the students' patient-centredness before (M=69.4, SD=10.0) and after (M=73.8, SD=8.6) the intervention t(97)=2.38, p= 0.02, but no changes in attitudes t(98) =1.07, p=0.28. In the control group, we found no changes in patient-centredness or attitudes. Conclusions: Video cases in preparatory lectures appear to be better than text-based material at improving students' patient-centredness in psychiatry. However, neither video cases nor text-based material seem to influence the students' attitudes.


Assuntos
Educação Médica/métodos , Assistência Centrada no Paciente/normas , Psiquiatria/educação , Estudantes de Medicina/psicologia , Estágio Clínico/métodos , Dinamarca , Avaliação Educacional , Humanos , Entrevista Psicológica/métodos , Inquéritos e Questionários , Gravação em Vídeo
5.
South Med J ; 112(10): 526-530, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31583412

RESUMO

OBJECTIVES: The University of Alabama School of Medicine Tuscaloosa Regional Campus conducted a 2-month block in rural family practice, but committed to expanding to an 8-month longitudinal rural curriculum. We wanted to explore how rural physicians feel about teaching students in a prolonged rural preceptorship. METHODS: We brainstormed with colleagues, reviewed the literature, and conducted two focus groups supplemented by five interviews with rural physicians. The focus groups explored satisfaction and dissatisfaction in teaching, medical school and community support, evaluation of preceptors, and the sharing of information between students and preceptors. The analysis sought common themes among study participants and colleagues. RESULTS: Twenty-one study participants included 19 family physicians, 15 in private practice. Eleven had taught medical students. Our key finding, combining four themes, was that a satisfactory context within which to teach medical students long term in rural sites depends on the optimization of the roles of preceptors, students, communities, and educational institutions. There were comments addressing each of these roles. This finding cannot be generalized beyond the study group because of the qualitative methodology using a convenience sample. CONCLUSIONS: These physicians' concerns foment hypotheses about engaging rural physicians in their own unique local networks involving preceptors, students, community, and educational institutions to conduct satisfactory long-term medical education in rural sites. We recommend investigations to substantiate a prevalence among rural physicians of concern about the four roles and to describe various contexts in which these roles produce satisfactory long-term preceptorships, perhaps as best practices in different settings.


Assuntos
Atitude , Estágio Clínico/métodos , Educação Médica/métodos , Medicina de Família e Comunidade/educação , Médicos de Família/psicologia , Preceptoria , Estudantes de Medicina/psicologia , Currículo , Humanos
6.
Enferm. clín. (Ed. impr.) ; 29(5): 264-270, sept.-oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184150

RESUMO

Objetivo: Explorar la percepción de los estudiantes de cuarto curso del Grado en Enfermería sobre el entorno asistencial donde tiene lugar su proceso formativo en prácticas clínicas. Método: Estudio cualitativo fenomenológico basado en la filosofía hermenéutica de Gádamer que contó con el desarrollo de grupos focales y entrevistas semiestructuradas en estudiantes de cuarto curso del Grado de Enfermería de la Universidad de Almería. El periodo de recogida fue en febrero de 2016. La información obtenida se transcribió y analizó mediante estrategias inductivas en busca de categorías emergentes. Resultados: El análisis reveló dos categorías principales: (1) influencia del entorno clínico en el desempeño asistencial y docente de las enfermeras y en el aprendizaje de los estudiantes y (2) formación y perspectivas laborales para los futuros profesionales. Cada una de ellas mostró dos subcategorías con sus correspondientes códigos. La información recogida reflejó las experiencias y percepciones de los estudiantes de Enfermería sobre el entorno asistencial donde tiene lugar su proceso formativo en prácticas clínicas. Conclusiones: Este estudio permitió conocer la percepción de los estudiantes de cuarto curso del Grado de Enfermería sobre el entorno donde tiene lugar su proceso formativo en prácticas clínicas. Conocer dicho fenómeno ayuda a identificar déficits en el aprendizaje clínico de los estudiantes y a adaptar los planes de estudios de las universidades a sus necesidades formativas a fin de garantizar su éxito como profesionales ante las futuras demandas del contexto clínico-laboral


Aim: To explore the perception of fourth-year nursing students of the healthcare environment where their training process in clinical practices takes place. Methods: Phenomenological qualitative study based on the hermeneutical philosophy of Gádamer that included the development of focus groups and semi-structured interviews in a sample of fourth-year nursing students from the University of Almería. The collection period was in February 2016. The information obtained was transcribed and analyzed by inductive strategies in search of emerging categories. Results: The analysis revealed two main categories: (1) influence of the clinical environment on the healthcare and teaching performance of nurses and on student learning and (2) training and job prospects for the future professionals. Each of them showed two subcategories with their corresponding codes. The information collected showed the experiences and perceptions of Nursing students regarding the healthcare environment where their training process in clinical practices takes place. Conclusions: This study enabled us to discover the perception of fourth-year nursing students of the environment where their training process in clinical practices takes place. Knowledge of this phenomenon helps to identify deficits in students' clinical learning and to adapt university curricula to their training needs in order to guarantee their success as professionals facing future clinical-labour demands


Assuntos
Humanos , Percepção , Estudantes de Enfermagem/psicologia , Estudantes de Enfermagem/estatística & dados numéricos , Estágio Clínico/métodos , Estágio Clínico/normas , Enfermagem Prática , 25783 , Educação em Enfermagem , Aprendizagem
8.
Acad Med ; 94(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 58th Annual Research in Medical Education Sessions): S86-S94, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31365398

RESUMO

PURPOSE: To determine the effect of patient debrief interviews on pediatric clerkship student depth of reflection and learning. METHOD: The authors conducted a multi-institutional, mixed-methods, cluster randomized trial among pediatric clerkship students from May 2016 to February 2017. Intervention students completed a debrief interview with a patient-caregiver, followed by a written reflection on the experience. Control students completed a written reflection on a memorable patient encounter. Three blinded authors scored written reflections according to the 4-level REFLECT rubric to determine depth of reflection. Interrater reliability was examined using kappa. REFLECT scores were analyzed using a chi-square test; essays were analyzed using content analysis. RESULTS: Eighty percent of eligible students participated. One hundred eighty-nine essays (89 control, 100 intervention) were scored. Thirty-seven percent of the control group attained reflection and critical reflection, the 2 highest levels of reflection, compared with 71% of the intervention group; 2% of the control group attained critical reflection, the highest level, compared with 31% of the intervention group (χ(3, N = 189) = 33.9, P < .001). Seven themes were seen across both groups, 3 focused on physician practice and 4 focused on patients. Patient-centered themes were more common in the intervention group, whereas physician-focused themes were more common in the control group. CONCLUSIONS: Patient debrief interviews offer a unique approach to deepen self-reflection through direct dialogue and exploration of patient-caregiver experiences during hospitalization.


Assuntos
Estágio Clínico/métodos , Educação de Graduação em Medicina/métodos , Feedback Formativo , Entrevistas como Assunto , Pediatria/educação , Estudantes de Medicina/psicologia , Adulto , Cuidadores/psicologia , District of Columbia , Família/psicologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pacientes/psicologia , Reprodutibilidade dos Testes , Adulto Jovem
9.
South Med J ; 112(8): 450-454, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31375843

RESUMO

OBJECTIVE: Although considerable emphasis is placed on the attainment of honors in core medical school clerkships, little is known about what student characteristics are used by attending physicians to earn this designation. The purpose of this study was to evaluate what values and characteristics that attending physicians consider important in the evaluation of Pediatrics and Internal Medicine clerkship students for clinical honors designation. METHODS: This cross-sectional survey study was framed around Accreditation Council for Graduate Medical Education (ACGME) competencies. It was administered at three tertiary care hospitals associated with one large medical school in an urban setting. Teaching ward attendings in Pediatrics and Internal Medicine who evaluated third-year medical students between 2013 and 2016 were surveyed. RESULTS: Overall, Pediatric and Internal Medicine faculty demonstrated close agreement in which competencies were most important in designating clinical honors. Both groups believed that professionalism was the most important factor and that systems-based practice and patient care were among the least important factors. The only competency with a significant difference between the two groups was systems-based practice, with Internal Medicine placing more emphasis on the coordination of patient care and understanding social determinants of health. CONCLUSIONS: Professionalism, communication skills, and medical knowledge are the most important characteristics when determining clinical honors on Pediatrics and Internal Medicine clerkships.


Assuntos
Estágio Clínico/métodos , Competência Clínica/normas , Educação de Pós-Graduação em Medicina/normas , Docentes de Medicina , Medicina Interna/educação , Assistência ao Paciente/normas , Pediatria/educação , Criança , Estudos Transversais , Currículo , Humanos , Estudos Retrospectivos , Estudantes de Medicina/estatística & dados numéricos , Estados Unidos
12.
Acad Med ; 94(12): 1910-1915, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31335816

RESUMO

PROBLEM: Identifying and processing medical errors are overlooked components of undergraduate medical education. Organizations and leaders advocate teaching medical students about patient safety and medical error, yet few feasible examples demonstrate how this teaching should occur. To provide students with familiarity in identifying, reporting, and analyzing medical errors, the authors developed the interactive patient safety reporting curriculum (PSRC), requiring clinical students to engage intellectually and emotionally with personally experienced events in which the safety of one of their patients was compromised. APPROACH: In 2015, the authors incorporated the PSRC into the third-year internal medicine clerkship. Students completed a structured written report, analyzing a patient safety incident they experienced. The report focused on severity of outcome, root cause(s) analysis, system-based prevention, and personal reflection. The report was bookended by 2 interactive, case-based sessions led by faculty with expertise in patient safety, quality improvement, and medical errors. OUTCOMES: Students accurately analyzed the severity of the outcome, and their reports directly led to 2 formal root cause analyses and 4 system-based improvements. NEXT STEPS: The time- and resource-efficient PSRC allows students to apply patient safety knowledge to a medical error they experienced in a way that can directly affect care delivery. This model-interactive learning sessions coupled with engaging in a personally experienced case-can be implemented in various settings. Educators seeking to use student-experienced events for learning should not discount the emotional effects of those events on medical students.


Assuntos
Estágio Clínico/métodos , Currículo , Educação de Graduação em Medicina/métodos , Erros Médicos , Segurança do Paciente , Gestão de Riscos/métodos , Estudantes de Medicina/psicologia , Compreensão , Humanos , Medicina Interna/educação , Erros Médicos/prevenção & controle , Erros Médicos/psicologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Estados Unidos
13.
GMS J Med Educ ; 36(3): Doc30, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31211225

RESUMO

Background: During clinical clerkships students experience complex and challenging clinical situations related to problems beyond the domain of the "Medical Expert". Workplace routine may leave little opportunity to reflect on these situations. The University of Zurich introduced a mandatory course directly after the clinical clerkship year (CCY) to work up these situations. Prior to the course each student submitted a vignette on a case he or she had perceived challenging during the CCY and which was not related to the domain of the "Medical Expert" role. In this paper we want to characterize these cases in respect to most prominent themes and related CanMEDS roles. The goal was to inform clinical supervisors about potential teaching demands during the CCY. Methods: All case vignettes submitted by a years' cohort were analysed by three researchers in two ways: for the clinical characteristics and the main theme of the underlying problem and the most prominent CanMEDS roles involved. Themes of the underlying problem were aggregated to overarching topics and subsequently to main categories by pragmatic thematic analysis. Results: 254 case vignettes covered the whole spectrum of clinical disciplines. A wide range of underlying themes could be assigned to five main categories: "communication within team" (23.2%), "communication with patients and relatives" (24.8%), "patient behavior and attitudes" (18.5%), "clinical decision making" (24.0%), and "social and legal issues" (9.4%). Most frequent CanMEDS roles were "Communicator" (26.9%) and "Professional" (23.5%). Conclusions: Cases students perceived as challenging beyond the "Medical Expert" were reported from all clinical disciplines. These were mainly related to communicational and professional issues, mirrored by the CanMEDS roles "Communicator" and "Professional". Therefore, supervisors in clinical clerkships should put an additional teaching focus on communication and professionalism.


Assuntos
Estágio Clínico/normas , Currículo/normas , Estudantes de Medicina/psicologia , Adulto , Atitude do Pessoal de Saúde , Estágio Clínico/métodos , Competência Clínica/normas , Currículo/estatística & dados numéricos , Grupos Diagnósticos Relacionados/normas , Educação de Graduação em Medicina/métodos , Educação de Graduação em Medicina/normas , Feminino , Humanos , Masculino , Treinamento por Simulação/métodos , Treinamento por Simulação/normas
14.
PLoS One ; 14(6): e0218004, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31181132

RESUMO

BACKGROUND: Atraumatic needles are proposed to lower complication rates after lumbar puncture (LP). Only a minority of physicians use such needles. Here we aimed to assess the impact of specific training in LP during clinical clerkship on the proportion of medical students using atraumatic needles. METHODS: We performed a case-control study comparing medical students undergoing clinical clerkship and students undergoing specific LP training. The 176 students of a class underwent training in LP just before beginning their clinical rotations. This training consisted of 45 minutes of theoretical training and a 90-minute practical session with a dummy. Twenty students were selected from the class at random, and their competence was assessed with a multiple choice questionnaire (MCQ) and an objective structured clinical examination (OSCE), nine months after the specific training. These 20 cases were compared with 20 students randomly selected from a class of 180 students who had not undergone specific training in LP and were at the end of their clinical clerkship. RESULTS: We found that 60% of the students with specific training and 25% of those with classic clinical training used an atraumatic needle during the OSCE (p = 0.025). The mean MCQ (/100) scores obtained were 57±15 and 60±15 for the specific and classic training groups, respectively (p = 0.35). Overall OSCE score was similar in the two groups (63.5±9.3 vs. 65.8±9.3; p = 0.20). CONCLUSION: Very few practicing physicians use atraumatic needles, which limits the teaching of their use to medical students. Specific training durably increases the use of appropriate needles.


Assuntos
Estágio Clínico/métodos , Punção Espinal/métodos , Estudos de Casos e Controles , Competência Clínica , Educação Médica/métodos , Feminino , Humanos , Masculino , Agulhas/efeitos adversos , Estudantes de Medicina , Inquéritos e Questionários , Adulto Jovem
15.
Acad Med ; 94(11): 1806-1813, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31169536

RESUMO

PURPOSE: The longitudinal integrated clerkship (LIC) model, which allows medical students to participate in comprehensive care of a panel of patients over time, is rapidly expanding because of recognized benefits to students and faculty. This study aimed to determine how LIC student contact affected patients' experiences and self-described health outcomes. METHOD: This qualitative case study used semistructured patient interviews to understand the impact of LIC learners at the University of Colorado School of Medicine on patients at Denver Health. Patients with at least 3 encounters with an LIC student and over age 18 were selected. Thirty patients were invited to participate in 2016-2017; 14 (47%) completed interviews before the thematic analysis reached saturation. Four researchers independently analyzed interview transcripts and reached consensus on emergent categories and themes. RESULTS: Six broad themes were identified: beginnings of a relationship, caring demonstrated by student, growing to trust student, reaching a therapeutic alliance, improvement of patient outcomes due to student involvement, and a sense of loss after students completed the LIC program. CONCLUSIONS: Patients deeply valued the therapeutic alliances built with LIC students involved in their care over time. These alliances led to improved patient experience, mitigation of perceived health system failures, and subjective improvement in health outcomes. Patients described a sense of loss at the end of the LIC when students were no longer involved in their care. Curricula that support students building longitudinal therapeutic relationships with their patients are an opportunity to improve patient experience while promoting students' professional development.


Assuntos
Estágio Clínico/métodos , Educação de Graduação em Medicina/organização & administração , Docentes de Medicina/normas , Modelos Educacionais , Pesquisa Qualitativa , Estudantes de Medicina/psicologia , Confiança , Adulto , Currículo/normas , Avaliação Educacional/métodos , Feminino , Humanos , Aprendizagem , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Estudos Retrospectivos
16.
Acad Med ; 94(12): 1858-1864, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31169542

RESUMO

In the move toward competency-based medical education, leaders have called for standardization of learning outcomes and individualization of the learning process. Significant progress has been made in establishing defined expectations for the knowledge, skills, attitudes, and behaviors required for successful transition to residency training, but individualization of educational processes to assist learners in reaching these competencies has been predominantly conceptual to date. The traditional time-based structure of medical education has posed a challenge to individualization within the curriculum and has led to more attention on innovations that facilitate transition from medical school to residency. However, a shift of focus to the clerkship-to-postclerkship transition point in the undergraduate curriculum provides an opportunity to determine how longitudinal competency-based assessments can be used to facilitate intentional and individualized structuring of the long-debated fourth year.This Perspective demonstrates how 2 institutions-the University of Virginia School of Medicine and the University of Michigan Medical School-are using competency assessments and applying standardized outcomes in decisions about individualization of the postclerkship learning process. One institution assesses Core Entrustable Professional Activities for Entering Residency, whereas the other has incorporated Accreditation Council for Graduate Medical Education core competencies and student career interests to determine degrees of flexibility in the postclerkship phase. Individualization in addition to continued assessment of performance presents an opportunity for intentional use of curriculum time to develop each student to be competently prepared for the transition to residency.


Assuntos
Estágio Clínico/normas , Competência Clínica/normas , Educação Baseada em Competências/normas , Educação de Graduação em Medicina/normas , Estágio Clínico/métodos , Estágio Clínico/organização & administração , Educação Baseada em Competências/métodos , Educação Baseada em Competências/organização & administração , Educação de Graduação em Medicina/métodos , Educação de Graduação em Medicina/organização & administração , Humanos , Michigan , Virginia
17.
MedEdPORTAL ; 15: 10800, 2019 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-31139730

RESUMO

Introduction: Clinical reasoning is the complex cognitive process that drives the diagnosis of disease and treatment of patients. There is a national call for medical educators to develop clinical reasoning curricula in undergraduate medical education. To address this need, we developed a longitudinal clinical reasoning curriculum for internal medicine clerkship students. Methods: We delivered six 1-hour sessions to approximately 40 students over the 15-week combined medicine-surgery clerkship at Penn State College of Medicine. We developed the content using previous work in clinical reasoning, including the American College of Physicians' Teaching Medicine Series book Teaching Clinical Reasoning. Students applied a clinical reasoning diagnostic framework to written cases during each workshop. Each session followed a scaffold approach and built upon previously learned clinical reasoning skills. We administered a pre- and postsurvey to assess students' baseline knowledge of clinical reasoning concepts and perceived confidence in performing clinical reasoning skills. Students also provided open-ended responses regarding the effectiveness of the curriculum. Results: The curriculum was well received by students and led to increased perceived knowledge of clinical reasoning concepts and increased confidence in applying clinical reasoning skills. Students commented on the usefulness of practicing clinical reasoning in a controlled environment while utilizing a framework that could be deliberately applied to patient care. Discussion: The longitudinal clinical reasoning curriculum was effective in reinforcing key concepts of clinical reasoning and allowed for deliberate practice in a controlled environment. The curriculum is generalizable to students in both the preclinical and clinical years.


Assuntos
Estágio Clínico/métodos , Currículo/normas , Cirurgia Geral/educação , Medicina Interna/educação , Competência Clínica/estatística & dados numéricos , Cognição/fisiologia , Educação , Educação de Graduação em Medicina/métodos , Avaliação Educacional/métodos , Humanos , Conhecimento , Aprendizagem/fisiologia , Estudantes de Medicina/psicologia , Ensino/tendências , Estados Unidos/epidemiologia
18.
J Prof Nurs ; 35(3): 224-227, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31126400

RESUMO

Securing clinical sites that facilitate achievement of nursing skills to competently care for children is often challenging for nursing faculty. An additional challenge is helping nursing students learn the importance of conceptually driven practice and its application in the delivery of high quality care. This manuscript describes an alternative pedagogical approach that utilizes elementary schools for pediatric practicum, which is framed by the Whole School, Whole Community, Whole Child Model. Our model driven approach not only provides a framework by which baccalaureate nursing students gain the skills necessary to interact with, educate, and care for children, but also one in which they can gain a greater understanding of how the home, school and community influence the overall health and well-being of children. Subsequently, this pedagogy serves as an exemplar of how an alternative site can be utilized to successfully educate nursing students regarding the care of children.


Assuntos
Saúde da Criança , Estágio Clínico/métodos , Enfermagem Pediátrica/educação , Aprendizagem Baseada em Problemas , Instituições Acadêmicas , Criança , Competência Clínica , Bacharelado em Enfermagem , Educação em Saúde , Humanos , Estudantes de Enfermagem
19.
Teach Learn Med ; 31(5): 497-505, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31084222

RESUMO

Phenomenon: Pimping has become a well-known and distinct form of questioning in medical education, and as a pedagogical method it has both proponents and detractors. Pimping occurs when a teacher (pimper) asks difficult questions of the learner (pimpee), usually in rapid succession. There is a paucity of literature formally studying this technique and its effects on teachers and learners. Our study examines the use of and attitudes toward pimping in a pathology residency program to better understand its perceived value and effectiveness. Approach: Using a qualitative approach, we conducted semistructured interviews with 8 pathology trainees and 9 pathologists. As part of the interview process, we asked participants to draw a rich picture of a pimping encounter. Consistent with this qualitative method, we analyzed data iteratively using constant comparison. Findings: Negative emotions including anxiety and self-doubt dominated among the learners during pimping encounters. For some, these resulted in motivation to study, and for others this was a futile, nonmotivating experience. Most trainees felt that they were being judged during pimping; however, they perceived that the intentions of pimping were not malicious and in their best interests. This was supported by pathologists, who stated that their motivation for pimping was to identify knowledge gaps, thus benefiting the trainee. Insights: Pimping created a dichotomy of emotions within the majority of learners in this study. Negative emotions occurred during pimping encounters; however, following the encounter, pimping was perceived in a more positive light. Recognizing when and how pimping can create negative emotions that may interfere with learning may enable educators to create more consistently meaningful interactions.


Assuntos
Estágio Clínico/métodos , Docentes de Medicina/psicologia , Internato e Residência/métodos , Relações Interprofissionais , Estudantes de Medicina/psicologia , Adulto , Competência Clínica , Avaliação Educacional , Feminino , Humanos , Masculino , Pesquisa Qualitativa
20.
MedEdPORTAL ; 15: 10803, 2019 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-30931382

RESUMO

Introduction: A large body of evidence implicates adverse childhood experiences (ACEs) as significant factors in shaping adult health outcomes. Despite their wide-ranging impact on health, training on ACEs is lacking in most medical school curricula. As part of a required health equity course for first-year medical students, we developed a novel workshop on ACEs with an introduction to protective effects of resilience and trauma-informed care. Methods: This educational module on ACEs incorporated a didactic session on the science and health consequences of ACEs and best practices for trauma-informed care, followed by a facilitated case discussion in small groups exploring an ACE survey tool and a resilience questionnaire. Results: A total of 535 first-year medical students participated in the workshop in academic years 2016-2017, 2017-2018, and 2018-2019. In the session evaluation, students reported that the small-group, case-based discussion provided the richest learning experience. Areas identified by the students for improvement included delving more deeply into how to incorporate asking about ACEs in clinical care and how to involve multidisciplinary services in addressing ACEs. Discussion: The focus on raising awareness of the health impact of ACEs as well as enhancing resilience using a case-based approach was successful in meeting the stated objectives for the workshop. Future work will consist of building on this introductory content by designing curricular elements that explore multidisciplinary approaches to ACEs and trauma-informed care interventions in the clinical clerkships.


Assuntos
Experiências Adversas da Infância/estatística & dados numéricos , Currículo/normas , Educação/métodos , Estudantes de Medicina/psicologia , Adulto , Experiências Adversas da Infância/métodos , Conscientização , Criança , Estágio Clínico/métodos , Currículo/tendências , Feminino , Equidade em Saúde/ética , Avaliação do Impacto na Saúde/métodos , Humanos , Comunicação Interdisciplinar , Guias de Prática Clínica como Assunto/normas , Aprendizagem Baseada em Problemas/estatística & dados numéricos , Resiliência Psicológica , Inquéritos e Questionários , Ferimentos e Lesões/epidemiologia
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