AMEE 2009 spotlight on educational research.

The AMEE meeting is unique among the medical education conferences in that it is truly international. Educational research presented at the 2009 AMEE Meeting was both diverse and robust. In this article, we will present an overview of educational research from the meeting. We will begin with outlining our methods for the selection and categorization of themes, discuss some highpoints from some of the respective themes, and finally from the conference overall.

Using formal evaluation sessions for case-based faculty development during clinical clerkships.

Developing housestaff and faculty in their roles as medical educators is a dynamic process. The rigorous clinical evaluation method used during the third-year internal medicine clerkship at the Uniformed Services University uniquely incorporates faculty development into the process of evaluation and generating feedback for students. Formal evaluation sessions are held monthly at all clerkship sites throughout the 12-week clerkship and are moderated by either the internal medicine clerkship director or the on-site clerkship directors. Although designed to provide an opportunity for faculty to evaluate student performance and prepare formative feedback, the sessions also function as formal, planned, and longitudinal forums of "real-time," "case-based" faculty development that address professional, instructional, and leadership development. The evaluation sessions are used as a means to model and teach the key concepts of the Stanford Faculty Development Program. Providing a unifying form of evaluation across multiple teaching sites and settings makes formal evaluation sessions a powerful, state-of-the-art tool for faculty development.

The effectiveness of formal evaluation sessions during clinical clerkships in better identifying students with marginal funds of knowledge.

PURPOSE: To compare evaluation methods for identifying third-year medical students whose funds of knowledge are marginal. METHOD: The written evaluation forms and comments from a formal evaluation session for 124 students in the inpatient medicine clerkship in 1992-93 at the Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine were reviewed. The written and verbal ratings of a student's general fund of knowledge were converted to similar five-point categorical scales. For each evaluation method, chi-square analysis was used to compare the students identified as having marginal funds of knowledge with those who scored < or = 300 on the end-of-clerkship NBME subject examination. RESULTS: Sixteen students scored < or = 300 on the NBME subject examination. For the checklist descriptors, ratings of "marginal" identified three of these 16 students (a sensitivity of 19%). For the written comments on the evaluation form, ratings of "marginal" identified four of the 16 (a sensitivity of 25%). For the formal evaluation session, however, ratings of "marginal" identified seven of the 16 (a sensitivity of 44%). The specificity of a "marginal" rating was excellent (> or = 95%) for all three evaluation methods. Chi-square analysis was significant for each method (p < or = .01). CONCLUSION: Although the ability of housestaff and faculty to identify students with weak funds of knowledge may be less than ideal, it may be improved by the routine use of a formal evaluation session. If done during the clerkship, this would allow for a specific plan of remediation to be designed with the instructors for the students at risk.

Using in-clerkship tests to identify students with insufficient knowledge and assessing the effect of counseling on final examination performance.

PURPOSE: To determine whether in-clerkship tests identify students with insufficient knowledge and whether counseling affects final examination pass rates. METHOD: The authors reviewed students' mean scores from two internal medicine clerkship tests at the Wright State University School of Medicine from February 1993 to July 1996. To determine the sensitivity and specificity of the tests for identifying students with insufficient knowledge, they compared students in the lowest quartile of clerkship test results with those who scored 290 or less on the end-of-clerkship National Board of Medical Examiners' (NBME) subject examination in medicine. The authors also compared the final examination pass rates of counseled and non-counseled students. RESULTS: Twenty-five students scored 290 or less on the NBME subject examination. Of those, 17 had low mean clerkship test scores (sensitivity of 68%). The specificity of a low mean clerkship test score was 81%. Counseling did not improve final examination pass rates. CONCLUSION: In-clerkship tests can identify students who are at risk of failing an end-of-clerkship examination. Because counseling may be insufficient to raise final examination pass rates, further study into the appropriate clerkship intervention for low-achievement students is needed.

Assessing how well three evaluation methods detect deficiencies in medical students' professionalism in two settings of an internal medicine clerkship.

PURPOSE: To compare the performances of three evaluation methods in detecting deficiencies of professionalism among third-year medical students during their ambulatory care and inpatient ward rotations of a core internal medicine clerkship. METHOD: From 1994 to 1997, 18 students at The Uniformed Services University of the Health Sciences failed to satisfactorily complete their core 12-week third-year internal medicine clerkship due to deficiencies in professionalism. Three evaluation methods had been used to assess all students' professionalism during the two rotations of their clerkship: standard checklists, written comments, and comments from formal evaluation sessions. Using qualitative methods and the information obtained by the three evaluation methods, the authors abstracted the record of each student concerning his or her clerkship behavior in terms of the six domains of professionalism used on the standard checklist. A detection index, which is the percentage of all instructors' less-than-acceptable ratings of a student across the six professionalism domains, was calculated for each evaluation method for each of the two clerkship settings. RESULTS: For each evaluation method, deficiencies in professionalism were twice as likely to be identified during the ward rotation as during the ambulatory care rotation (p < .002 for all). Formal evaluation session comments had the highest detection index in both clinical settings. Although the numbers of written and formal evaluation session comments per evaluator and per cited professionalism domain were similar, nearly a fourth of the instructors made identifying comments at the evaluation sessions only. CONCLUSION: In the clerkship studied, deficiencies in professionalism of such magnitude as to require remediation were more likely to be identified in the inpatient than in the ambulatory care setting. Of the three evaluation methods studied, the face-to-face, formal evaluation sessions significantly improved the detection of unprofessional behavior in both clerkship settings. Further efforts at such an interactive evaluation process with ambulatory care clerkship instructors may be essential for improving the identification of unprofessional behavior in that setting.

The responsibilities and activities of internal medicine clerkship directors.

PURPOSE: To characterize the responsibilities, activities, and scholarly productivity of internal medicine clerkship directors (CDs). METHODS: In 1999, internal medicine CDs from 122 U.S. medical schools and one Canadian medical school were surveyed. The instrument asked about the CDs' demo-graphics, workloads, clerkship characteristics, and scholarly productivity. RESULTS: The response rate was 89%; 72% of the respondents were men. Mean age was 45 years, mean time as CD was 6.5 years, and 58% of the CDs had completed fellowship training. The CDs spent 28% of their professional time on the clerkship, three half days weekly in clinic, and three months on inpatient services. The CDs had published a mean of 2.2 (range 0-20) articles and received a mean of 0.7 (range 0-4) grants. Similar factors were associated with publishing articles and receiving grants; gender (men), < or = three clinic half days weekly, fellowship training, having a faculty development program, teaching other courses, and discussing expectations with their department chairs. In a multivariate analysis, fellowship training, clinic half days, teaching other courses, and discussing expectations explained 22% of the variance for papers published. For grants received, a model with gender, clinic half days, a faculty development program, discussing expectations, and teaching other courses explained 35% of the variance. CONCLUSIONS: An internal medicine CD invests significant effort administering the clerkship and contributing to clinical and educational activities. The factors associated with successful scholarship may be useful for fostering CDs' academic careers.

Newly diagnosed human immunodeficiency virus after sepsis-like reaction of trimethoprim-sulfamethoxazole.

A rare sepsis-like hypersensitivity reaction has been observed in persons with human immunodeficiency virus (HIV) after exposure to trimethoprim-sulfamethoxazole. This reaction most commonly occurs on rechallenge with the drug and is manifested by a syndrome resembling bacterial sepsis. The mechanism of this unusual reaction remains unclear. We describe the first case in which this severe hypersensitivity reaction was the initial manifestation of HIV.