A survey study of evidence-based medicine training in US and Canadian medical schools.

PURPOSE: The authors conducted a survey examining (1) the current state of evidence-based medicine (EBM) curricula in US and Canadian medical schools and corresponding learning objectives, (2) medical educators' and librarians' participation in EBM training, and (3) barriers to EBM training. METHODS: A survey instrument with thirty-four closed and open-ended questions was sent to curricular deans at US and Canadian medical schools. The survey sought information on enrollment and class size; EBM learning objectives, curricular activities, and assessment approaches by year of training; EBM faculty; EBM tools; barriers to implementing EBM curricula and possible ways to overcome them; and innovative approaches to EBM education. Both qualitative and quantitative methods were used for data analysis. Measurable learning objectives were categorized using Bloom's taxonomy. RESULTS: One hundred fifteen medical schools (77.2%) responded. Over half (53%) of the 900 reported learning objectives were measurable. Knowledge application was the predominant category from Bloom's categories. Most schools integrated EBM into other curricular activities; activities and formal assessment decreased significantly with advanced training. EBM faculty consisted primarily of clinicians, followed by basic scientists and librarians. Various EBM tools were used, with PubMed and the Cochrane database most frequently cited. Lack of time in curricula was rated the most significant barrier. National agreement on required EBM competencies was an extremely helpful factor. Few schools shared innovative approaches. CONCLUSIONS: Schools need help in overcoming barriers related to EBM curriculum development, implementation, and assessment. IMPLICATIONS: Findings can provide a starting point for discussion to develop a standardized competency framework.

Integration of basic clinical skills training in medical education: an interprofessional simulated teaching experience.

BACKGROUND: A 2004 survey reveals that the implementation of the 1998 AAMC report on medical student clinical skills training is slow. Given the importance of intravenous catheter placement, a creative approach evolved to educate medical students on this important skill. DESCRIPTION: As part of a community service learning initiative, six graduate nursing students developed, implemented, and evaluated a pilot IV Cannulation Education Module taught to medical students. EVALUATION: Data analysis of 63 participants reveals improved knowledge and confidence in medical students' ability to place an intravenous catheter. The objectives were met and the process enjoyed by students of both professions. CONCLUSION: Opportunities for interprofessional teaching and learning include clinical skills training. Medical students learned an important skill taught by graduate nursing students who developed and evaluated a curriculum that met their own graduate course objectives. Both professions appreciated the opportunity to work collaboratively to achieve their respective programmatic goals.

Global Longitudinal Pathway: has medical education curriculum influenced medical students' skills and attitudes toward culturally diverse populations?

BACKGROUND: The Pathway represents a longitudinal program for medical students, consisting of both domestic and international experiences with poor populations. A previous study reported no significant attitudinal changes toward the medically indigent between Pathway and non-Pathway students. PURPOSE: The purpose of this study was to investigate and differentiate the skills and attitudes of Pathway and non-Pathway students in working with culturally diverse populations by conducting quantitative and qualitative analyses. METHODS: Selected items from a cultural assessment were analyzed using independent t-tests and a proportional analysis using approximation of the binomial distribution. In addition, a qualitative assessment of non-Pathway and Pathway students was conducted. RESULTS: A statistically significant difference was found at the end of Years 2, 3, and 4 regarding student confidence ratings, and qualitative results had similar findings. CONCLUSIONS: Clear and distinct differences between the two studied groups were found indicating the root of this increased confidence may have developed due to exposure to the Pathway program.

Tracking the longitudinal stability of medical students' perceptions using the AAMC graduation questionnaire and serial evaluation surveys.

BACKGROUND: This study examined the longitudinal stability of students' perceptions by comparing ratings on similar survey items in three sequential evaluations: end-of-clerkship (EOC), AAMC graduation questionnaire (GQ), and a postgraduate survey (PGY1). METHOD: For the classes of 2000 and 2001, ratings were compiled from EOC evaluations and comparable items from the GQ. For both cohorts, selected GQ items were included in the PGY1 survey and these ratings were compiled. Matched responses from EOC versus GQ and PGY1 versus GQ were compared. RESULTS: Proportions of "excellent" ratings were consistent across EOC and GQ surveys for all clerkships. Comparison of GQ and PGY1 ratings revealed significant differences in only seven of 31 items. CONCLUSION: Student perceptions as measured by GQ ratings are notably consistent across the clinical years and internship. This longitudinal stability supports the usefulness of the GQ in programmatic assessment and reinforces its value as a measure of student satisfaction.

A longitudinal study of multicultural curriculum in medical education.

OBJECTIVE: To evaluate impact a multicultural interclerkship had on students' perception of knowledge, interview skills, and empathy towards serving culturally diverse populations and role student demographics played in learning. METHODS: Data extracted from students' self-reported course evaluations and pre/post questionnaires during multiculturalism interclerkship across 11 academic years. Inquired students' opinion about four areas: effectiveness, small group leaders, usefulness, and overall experience. Subscale and item ratings were compared using trend tests including multivariate analyses. RESULTS: During studied years, 883 students completed course evaluation with high overall mean rating of 3.08 (SD=0.45) and subscale mean scores ranging from 3.03 to 3.30. Trends in three of four subscales demonstrated clear uptrend (p<0.0001). Positive correlations between ratings of leaders and "usefulness" were observed (p<0.0001). Pre/post matched dataset (n=967) indicated majority of items (19/23) had statistically significant higher post interclerkship ratings compared to pre scores with nine of 19 having statistically significant magnitudes of change. Questionnaire had high overall reliability (Cronbach alpha=0.8), and item-to-group correlations ranged from 0.40 to 0.68 (p<0.0001). CONCLUSIONS: By increasing students' exposure and interaction with diverse patients, their knowledge, attitude, and skills were increased and expanded in positive manner. These findings might inform those who are interested in enhancing this important competence. This is especially true given increasing scrutiny this global topic is receiving within and across healthcare professions around the world.

Assessing professionalism in the context of an objective structured clinical examination: an in-depth study of the rating process.

INTRODUCTION: Professionalism is fundamental to the practice of medicine. Objective structured clinical examinations (OSCEs) have been proposed as appropriate for assessing some aspects of professionalism. This study investigated how raters assign professionalism ratings to medical students' performances in OSCE encounters. METHODS: Three standardised patients, 3 doctor preceptors, and 3 lay people viewed and rated 20 videotaped encounters between 3rd-year medical students and standardised patients. Raters recorded their thoughts while rating. Qualitative and quantitative analyses were conducted. Comments about observable behaviours were coded, and relative frequencies were computed. Correlations between counts of categorised comments and overall professionalism ratings were also computed. RESULTS: Raters varied in which behaviours they attended to, and how behaviours were evaluated. This was true within and between rater type. Raters also differed in the behaviours they consider when providing global evaluations of professionalism. CONCLUSIONS: This study highlights the complexity of the processes involved in assigning ratings to doctor-patient encounters. Greater emphasis on behavioural definitions of specific behaviours may not be a sufficient solution, as raters appear to vary in both attention to and evaluation of behaviours. Reliance on global ratings is also problematic, especially if relatively few raters are used, for similar reasons. We propose a model highlighting the multiple points where raters viewing the same encounter may diverge, resulting in different ratings of the same performance. Progress in assessment of professionalism will require further dialogue about what constitutes professional behaviour in the medical encounter, with input from multiple constituencies and multiple representatives within each constituency.