Family practice clerkship encounters documented with structured phrases on paper and hand-held computer logs.
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Patient encounter logs allow faculty to monitor students' clinical experiences, especially in decentralized clerkships. However, there are generally tradeoffs involving the expressiveness of patient encounter forms, the effort required to complete the forms, and the utility of the forms for informing the clerkship director. The family practice clerkship at Washington University changed the school's standard free text, paper log to a controlled vocabulary paper log, borrowing 93 generic ICD-9 codes and the SNOMED concept of 'process at location' phrases for localized problems. Subsequently, this architecture was used in a Palm computer program. Students using the structured paper logs documented slightly more patient encounters than students using free text logs in the previous year, with similar numbers of problems per patient (1.3 to 1.4) and prevalence of common illnesses, but used the phrase structure and code vocabulary inconsistently. Students using computer logs documented many more patient encounters, but only documented 1.09 problems per patient. Students' documentation of psychosocial diagnoses declined significantly with the computer log. Although the computer program was flexible, the effort required to enter multiple problems exceeded the effort of finding similar codes on a short paper form. This problem confounds efforts to monitor exposure to complex patients and hidden medical problems. Another design for the hand-held computer log is being tested. (+info)
Managed care education in osteopathic medical schools: development of a fourth-year predoctoral healthcare management clerkship.
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This article describes the current managed care curricula in osteopathic medical schools and summarizes the development and implementation of a healthcare management clerkship for fourth-year osteopathic medical students at Ohio University College of Osteopathic Medicine. Results of a survey of the 19 osteopathic medical schools indicated that only three schools currently have a stand-alone, managed care elective. No schools have required managed care courses, clerkships, or rotations. The remaining osteopathic medical schools have incorporated managed care-related topics into courses in their schools' curricula. To produce physicians fully competent to succeed in the 21st century's managed healthcare environment, medical schools need to affiliate with managed care organizations, integrate more managed care components into their curricula, and develop required or elective stand-alone managed care courses and clerkships. This article describes content to be integrated in a predoctoral managed care clerkship, including goals and objectives. It also describes the components and learning activities of Ohio University College of Osteopathic Medicine's Healthcare Management Clerkship. (+info)
Educational instruction on a hospital information system for medical students during their surgical rotations.
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OBJECTIVE: To evaluate the benefit, for medical students on their surgical rotations, of real-time educational instruction during order entry on a hospital information system. DESIGN: Prospective controlled trial. INTERVENTION: Access to educational information during computerized order entry. SUBJECTS: Medical students in their final year at the University of Calgary. MAIN OUTCOMES: Attainment of the surgery rotation educational objectives, as measured by performance on a multiple-choice examination. METHODS: Before they began their surgical rotations, students at two hospitals took a multiple-choice examination to measure their knowledge of surgery. One hospital had an information system with computerized order entry; students at this hospital had access, while composing orders, to educational material on the system. The other hospital did not have an information system; students there wrote orders on a paper chart. At the end of the rotation, all students took another multiple-choice examination. RESULTS: Of 50 eligible students, 45 agreed to participate in the project, 21 in the treatment group and 24 in the control group. Pre-rotation scores were similar for the two groups (43 percent in the treatment group and 40 percent in the control group; SD, 10 percent). Post-rotation scores were identical for the two groups (65 percent in the treatment group and 65 percent in the control group; SD, 12 percent). A t-test analysis revealed no significant difference in performance on the examinations between the two groups. CONCLUSION: This study did not demonstrate a learning advantage for medical students who have access to educational material on a hospital information system. (+info)
Introduction of evidence-based medicine into an ambulatory clinical clerkship.
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Evidence-based medicine (EBM) has emerged has a critical clinical competency in the 21st century. Medical schools usually introduce students to critical appraisal in the preclinical years, but there have been few evaluated interventions in teaching EBM in the clinical years. We describe a strategy to encourage students to practice EBM during a required ambulatory medicine clerkship. During this clerkship, our students are required to submit an EBM report, which is prompted by an individual case, and structured with a 5-step approach. One small-group session is devoted to modeling this approach with a case of chest pain. Using a checklist to grade 216 consecutive EBM reports, we found that students were quite successful with the exercise, achieving on average 89.6% of possible checklist points. Students who followed the structure of the exercise closely were more likely to extend their discussions beyond that required and to suggest potential further areas of investigation or design. (+info)
Effect of an integrated nutrition curriculum on medical education, student clinical performance, and student perception of medical-nutrition training.
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BACKGROUND: Ninety-eight percent of medical schools report nutrition as a component of medical education. However, most schools do not have an identifiable nutrition curriculum. Medical schools that do include nutrition have not evaluated its effect on clinical skills. OBJECTIVE: The objective was to determine the efficacy of an integrated undergraduate medical curriculum to increase the quantity of nutrition instruction and to advance nutrition clinical skills demonstrated by medical students. DESIGN: A quasiexperimental design was constructed to determine whether an integrated nutrition curriculum increased the performance on nutrition-oriented clinical examinations of medical school classes that received 1, 2, or 3 y of the curriculum. The evaluation of the curriculum focused on 3 areas: 1) hours of nutrition instruction, 2) the application of nutrition within a clinical setting, and 3) perceptions about the nutrition curriculum. The Objective Structured Clinical Examination (OSCE) nutrition score was compared between graduating classes by use of analysis of variance. Data from the American Association of Medical Colleges were analyzed to determine the change in the proportion of students who reported that the amount of time devoted to nutrition was adequate. RESULTS: The implementation of the integrated nutrition curriculum resulted in a doubling of the total hours of required instruction in the medical curriculum (35 compared with 75 h). The mean (+/-1 SEM) OSCE nutrition score significantly improved after the implementation of the curriculum (41.7 +/- 0.9% compared with 50.6 +/- 1.1%) and the percentage of students who reported that the amount of nutrition taught during medical school was inadequate decreased (68.4% compared with 11.5%). CONCLUSION: Medical students improved their clinical nutrition practice skills through participation in an integrated nutrition curriculum. (+info)
Student operator-assistant pairs: an update.
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OBJECTIVE: To seek the opinions of undergraduates using the operator-assistant pairs system. DESIGN: A five-year evaluation of third-, fourth- and fifth-year students using a short, anonymous questionnaire OUTCOME MEASURES: This study set out to evaluate, but does not attempt to formally assess, the system. RESULT: Most students enjoyed working in pairs, citing mutual support and collaborative learning as being the main advantages. However, 67% of responding third- year students, 79% of fourth-year students and 54% of fifth-year students indicated that they did not know why paired working had been introduced. CONCLUSIONS: The majority of students found the pairs system advantageous over teacher-led situations. It encouraged greater efficiency, mutual support and help and collaborative learning. (+info)
Introducing quality improvement to pre-qualification nursing students: evaluation of an experiential programme.
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OBJECTIVE: To evaluate a programme introducing quality improvement (QI) in nursing education. SETTINGS: Betanien College of Nursing and clinical practices at hospitals in Bergen. SUBJECTS: 52 nursing students from a second year class working in 16 groups undertaking hospital based practical studies. INTERVENTION: Second year nursing students were assigned to follow a patient during a day's work and to record the processes of care from the patient's perspective. Data collected included waiting times, patient information, people in contact with the patient, investigations, and procedures performed. Students also identified aspects of practice that could be improved. They then attended a 2 day theoretical introductory course in QI and each group produced flow charts, cause/effect diagrams, and outlines of quality goals using structure, process, and results criteria to describe potential improvements. Each group produced a report of their findings. Main measures-A two-part questionnaire completed by the students before and after the intervention was used to assess the development of their understanding of QI. Evidence that students could apply a range of QI tools and techniques in the specific setting of a hospital ward was assessed from the final reports of their clinical attachments. RESULTS: The students had a significantly better knowledge of QI after the introductory course and group work than before it, and most students indicated that they considered the topic highly relevant for their later career. They reported that it was quite useful to observe one patient throughout one shift and, to some extent, they learned something new. Students found the introductory course and working in groups useful, and most thought the programme should be included in the curriculum for other nursing students. They considered it important for nurses in general to have knowledge about QI, indicating a high perceived relevance of the course. All 16 groups delivered reports of their group work which were approved by the tutors. Through the reports, all the groups demonstrated knowledge and ability to apply tools and techniques in their practical studies in a hospital setting. CONCLUSIONS: The introduction of a short experience-based programme into the practical studies of second year nursing students enabled them to learn about the concepts, tools, and techniques of continuous QI in a way that should provide them with the skills to undertake it as part of routine practice. (+info)
Determining teaching objectives for the family medicine clerkship in medical school--an Israeli national Delphi survey.
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BACKGROUND: Most of the published documents proposing teaching objectives for undergraduate clerkships were prepared by expert bodies. Seldom have the clinical teachers, who are critical to the learning process and to the implementation of the teaching objectives, been the actual proponents of its core content. OBJECTIVE: To develop a national-scale proposal of teaching objectives for the family medicine clerkship in medical school, using a consensus method and the actual, community-based teachers as the expert body. METHODS: The Delphi method was chosen for that purpose. In the first round all 189 family medicine teachers in Israeli medical schools were asked to propose five teaching objectives. In the second round the objectives, which were generated in the first round, were characterized by key words and were sent to the participants as a second round for ranking according to their importance. RESULTS: A total of 116 family medicine teachers (61.38%) responded in the first round and 91 of the 116 (78.5%) in the second round. They formulated 51 teaching objectives listed in order of importance, covering a wide array of themes and including knowledge, attitude and skills objectives. The most important objectives were common problems in primary care, recognition of the biopsychosocial model, and understanding the importance of the doctor-patient relationship. The structure of the list provides a unique insight into the relative importance of each objective in the context of the whole core content of the clerkship. CONCLUSIONS: Constructing a proposal for teaching objectives is feasible using the Delphi method and the field instructors as the selecting body. The process and its results can provide faculty with relevant and important suggestions on the content and structure of the family medicine clerkship. (+info)