Browsing by Subject "Undergraduate medical education"
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Item Assessment of Medical Students' Ability to Integrate Point-of-Care Cardiac Ultrasound Into a Case-Based Simulation After a Short Intervention(Springer Nature, 2022-07-31) Russell, Frances M.; Herbert, Audrey; Peterson, Dina; Wallach, Paul M.; Ferre, Robinson M.; Emergency Medicine, School of MedicineIntroduction: While a large amount of point-of-care ultrasound (POCUS) undergraduate medical education research exists, very little assesses the effectiveness of teaching on the student's ability to utilize POCUS within a clinical context. We set out to assess the ability of pre-clinical (second year) medical students to perform and interpret a parasternal long axis (PSLA) cardiac ultrasound view, and to diagnose a pericardial effusion on POCUS in a simulated patient with hypotension. Methods: This was a prospective study assessing second-year medical students before and after focused cardiac POCUS instruction. Pre-instruction, students completed a pre-assessment and test. They then watched a short video on cardiac ultrasound technique, anatomy, and pathology. Students then participated in 10 minutes of one-on-one hands-on instruction using a simulated patient. Immediately after didactics and hands-on instruction, students in groups of two to four completed a case simulation where they performed a PSLA view, identified pathology, and made a diagnosis. Differences between pre- and post-workshop responses were analyzed using the Chi-square test. Results: We analyzed data on 132 pre-clinical second-year medical students; 126 (95%) had limited to no POCUS experience prior to the workshop. Comparing pre- to post-workshop responses, we found significant improvement in students' ability to identify a pericardial effusion (46% to 69%) (p=0.002) on a PSLA cardiac view. Of the 57 student groups (132 students), 41 (72%) groups were able to adequately obtain a PSLA view on a mannequin using an ultrasound simulator without needing guidance with probe placement or maneuvering. Thirty-five (61%) student groups were able to identify a pericardial effusion and diagnose cardiac tamponade in a simulated patient with hypotension. Conclusion: After short, structured training, pre-clinical medical students, novice to cardiac POCUS, showed improved knowledge with identifying a pericardial effusion on an ultrasound image. The majority of students were able to obtain a PSLA view and diagnose cardiac tamponade in a hypotensive patient during a during a case-based simulation.Item Attitudes toward cost-conscious care among U.S. physicians and medical students: analysis of national cross-sectional survey data by age and stage of training(BMC, 2018-11-22) Leep Hunderfund, Andrea N.; Dyrbye, Liselotte N.; Starr, Stephanie R.; Mandrekar, Jay; Tilburt, Jon C.; George, Paul; Baxley, Elizabeth G.; Gonzalo, Jed D.; Moriates, Christopher; Goold, Susan D.; Carney, Patricia A.; Miller, Bonnie M.; Grethlein, Sara J.; Fancher, Tonya L.; Wynia, Matthew K.; Reed, Darcy A.; Medicine, School of MedicineBACKGROUND: The success of initiatives intended to increase the value of health care depends, in part, on the degree to which cost-conscious care is endorsed by current and future physicians. This study aimed to first analyze attitudes of U.S. physicians by age and then compare the attitudes of physicians and medical students. METHODS: A paper survey was mailed in mid-2012 to 3897 practicing physicians randomly selected from the American Medical Association Masterfile. An electronic survey was sent in early 2015 to all 5,992 students at 10 U.S. medical schools. Survey items measured attitudes toward cost-conscious care and perceived responsibility for reducing healthcare costs. Physician responses were first compared across age groups (30-40 years, 41-50 years, 51-60 years, and > 60 years) and then compared to student responses using Chi square tests and logistic regression analyses (controlling for sex). RESULTS: A total of 2,556 physicians (65%) and 3395 students (57%) responded. Physician attitudes generally did not differ by age, but differed significantly from those of students. Specifically, students were more likely than physicians to agree that cost to society should be important in treatment decisions (p < 0.001) and that physicians should sometimes deny beneficial but costly services (p < 0.001). Students were less likely to agree that it is unfair to ask physicians to be cost-conscious while prioritizing patient welfare (p < 0.001). Compared to physicians, students assigned more responsibility for reducing healthcare costs to hospitals and health systems (p < 0.001) and less responsibility to lawyers (p < 0.001) and patients (p < 0.001). Nearly all significant differences persisted after controlling for sex and when only the youngest physicians were compared to students. CONCLUSIONS: Physician attitudes toward cost-conscious care are similar across age groups. However, physician attitudes differ significantly from medical students, even among the youngest physicians most proximate to students in age. Medical student responses suggest they are more accepting of cost-conscious care than physicians and attribute more responsibility for reducing costs to organizations and systems rather than individuals. This may be due to the combined effects of generational differences, new medical school curricula, students' relative inexperience providing cost-conscious care within complex healthcare systems, and the rapidly evolving U.S. healthcare system.Item Curated collections for educators: Six key papers on teaching procedural skills(Wiley, 2021-08-01) Quinn, Antonia; Falvo, Lauren; Ford, Tabitha; Kennedy, Sarah; Kaminsky, Jennifer; Messman, Anne; Emergency Medicine, School of MedicineBackground: Competence in teaching procedural skills is required for faculty in all specialties. Regardless of involvement in undergraduate medical education (UME) versus graduate medical education (GME), faculty will likely be involved in teaching procedures to novice learners at some point, with the goal of having the learner achieve graduated independence and technical competence in a skill set. A large body of literature exists addressing the best practices for teaching and maintaining procedural skills. We searched for articles that describe the best practices for teaching procedural skills to all levels of learners. Methods: We conducted a literature search for papers on procedural skills training and teaching. We also made a call for papers on social media from members of the online #MedEd and #FOAMed communities. Once a list of the articles was compiled, we conducted a three-round modified Delphi process to identify those illustrating best practices for teaching procedural skills by both junior and senior faculty. Results: We identified 98 relevant articles on the topic of procedural skills training. Six articles were deemed to be highly relevant after three rounds of the modified Delphi. Best practices included using an established educational framework when designing procedural skills teaching sessions, providing positive feedback to learners with opportunities for improvement, and demonstrating the procedure to the learners. Conclusions: Medical educators should employ evidence-based practices when designing and delivering procedural skills sessions. Educational frameworks provide faculty developers and facilitators with an organized approach to teaching these sessions. Maintenance of procedural skills over time is key; faculty can utilize simulation-based procedural training and deliberate practice to prevent decay of learned skills.Item "Do I really have to complete another evaluation?" exploring relationships among physicians' evaluative load, evaluative strain, and the quality of clinical clerkship evaluations(2017-06) Traser, Courtney Jo; Brokaw, James J.Background. Despite widespread criticism of physician-performed evaluations of medical students’ clinical skills, clinical clerkship evaluations (CCEs) remain the foremost means by which to assess trainees’ clinical prowess. Efforts undertaken to improve the quality of feedback students receive have ostensibly led to higher assessment demands on physician faculty; the consequences of which remain unknown. Accordingly, this study investigated the extent to which physicians’ evaluative responsibilities influenced the quality of CCEs and qualitatively explored physicians’ perceptions of these evaluations. Methods. A questionnaire was delivered to physicians (n = 93) at Indiana University School of Medicine to gauge their perceived evaluative responsibilities. Evaluation records of each participant were obtained and were used to calculate one’s measurable quantity of CCEs, the timeliness of CCE submissions, and the quality of the Likert-scale and written feedback data included in each evaluation. A path analysis estimated the extent to which one’s evaluative responsibilities affected the timeliness of CCE submissions and CCE quality. Semi-structured interviews with a subset of participants (n = 8) gathered perceptions of the evaluations and the evaluative process. Results. One’s measurable quantity of evaluations did not influence one’s perceptions of the evaluative task, but did directly influence the quality of the Likert-scale items. Moreover, one’s perceptions of the evaluative task directly influenced the timeliness of CCE submissions and indirectly influenced the quality of the closed-ended CCE items. Tardiness in the submission of CCEs had a positive effect on the amount of score differentiation among the Likert-scale data. Neither evaluative responsibilities nor the timeliness of CCE submissions influenced the quality of written feedback. Qualitative analysis revealed mixed opinions on the utility of CCEs and highlighted the temporal burden and practical limitations of completing CCEs. Conclusions. These findings suggest physicians’ perceptions of CCEs are independent of their assigned evaluative quantity, yet influence both the timeliness of evaluation submissions and evaluative quality. Further elucidation of the mechanisms underlying the positive influence of evaluation quantity and timely CCE submissions on CCE quality are needed to fully rationalize these findings and improve the evaluative process. Continued research is needed to pinpoint which factors influence the quality of written feedback.Item Dynamic changes in medical education amidst the COVID-19 pandemic: Adapting to virtual ophthalmology residency interviews(Elsevier, 2022) Patel, Om U.; Bonner, Andrew; Sisk, Morgan; Grant, Maria B.; Ophthalmology, School of MedicineItem Enhancing Medical Students’ Understanding of Team-Based Care to Address Social Determinants of Health: A Case-Based Experience(Society of Teachers of Family Medicine, 2024) Taylor, Jennifer D.; King, Jalysa; Medicine, School of MedicineBackground and objectives: Social and structural factors play a critical role in driving inequitable health outcomes, resulting in the need for undergraduate medical education to include important care components such as team-based care to address social determinants of health. Research shows that learning strategies such as case-based initiatives are valuable opportunities to impact knowledge of population health, health disparities, and social determinants that impact care. The purpose of this study was to assess the impact of a clinical case-based experience on medical students' self-efficacy and future intent to use the team-based care necessary to address social determinants of health. Methods: We used a retrospective analysis of program data from 640 third-year medical students who engaged in a case-based experience and small-group debriefing around the impact of team-based care and social determinants of health on patient care during their family medicine clerkship between July 2020 and April 2022. Results: We found a statistically significant improvement in students' reported self-efficacy and intent to collaborate with other health care workers (team-based care) to address patient care needs in rural and urban underserved community settings. Conclusions: Our students reported that a case-based experience coupled with a small-group debriefing was an effective method for teaching them how to use a team-based approach to address social determinants of health.Item From Passive Gatekeeper to Quarterback: Evolving Perceptions of Primary Care Among Medical Students in Longitudinal Outpatient Clerkships(Springer, 2022) Henschen, Bruce L.; Shaunfield, Sara; Golden, Blair P.; Gard, Lauren A.; Bierman, Jennifer; Evans, Daniel B.; Wayne, Diane B.; Ryan, Elizabeth R.; Yang, Monica; Cameron, Kenzie A.; Medicine, School of MedicineBackground: Longitudinal clerkships provide students with meaningful clinical care roles that promote learning and professional development. It remains unclear how longitudinal primary care clerkships inform students' perceptions of primary care. Objective: To explore perceptions of primary care among medical students enrolled in longitudinal primary care clerkships. Design: Qualitative, semi-structured interviews with medical students over 4 years. Participants: Thirty-eight medical students participated at baseline; 35 participated in a 2-year follow-up interview; 24 participated at 4 years. Each student was enrolled in one of two longitudinal primary care clerkships: a team-based Education-Centered Medical Home (ECMH) or a one-on-one individual preceptorship (IP). Approach: De-identified interview transcripts were analyzed using a process of open and axial coding, followed by elaborative coding for longitudinal analysis. Codes were compiled into a set of themes and compared across time periods and between clerkships. Key results: Students reported that primary care serves as a first point of contact, emphasizing longitudinal care with a wide scope of practice and approaching patient care with a biopsychosocial perspective. Student perceptions of primary care greatly expanded over the course of 4 years: for instance, initial perceptions of primary care physicians evolved from "passive gatekeeper" to a more nuanced "quarterback." Students in ECMH, whose clerkship provided more opportunity for patient continuity, further reflected on the relationships they themselves developed with patients. Conclusions: Regardless of their eventual specialty choice, longitudinal experiences may aid all students in fostering a sense of the broad scope and importance of primary care. However, without numerous opportunities to witness continuity of care, students may perceive primary care as having limited scope and importance. Longitudinal clerkships, emphasizing continuity with patients and preceptors, may foster in students a broad and nuanced perspective of the scope of primary care as a field.Item Resilience matters: Student perceptions of the impact of COVID-19 on medical education(Elsevier, 2022) Haskett, Lindsay A.; Doster, Dominique L.; Athanasiadis, Dimitrios I.; Anton, Nicholas E.; Huffman, Elizabeth K.; Wallach, Paul; Walvoord, Emily; Stefanidis, Dimitrios; Mitchell, Sally A.; Lee, Nicole K.; Surgery, School of MedicineIntroduction: We assessed students' perception of the impact of the pandemic on their well-being, education, academic achievement, and whether grit and resilience alter students' ability to mitigate the stress associated with disruptions in education. We hypothesized that students would report a negative impact, and those with higher grit and resilience scores would be less impacted. Methods: A multidisciplinary team of educators created and distributed a survey to medical students. Survey results were analyzed using descriptive statistics, ANOVA, and multivariate linear regressions. A p-value <.05 was considered statistically significant. Results: A total of 195 students were included in the study. Approximately 92% reported that clinical education was negatively affected, including participants with higher grit scores. Students with higher resilience scores were more optimistic about clinical education. Those with higher resilience scores were less likely to report anxiety, insomnia, and tiredness. Conclusion: More resilient students were able to manage the stress associated with the disruption in their education. Resiliency training should be year-specific, and integrated into the UME curriculum due to the different demands each year presents.Item Training the Trainer: Faculty From Across Multiple Specialties Show Improved Confidence, Knowledge and Skill in Point of Care Ultrasound After a Short Intervention(Cureus, 2020-12) Russell, Frances M.; Herbert, Audrey; Zakeri, Bita; Blaha, Mary; Ferre, Robinson M.; Sarmiento, Elisa J.; Wallach, Paul M.; Emergency Medicine, School of MedicineObjectives: Lack of faculty skill and confidence in performing and teaching point-of-care ultrasound (POCUS) remains a significant barrier to implementation of a longitudinal ultrasound curriculum in undergraduate medical education. Our objective was to assess faculty comfort, knowledge and skill with performing and teaching POCUS before and after a focused workshop. Methods: This was a prospective study assessing faculty from multiple specialties. Faculty completed a pre- and post-workshop survey and ultrasound knowledge assessment, and a post-workshop objective structured clinical examination (OSCE) to assess ability to perform POCUS. Differences between pre- and post-workshop responses were analyzed using Fisher's Exact and Wilcoxon tests, and statistical significance was accepted for p<0.05. Results: We analyzed data on 78 faculty from multiple disciplines. Faculty had a median of 7.5 years of experience with medical student teaching. Sixty-eight percent of faculty had performed <25 prior ultrasound (US) examinations. Comparing pre- to post-workshop responses, we found significant reductions in barriers to using US, and improved confidence with using, obtaining and interpreting POCUS (p<0.01). Faculty felt significantly more comfortable with the idea of teaching medical students POCUS (p<0.01). POCUS knowledge improved from 50% to 86% (p<0.01). On the post-workshop OSCE, 90% of anatomic structures were correctly identified with a median image quality of 4 out of 5. Conclusion: After attending a six-hour workshop, faculty across multiple specialties had increased confidence with using and teaching POCUS, showed improved knowledge, and were able to correctly identify pertinent anatomic structures with ultrasound while obtaining good image quality.