2011 - UCSF School of Medicine - University of California, San ...

UCSF Education Day 2011Curriculum Evaluation & Educational Research Posters2007 - 2010 Match Data from ModelSFGH on Underserved and PrimaryCare Residency ChoiceMargo Vener, MD, MPH, UCSF, mvener@fcm.ucsf.edu;Elisabeth Wilson, MD, MPH, UCSF,ewilson@fcm.ucsf.edu; Anna Loeb, MS3, UCSF,anna.loeb@ucsf.edu; Nili Sommavilla, MS3, UCSF,nili.sommavilla@ucsf.edu; Julia Bruckner, MS 3, UCSF,julia.bruckner@ucsf.edu; Margaret Wheeler, MD, UCSF,mwheeler@medsfgh.ucsf.eduAreas abstract covers: UME, GMEDomain(s) addressed: Career Choice, CurricularInnovation, Primary CarePurpose: To evaluate whether Model SFGH increasesthe number students matching into primary care and/orunderserved residenciesBackground: The US faces a primary care physicianshortage, especially in underserved communities (1).Students trained in underserved programs have morepositive attitudes toward underserved patients (2) andhigher intentions of practicing in underservedcommunities (3). Model SFGH is an innovative 6-monthtrack for third-year students interested in urban health.Students complete three semi-integrated clerkships inunderserved settings, follow continuity patients, andwork in community health.Methods: Using match data from 2007-10, wecompared specialty and program choice of graduatingstudents who completed Model SFGH (59) to graduatingstudents who had not participated (600). We alsoevaluated match results from 2004-6, before ModelSFGH.Results: Compared to non-participants, Model SFGHstudents have higher rates of matching into primary careresidencies (66% vs. 38%), and/or programs inunderserved communities (37% vs. 18%). Compared tothe three years before implementation of Model SFGH,this represents an increase in the rate of matching intoprimary care for the total graduating class (40% vs 30%)but not an increase in underserved programs (19% vs20%).Discussion: Model SFGH students match morefrequently into primary care and/or underservedresidencies than non-participants. This increase issignificant in training new primary care physicians; sinceModel SFGH began, the total rate of UCSF graduatesmatching into primary care has increased. Furtherresearch should clarify what curricular factors(peer/faculty support, patient continuity) most profoundlyimpact students’ decisions.Reflective critique: We presented this work at STFMfor feedback. Further research will track students whowanted to do Model SFGH but were not selected in thelottery.References:1. Center for Workforce Studies, AAMC, 2007.2. Godkin et al, Teach Learn Med. 2006.3. Ko, et al Academic Medicine, 2005.A Randomized Trial of Hypothesis-Driven versus ScreeningNeurological ExaminationHooman Kamel, MD, UCSF, hooman.kamel@ucsf.edu;Gurpreet Dhaliwal, MD, UCSF; Maulik Shah, MD, UCSF;Amar Dhand, MD, DPhil, UCSF; Babak Navi, MD,UCSF; S. Andrew Josephson, MD, UCSFAreas abstract covers: GMEDomain(s) addressed: Clinical Instruction andPerformancePurpose: We hypothesized that trainees would performbetter using a hypothesis-driven approach to theneurological examination, rather than the traditionalscreening examination.Background: The neurological examination is importantbut complex and difficult to master.Methods: We randomly assigned 16 medical students toperform screening examinations of all major aspects ofneurological function or hypothesis-driven examinationsfocused on aspects suggested by the history. Eachstudent examined 4 patients, two of whom had focaldeficits. Outcomes of interest were the correctidentification of patients with focal deficits, number ofspecific deficits detected, and examination duration.Outcomes were assessed by an investigator blinded togroup assignments. McNemar’s test was used tocompare the sensitivity and specificity of the twoexamination methods.Results: Sensitivity was higher with hypothesis-drivenexaminations than screening examinations (78% versus56%; p = 0.046), although specificity was lower (71%versus 100%; p = 0.046). The hypothesis-driven groupidentified 61% of specific examination abnormalities,while the screening group identified 53% (p = 0.008).University of California, San Francisco • School of Medicine 25