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

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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
UCSF Education Day 2011Median examination duration was 1 minute shorter in thehypothesis-driven group (7.0 minutes versus 8.0minutes; p = 0.13).Discussion: In this randomized trial comparing twomethods of neurological examination, a hypothesisdrivenapproach resulted in greater sensitivity and atrend towards faster examinations, at the cost of lowerspecificity, compared to the traditional screeningapproach. Our findings suggest that while a screeningexamination may be preferable when a focal deficit isunlikely, a hypothesis-driven approach may be superiorwhen the history is concerning for an acute focalneurological process.Reflective critique: We are working with our colleaguesin Emergency Medicine to further test this curriculum.A Review of Longitudinal MedicalEducational Programs Relating to aPsychiatry Residency ClinicalCurriculum RedesignColin E. Stewart, MD, UCSF, Department of Psychiatry,Colin.Stewart@ucsf.edu; Danielle Carlin, MD, UCSF,Department of Psychiatry, Danielle.Carlin@ucsf.edu;John Q. Young, MD, MPP, UCSF, Department ofPsychiatry, JQYoung@lppi.ucsf.edu; Amin Azzam, MD,MA, UCSF, Department of Psychiatry,Amin.Azzam@ucsf.eduAreas abstract covers: UME, GMEDomain(s) addressed: Clinical Instruction andPerformance, Curricular Innovation, LongitudinalEducational Activities, ResidencyPurpose: We sought to review the literature onlongitudinal educational programs, search for bestpractices and innovations, and relate findings to ourclinical curriculum redesign.Background: UCSF’s general adult psychiatryresidency is redesigning its clinical curriculum. Based onour knowledge of adult and workplace learning, weintend to include longitudinal educational programs inthe curriculum.Methods: Two authors did independent PubMedliterature searches on longitudinal curricula using MeSHterms from seminal articles in the field. Almost 1,000articles were retrieved. After scanning all titles andreading pertinent abstracts, relevant articles werereviewed. Findings were recorded in a template andcommon themes identified.Results: Factors that significantly impact residentsatisfaction and learning include: 1) Clear goals andobjectives, 2) preceptor and patient care continuity, 3)protection from inpatient responsibilities, and 4)adequate ancillary support. Clinic objectives are oftenbased on needs assessments completed via residentsurvey. Other longitudinal experiences such ascommunity projects and problem-based learning (PBL)cases can easily be integrated into clinics to complementlearning in clinical settings. As residents advance, theyneed less direct observation, more guidance in practicemanagement, and more opportunities for self-directedquality improvement projects.Discussion: An ideal longitudinal educational programin a psychiatry residency might involve a weeklyexperience in a general psychiatry continuity clinicspanning all four years that involves lasting relationshipswith preceptors and gradually decreasing direct clinicalsupervision complemented by increasing involvement inpractice management decisions and projects. Anadaptation of this abstract was submitted to the WGEA.Reflective critique: A psychiatry residency clinicalcurriculum committee (CCC) comprised of educatorsfrom multiple UCSF training sites meets regularly toreview findings and discuss their implications for ourcurriculum redesign. Resident feedback is also beinggathered from a pilot continuity clinic at our VA trainingsite and will be reviewed by the CCC prior toimplementing further pilot programs.Anesthesia Journal Clubs: GeneralPractices and Successful FeaturesKathryn Price, MS, University of California SanFrancisco, School of Medicine, kathryn.price@ucsf.edu;Marek Brzezinski, MD PhD, University of California SanFrancisco, Department of Anesthesia and PerioperativeCare, BrzezinM@anesthesia.ucsf.edu; H. Nicole Tran,MD, Kaiser Permanente: Oakland Medical Center,,hiennicole@gmail.com; Kathy Schlecht, DO, SouthOakland Anesthesia Associates P.C.,2kschlecht@comcast.net; Annette Mizuguchi, MD PhD,Brigham and Women’s Hospital,AMIZUGUCHI@partners.org; Stephen Kimatian, MD,Cleveland Clinic, kimatis@ccf.org; Guneet Natt, MD,San Francisco VA Medical Center,guneet_nat@yahoo.com; John Mitchell, MD, HarvardMedical School, Beth Israel Deaconess Medical Center,jdmitche@bidmc.harvard.eduAreas abstract covers: GMEDomain(s) addressed: Evaluation of Programs andCurricula, Quality Improvement, ResidencyPurpose: To identify general characteristics of journalclub and features associated with higher residentattendance and longevity.26 The Haile T. Debas Academy of Medical Educators
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