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

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UCSF Education Day 2011standardized patient examination.Background: Risk behaviors tend to cluster andsmokers in particular are likely to engage in multiplerisks. Treating multiple risk behaviors improves patienthealth outcomes and reduces health care costs.Methods: Using a randomized experimental design,medical students’ counseling interactions wereevaluated with a standardized patient presenting withsexual health concerns and current tobacco use withvaried problematic drinking status (alcohol-positive oralcohol-negative). Participants were 156 third yearmedical students at the University of California, SanFrancisco. Checklists completed by standardizedpatients evaluated students’ clinical performance. Afterthe encounter, students completed surveys of theirknowledge and attitudes for treating smokers withalcohol problems.Results: Overall, most students assessed tobacco use(85%); fewer assessed alcohol use (54%). Relative tothe alcohol-negative case, students seeing the alcoholpositivecase were less likely to assess STD history(80% vs. 91%, Ï‡2(1)=4.15, p=.042) or patients’readiness to quit smoking (41% vs. 60%, Ï‡2(1)=5.01,p=.025) and endorsed greater attitudinal barriers totobacco treatment, F(1,155)=4.79, p=.030. Patientsatisfaction, expressed as willingness to continuemedical treatment with the student doctor, wassignificantly lower for the alcohol-positive than thealcohol-negative case, Ï‡2(1)=5.18, p=.023. Clinicalperformance ratings moderated the relationship betweenpatient case version and patient satisfaction.Discussion: When presented with a case of multiplerisk behaviors (sexual health, tobacco and alcohol),medical students performed less effectively and receivedlower patient satisfaction ratings than with a caseinvolving fewer behavioral risks. Findings weremoderated by ratings of students’ overall clinicalperformance.Reflective critique: The findings support the need forparadigm shifts in medical education that emphasizeassessment of multiple risks, new models ofconceptualizing behavior change as a generalizedprocess, and treatment of the whole patient foroptimizing health outcomes.Physical Examination Teaching: ASystematic Review of the LiteratureSomnath Mookherjee, MD, UCSF, Department ofMedicine, Division of Hospital Medicine,SMookherjee@medicine.ucsf.edu; Lara Pheatt, MA,UCSF School of Medicine, Office of Medical Education,PheattL@medsch.ucsf.edu; Calvin L. Chou, MD, PhD,UCSF and VA Department of Medicine, Division ofGeneral Internal Medicine, calvin.chou@ucsf.eduAreas abstract covers: UME, GME, CMEDomain(s) addressed: Clinical Instruction andPerformance, Evaluation of Programs and Curricula,Patient CarePurpose: To review physical examination (PE) teachingmethods studied in the literature, summarize findings,and recommend best practices.Background: Physicians must be competent in the“synthesis” of PE data to make optimal patient caredecisions. Recent reports have bemoaned theinadequacy of physicians' PE skills; however, mostschools teach a comprehensive PE without links topatient care. Therefore, PE education needsimprovement, but the most effective teaching methodsare unknown.Methods: We included all publications of PE teachingpublished from 1951-2011 that studied the effects of acurricular intervention and reported on teaching efficacy.Data extracted included organ system targeted, studydesign, types of curricula, measurements of efficacy,and domains of PE learning (psychomotor skills,knowledge, communication, and “synthesis” of data intoclinical application).Results: Of 3665 papers retrieved, 121 met inclusioncriteria. The most represented organ systems werecardiovascular, musculoskeletal, gynecological, andgeneral (multiple organ systems or comprehensive PE).Sixty-six (55%) studies included control groups. Majorcategories of educational interventions includedsimulation with standardized patients (SPs), simulationof aspects of PE (such as recordings of heart sounds),bedside teaching, and peer examination or tutoring.Common assessment methods included checklists withobserved structured clinical examinations, written tests,and surveys of learner satisfaction and self-assessedcompetence. Psychomotor skills and knowledgeacquisition were the most common competenciestargeted; seventeen papers (14%) were judged to teachPE in the “synthesis” realm.Discussion: Despite heightened awareness of theimportance of PE skills in guiding patient care, we foundfew curricula that taught PE “synthesis.” Heterogeneity inUniversity of California, San Francisco • School of Medicine 37
UCSF Education Day 2011interventions and outcome measurements impedesidentification of the most effective teaching methods.Higher quality studies of PE teaching, particularly in therealm of synthesis, will allow for better identification ofbest practices in this area.Reflective critique: Based on recommendations fromESCape, we will add statistical expertise to the project toassess effect sizes.Pilot of a Lifelong ProfessionalDevelopment Metric in a ScholarlyConcentration ProgramRenee Courey, PhD, UCSF, renee.courey@ucsf.edu;Carrie Chen, MD, MSEd, UCSF,chenhc@peds.ucsf.edu; Louise Aronson, MD, MA,UCSF, aronsonl@medicine.ucsf.edu; Kristen Fitzhenry,MS, UCSF, FitzhenryK@medsch.ucsf.edu; Josh Adler,MD, UCSF, aadlerj@ucsfmedcenter.org; AdditionalPathway to Discovery Directors, UCSFAreas abstract covers: UME, GME, IPHEDomain(s) addressed: Competencies, Evaluation ofPrograms and Curricula, Longitudinal EducationalActivities, MentoringPurpose: To design and pilot an assessment tool thatdescribes progress in skills acquisition for scholarshipand leadership careers.Background: The UCSF Pathways to Discoveryprogram prepares interprofessional UME and GMEtrainees in discovery and leadership. Learners completeformal curricula and faculty-mentored projects in areasranging from the molecular to the global. Traditionally,assessment measured only course participation, projectquality, presentations, publications, and learnersatisfaction. Because the program aims to launchcareers in innovation, academia and leadership, ameans of charting steps along the continuum ofprofessional development was also required.Methods: We adapted the Dreyfus scale of skillacquisition from novice to expert to measure progress inthree competency areas, “Research and Scholarship,”Leadership and Advocacy,” and “Professional IdentityDevelopment.” The scale was sent to 52 faculty mentorsand did not allow selection of expert.Results: 33/52 faculty mentors responded. For the threecompetency areas, 52%, 64%, and 67%, respectively,placed their mentees at proficient, the highest availablelevel, describing competency usually achieved at theassistant professor stage.Discussion: The number of mentors selecting thehighest level of achievement greatly exceededexpectations. Program leaders anticipated that mostUME learners would move from novice or beginner tobeginner or competent. The failure to capture accuratedata on the stage of learners’ professional developmentmay be due to the culture of grading. Mentor educationand explicit distinction of formative career progressionassessment from summative performance assessmentmay improve appropriate scale use by mentors.Reflective critique: The results of the pilot evaluationhave been presented to the Committee on Curriculumand Educational Policy (CCEP). The Pathways toDiscovery Directors have also reviewed this data.Professional Deformation: TheRepression of Personal Values andAttributes in Medical EducationMichael W. Rabow, MD, UCSF,mrabow@medicine.ucsf.edu; Carrie N. Evans, MA,UCSF, Carrie.Evans@ucsf.edu; Rachel N. Remen, MD,UCSF, drrachel@commonweal.orgAreas abstract covers: UMEDomain(s) addressed: Medical Humanities,Professionalism, Reflection, ResearchPurpose: To understand what personal qualities orvalues students believe they might lose or be forced tosurrender during the course of their medical education.Background: The process of developing character andcommitment to the highest values of medicine has beencalled “professional formation" (1). However, medicalstudents are at risk for “deformation” as well. Asstudents progress through medical school, they gainprofessional competence but may also be at risk forharm. Prior research has documented the developmentof depression and the loss of empathy during medicaltraining. Little research has examined students’ ownexperience of such changes.Methods: In 2007-08, Healer’s Art elective studentsinternationally submitted words that described a part ofthemselves that they were wary about showing oractually did not let show in school. These words wereanalyzed using qualitative and quantitative techniques.Results: Words from 673 medical students from 31medical schools were analyzed. Eleven themes wereidentified. The most common themes were Spirituality,Emotional Engagement, Identity/Self-expression,Freedom/Spontaneity, and Relationships. The mostcommon individual words used were “Creativity,”“Family,” “Balance,” “Freedom,” “Love,” and “Peace.”38 The Haile T. Debas Academy of Medical Educators
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2011 - UCSF School of Medicine - University of California, San ...

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