Our medical students appear quite willing to accept shared decision making as a skill that they should have in working with patients, and this was the primary focus of the newly implemented module. However, we have learned that students need to deepen their understanding of screening services in order to help patients understand the associated benefits and risks. The final videotaped interaction with a simulated patient about colorectal cancer screening has been very helpful in making it more obvious to faculty what students believe and know about screening for colorectal cancer. As the students are asked to discuss clinical issues with patients and discuss the pros and cons of screening tests as part of the shared decision-making process, their thinking becomes transparent and it is evident where curricular changes and enhancements are required. We have found that an explicit model that allows students to demonstrate a process for shared decision making is a good introductory tool. We think it would be helpful to provide students with more formative feedback. We would like to develop faculty development programs around shared decision making so that more of our clinical faculty would model such a process with patients. Performance-based assessments are resource-intensive, but they appear to be worth the added effort in terms of enhanced skills development and a more comprehensive appraisal of student learning.
Background: It is not clear that teaching specific history taking, physical examination and patient teaching techniques to medical students results in durable behavioural changes. We used a quasiexperimental design that approximated a randomized double blinded trial to examine whether a Participatory Decision-Making (PDM) educational module taught in a clerkship improves performance on a Simulated Patient Exercise (SPE) in another clerkship, and how this is influenced by the time between training and assessment.
A significant amount of provider activity was directed at the delivery of health care; direct patient care and clinic operations combined accounted for approximately 75% of clinic activity. Patient, classroom, and group education activities, as well as contacts with parents and school staff accounted for 20% of all clinic activity and represent important SBHC functions that other productivity measures such as billing data might not consistently track. Overall, the method was acceptable to professional staff as a means of tracking activity and was adaptable to meet their needs.
This article describes the development of residents' report cards as one component of a curriculum on physician profiling for primary care residents. Thirty-two first-year residents matriculating into family practice, internal medicine, pediatrics, and obstetrics-gynecology residency programs in 1998 were profiled. The patient information in the report cards was limited to data on a panel of Medicaid patients initially seen in the resident ambulatory care clinics. All subsequent patient care for that population was also included. The method was multi-step and complex, involving hospital billing personnel and cooperation with a managed care partner. A three-session educational program was developed to introduce the concept of physician profiling. The first session consisted of a panel discussion on managed care. The second session was devoted to a discussion of hypothetical physician profiles with inappropriate length of stays, days/1,000, low numbers of office visits combined with high urgent-care use, and high outpatient services utilization. Small groups of residents participated in a problem-identification process as if they were members of a group practice. Residents identified problems in the reports and made suggestions for behavioral changes. A final session presented residents with their own personal report cards. Residents were surveyed both at the beginning of their first year and before and after the educational intervention on profiling. Resident attitudes, which were negative toward managed care at the outset, became generally more positive. Comparisons of pre-test and post-test means on the five-point Likert scale, using a paired-samples t-test, revealed significant changes in the residents' attitudes overall.
learning the new skill of balancing and rowing synchronously in a shell. The scholars also completed a team management-style profile and, in the second session, received personalised feedback about their preferred approaches to work and work-related interactions. Based on this information, the scholars selected accountability partners, who help them plan and achieve career goals. The third session was devoted to identifying these goals and writing action plans to accomplish them. This process includes identifying individuals who should be recruited Ôinto oneÕs boat' to help one reach goals. Evaluation of results During the final session, scholars identified the programme's strengths and weaknesses. Scholars were engaged by the actual rowing and its use as metaphor. They found learning about their personal management styles, preferences and techniques valuable for interacting with people with opposite styles. The scholars desired opportunities to bring members of their departmental work teams into sessions, and to create exercises ⁄ language tailored specifically for health professions educators. Despite initial resistance to viewing their cohort as their team of reference, several reported that they planned to remain in contact with their accountability partners. Further, the group committed to working together past graduation to mount a faculty development workshop for clinician educators. A revised OARS Programme will galvanise future cohorts and graduated scholars into a force for educational innovation and change. Context and setting This project was sponsored by the Michigan State University Centre for Excellence in Minority Education and Health. A 5-week, full-time summer research programme was designed, with a focus on enhancing medical students' knowledge of health care disparities and cultural diversity, basic principles of research, and increasing under-represented minority students' awareness of careers in academic medicine. Why the idea was necessary According to the Institute of Medicine's 2002 report Unequal Treatment, evidence of racial and ethnic disparities in health care is remarkably consistent across a broad range of health care issues and services. We need to increase the proportion of under-represented US racial and ethnic minorities among health professionals, and there remains a need for research into issues that impact minority populations and are related to health services and policy, epidemiology, health promotion and disease prevention, and outcomes. What was done Small groups were used to increase students' coverage of issues and to encourage collaborative skills. Students formed work groups around 1 of 4 pre-selected general topics related to health disparities: (a) diabetes; (b) mental health; (c) infant mortality, and (d) cancer screening and management.An introductory binder of readings was created for each group to help jumpstart students' scholarship about their chosen area. Each group was expected to focus on a more specific question within the general area. They were required...
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