Linking a service learning elective to a pre-existing course worked well, achieved its objectives, and will be continued

The author provides (1) a brief overview of the literature concerning program evaluation as applied to medical education, (2) a task-oriented conceptual model for use by residency directors in planning for program evaluation of graduate medical education training programs, (3) an explanation of the term "outcomes evaluation" including distinguishing between types of educational outcomes, and (4) a description of a five-step process of implementing the conceptual model.Recent accreditation standards for graduate medical education programs require a shift from a process-oriented to an outcomes-oriented model of evaluation. Accordingly, residency program directors must ensure compliance by undertaking comprehensive program evaluation procedures that demonstrate educational outcomes. Such procedures include attention to the need and focus of the evaluation; the evaluation methods to be used; and the documentation and presentation of evaluation results to key constituents. Involving teaching faculty and residents in developing a comprehensive evaluation program is vital to success. Regardless of philosophic debates pertaining to the appropriateness of the outcomes model for medical education, this approach appears likely to predominate in the foreseeable future particularly as related to the six general competencies of the physician. A practical, task-oriented approach will assist program directors in ensuring compliance with program evaluation standards.

Psychometric properties of this new ratings format are encouraging. The tool was a useful way to provide formative feedback to residents regarding professionalism and performance. Residency program directors can use this approach to fulfill Accreditation Council for Graduate Medical Education mandates to use a variety of assessment methods regarding resident education. However, potential sex bias and other issues affecting performance ratings should be considered in interpreting results and warrant further study.

Inadequate training of physicians contributes to the undertreatment of cancer pain. To address these concerns, the University of Kentucky has introduced a 4-week course for final-year medical students that teaches the principles of clinical pharmacology and pain management. The purposes of this study are to assess the knowledge deficits of final-year medical students about the use of morphine for cancer pain and to assess the efficacy of a short course on cancer pain management. Eighty-six final-year medical students completed a 22-item questionnaire assessing their knowledge and attitudes toward the use of morphine for cancer pain. Students indicated their agreement with each statement on a four-point scale (one, strongly disagree; four, strongly agree). All students then completed a compulsory short course on pain management. The course content included a 1-hr lecture on chronic nonmalignant pain, a 1-hr lecture on acute pain management, and a 1-hr lecture on cancer pain management. In addition, students completed small-group, problem-based learning modules on several aspects of pain management. After the course, all students completed the same 22-item survey. The alpha reliability score of the pretest instrument was 0.55, and the posttest reliability was 0.86. Upon course completion, students agreed most strongly (mean +/- SEM) that morphine should be given on a regular schedule for cancer pain (3.41 +/- 0.08), that cancer pain management frequently requires co-analgesics (3.36 +/- 0.06), and that patients with good pain relief function better than those with continuing pain (3.39 +/- 0.08). A comparison of pretest and posttest means on specific items suggested that the greatest amount of learning took place in the following content areas: morphine is a good oral analgesic; increases in cancer pain should be treated by increasing the morphine dose; respiratory depression is not a concern for cancer pain patients; and morphine can be used over a wide range of doses. The regular use of morphine was recognized as the treatment drug of choice for cancer pain. The students showed improved knowledge scores on ten of the 22 items on the posttest survey. A significant increase in learning occurred on six knowledge and attitude items. On only one item (nausea as a side effect of morphine) did the knowledge scores decrease on the posttest. A significant minority (40%) of senior medical students had deficits in knowledge about the use of morphine for cancer pain. The risk of addiction, respiratory depression, and tolerance were misunderstood by a significant minority (25%) of students.

BackgroundProfessionalism has been an important tenet of medical education, yet defining it is a challenge. Perceptions of professional behavior may vary by individual, medical specialty, demographic group and institution. Understanding these differences should help institutions better clarify professionalism expectations and provide standards with which to evaluate resident behavior.MethodsDuke University Hospital and Vidant Medical Center/East Carolina University surveyed entering PGY1 residents. Residents were queried on two issues: their perception of the professionalism of 46 specific behaviors related to training and patient care; and their own participation in those specified behaviors. The study reports data analyses for gender and institution based upon survey results in 2009 and 2010. The study received approval by the Institutional Review Boards of both institutions.Results76% (375) of 495 PGY1 residents surveyed in 2009 and 2010 responded. A majority of responders rated all 46 specified behaviors as unprofessional, and a majority had either observed or participated in each behavior. For all 46 behaviors, a greater percentage of women rated the behaviors as unprofessional. Men were more likely than women to have participated in behaviors. There were several significant differences in both the perceptions of specified behaviors and in self-reported observation of and/or involvement in those behaviors between institutions.Respondents indicated the most important professionalism issues relevant to medical practice include: respect for colleagues/patients, relationships with pharmaceutical companies, balancing home/work life, and admitting mistakes. They reported that professionalism can best be assessed by peers, patients, observation of non-medical work and timeliness/detail of paperwork.ConclusionDefining professionalism in measurable terms is a challenge yet critical in order for it to be taught and assessed. Recognition of the differences by gender and institution should allow for tailored teaching and assessment of professionalism so that it is most meaningful. A shared understanding of what constitutes professional behavior is an important first step.

This study evaluated the impact of a 2-wk required rotation in Physical Medicine and Rehabilitation (PM&R) on fourth-year medical students' knowledge of PM&R and attitude toward teamwork in patient care. Survey results on attitudes toward a team approach to patient care and knowledge in PM&R were compared prerotation and postrotation. One hundred thirty-eight fourth-year medical students participated in this 2-yr study. The combined response rates for the attitude and knowledge surveys were 62% and 56%, respectively. As measured by a pretest and posttest self-reported knowledge assessment, the rotation increased knowledge of PM&R (P ≤ 0.05). Four aspects of the rotation that were rated higher by students from the second year of the rotation were role and responsibility definition, incorporation of current literature, enhancement of clinical skills, and general rotation satisfaction. The rotation provides an experience for medical students to increase their knowledge of PM&R.

Although students who were exposed to material on spirituality in medicine reported greater understanding of the issue, no difference in clinical performance was observed.

Hospital chaplaincy and spiritual care services are important to patients' medical care and well-being; however, little is known about healthcare providers' experiences receiving spiritual support. A phenomenological study examined the shared experience of spiritual care between hospital chaplains and hospital-based healthcare providers (HBHPs). Six distinct themes emerged from the in-depth interviews: Awareness of chaplain availability, chaplains focus on building relationships with providers and staff, chaplains are integrated in varying degrees on certain hospital units, chaplains meet providers' personal and professional needs, providers appreciate chaplains, and barriers to expanding hospital chaplains' services. While HBHPs appreciated the care received and were able to provide better patient care as a result, participants reported that administrators may not recognize the true value of the care provided. Implications from this study are applied to hospital chaplaincy clinical, research, and training opportunities.