Context Many medical schools assert that a racially and ethnically diverse student body is an important element in educating physicians to meet the needs of a diverse society. However, there is limited evidence addressing the educational effects of student body racial diversity. Objective To determine whether student body racial and ethnic diversity is associated with diversity-related outcomes among US medical students. Design, Setting, and Participants A Web-based survey (Graduation Questionnaire) administered by the Association of American Medical Colleges of 20 112 graduating medical students (64% of all graduating students in 2003 and 2004) from 118 allopathic medical schools in the United States. Historically black and Puerto Rican medical schools were excluded. Main Outcome Measures Students' self-rated preparedness to care for patients from other racial and ethnic backgrounds, attitudes about equity and access to care, and intent to practice in an underserved area. Results White students within the highest quintile for student body racial and ethnic diversity, measured by the proportion of underrepresented minority (URM) students, were more likely to rate themselves as highly prepared to care for minority populations than those in the lowest diversity quintile (61.1% vs 53.9%, respectively; PϽ.001; adjusted odds ratio [OR], 1.33; 95% confidence interval [CI], 1.13-1.57). This association was strongest in schools in which students perceived a positive climate for interracial interaction. White students in the highest URM quintile were also more likely to have strong attitudes endorsing equitable access to care (54.8% vs 44.2%, respectively; PϽ.001; adjusted OR, 1.42; 95% CI, 1.15-1.74). For nonwhite students, after adjustment there were no significant associations between student body URM proportions and diversity-related outcomes. Student body URM proportions were not associated with white or nonwhite students' plans to practice in underserved communities, although URM students were substantially more likely than white or nonwhite/ non-URM students to plan to serve the underserved (48.7% vs 18.8% vs 16.2%, respectively; PϽ.001). Conclusion Student body racial and ethnic diversity within US medical schools is associated with outcomes consistent with the goal of preparing students to meet the needs of a diverse population.

Fifteen educational innovations in academic medicine are described in relation to 5 environmental trends. The first trend, demands for increased clinical productivity, has diminished the learning environment, necessitating new organizational structures to support teaching, such as academies of medical educators, mission-based management, and faculty development. The second trend is multidisciplinary approaches to science and education. This is stimulating the growth of multidisciplinary curricular design and oversight along with integrated curricular structures. Third, the science of learning advocates the use of case-based, active learning methods; learning communities such as societies and colleges; and instructional technology. Fourth, shifting views of health and disease are encouraging the addition of new content in the curriculum. In response, theme committees are weaving content across the curriculum, new courses are being inserted into curricula, and community-based education is providing learning experiences outside of academic medical centers. Fifth, calls for accountability are leading to new forms of performance assessment using objective structured clinical exams, clinical examination exercises, simulators, and comprehensive assessment programs. These innovations are transforming medical education.KEY WORDS: educational innovations; environmental trends.

Teaching in small increments of time during patient care can provide powerful learning experiences for trainees. This article explores the ways that clinical teachers might do this in a time efficient way

With the increased interest in problem-based, small-group learning in medical education, a debate has arisen about whether the tutor should be an expert in the subject under discussion. This 1988 study at Harvard Medical School demonstrates that tutors' expertise has important effects on the process of discussion in a problem-based tutorial. In comparing discussions of subjects in which the tutors described themselves as expert with those in which they did not, the authors found that the tutors with expertise tended to take a more directive role in tutorials: they spoke more often and for longer periods, provided more direct answers to the students' questions, and suggested more of the topics for discussion. Tutor-to-student exchanges predominated, with less student-to-student discussion. These effects endanger an important goal of problem-based learning: the development of students' skills in active, self-directed learning.

Despite the trend toward curricular reform in the preclinical and core clerkship years, the fourth year of medical school is commonly unstructured, allowing students to take multiple "audition electives" in preparation for residency. Students struggle to identify mentors in their intended specialty in time to plan a well-rounded elective schedule and to prepare adequately for residency selection. The authors described the impact that an innovative fourth-year curriculum, the "College Program" at the David Geffen School of Medicine at the University of California-Los Angeles, which focuses on mentoring and required curricular components, has had on student perceptions of access to career mentors and overall satisfaction with the fourth-year experience. Pre- and postintervention cohorts participated in a 25-question telephone survey about their experience with mentors and overall satisfaction with their fourth year in 2001 and 2003. The Association of American Medical Colleges Graduation Questionnaire was analyzed as a secondary outcome measure, and responses were compared with those of national peers. Data were analyzed using two tailed t tests. Students in the intervention group reported a higher degree of satisfaction with accessibility to mentors and the impact they had on their educational experiences and careers than the preintervention cohort. Despite initial concerns that student freedom was going to be compromised, the students who participated in the College curriculum reported increased satisfaction with an intense foundations course, longitudinal experiences in the clinical setting, and scholarly projects during their senior year. Fourth-year students in the College Program were more likely to identify and develop better relationships with faculty mentors than their preintervention counterparts. They indicated excellent residency preparedness, and their overall impression of the fourth year was favorable.