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.
Background: Breast cancer (BC) incidence and mortality are lower in Poland than in the United States (US). However, Polish-born migrant women to US approach the higher BC mortality rates of US women. We evaluated the association between consumption of cabbage/sauerkraut foods and BC risk in Polish-born migrants to US. Methods: We conducted a case–control study of BC among Polish-born migrants in Cook County and the Detroit Metropolitan Area. Cases (n = 131) were 20–79 years old with histological/cytological confirmation of invasive BC. Population-based controls (n = 284) were frequency matched to cases on age and residence. Food frequency questionnaires assessed diet during adulthood and age 12–13 years. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated with conditional logistic regression. Consumption of total, raw/short-cooked, and long-cooked cabbage/sauerkraut foods was categorized as low, medium, or high (frequency of servings/week). Results: Higher consumption of total and raw/short-cooked cabbage/sauerkraut foods, during both adolescence and adulthood, was associated with a significantly lower BC risk. Consumption of long-cooked cabbage/sauerkraut foods was low and not significantly associated with risk. The multivariate OR for total cabbage/sauerkraut consumption, high vs. low (> 4 vs. ≤ 2 servings/week) during adolescence was 0.36 (95% CI = 0.18–0.71, ptrend < 0.01) and 0.50 (95% CI = 0.23–1.06, ptrend = 0.08) during adulthood. For raw/short-cooked cabbage/sauerkraut (>3 vs. ≤1.5 servings/week), the ORs were 0.35 (95% CI = 0.16–0.72, ptrend < 0.01) during adolescence and 0.37 (95% CI = 0.17–0.78, ptrend < 0.01) during adulthood. For joint adolescent/adult consumption of raw/short-cooked cabbage/sauerkraut foods, (high, high) vs. (low, low), the OR was 0.23 (95% CI = 0.07–0.65). The significant association for high adolescent consumption of raw/short-cooked cabbage/sauerkraut foods and reduced BC risk was consistent across all levels of consumption in adulthood. Conclusion: Greater consumption of total and raw/short-cooked cabbage/sauerkraut foods either during adolescence or adulthood was associated with significantly reduced BC risk among Polish migrant women. These findings contribute to the growing literature suggesting a protective effect of a potentially modifiable factor, cruciferous vegetable intake, on breast cancer risk.
Using the Programme Evaluation SOAP Note, clerkship leaders developed expanded lists of 'differential diagnoses' that could explain possible learner performance inadequacies in terms of system, curriculum and learner problems. This has informed programme improvement efforts currently underway. We plan to continue using the Programme Evaluation SOAP Note for ongoing programme improvement.
limitation by supplementing the SP encounter with computer-or manikin-based simulation. A key limitation of this technique is that the presence of a simulator cues the learner to anticipate an abnormality. Why the idea was necessary We were interested in determining whether students would correctly identify actual abnormal findings during an SP encounter. We therefore developed cases specifically for SPs with known physical abnormalities for our senior medical student clinical skills examination. What was done Cases were developed for 2 experienced SPs with stable cardiovascular abnormalities. The presenting problem for each case was neurological, but the case history was constructed to ensure that a cardiovascular examination would be warranted as part of the focused physical examination. Case 1 was portrayed by an SP with a mechanical aortic valve. Physical findings included a loud metallic valvular click and a grade II)III ⁄ VI systolic murmur. Case 2 was portrayed by an SP with chronic renal failure. His physical findings included a grade II)III ⁄ VI systolic murmur.Students were allowed 15 minutes with the patient, followed by 10 minutes to document pertinent interview and physical examination findings. All student)SP encounters were videotaped. Evaluation of results and impact A total of 53 students encountered these cases. Notes were reviewed for written documentation of the abnormal cardiac findings.Correct documentation for each SP were: case 1 (n ¼ 27) valvular click 6 (22%), murmur 6 (22%); case 2 (n ¼ 26) murmur 10 (38%). None of the students who described the click in case 1 also correctly described the murmur. Across both cases, 5 additional students documented the presence of a murmur, but described it incorrectly. A total of 23 students (43%) specifically wrote Ôno murmur, rub or gallopÕ for cardiac auscultation. Video review showed that all 23 of these students performed a technically sufficient examination to detect the murmur. Documentation of any cardiovascular examination was missing from 9 notes.The limited correct documentation of the abnormal cardiac findings we observed is quite concerning. We initially thought that students might have missed the abnormalities due to inadequate examinations; however, videotape review suggested otherwise. Deliberate disregard of findings in the SP is a possible explanation, although students are instructed to accept all information obtained from SPs. Careless documentation may explain the lack of inclusion of findings, but the specific recording of Ôno murmur, rub or gallopÕ in a substantial percentage of notes suggests that the students simply did not identify the auscultatory abnormalities.Students must both master the technical skills of the physical examination and learn to differentiate between normal and abnormal findings. Assessments using SPs are typically used to observe how well students select and perform specific, focused examinations. By using SPs with stable physical findings, student skill in detecting abnormalities can also be determined. ...
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