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As medical schools have changed their curricula to address foundational and clinical sciences in a more integrated fashion, teaching methods such as concept mapping have been incorporated in small group learning settings. Methods that can assess students' ability to apply such integrated knowledge are not as developed, however. The purpose of this project was to assess the validity of scores on a focused version of concept maps called mechanistic case diagrams (MCDs), which are hypothesized to enhance existing tools for assessing integrated knowledge that supports clinical reasoning. The data were from the medical school graduating class of 2018 (N = 136 students). In 2014-2015 we implemented a total of 16 case diagrams in case analysis groups within the Mechanisms of Health and Disease (MOHD) strand of the pre-clinical curriculum. These cases were based on topics being taught during the lectures and small group sessions for MOHD. We created an overall score across all 16 cases for each student. We then correlated these scores with performance in the preclinical curriculum [as assessed by overall performance in MOHD integrated foundational basic science courses and overall performance in the Clinical and Professional Skills (CAPS) courses], and standardized licensing exam scores [United States Medical Licensing Exam (USMLE)] Step 1 (following core clerkships) and Step 2 Clinical Knowledge (at the beginning of the fourth year of medical school). MCD scores correlated with students' overall basic science scores (r = 0.46, p = 0.0002) and their overall performance in Clinical and Professional Skills courses (r = 0.49, p < 0.0001). In addition, they correlated significantly with standardized exam measures, including USMLE Step 1 (r = 0.33, p [less than or equal to] 0.0001), and USMLE Step 2 CK (r = 0.39, p < 0.0001). These results provide preliminary validity evidence that MCDs may be useful in identifying students who have difficulty in integrating foundational and clinical sciences.

The article focuses on a study regarding grade reliability within one medical school. It mentions the association between reliable indicator of student achievement and imprecision of medical school grades. It also mentions that pass or fail system of grading provides little information about a student's level of performance.

Background: Early in medical education, physicians must develop competencies needed for tobacco dependence treatment.Objective: To assess the effect of a multi-modal tobacco dependence treatment curriculum on medical students' counseling skills.Design: A group-randomized controlled trial (2010-2014) included ten U.S. medical schools that were randomized to receive either multi-modal tobacco treatment education (MME) or traditional tobacco treatment education (TE).Setting/participants: Students from the classes of 2012 and 2014 at ten medical schools participated. Students from the class of 2012 (N = 1345) completed objective structured clinical examinations (OSCEs), and 50 % (N = 660) were randomly selected for pre-intervention evaluation. A total of 72.9 % of eligible students (N = 1096) from the class of 2014 completed an OSCE and 69.7 % (N = 1047) completed pre and post surveys.Interventions: The MME included a Web-based course, a role-play classroom demonstration, and a clerkship booster session. Clerkship preceptors in MME schools participated in an academic detailing module and were encouraged to be role models for third-year students.Measurements: The primary outcome was student tobacco treatment skills using the 5As measured by an objective structured clinical examination (OSCE) scored on a 33-item behavior checklist. Secondary outcomes were student self-reported skills for performing 5As and pharmacotherapy counseling.Results: Although the difference was not statistically significant, MME students completed more tobacco counseling behaviors on the OSCE checklist (mean 8.7 [SE 0.6] vs. mean 8.0 [SE 0.6], p = 0.52) than TE students. Several of the individual Assist and Arrange items were significantly more likely to have been completed by MME students, including suggesting behavioral strategies (11.8 % vs. 4.5 %, p < 0.001) and providing information regarding quitline (21.0 % vs. 3.8 %, p < 0.001). MME students reported higher self-efficacy for Assist, Arrange, and Pharmacotherapy counseling items (ps ≤0.05).Limitations: Inclusion of only ten schools limits generalizability.Conclusions: Subsequent interventions should incorporate lessons learned from this first randomized controlled trial of a multi-modal longitudinal tobacco treatment curriculum in multiple U.S. medical schools. NIH Trial Registry Number: NCT01905618. [ABSTRACT FROM AUTHOR]

Background: The medical education research literature consistently recommends a structured format for the medical school preadmission interview. There is, however, little direct evidence to support this recommendation. Purpose: To shed further light on this issue, the present study examines the respective reliability contributions from the structured and unstructured interview components at the University of Iowa. Methods: We conducted three univariate G studies on ratings from 3,043 interviews and one multivariate G study using responses from 168 applicants who interviewed twice. Results: Examining interrater reliability and test-retest types of reliability, the unstructured format proved more reliable in both instances. Yet, combining measures from the two interview formats yielded a more reliable score than using either alone. Conclusions: At least from a reliability perspective, the popular advice regarding interview structure may need to be reconsidered. Issues related to validity, fairness, and reliability should be carefully weighed when designing the interview process. [ABSTRACT FROM AUTHOR]

For medical schools, the increasing presence of women makes it especially important that potential sources of gender bias be identified and removed from student evaluation methods. Our study looked for patterns of gender bias in adjective data used to inform our Medical Student Performance Evaluations (MSPEs). Multigroup Confirmatory Factor Analysis (CFA) was used to model the latent structure of the adjectives attributed to students (n = 657) and to test for systematic scoring errors by gender. Gender bias was evident in two areas: (a) women were more likely than comparable men to be described as ''compassionate,'' ''sensitive,'' and ''enthusiastic'' and (b) men were more likely than comparable women to be seen as ''quick learners.'' The gender gap in ''quick learner'' attribution grows with increasing student proficiency; men's rate of increase is over twice that of women's. Technical and nontechnical approaches for ameliorating the impact of gender bias on student recommendations are suggested. [ABSTRACT FROM AUTHOR]

Background: While reflection on experiences and attitudes related to death can be an important component of learning to care for the dying, opportunities within the medical school curriculum to promote learner reflection are often limited. Objective: To describe implementation and evaluation of activities in an end-of-life curriculum to promote self-reflection and student concerns and thoughts revealed through reflection exercises. Design: Within a lecture-based course on end-of-life care, second-year medical students participated in four activities to promote self-reflection, including: (1) visualizing their own deaths; (2) documenting their experiences with death; (3) writing essays reacting to course content; and (4) participating in physician-led small group sessions. Measurements: Student reaction essays and small group evaluations. Results: Qualitative analysis of student reaction essays (2002–2004; total, n = 522) revealed nine major themes in student concerns and thoughts related to caring for the dying. These included: (1) expressing emotions; (2) personal grief and emotional detachment; (3) communicating effectively; (4) spending enough time; (5) feeling ill-prepared to deal with death; (6) losing a loved one; (7) shifting emphasis from curing to caring; (8) listening to patients and respecting their decisions and (9) previous negative end-of-life experiences. Analysis of essays and evaluations assessed the impact of the various reflection activities and demonstrated that these activities allowed students to critically examine and discuss their experiences and concerns regarding providing end-of-life care. Conclusions: A variety of activities can be incorporated successfully into a largely didactic curriculum to promote student reflection on their attitudes and concerns related to end-oflife care, thereby laying an important foundation for their future practice in caring for the dying. In addition, analysis of student reflection essays can serve as an important curriculum evaluation tool. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to compare the attitudes of faculty and medical students toward case-based learning and lecture format during the obstetrics and gynecology clerkship. Study design: For this prospective comparative study, student presentations were alternately assigned to traditional lecture- or case-based format every 6 weeks. Presentations were made to other students and a single faculty. A total of 31 faculty members, 30 student presenters, and 122 student participants completed evaluations. Teaching methods were compared. Results: Faculty members favored lecture format over case-based learning for ‘attentiveness and interaction of the group’ (3.9 vs 4.5, P < .018) and for ‘meeting the objectives’ (3.7 vs 4.5, P < .002). Student participants favored case-based learning in ‘understanding the relationship between knowledge and clinical practice’ (4.34 vs 4.06, P < .05) and ‘enjoyed’ (4.34 vs 3.90, P < .008). Student presenters showed no differences between groups. Conclusion: Faculty favored lecture format whereas student participants favored a case-based presentation. Student presenters were comfortable with both formats. [ABSTRACT FROM AUTHOR]

Background. Training medical students in tobacco prevention and treatment skills is critical if we are to have competent physicians prepared to address the grave levels of morbidity and mortality associated with tobacco use. Tobacco Prevention and Cessation Education at US Medical Schools (PACE), a National Cancer Institute funded project, was launched to assess and improve curriculum content and teaching at 12 US medical schools. Methods. The 2003 survey was completed by faculty and administrators. The survey was divided into four main sections: tobacco content and skills, curricular evaluation, faculty perceptions of barriers and promoters, and educational vision. Results. Thirty-six percent of all medical school courses had some tobacco-related content. Five schools provided a total of between 4 and 8 hours of teaching, 5 schools provided 10-13 hours, and 2 schools provided 17 and 18 hours of teaching. Of the12 schools, 8 had fewer hours devoted to tobacco teaching in the clerkships than during the 1st-year courses. Only 2 schools noted any tobacco content for Obstetrics/Gynecology clerkships, and only 4 schools provided teaching in the pediatric setting (range 5-201 minutes). Conclusion. In comparison to earlier studies, it appears that more tobacco content is now integrated into medical school courses. More improvement is necessary, however, particularly in tobacco use prevention. Institutions need to examine the role of faculty in prioritizing tobacco information and promoting a culture that builds competency in tobacco control and treatment. [ABSTRACT FROM AUTHOR]

Purpose. To examine the validity of using scores from a clinical evaluation form as an assessment of clinical competence. Method. Investigators collected a longitudinal clinical skills assessment database that included scores reflecting performance on standardized patient interactions, case-based learning performance, scores on multiple-choice clinical examinations, and preceptors' ratings of students during their clerkships. Pearson correlation coefficients and coefficients corrected for attenuation were calculated between the mean preceptor rating CEF score and the other measures collected during years one and two. Results. Estimates from an earlier across-clerkship generalizability study of the CEF demonstrated that a mean rating computed across 28 forms and four clerkships (the average measurement frequencies observed in this study), yielded an estimated G-coefficient of 0.62 (Kreiter and Ferguson, 2001). Reliabilities for the other measures ranged from 0.23 to 0.56. Nine of the twelve clinical skill measures correlated with the CEF. For those significantly correlated measures where reliabilities could be calculated, correlations corrected for attenuation ranged from 0.46 to 0.58. Conclusion. This study indicates that the skills measured by the CEF are related to other clinical performance measures and, conversely, that pre-clinical measures of skills that are believed to be important during clinical years are in fact predictors of preceptors' ratings of clinical performance later in medical school. In addition, the magnitude of the disattenuated coefficients suggests that ratings on the CEF are dependent on important aspects such as clinical knowledge. This study suggests that when averaged over a large number of observations, mean CEF scores demonstrate validity coefficients large enough to support their use as part of an evaluation of students' clinical performance. [ABSTRACT FROM AUTHOR]

The article reports on the use of case-based learning patient questions to assess clinical reasoning. It details the development of an evaluation mechanism to reflect the goals of case-based learning (CBL). CBL occurs in Foundations of Clinical Practice during the first semester of medical school. The article discusses the need to have an appropriate evaluation mechanism that encourages students to synthesize the information they have learned.

Physicians have an important role addressing the obesity epidemic. Lack of adequate teaching to provide weight management counseling (WMC) is cited as a reason for limited treatment. National guidelines have not been translated into an evidence-supported, competency-based curriculum in medical schools. Weight Management Counseling in Medical Schools: A Randomized Controlled Trial (MSWeight) is designed to determine if a multi-modal theoretically-guided WMC educational intervention improves observed counseling skills and secondarily improve perceived skills and self-efficacy among medical students compared to traditional education (TE). Eight U.S. medical schools were pair-matched and randomized in a group randomized controlled trial to evaluate whether a multi-modal education (MME) intervention compared to traditional education (TE) improves observed WMC skills. The MME intervention includes innovative components in years 1–3: a structured web-course; a role play exercise, WebPatientEncounter, and an enhanced outpatient internal medicine or family medicine clerkship. This evidence-supported curriculum uses the 5As framework to guide treatment and incorporates patient-centered counseling to engage the patient. The primary outcome is a comparison of scores on an Objective Structured Clinical Examination (OSCE) WMC case among third year medical students. The secondary outcome compares changes in scores of medical students from their first to third year on an assessment of perceived WMC skills and self-efficacy. MSWeight is the first RCT in medical schools to evaluate whether interventions integrated into the curriculum improve medical students' WMC skills. If this educational approach for teaching WMC is effective, feasible and acceptable it can affect how medical schools integrate WMC teaching into their curriculum. [ABSTRACT FROM AUTHOR]