scholarly journals The WRITE Stuff: A Rural Longitudinal Integrated Clerkship Addresses Workforce Needs

2019 ◽  
Vol 2 (5) ◽  
Author(s):  
Misbah Keen ◽  
Danielle Bienz ◽  
Toby Keys ◽  
Douglas Schaad ◽  
David Evans
Keyword(s):  
Primary Care ◽  
Medical Students ◽  
Family Medicine ◽  
Medical School ◽  
First Year ◽  
Key Word ◽  
Usmle Step 1 ◽  
Longitudinal Integrated Clerkship ◽  
Usmle Step ◽  
Workforce Needs

Introduction: The University of Washington School of Medicine has six campuses in the five state WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region. The WRITE (WWAMI Rural Integrated Training Experience) program is a 22 to 24 week long rural longitudinal integrated clerkship experience offered to medical students in their clinical phase (third year) of training. This program seeks to meet the rural workforce needs of the WWAMI region by increasing the number of medical students going into primary care. Critics of LIC’s have expressed concern about overall quality control of the more remote educational experience and the lack of specialty specific teaching.  The aim of this study was to compare medical school and PGY-1 performance of WRITE and Non-WRITE students while determining how well each cohort is meeting the regional workforce needs. Methods: The study group was all UWSOM students who matriculated from 2009 to 2013, advanced to graduation, and subsequently matched to a residency through the National Residency Match Program. WRITE and non-WRITE cohorts were compared for USMLE step 1 and 2 scores, MSPE (Medical Student Performance Evaluation) key word, and self and program director assessments in the first year of residency. The match results of the two cohorts were also compared to determine the proportions entering primary care residencies. Finally, for both cohorts the specialty choice at matriculation was compared with the match results. Descriptive statistics were used to test the comparisons. Results: The medical school performance of the WRITE and Non-WRITE cohorts was equivalent in all metrics (USMLE Step 1 and 2, MSPE key word, self and program director assessment of performance in the first year of residency). WRITE students were significantly more likely to match into primary care (67.6% vs 48.3%, p<0.001) overall and, in particular, Family Medicine as their specialty (40% vs 14.3%, p<0.001).  WRITE students were also more likely to match into the same specialty that they indicated on the UWSOM matriculation survey. For Family Medicine the loss of fidelity between matriculation and match among WRITE students was 3% (43.4 - 40.4) and among Non-WRITE students, it was 6.3% (20.6 - 14.3). Conclusions: Performance outcomes of the WRITE program are equivalent to a traditional block curriculum.  However, the WRITE cohort is significantly more likely to go into primary care fields, especially family medicine and is more likely to stay with the declared specialty at matriculation. Medical schools that seek to increase the number of students going into primary care may benefit from adopting a similar model.

scholarly journals Using Markov chain model to evaluate medical students’ trajectory on progress tests and predict USMLE step 1 scores---a retrospective cohort study in one medical school

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ling Wang ◽  
Heather S. Laird-Fick ◽  
Carol J. Parker ◽  
David Solomon
Keyword(s):  
Markov Chain ◽  
Medical Students ◽  
Medical School ◽  
Markov Chain Model ◽  
First Year ◽  
Chain Model ◽  
Progress Test ◽  
Usmle Step 1 ◽  
Licensing Examination ◽  
Usmle Step

Abstract Background Medical students must meet curricular expectations and pass national licensing examinations to become physicians. However, no previous studies explicitly modeled stages of medical students acquiring basic science knowledge. In this study, we employed an innovative statistical model to characterize students’ growth using progress testing results over time and predict licensing examination performance. Methods All students matriculated from 2016 to 2017 in our medical school with USMLE Step 1 test scores were included in this retrospective cohort study (N = 358). Markov chain method was employed to: 1) identify latent states of acquiring scientific knowledge based on progress tests and 2) estimate students’ transition probabilities between states. The primary outcome of this study, United States Medical Licensing Examination (USMLE) Step 1 performance, were predicted based on students’ estimated probabilities in each latent state identified by Markov chain model. Results Four latent states were identified based on students’ progress test results: Novice, Advanced Beginner I, Advanced Beginner II and Competent States. At the end of the first year, students predicted to remain in the Novice state had lower mean Step 1 scores compared to those in the Competent state (209, SD = 14.8 versus 255, SD = 10.8 respectively) and had more first attempt failures (11.5% versus 0%). On regression analysis, it is found that at the end of the first year, if there was 10% higher chance staying in Novice State, Step 1 scores will be predicted 2.0 points lower (95% CI: 0.85–2.81 with P < .01); while 10% higher chance in Competent State, Step 1scores will be predicted 4.3 points higher (95% CI: 2.92–5.19 with P < .01). Similar findings were also found at the end of second year medical school. Conclusions Using the Markov chain model to analyze longitudinal progress test performance offers a flexible and effective estimation method to identify students’ transitions across latent stages for acquiring scientific knowledge. The results can help identify students who are at-risk for licensing examination failure and may benefit from targeted academic support.

scholarly journals Quantifying the Financial Value of Clinical Specialty Choices and its Association with USMLE Step 1 Scores

2020 ◽  
Author(s):  
Pranav Puri ◽  
Natalie Landman ◽  
Robert K. Smoldt ◽  
Denis A. Cortese
Keyword(s):  
Medical Students ◽  
Family Medicine ◽  
Net Present Value ◽  
Economic Incentives ◽  
Specialty Choice ◽  
Present Value ◽  
Clinical Specialty ◽  
Economic Agents ◽  
Usmle Step 1 ◽  
Usmle Step

AbstractImportanceThe factors influencing medical student clinical specialty choice have important implications for the future composition of the US physician workforce. The objective of this study was to determine the career net present values of US medical students’ clinical specialty choices and identify any relationships between a specialty’s net present value and competitiveness of admissions as measured by US Medical Licensing Examination (USMLE) Step 1 scores.MethodsNet present values were calculated by using results of the 2019 Doximity Physician Compensation report, a survey of 90,000 physicians. Mean USMLE Step 1 scores for matched US allopathic seniors in the 2018 National Resident Matching Program were used as a measure of clinical specialties’ competitiveness of admissions. We calculated a composite measure of net present value and annual work-hours by dividing each specialty’s net present value by the reported average number of hours worked per year.ResultsIn our analysis, orthopedic surgery had the highest net present value ($10,308,868), whereas family medicine had the lowest net present value ($5,274,546). Dermatology and plastic surgery had the highest mean USMLE Step 1 scores (249 for both), whereas family medicine had the lowest (220). Clinical specialties’ net present values were positively associated with mean USMLE Step 1 scores (Pearson’s r=0.82; p<.001).Conclusion and RelevanceIn this study, we describe associations suggesting that medical students choose clinical specialties as rational economic agents and that these decisions are mediated by USMLE Step 1 scores. This underscores the importance of titrating and aligning economic incentives to improve the allocation of medical students into clinical specialties

scholarly journals Medical Students’ Attitudes towards Careers in Primary Care in Singapore

2020 ◽  
Author(s):  
Humairah Zainal ◽  
Helen Elizabeth Smith
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Medical Students ◽  
Family Medicine ◽  
Medical School ◽  
Medical Schools ◽  
School Experience ◽  
Ageing Population ◽  
Family Doctors ◽  
Students Attitudes

Abstract Background: Singapore needs more family doctors to care for its ageing population and their chronic conditions. To boost the recruitment of doctors within primary care, we need to better understand medical students’ attitudes and experience of General Practice and Family Medicine. While many studies have explored the facilitators and barriers to teaching undergraduate medical students in this field of medicine from the perspectives of GP teachers and trainers, few have examined students’ exposure to primary care in medical schools. Although there are works on factors influencing students’ attitudes towards primary care careers, the roles of medical schools, professional bodies and state institutions tend to be discussed independently of one another. This article explores medical students’ perceptions towards careers in primary care and how different stakeholders might collaborate in strengthening the medical school experience. Methods: Six focus groups involving 54 students from three medical schools in Singapore were conducted. Discussions focussed on their primary care experience, their professional and career aspirations, and perceptions towards the opportunities and challenges of primary care careers. Thematic analysis was used to interpret the qualitative data. Results: 15 key themes emerged from the discussions; 10 reflected key concerns of pursuing primary care careers whereas 5 others highlighted their positive aspects. The former include society’s perceptions of primary care professions as sub-standard, specialists’ negative attitudes towards family doctors, the emphasis on the lifestyle benefits of primary care careers rather than their professional characteristics, mundane case mix, limited professional opportunities, lack of continuity of care, limited consultation time, low remuneration, need for business acumen, and conflicts created by business in clinical care. However, the respondents also articulated positive views, including its lifestyle benefits, autonomy of private practice and better patient care, opportunities for entrepreneurialism and a portfolio career, breadth of clinical problems presented, and an improved future for General Practice and Family Medicine. Conclusion: The findings demonstrate that coordinated initiatives from multiple stakeholders would help to increase the attractiveness of primary care as a career choice among students. Improvements in the medical school experience will significantly enhance the prestige of General Practice and Family Medicine.

to trends in a profession which has incurred lessened emphasis on human contact as price for gaining control over disease through technology and laboratory resources. This new speciality clearly has its controversial components. The rhetoric of family medicine and its coverage by the mass media have served as a readily available symbol for a new version of personalized medicine. For some, this specialty is a move into a new direction of sophisticated caring, while to others it symbolizes a return to old-fashioned virtues of human concern. Within the health field itself, family medicine has evoked controversy. Its very existence has visibly influenced certain specialties such as internal medicine and pediatrics; one consequence is the trend of developing programs in primary care within these disciplines. In some states, legislatures have voted funds specifically earmarked to support family medicine, frequently governed by the perception that fostering family medicine is tantamount to providing physicians for rural America and other heretofore medically underserved areas. The spectrum of images identified with family medicine ranges from appearing as the great hope of holistic concerns in health care to being labeled a short-lived fluff and fashion. Questions need to be raised about how this new specialty fares when medical students choose their careers. Anticipatory perceptions and interests, held at the point of entry into medical school, need to be explored. These views and preferences must be monitored as they are exposed to the various socializing influences of the medical school career. A longitudinal study of medical student career choices, conducted at a midwestern state university, suggests certain suggestive insights into this issue. Although this study is designed to explore the entire range of specialty choices by medical students and to examine the factors underlying the selection of rural or urban practice sites, certain initial findings are specifically applicable to the choice of family medicine. Briefly, the design of the study involves the administration of a number of data collection instruments to medical students at the beginning of their first and second years, and then again at the end of their fourth year (Liccione & McAllister, 1974). Among the instruments used is the Colwill Medical Specialty Perception Inventory, which was administered at the end of the first year and at the end of the fourth year of the students' progression through the medical school. During the third and fourth years of this progression, in-depth interviews were conducted with each student. It is during this time that students rotate through eight-week clinical blocks of each major medical subspecialty. The interviews were systematically distributed to be associated with the range of clinical blocks. Each student was interviewed in connection with one of the blocks in his or her rotation; one interview before and one after the desig-

2014 ◽  
pp. 92-98
Keyword(s):  
Medical Students ◽  
Family Medicine ◽  
Medical School ◽  
Medical Specialty ◽  
First Year ◽  
State University ◽  
Human Contact ◽  
Point Of Entry ◽  
School Career ◽  
Medical Subspecialty

scholarly journals Objective predictors of intern performance

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amanda C. Filiberto ◽  
Lou Ann Cooper ◽  
Tyler J. Loftus ◽  
Sonja S. Samant ◽  
George A. Sarosi ◽  
...  
Keyword(s):  
Medical Students ◽  
Medical School ◽  
Core Competencies ◽  
Cohort Analysis ◽  
The United States ◽  
Grade Point ◽  
Class Rank ◽  
Residency Programs ◽  
Usmle Step 1 ◽  
Usmle Step

Abstract Background Residency programs select medical students for interviews and employment using metrics such as the United States Medical Licensing Examination (USMLE) scores, grade-point average (GPA), and class rank/quartile. It is unclear whether these metrics predict performance as an intern. This study tested the hypothesis that performance on these metrics would predict intern performance. Methods This single institution, retrospective cohort analysis included 244 graduates from four classes (2015–2018) who completed an Accreditation Council for Graduate Medical Education (ACGME) certified internship and were evaluated by program directors (PDs) at the end of the year. PDs provided a global assessment rating and ratings addressing ACGME competencies (response rate = 47%) with five response options: excellent = 5, very good = 4, acceptable = 3, marginal = 2, unacceptable = 1. PDs also classified interns as outstanding = 4, above average = 3, average = 2, and below average = 1 relative to other interns from the same residency program. Mean USMLE scores (Step 1 and Step 2CK), third-year GPA, class rank, and core competency ratings were compared using Welch’s ANOVA and follow-up pairwise t-tests. Results Better performance on PD evaluations at the end of intern year was associated with higher USMLE Step 1 (p = 0.006), Step 2CK (p = 0.030), medical school GPA (p = 0.020) and class rank (p = 0.016). Interns rated as average had lower USMLE scores, GPA, and class rank than those rated as above average or outstanding; there were no significant differences between above average and outstanding interns. Higher rating in each of the ACGME core competencies was associated with better intern performance (p < 0.01). Conclusions Better performance as an intern was associated with higher USMLE scores, medical school GPA and class rank. When USMLE Step 1 reporting changes from numeric scores to pass/fail, residency programs can use other metrics to select medical students for interviews and employment.

scholarly journals A Preclinical Course to Develop Clinical Reasoning Skills of First-year Medical Students

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Alan Johns ◽  
Raymond Christensen
Keyword(s):  
Medical Students ◽  
Family Medicine ◽  
Medical School ◽  
Clinical Reasoning ◽  
First Year ◽  
University Of Minnesota ◽  
One Year ◽  
The University ◽  
First Year Medical Students ◽  
Diagnostic Thinking

Background and Objectives: Clinical reasoning is developed sometime during medical school training.  When and how this knowledge is attained is less clear. This study looks at clinical reasoning development after initiation of a rural experiential course for first-year medical students at the University of Minnesota Medical School, Duluth (regional) Campus. Methods: The Rural Medical Scholars Program course (RMSP) was developed to create a longitudinal rural family medicine experience for first and second-year students at the University of Minnesota Medical School Duluth. Sixty-three first year medical students participated in this required course and their clinical reasoning levels were measured using the Diagnostic Thinking Inventory (DTI).  The DTI was given to the medical students after one year of participation in the RMSP course. A previous cohort before the RMSP course was developed was used as a control. A literature search was used for comparison to other schools that measured the DTI in their students. Results: Student diagnostic thinking performance as measured by the DTI after one year of the Rural Medical Scholars Program course significantly increased when compared to a previous cohort of first-year students who did not take the RMSP course. When compared to previously published DTI data, students after one year of RMSP had clinical reasoning levels of second through fourth-year students from other schools. Conclusions: The addition of a rural experiential course with family medicine preceptors significantly increased clinical reasoning levels of first-year medical students.   Financial support: None Conflicts of Interests: No conflicts to report

scholarly journals Deferred Action for Childhood Arrivals (DACA) medical students – an examination of their journey and experiences as medical students in limbo

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christina Gillezeau ◽  
Wil Lieberman-Cribbin ◽  
Kristin Bevilacqua ◽  
Julio Ramos ◽  
Naomi Alpert ◽  
...  
Keyword(s):  
Medical Students ◽  
Medical School ◽  
First Year ◽  
Convenience Sample ◽  
Student Sample ◽  
Medical Specialties ◽  
Residency Programs ◽  
Deferred Action ◽  
The Status ◽  
Depth Interviews

Abstract Background Although the value of DACA medical students has been hypothesized, no data are available on their contribution to US healthcare. While the exact number of DACA recipients in medical school is unknown, DACA medical students are projected to represent an increasing proportion of physicians in the future. The current literature on DACA students has not analyzed the experiences of these students. Methods A mixed-methods study on the career intentions and experiences of DACA medical students was performed utilizing survey data and in-depth interviews. The academic performance of a convenience sample of DACA medical students was compared to that of matriculated medical students from corresponding medical schools, national averages, and first-year residents according to specialty. Results Thirty-three DACA medical students completed the survey and five participated in a qualitative interview. The average undergraduate GPA (SD) of the DACA medical student sample was 3.7 (0.3), the same as the national GPA of 2017–2018 matriculated medical students. The most common intended residency programs were Internal Medicine (27.2%), Emergency Medicine (15.2%), and Family Medicine (9.1%). In interviews, DACA students discussed their motivation for pursuing medicine, barriers and facilitators that they faced in attending medical school, their experiences as medical students, and their future plans. Conclusions The intent of this sample to pursue medical specialties in which there is a growing need further exemplifies the unique value of these students. It is vital to protect the status of DACA recipients and realize the contributions that DACA physicians provide to US healthcare.

scholarly journals Student engagement and higher order skill proficiency: a comparison of traditional didactic and renewed integrated active learning curricula

2018 ◽  
Vol 42 (4) ◽  
pp. 685-692 ◽  
Author(s):  
Mari K. Hopper ◽  
Daniela A. Brake
Keyword(s):  
Student Engagement ◽  
Medical Students ◽  
Active Learning ◽  
Medical School ◽  
Curriculum Reform ◽  
Higher Order ◽  
Poor Correlation ◽  
First Year ◽  
Cohort Groups ◽  
The Impact

A large, multicampus, public medical school underwent curricular renewal, emphasizing a student-centered approach with 50% of all course contact time devoted to active learning. Determining the impact of active learning on student engagement and higher order skill (HOS) proficiency was the primary aim of this study. Following Institutional Review Board approval, two cohort groups of first-year medical students were enrolled. The first cohort ( n = 54) included students before curriculum reform in the legacy curriculum (LC). The second cohort ( n = 73) included students completing studies in the renewed curriculum (RC). Near the end of the first year of medical school, both cohorts completed a validated survey of student engagement, and a proctored problem-based assessment of HOS proficiency [Collegiate Learning Assessment (CLA+)]. Results indicated RC students perceived greater levels of engagement than LC (39.5+5.8 vs. 33.3+5.6), and greater reliance on HOS, including analysis, synthesis, and application. However, there were no significant differences between cohorts in proficiency of HOS when assessed by the CLA+ (LC = 1,878 ± 161 vs. RC = 1,900 ± 157). Additionally, poor correlation between engagement and HOS for both LC and RC indicated more engaged students do not necessarily possess greater HOS proficiency. Ceiling effect may explain results as medical students enter medical school as highly skilled learners with potentially little room for improvement. It will be informative to continue to track engagement and HOS of both cohort groups as they continue their medical studies.

scholarly journals First year medical students’ perceptions of the impact of wearing scrubs on professional identity: a narrative analysis in the United Arab Emirates

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e039357
Author(s):  
Sara Sorrell ◽  
Halah Ibrahim
Keyword(s):  
Medical Students ◽  
Qualitative Analysis ◽  
Medical School ◽  
Professional Identity ◽  
United Arab Emirates ◽  
Medical Curriculum ◽  
First Year ◽  
Written Narratives ◽  
First Year Medical Students ◽  
The Impact

ObjectivesMedical school serves as a critical developmental period for future physicians, during which students begin to form a professional identity. Just as personal appearance, particularly clothing, is an important external expression of one’s personal identity, ‘uniforms’ in healthcare, including white coats and scrubs, symbolise status and a group identity. There are, however, limited studies on the impact of physician attire on medical students’ formation of professional identity. Accordingly, through qualitative analysis of written narratives, we sought to analyse medical students’ experiences of wearing professional physician attire, namely scrubs, and how the uniform impacted their confidence level, performance and behaviours, as well as their identity as future physicians.DesignQualitative analysis of medical student’s written narratives.SettingKhalifa University College of Medicine and Health Sciences (KU CMHS) is a new medical school in the United Arab Emirates, with an inaugural class of 30 students admitted in August 2019. It is the only medical school in the city of Abu Dhabi, and the only school in the country that follows a postgraduate medical curriculum.ParticipantsAll first year medical students at KU CMHS were purposively sampled.MethodsStudents completed a voluntary online anonymous questionnaire. We employed a social identity approach to data analysis. Thematic content analysis was conducted on their narratives to identify themes.ResultsWe identified three major themes, namely (1) emotions, (2) logistics and (3) interpersonal relationships.ConclusionsMedical students form early perceptions regarding physician attire and its impact on their professional identity. Engaging in conversations regarding professional attire with educators or mentors could provide an important opportunity for students to discuss and explore professional identity early in training.

scholarly journals On Teaching the Sum While Paying Attention to the Parts: Whole Person Care through Ethnography in Medical Education

2015 ◽  
Vol 2 (2) ◽  
Author(s):  
Vasiliki Nataly Rahimzadeh ◽  
David Lessard ◽  
Peter Nugus
Keyword(s):  
Medical Students ◽  
Family Medicine ◽  
Medical School ◽  
Professional Identity ◽  
Identity Formation ◽  
Medical Training ◽  
Academic Discipline ◽  
Professional Identity Formation ◽  
Patient Centered ◽  
Whole Person

Objective—This article provides a reflection on medical teaching opportunities for whole person care based on our experiences mentoring 2nd-year medical students through an Ethnography Practicum at a Canadian university.                                                                  Background—The Ethnography Practicum is a new addition to the Family Medicine Transition to Clinical Practice (TCP) curriculum introduced in the second year of medical school at McGill University. It involves 30 hours of instruction (6 hours in lectures with an instructor, and 24 hours in small-group tutorials with the authors), and 9 hours of fieldwork observations in various community health settings across Montreal, QC. The primary aims of the Practicum converge with those of the TCP generally in two important ways: to inculcate in students the concepts of patient centered care, and to promote family medicine as both an academic discipline and career option.                    Results and Discussion— Our experiences illustrate two tensions that shape students’ expectations and experiences throughout their involvement in the Practicum and, in turn, highlight the implications for teaching whole-person care. First, ethnography as a combination of different methods has itself been the locus of tensions between positivist and critical traditions in the three last decades. Second, the Practicum is situated precisely at the crossroads of key moments on the professional identity formation continuum for our students. Such a crossroads is disruptive to the status quo of medical traineeship characteristic of the first two years in medical school, and thus reorients professional identity formation. The above tensions reveal how ethnography is not only a revered research tradition in the humanities, but can also be a conduit to whole person care-inspired clinical practice.Conclusion—As instructors and mentors involved in this Ethnography Practicum, we are continually forging a new relevance for organizational ethnography in medical training, where medical students can reflect and act on competencies beyond clinical ones. The Practicum provides a space for students to wrestle with alternative epistemologies to understanding the social world in which medicine is embedded. We lastly provide pragmatic ways to better address these tensions in an effort to support students as they proceed through the (multifaceted) development of their professional identities as future physicians.

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