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Evaluating the third-year curriculum: Disparities in medical education among hospital sites. MEC Executive Committee Meeting July 13, 2007 David Geffen School of Medicine at UCLA. I. INTRODUCTION. Diverse clinical training opportunities Advantages: Increased exposure

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evaluating the third year curriculum disparities in medical education among hospital sites

Evaluating the third-year curriculum: Disparities in medical education among hospital sites

MEC Executive Committee Meeting

July 13, 2007

David Geffen School of

Medicine at UCLA

i introduction
I. INTRODUCTION
  • Diverse clinical training opportunities
  • Advantages: Increased exposure
  • Disadvantages: Educational differences among sites
    • Lecture time
    • Attending interaction
    • Resident teaching
i introduction1
I. INTRODUCTION
  • Study Objectives:
    • Assess and compare the educational experience at training sites for different subspecialties
    • Receive student feedback regarding ways to improve the curriculum during the third year
ii methods
II. METHODS
  • Participants- 3rd and 4th Year Medical Students invited to take confidential, anonymous online survey
  • Online survey- 130 questions assessing individual clerkship experiences
  • Design- Participants given 1 week to submit survey
  • Statistical analyses- One-way ANOVAs and correlations using SPSS
iii results
III. RESULTS
  • Participants: 145 medical students
    • 66 Men, 79 Women
    • 117 third-year, 28 fourth-year students
iii results continued
III. RESULTS (continued)
  • Comparison of sites for individual clerkships
    • Quality
    • Lecture time
    • Attending interaction
    • Resident teaching
  • One-way ANOVA
  • Correlations
pediatrics3
Pediatrics
  • Cedars
    • Excellent and enthusiastic teaching by site directors and residents
    • Outpt clinics less helpful
    • “the best rotation of the year”
    • Excellent (albeit very long) lectures
      • Kaiser students attended these as well
    • Good variety of experiences (clinic, inpt, nursery, specialty clinics, etc.)
    • Extremely well-organized
inpatient surgery
Inpatient Surgery
  • Cedars
    • General surgery
      • Minimal teaching by housestaff/attendings, no guidance
      • Students not allowed to write notes/orders
      • Good exposure to variety of surgeries
    • Trauma Surgery
      • No hands-on experience, very little “true trauma”
      • Some students were not allowed to write notes/orders, some were “scutted out” all day
      • “this should not have been a surgery rotation”
inpatient surgery continued
Inpatient Surgery (continued)
  • Harbor
    • Great teaching by housestaff and attendings
    • Excellent lectures and conferences (particularly the student-directed ones)
    • Good learning on call nights
    • Excellent variety of cases
    • Significant amount of 1:1 time with attendings
    • Good continuity of care via clinic activities
outpatient surgery
Outpatient Surgery
  • General comments
    • Great introduction to subspecialty surgeries
    • “I now want to go into _________”
    • Excellent opportunity to “create your own rotation”
    • Very good way to find out when to refer to different subspecialists
    • Good teaching “as long as you showed interest”
    • Not enough time spent with any given subspecialty
neurology2
Neurology
  • General comments
    • 3 weeks is too short
    • Excellent Monday lectures
  • Harbor
    • Good teaching faculty
  • OVH
    • Too many students per team, leading to limited pt interaction
    • Good teaching by residents/housestaff
  • CHS
    • Stroke team sees very little other than strokes
  • WVA
    • Good teaching by residents, but little to no interaction with and teaching from attendings
psychiatry1
Psychiatry
  • General comments
    • Little to no benefit of PBLs
    • Organized didactics would be helpful
    • “5 weeks is too long”
internal medicine1
Internal medicine
  • Cedars
    • Excellent residents and resident teaching
    • Less interaction with attendings
    • Slower service allows more teaching; good lectures
  • Harbor
    • Good 1:1 interaction w/ attendings, but residents overworked leading to minimal resident teaching
    • Excellent breadth of exposure
  • Kaiser Sunset
    • Excellent organized didactics and conferences
    • Good teaching by “friendly residents,” though some residents less interested in teaching than others
internal medicine continued
Internal medicine (continued)
  • OVH
    • Fantastic teaching by housestaff and attendings
    • Significant 1:1 time with attendings
    • Good patient exposure and variety
    • Great pt continuity 2/2 f/u clinic responsibilities
  • CHS
    • Excellent teaching by attendings, less by housestaff 2/2 time constraints
    • Many complicated patients, can take away from learning
  • WVA
    • Great interaction w/ attendings
    • Mixed response to computer system, could use “orientation”
    • “great patient population”
ob gyn1
OB/GYN
  • Cedars
    • Typically good exposure, but many private pts can hinder this
    • Poor organization, poor/minimal teaching by many “catty residents,” attendings, and “temperamental” site director
    • Good prep for exam by site director but lectures prep for exam much more than general OB/GYN knowledge
  • CHS
    • Good exposure to a variety of cases
    • Some residents unfairly abusive of students
ob gyn continued
OB/GYN (continued)
  • Harbor
    • Good, friendly residents and attendings; good teaching
    • Need for more organized didactics
    • Long hours, but good amount of hands-on experience
  • OVH
    • Long hrs, frequent resident-on-resident abuse, which often filtered down to students
    • Good didactics but often late/poorly organized
ambulatory medicine2
Ambulatory Medicine
  • Cedars
    • Great experience at LA Free Clinic w/ good breadth
  • Harbor
    • Excellent attendings; significant autonomy
  • Kaiser-Sunset
    • Great pt exposure in urgent care clinic
  • King-Drew
    • Great variety but very busy, allowing for minimal teaching
ambulatory medicine cont d
Ambulatory Medicine (cont’d)
  • OVH
    • Good 1:1 interaction with attendings, good teaching
  • Sepulveda VA
    • Excellent autonomy (sometimes TOO much), continuity of care, 1:1 interaction with attendings
  • CHS
    • Good interaction w/ GIM attendings, good variety
    • Poorly organized, specialty clinics mostly shadowing
  • WVA
    • Very mixed responses
radiology1
Radiology
  • Structured radiology clerkship necessary
  • Lecturers often do not show up
  • Slides should be labeled to allow for reviewing after lecture
  • Poor correlation between material covered by radiology lectures and radiology exam questions
  • “the worst part of third year”
iv results summary
IV. RESULTS SUMMARY
  • Educational experience varies by clinical training site
  • Quality of the clerkship is strongly associated with:
    • Amount of lecture time
    • Amount of attending interaction
    • Amount of resident teaching
v results and the cetf
V. RESULTS AND THE CETF
  • Lack of clinical teaching
  • Lack of exposure to health care systems
  • Lack of ownership
v results and the cetf1
V. RESULTS AND THE CETF
  • Lack of clinical teaching
    • Some sites with excellent teaching and/or didactics (ie, med @ OVH, peds @ Cedars, surg @ Harbor, neuro @ CHS)
  • Lack of exposure to health care systems
    • Best experiences are at various different sites
    • Across the board, students enjoyed variety
  • Lack of ownership
    • Methods in place in some rotations to promote continuity of care (ie, f/u med clinic @ OVH, surg clinic @ Harbor)
    • Some rotations severely lacking in ownership/autonomy (ie, surg @ cedars, amb med @ CHS
acknowledgements
ACKNOWLEDGEMENTS
  • Survey author: Liz Volkmann
  • Web manager: Vivian Ng
  • Survey contributors: Jon Marron, Wendy Liu, Kevin Koo
  • Statistical analysis: Liz Volkmann
  • Staff Collaborator: Sebastian Uijtdehaage