Accrediting bodies for medical schools require that medical students be provided with formative assessment in all clerkship courses. The literature describes many strategies for formative assessment in clerkship settings, but qualitative studies of clerk and supervisor experiences with formative assessment are lacking. In this thesis, I describe a study that explores clerk and supervisor experiences with formative assessment in one internal medicine clerkship course. First, the literature was reviewed to determine current conceptions of formative assessment and learning in medical education. Then, novice and experienced clerks were recruited to participate. Prior to starting their Core Internal Medicine course, each clerk participated in an interview to understand his or her concepts of learning and assessment. During the six-week course, they replied to an electronic weekly questionnaire to describe and reflect on learning experiences. Finally, they participated in a focus group at the end of the course, to explore their experiences with formative assessment. Supervisors, (residents and attending physicians), who supervised clerks were recruited to participate in one interview to explore their approach to supervision and assessment of clerks, and to understand factors that influenced their ability to do this. All relevant artifacts (forms, policies, procedures) were collected for subsequent analyses. Four experienced clerks and eleven novice clerks participated, along with eight attending physicians and five residents. Participants identified four key themes as playing a significant role in assessment and learning: (a) the developing role of doctor, (b) the role of the team, (c) working and learning environments, and (d) educational strategies. Data analysis revealed the participants had unclear formal concepts of formative assessment, even though they could all describe the key concepts about how assessment affects learning, and were quite clear about what factors supported learning, and which ones were barriers to learning. The study contributes to our understanding of clerks’ and supervisors’ experiences with assessment and learning in a workplace-based learning setting. Finally, the study led to recommendations about how to better support formative assessment in the Core Internal Medicine course, and for further research. / Thesis (Master, Education) -- Queen's University, 2012-12-24 07:06:24.439

There are three interrelated concepts of what medical students learn, which include the formal, informal, and hidden curriculum. Several researchers who have investigated notions of the hidden curriculum have demonstrated how the experiences of medical training entrenched in the hidden curriculum can have a profound impact on medical student adaptation. The most influential transitional stage in undergraduate medical education is the third-year clinical clerkship, when medical students transition from classroom learners into clinicians. The Northern Ontario School of Medicine’s (NOSM) clinical clerkship year consists of a mandatory eightmonths of living and working in rural and northern communities throughout Northern Ontario, and learning in the context of rural family practice. Informed by a social constructivist research paradigm, I explored how 12 third-year students described the challenges they had to manage and, in response, the strategies they employed to adapt to their clerkship. I elicited their experiences and perspectives to contribute to a rich understanding of how students at the NOSM describe developing processes of adaptation during the Comprehensive Community Clerkship. Data were collected between August 2011 and April 2012, including: a) pre-clerkship interviews and a demographic questionnaire, b) mobile methods in the form of ‘guided walks’ in the communities, and c) post-clerkship interviews. The quality of the data collection and analysis were enhanced through processes of methodological and interpretive rigour, representativeness and authenticity, rich description and contextual relevance, audit trail, and reflexivity. Through an inductive thematic analysis of the data, the findings provide a rich description of events experienced such as medical training in one’s hometown or a familiar community, iv transitions including adaptation to the clinical setting and to the medical profession, and the influence of the clerkship on career path, personal well-being, and empathy for patients. The findings serve to advance our understanding of how medical students describe developing processes of adaptation throughout a longitudinal integrated clerkship. Implications are considered for medical students, the NOSM, the clerkship communities, and medical schools nationally and internationally. I propose recommendations regarding the suitability of authentic methods in medical education research, and discuss the implications for rural and northern health research.

Indiana University-Purdue University Indianapolis (IUPUI) / Background. Despite widespread criticism of physician-performed evaluations of medical students’ clinical skills, clinical clerkship evaluations (CCEs) remain the foremost means by which to assess trainees’ clinical prowess. Efforts undertaken to improve the quality of feedback students receive have ostensibly led to higher assessment demands on physician faculty; the consequences of which remain unknown. Accordingly, this study investigated the extent to which physicians’ evaluative responsibilities influenced the quality of CCEs and qualitatively explored physicians’ perceptions of these evaluations. Methods. A questionnaire was delivered to physicians (n = 93) at Indiana University School of Medicine to gauge their perceived evaluative responsibilities. Evaluation records of each participant were obtained and were used to calculate one’s measurable quantity of CCEs, the timeliness of CCE submissions, and the quality of the Likert-scale and written feedback data included in each evaluation. A path analysis estimated the extent to which one’s evaluative responsibilities affected the timeliness of CCE submissions and CCE quality. Semi-structured interviews with a subset of participants (n = 8) gathered perceptions of the evaluations and the evaluative process. Results. One’s measurable quantity of evaluations did not influence one’s perceptions of the evaluative task, but did directly influence the quality of the Likert-scale items. Moreover, one’s perceptions of the evaluative task directly influenced the timeliness of CCE submissions and indirectly influenced the quality of the closed-ended CCE items. Tardiness in the submission of CCEs had a positive effect on the amount of score differentiation among the Likert-scale data. Neither evaluative responsibilities nor the timeliness of CCE submissions influenced the quality of written feedback. Qualitative analysis revealed mixed opinions on the utility of CCEs and highlighted the temporal burden and practical limitations of completing CCEs. Conclusions. These findings suggest physicians’ perceptions of CCEs are independent of their assigned evaluative quantity, yet influence both the timeliness of evaluation submissions and evaluative quality. Further elucidation of the mechanisms underlying the positive influence of evaluation quantity and timely CCE submissions on CCE quality are needed to fully rationalize these findings and improve the evaluative process. Continued research is needed to pinpoint which factors influence the quality of written feedback.

Einleitung: In Anbetracht der Qualitätssicherung und -verbesserung der Lehre finden Studentenevaluationen eine größer werdende Beachtung. Dies gilt auch für das Blockpraktikum Allgemeinmedizin. Bisherige Studien konnten belegen, dass die Studierenden diese Veranstaltung sehr positiv erleben. Jedoch gibt es keine ausreichenden Erkenntnisse darüber, ob und wenn ja, in welchem Umfang, sich das Berufsziel der Studierenden, sowie örtliche und zeitliche Rahmenbedingungen auf die studentischen Evaluationen auswirken. Das Ziel der vorliegenden Arbeit war es, die Entwicklung der Studentenzufriedenheit bezüglich des Blockpraktikums in einem Zeitraum von 2004 bis 2012 zu untersuchen. Darüber hinaus wurde überprüft, inwiefern die Dauer des Blockpraktikums (ganz- vs. halbtags), die Lage der Lehrarztpraxis (Groß- / Mittelstadt vs. Ländlich geprägter Raum), sowie das Berufsziel der Befragten die Zufriedenheit und den subjektiv bewerteten Lernerfolg von Studierenden beeinflussen. Methode: Das Blockpraktikum Allgemeinmedizin wurde an der Universität Leipzig gemäß der ärztlichen Approbationsordnung (2002) reformiert und seit 2004 in dieser Form von den Studierenden schriftlich evaluiert. Für die Teilnahme am Blockpraktikum standen hausärztliche Lehrarztpraxen in der Stadt Leipzig, im Leipziger Umland, sowie vereinzelt in benachbarten Bundesländern zur Verfügung. Die Studierenden des 7. / 8. Fachsemesters konnten dabei wählen, das Blockpraktikum entweder innerhalb des laufenden Semesters zwei Wochen lang halbtags, oder innerhalb der Semesterferien eine Woche lang ganztags zu absolvieren. Die Evaluation fand am Ende der Praktikumsphase statt. Im Rahmen der Evaluation wurden die allgemeine Zufriedenheit der Studierenden mit dem Blockpraktikum, das Erlernen von hausärztlichen Fähigkeiten und Fertigkeiten (z.B. Hausbesuche, Impfungen), sowie die didaktische Durchführung des Praktikums abgefragt. Als Antwortmöglichkeiten wurden 6 - und 10 - stufige Likert-Skalen vorgegeben. Die gesammelten Daten wurden in das Statistikprogramm SPSS 20.0 übertragen. Neben einer deskriptiven Auswertung erfolgten Gruppenvergleiche bezüglich der Dauer des Blockpraktikums, der Lage der Lehrarztpraxis und des Berufsziels, wobei verschiedene prüfstatistische Testverfahren wie der Chi -Quadrat-Test, der Mann-Whitney-U-Test und der Kruskal-Wallis-Test angewendet wurden. Ergebnisse: Im Rahmen dieser Studie konnten die Evaluationen von 2599 Studierenden (94,9 %) aus den Jahren 2004 bis 2012 ausgewertet werden. Die Teilnehmer waren mit der Qualität des Blockpraktikums insgesamt sehr zufrieden. Die Beurteilungen blieben innerhalb des untersuchten Zeitraumes konstant positiv. Es ließen sich beim Vergleich der einzelnen Jahrgänge keine tiefgreifenden Veränderungen im Sinne kontinuierlicher Tendenzen in den Evaluationen erkennen. Im Vergleich zum vormals bestehenden 2-Tages-Praktikum zeigte sich eine verbesserte Bewertung einzelner Kompetenzbereiche. Die Auswertungen der Gruppenvergleiche ergaben hinsichtlich der Studentenzufriedenheit und des Lernerfolges der Studierenden signifikante Unterschiede. So gingen die Teilnahme am Blockpraktikum innerhalb einer Woche ganztags und das Absolvieren des Blockpraktikums im ländlich geprägten Raum mit einer besseren Evaluation seitens der Studierenden einher. Zudem bewerteten Studierende mit dem definitiven Berufsziel Allgemeinmedizin die Veranstaltung noch einmal besser als ihre Kommilitonen. Schlussfolgerungen: Die Auswertung der Studentenevaluationen belegt, dass das Blockpraktikum Allgemeinmedizin von den Leipziger Studierenden überwiegend positiv wahrgenommen wurde. Die vorgestellten Ergebnisse können im Hinblick auf die zeitliche Gestaltung des Blockpraktikums und bei der Verteilung der Studierenden auf die Lehrpraxen einen wichtigen Beitrag leisten. Darüber hinaus scheinen junge Mediziner, die die Allgemeinmedizin als Karriereoption in Betracht ziehen, durch das Blockpraktikum in ihrem Berufsziel bestätigt zu werden. Weitere Studien sollten klären, inwiefern es noch weitere Faktoren gibt, die sich auf das studentische Erleben des Blockpraktikums Allgemeinmedizin auswirken.

BACKGROUND: Less than two decades into the 21st century, U.S. medical schools are experiencing substantial curricular reform affecting multiple aspects of teaching and learning. The pace of change is rapid when compared to that of the previous century. Little changed in medical education for 100 years after Abraham Flexner’s 1910 recommendations from his evaluation of North American medical schools. Using a case-study approach to examine a single medical school, this dissertation study explores pre-clerkship faculty perspectives of select curricular changes over a ten-year span at Boston University School of Medicine (BUSM). These changes include the adoption of educational technologies and student-centered pedagogical approaches, as well as curricular content integration designed for foundational science courses. PURPOSE: This study seeks to understand and document faculty experiences with change, factors influencing change, effective and challenging aspects of change, and recommendations for successful future changes. It also explores faculty change adoption tendencies and change leadership styles for those who led groups through a newly integrated curriculum. METHODS: This is a mixed-methods study using qualitative and quantitative inquiry in three phases of data collection with two subject sets. In the first phase, qualitative data was collected from interviews with a subset of 12 subjects to inform creation of a researcher-designed survey, which was used in the second phase collecting responses from a larger pool of 55 subjects. The third phase collected quantitative data from an externally-validated instrument, Change Intelligence (CQ) (Trautlein, 2013), which assessed change leadership styles of the subset of 12 subjects who experienced all changes studied. RESULTS: BUSM faculty members are motivated towards continuous improvement of the curriculum to foster students’ success. Faculty are challenged by compressed time to plan and implement change and when change is mandated without opportunity for pre-decision input. BUSM faculty adopt changes at higher rates than the normal curve defined in Diffusion of Innovations (Rogers, 2003). The subset of 12 subjects assessed for change leadership styles focus on people and process when leading change. CONCLUSION: Medical education change studies on the faculty perspective are limited. This study provides insight and recommendations for future study and successful change.

This study was conducted using a quantitative, non-experimental, correlation design to explore the relationships between student-patient encounters with Diabetes Mellitus and the scores on the Diabetes Mellitus OSCE during Family Medicine clerkship. The focus of the research was to explore relationships between various methods of competency measures of third-year medical students during their Family Medicine clerkship as they encountered patients diagnosed with Diabetes Mellitus (DM). A paradigm shift in medical education is taking place and driven by the Liaison Committee for Medical Education (LCME). These changes are fueled by the public outcry demanding verification of competency of our physicians. The study's focus is on the competency outcome measures from a new educational design, moving away from patient-centered education to competency-based, student-centered education and away from a norm-referenced assessment to a criterion-referenced assessment. Relevant literature on the need for competency-based medical education and various methods for implementation informed this study, including Miller (1990); Barman (2005); Barrows (1993), De Champlain, Margolis, Macmillan, and Klass (2001); Harden and Gleeson (1979); and Howley and Wilson (2004). More direct observation of student performance must be instituted with documentation of student clinical skills. Findings revealed no differences are seen in medical student competency acquisition during encounters of patients diagnosed with DM, in terms of cognitive, psychomotor, neck exam or affective measures, during the VCU SOM Family Medicine Clerkship. Significant differences are noted in the psychomotor subscale scores of the DM OSCE as the result of suburban clerkship site placement, as opposed to rural or urban sites. Finally, students at non-residencies see more patients with DM than at residency clerkship sites. Implications for further research were discussed focusing on 1) why differences were found only found in suburban clerkship sites; 2) the possibility that cultural competency understanding may play a role in these differences; 3) how do students learn about DM prior to the FM clerkship; 4) the possibility that the OSCE does not reflect community FM practice models.

Einleitung: In Anbetracht der Qualitätssicherung und -verbesserung der Lehre finden Studentenevaluationen eine größer werdende Beachtung. Dies gilt auch für das Blockpraktikum Allgemeinmedizin. Bisherige Studien konnten belegen, dass die Studierenden diese Veranstaltung sehr positiv erleben. Jedoch gibt es keine ausreichenden Erkenntnisse darüber, ob und wenn ja, in welchem Umfang, sich das Berufsziel der Studierenden, sowie örtliche und zeitliche Rahmenbedingungen auf die studentischen Evaluationen auswirken. Das Ziel der vorliegenden Arbeit war es, die Entwicklung der Studentenzufriedenheit bezüglich des Blockpraktikums in einem Zeitraum von 2004 bis 2012 zu untersuchen. Darüber hinaus wurde überprüft, inwiefern die Dauer des Blockpraktikums (ganz- vs. halbtags), die Lage der Lehrarztpraxis (Groß- / Mittelstadt vs. Ländlich geprägter Raum), sowie das Berufsziel der Befragten die Zufriedenheit und den subjektiv bewerteten Lernerfolg von Studierenden beeinflussen. Methode: Das Blockpraktikum Allgemeinmedizin wurde an der Universität Leipzig gemäß der ärztlichen Approbationsordnung (2002) reformiert und seit 2004 in dieser Form von den Studierenden schriftlich evaluiert. Für die Teilnahme am Blockpraktikum standen hausärztliche Lehrarztpraxen in der Stadt Leipzig, im Leipziger Umland, sowie vereinzelt in benachbarten Bundesländern zur Verfügung. Die Studierenden des 7. / 8. Fachsemesters konnten dabei wählen, das Blockpraktikum entweder innerhalb des laufenden Semesters zwei Wochen lang halbtags, oder innerhalb der Semesterferien eine Woche lang ganztags zu absolvieren. Die Evaluation fand am Ende der Praktikumsphase statt. Im Rahmen der Evaluation wurden die allgemeine Zufriedenheit der Studierenden mit dem Blockpraktikum, das Erlernen von hausärztlichen Fähigkeiten und Fertigkeiten (z.B. Hausbesuche, Impfungen), sowie die didaktische Durchführung des Praktikums abgefragt. Als Antwortmöglichkeiten wurden 6 - und 10 - stufige Likert-Skalen vorgegeben. Die gesammelten Daten wurden in das Statistikprogramm SPSS 20.0 übertragen. Neben einer deskriptiven Auswertung erfolgten Gruppenvergleiche bezüglich der Dauer des Blockpraktikums, der Lage der Lehrarztpraxis und des Berufsziels, wobei verschiedene prüfstatistische Testverfahren wie der Chi -Quadrat-Test, der Mann-Whitney-U-Test und der Kruskal-Wallis-Test angewendet wurden. Ergebnisse: Im Rahmen dieser Studie konnten die Evaluationen von 2599 Studierenden (94,9 %) aus den Jahren 2004 bis 2012 ausgewertet werden. Die Teilnehmer waren mit der Qualität des Blockpraktikums insgesamt sehr zufrieden. Die Beurteilungen blieben innerhalb des untersuchten Zeitraumes konstant positiv. Es ließen sich beim Vergleich der einzelnen Jahrgänge keine tiefgreifenden Veränderungen im Sinne kontinuierlicher Tendenzen in den Evaluationen erkennen. Im Vergleich zum vormals bestehenden 2-Tages-Praktikum zeigte sich eine verbesserte Bewertung einzelner Kompetenzbereiche. Die Auswertungen der Gruppenvergleiche ergaben hinsichtlich der Studentenzufriedenheit und des Lernerfolges der Studierenden signifikante Unterschiede. So gingen die Teilnahme am Blockpraktikum innerhalb einer Woche ganztags und das Absolvieren des Blockpraktikums im ländlich geprägten Raum mit einer besseren Evaluation seitens der Studierenden einher. Zudem bewerteten Studierende mit dem definitiven Berufsziel Allgemeinmedizin die Veranstaltung noch einmal besser als ihre Kommilitonen. Schlussfolgerungen: Die Auswertung der Studentenevaluationen belegt, dass das Blockpraktikum Allgemeinmedizin von den Leipziger Studierenden überwiegend positiv wahrgenommen wurde. Die vorgestellten Ergebnisse können im Hinblick auf die zeitliche Gestaltung des Blockpraktikums und bei der Verteilung der Studierenden auf die Lehrpraxen einen wichtigen Beitrag leisten. Darüber hinaus scheinen junge Mediziner, die die Allgemeinmedizin als Karriereoption in Betracht ziehen, durch das Blockpraktikum in ihrem Berufsziel bestätigt zu werden. Weitere Studien sollten klären, inwiefern es noch weitere Faktoren gibt, die sich auf das studentische Erleben des Blockpraktikums Allgemeinmedizin auswirken.

Background: Medical school curricula are constantly evolving and change has potential positive and negative effects. At East Tennessee State University Quillen College of Medicine, a broader understanding of the effects of a curriculum change (reduction in clerkship length for one transitional year) was explored. Methods: A broad, system-wide evaluation was used to evaluate impacts on all stakeholders. Curriculum management data, including qualitative and quantitative data and short-term and follow-up perspectives of stakeholders, were used for evaluation. Results: Students evaluated the change positively. Academic performance in the transitional year was similar to the prior year. Differences in students’ clerkship evaluations were not statistically significant. Clerkship directors were concerned that students’ clinical experience suffered and noted that implementing changes was time consuming but recognized the benefits for students. Administrators dedicated a significant amount of time to planning the transitional year; however, the additional weeks at the beginning of fourth year made the scheduling process easier. Conclusion: This article demonstrates an overall positive result with this tool for curriculum change but also indicates the impacts differed across stakeholders. Knowledge gained from this experience can help other schools successfully anticipate challenges and prepare for a variety of outcomes in implementing necessary curriculum change.

Objective: To evaluate student perception of early simulation in dentistry. Material and Methods: The design of the study was quantitative, observational and cross-sectional. A total of 121 students, from third year to senior year were evaluated. The perception and its dimensions: satisfaction, self-confidence and good educational practices were evaluated by a survey with a high level of reliability (0.89), modified and adapted for the present investigation, checking coefficients for its use: Aiken's V, Cronbach's Alpha, Test-Retest (Spearman), classified in ability, scenario and general simulation practices, based on the Likert scale (from 1 to 5). For the univariate analysis, the descriptive statistics from qualitative and quantitative variables were obtained and for the bivariate analysis, Spearman's rank correlation coefficient and Kruskal Wallis and Mann-Whitney U-tests were employed. Results: The students rated the simulation perception positively with an average of 4.42±0.49, 4.14±0.63 y 4.73±0.66 regarding the ability, scenario and general simulation practices, respectively. No statistically significant differences were found between the perception of early preclinical practices with the variables age, gender, year of study and previous experience. Conclusion: The perception of students regarding early preclinical practices got a high score and it is not related with the variables studied, according to the survey modified and adapted. / Revisión por pares

Introduction: A trusting relationship between medical learners and clinical teachers is vital for educational and clinical productivity. Perceptions of a trusting relationship are influenced by the learner’s perception of the interpersonal risk (i.e. being humiliated) for engaging in learning behaviours (e.g. asking questions, seeking feedback, learning from mistakes). Perceptions of low interpersonal risk are linked to learners feeling comfortable engaging in learning behaviours. What is less clear is how the clinical environment may influence a medical learner’s perception of trust. Methods: Using constructivist grounded theory, we conducted semi-structured interviews with 19 medical clerks and 10 clinical educators affiliated with a single institution. Interviews explored participants’ personal experiences of positive, negative or challenging learner-teacher relationships in the clinical environment. Results: Through qualitative analysis, we developed a theory of Co-Navigation which describes how teachers and learners have common points of interaction to solidify or diminish trust as they navigate the dynamics of the clinical environment. These points in the relationship that each must co-navigate include: preparing to work together; asking questions; engaging in clinical work; and addressing learner mistakes. Perceptions of whether the opportunity solidified or dissolved trust, arose from learners’ perception of the amount of effort their teacher made to mitigate stress learners experienced in the learning environment. Limitations: Our interview participants were recruited as individuals; we did not examine their perceptions of their relationships with each other. Co-recruitment of teacher-learner dyads may be a strategy to further refine this theory in future research. Conclusion: The Co-Navigation theory helps teachers and learners identify key opportunities in the relationship and suggests approaches to solidifying trust at these critical junctures. It highlights the role the clinical environment plays in facilitating and constraining opportunities to establish trust. / Thesis / Master of Health Sciences (MSc) / This thesis project aimed to understand how the clinical environment shapes the way medical learners interact and build relationships with their clinical teachers. We interviewed medical students and clinical teachers who worked together during the medical learner’s clerkship year of clinical training in various healthcare specialties. In the interviews, we discussed learner experiences of positive and negative relationships with clinical teachers. We developed a theory which describes four opportunities that medical learners and clinical teachers will encounter that can support the development of a trusting relationship. This thesis project will contribute insight into types of interactions that can be highlighted as strategic points for educational interventions and administrative reform, to support the development of trusting learner-teacher relationships during clerkship.