Free clinics are an essential part of the United States health care safety net, and student-run f... more Free clinics are an essential part of the United States health care safety net, and student-run free clinics comprise a significant proportion of free clinics nationally. These clinics operate with limited resources but see a population of medically and socially complex patients. Complex care management is a spectrum of care models targeting high-need, high-cost patients designed to improve outcomes and reduce overutilization of health care which have been implemented in many health care settings. Common features of care management programs include patient selection, specialized care managers, and multidisciplinary medical teams. Patients seen at student-run free clinics would benefit from the principles of complex care management. The principles of complex care management have been incorporated into patient care at the University of Michigan Student-Run Free Clinic (UMSRFC) as part of a pilot care management protocol. Patients seen from May 2016 through April 2017 during the first ...
Purpose This study gathers validity evidence of an expanded History and Physical examination (H&P... more Purpose This study gathers validity evidence of an expanded History and Physical examination (H&P 360) to address chronic diseases through incorporation of biopsychosocial elements that are lacking in traditional H&P assessments via a multisite randomized controlled trial among medical students. Method Third- and fourth-year medical students (n = 159) at 4 schools participated in an Objective Structured Clinical Examination designed with 2 cases for chronic disease. Students were randomized into the treatment group, which involved brief written instructions on how to use the H&P 360 followed by a standardized patient (SP) interaction, or the control group, which used the traditional H&P in an SP interaction without additional instructions. Validity evidence was gathered for content (alignment with an empirically derived expanded history list), response process (feedback from raters and learners on the process), internal structure (reliability and item-level psychometrics), relations...
Consistency in clinical decision making may be necessary for reliable assessment of student perfo... more Consistency in clinical decision making may be necessary for reliable assessment of student performance and teaching effectiveness, yet little has been done to examine variation in periodontal diagnosis and treatment planning among dental school faculty. The purpose of this investigation was to examine variation among faculty in diagnosis and management of common periodontal diseases. Twenty‐seven clinical instructors (periodontists, general dentists, dental hygienists, and first‐ and second‐year periodontal graduate students) reviewed three web‐based cases and answered a brief questionnaire focusing on radiographic interpretation, periodontal diagnosis, and treatment planning. Response rates for the three cases ranged from 62 percent to 70 percent. Clinical instructors’ rating of percent bone loss in the majority of cases varied between three descriptive categories for the same tooth. Greater consistency in periodontal diagnosis was noted within the graduate student group as compar...
Problem Transforming medical school curricula to train physicians to better address society’s nee... more Problem Transforming medical school curricula to train physicians to better address society’s needs is a complex task, as students must develop expertise in areas other than clinical medicine. Approach In 2010, the University of Michigan Medical School (UMMS) launched the Global Health and Disparities (GHD) Path of Excellence as part of a larger curriculum transformation. The GHD Path is a co-curriculum with the goal of ameliorating health disparities in the United States and abroad. It was developed iteratively based on student and faculty feedback. Student feedback emphasized the value of the relationships with faculty and other students, the capstone project, and exposure to role models and professional networks. Faculty described the joy of interacting with students and the desire for recognition by their departments for their role as an advisor. Outcomes Informed by the GHD Path experience, UMMS embraced the Path model, which emphasized professional relationships, career develo...
Psychiatric services (Washington, D.C.), May 29, 2016
This column describes the planning and implementation of an integrated behavioral health project ... more This column describes the planning and implementation of an integrated behavioral health project which was facilitated and endorsed by a developing accountable health community, the Washtenaw Health Initiative (WHI). The WHI is a voluntary countywide coalition of academic, community, health system, and county government agencies dedicated to improving access to high-quality health care for low-income, uninsured, and Medicaid populations. When lack of access to mental health services was identified as a pressing concern, the WHI endorsed pilot testing of collaborative care, an evidence-based treatment model, in county safety-net clinics. Challenges, outcomes, and relevance of this initiative to other counties or regional entities are discussed.
Background Physician workforce projections by the Institute of Medicine require enhanced training... more Background Physician workforce projections by the Institute of Medicine require enhanced training in geriatrics for all primary care and subspecialty physicians. Defining essential geriatrics competencies for internal medicine and family medicine residents would improve training for primary care and subspecialty physicians. The objectives of this study were to (1) define essential geriatrics competencies common to internal medicine and family medicine residents that build on established national geriatrics competencies for medical students, are feasible within current residency programs, are assessable, and address the Accreditation Council for Graduate Medical Education competencies; and (2) involve key stakeholder organizations in their development and implementation. Methods Initial candidate competencies were defined through small group meetings and a survey of more than 100 experts, followed by detailed item review by 26 program directors and residency clinical educators from k...
Limited success of efforts to improve residents' critical appraisal skills may be... more Limited success of efforts to improve residents' critical appraisal skills may be due to poor understanding of their preintervention conceptual framework. To describe internal medicine residents' a priori conceptual approach to critical appraisal of intervention trials, we performed an exploratory content analysis of 41 residents' unprompted descriptions of strengths and weaknesses of a randomized trial of spa therapy for back pain. Eighty-eight percent of responses were assigned independently by 2 reviewers to 23 categories ( kappa .65). Residents agreed on some important characteristics (e.g., blinding), disagreed on others (e.g., similarity of treatment and control groups), frequently mentioned some irrelevant characteristics (e.g., "objective" vs. "subjective" outcomes), and rarely mentioned some important criteria (e.g., intention to treat). An open-ended questionnaire reliably revealed both expected and unexpected conceptions and misconceptions among residents who had received minimal or no formal instruction in critical appraisal. We propose a classification model for residents' critical appraisal concepts that can be tested in future studies and used to identify areas for focusing interventions to improve resident physicians' critical appraisal skills.
Recognizing and rewarding teaching faculty are increasingly important to medical schools and are ... more Recognizing and rewarding teaching faculty are increasingly important to medical schools and are often hampered by low perceived reliability and validity of measures of teaching ability. The purpose of this study was to cross-validate two independently generated measures of teaching from medical students and residents. A total of 2,318 medical student and 4,425 resident scores for single-item measures of teaching ability for 129 teaching faculty members of a department of internal medicine over a 6-year period were compared. Results showed that average teaching scores were higher for medical students than residents. Rank order of faculty were within 2 quintiles for the two groups for over 90% of faculty. Highly discordant evaluations were seen for only 8% of faculty. The authors conclude the general concordance of two independent measures of teaching ability adds evidence to the existing literature of the validity of single-item measures of teaching ability from two different types ...
Faculty development programs and faculty incentive systems have heightened the need to validate a... more Faculty development programs and faculty incentive systems have heightened the need to validate a connection between the quality of teaching and students' learning. This study was designed to determine the association between attending physicians' and residents' teacher ratings and their students' examination scores. From a database of 362 students, 138 faculty, and 107 residents in internal medicine, student-faculty (n = 476) and student-resident (n = 474) pairs were identified. All students were in their third year, rotating on inpatient general medicine and cardiology services, July 1994 through June 1996, at a single institution. The outcome measure for students' knowledge was the NBME Subject Examination in internal medicine. To control for students' baseline knowledge, the predictors were scores on the USMLE Step 1 and a sequential examination (a clinically-based pre- and post-clerkship examination). Teaching abilities of faculty and residents were rated by a global item on the post-clerkship evaluation. Faculty's ratings used only scores from prior to the study period; residents' ratings included those scores students gave during the study period. Multivariate analyses showed faculty's teaching ratings were a small but significant predictor of the increase in students' knowledge. Residents' teaching ratings did not predict an increase in students' knowledge. Attending faculty's clinical teaching ability has a positive and significant effect on medical students' learning.
Free clinics are an essential part of the United States health care safety net, and student-run f... more Free clinics are an essential part of the United States health care safety net, and student-run free clinics comprise a significant proportion of free clinics nationally. These clinics operate with limited resources but see a population of medically and socially complex patients. Complex care management is a spectrum of care models targeting high-need, high-cost patients designed to improve outcomes and reduce overutilization of health care which have been implemented in many health care settings. Common features of care management programs include patient selection, specialized care managers, and multidisciplinary medical teams. Patients seen at student-run free clinics would benefit from the principles of complex care management. The principles of complex care management have been incorporated into patient care at the University of Michigan Student-Run Free Clinic (UMSRFC) as part of a pilot care management protocol. Patients seen from May 2016 through April 2017 during the first ...
Purpose This study gathers validity evidence of an expanded History and Physical examination (H&P... more Purpose This study gathers validity evidence of an expanded History and Physical examination (H&P 360) to address chronic diseases through incorporation of biopsychosocial elements that are lacking in traditional H&P assessments via a multisite randomized controlled trial among medical students. Method Third- and fourth-year medical students (n = 159) at 4 schools participated in an Objective Structured Clinical Examination designed with 2 cases for chronic disease. Students were randomized into the treatment group, which involved brief written instructions on how to use the H&P 360 followed by a standardized patient (SP) interaction, or the control group, which used the traditional H&P in an SP interaction without additional instructions. Validity evidence was gathered for content (alignment with an empirically derived expanded history list), response process (feedback from raters and learners on the process), internal structure (reliability and item-level psychometrics), relations...
Consistency in clinical decision making may be necessary for reliable assessment of student perfo... more Consistency in clinical decision making may be necessary for reliable assessment of student performance and teaching effectiveness, yet little has been done to examine variation in periodontal diagnosis and treatment planning among dental school faculty. The purpose of this investigation was to examine variation among faculty in diagnosis and management of common periodontal diseases. Twenty‐seven clinical instructors (periodontists, general dentists, dental hygienists, and first‐ and second‐year periodontal graduate students) reviewed three web‐based cases and answered a brief questionnaire focusing on radiographic interpretation, periodontal diagnosis, and treatment planning. Response rates for the three cases ranged from 62 percent to 70 percent. Clinical instructors’ rating of percent bone loss in the majority of cases varied between three descriptive categories for the same tooth. Greater consistency in periodontal diagnosis was noted within the graduate student group as compar...
Problem Transforming medical school curricula to train physicians to better address society’s nee... more Problem Transforming medical school curricula to train physicians to better address society’s needs is a complex task, as students must develop expertise in areas other than clinical medicine. Approach In 2010, the University of Michigan Medical School (UMMS) launched the Global Health and Disparities (GHD) Path of Excellence as part of a larger curriculum transformation. The GHD Path is a co-curriculum with the goal of ameliorating health disparities in the United States and abroad. It was developed iteratively based on student and faculty feedback. Student feedback emphasized the value of the relationships with faculty and other students, the capstone project, and exposure to role models and professional networks. Faculty described the joy of interacting with students and the desire for recognition by their departments for their role as an advisor. Outcomes Informed by the GHD Path experience, UMMS embraced the Path model, which emphasized professional relationships, career develo...
Psychiatric services (Washington, D.C.), May 29, 2016
This column describes the planning and implementation of an integrated behavioral health project ... more This column describes the planning and implementation of an integrated behavioral health project which was facilitated and endorsed by a developing accountable health community, the Washtenaw Health Initiative (WHI). The WHI is a voluntary countywide coalition of academic, community, health system, and county government agencies dedicated to improving access to high-quality health care for low-income, uninsured, and Medicaid populations. When lack of access to mental health services was identified as a pressing concern, the WHI endorsed pilot testing of collaborative care, an evidence-based treatment model, in county safety-net clinics. Challenges, outcomes, and relevance of this initiative to other counties or regional entities are discussed.
Background Physician workforce projections by the Institute of Medicine require enhanced training... more Background Physician workforce projections by the Institute of Medicine require enhanced training in geriatrics for all primary care and subspecialty physicians. Defining essential geriatrics competencies for internal medicine and family medicine residents would improve training for primary care and subspecialty physicians. The objectives of this study were to (1) define essential geriatrics competencies common to internal medicine and family medicine residents that build on established national geriatrics competencies for medical students, are feasible within current residency programs, are assessable, and address the Accreditation Council for Graduate Medical Education competencies; and (2) involve key stakeholder organizations in their development and implementation. Methods Initial candidate competencies were defined through small group meetings and a survey of more than 100 experts, followed by detailed item review by 26 program directors and residency clinical educators from k...
Limited success of efforts to improve residents' critical appraisal skills may be... more Limited success of efforts to improve residents' critical appraisal skills may be due to poor understanding of their preintervention conceptual framework. To describe internal medicine residents' a priori conceptual approach to critical appraisal of intervention trials, we performed an exploratory content analysis of 41 residents' unprompted descriptions of strengths and weaknesses of a randomized trial of spa therapy for back pain. Eighty-eight percent of responses were assigned independently by 2 reviewers to 23 categories ( kappa .65). Residents agreed on some important characteristics (e.g., blinding), disagreed on others (e.g., similarity of treatment and control groups), frequently mentioned some irrelevant characteristics (e.g., "objective" vs. "subjective" outcomes), and rarely mentioned some important criteria (e.g., intention to treat). An open-ended questionnaire reliably revealed both expected and unexpected conceptions and misconceptions among residents who had received minimal or no formal instruction in critical appraisal. We propose a classification model for residents' critical appraisal concepts that can be tested in future studies and used to identify areas for focusing interventions to improve resident physicians' critical appraisal skills.
Recognizing and rewarding teaching faculty are increasingly important to medical schools and are ... more Recognizing and rewarding teaching faculty are increasingly important to medical schools and are often hampered by low perceived reliability and validity of measures of teaching ability. The purpose of this study was to cross-validate two independently generated measures of teaching from medical students and residents. A total of 2,318 medical student and 4,425 resident scores for single-item measures of teaching ability for 129 teaching faculty members of a department of internal medicine over a 6-year period were compared. Results showed that average teaching scores were higher for medical students than residents. Rank order of faculty were within 2 quintiles for the two groups for over 90% of faculty. Highly discordant evaluations were seen for only 8% of faculty. The authors conclude the general concordance of two independent measures of teaching ability adds evidence to the existing literature of the validity of single-item measures of teaching ability from two different types ...
Faculty development programs and faculty incentive systems have heightened the need to validate a... more Faculty development programs and faculty incentive systems have heightened the need to validate a connection between the quality of teaching and students' learning. This study was designed to determine the association between attending physicians' and residents' teacher ratings and their students' examination scores. From a database of 362 students, 138 faculty, and 107 residents in internal medicine, student-faculty (n = 476) and student-resident (n = 474) pairs were identified. All students were in their third year, rotating on inpatient general medicine and cardiology services, July 1994 through June 1996, at a single institution. The outcome measure for students' knowledge was the NBME Subject Examination in internal medicine. To control for students' baseline knowledge, the predictors were scores on the USMLE Step 1 and a sequential examination (a clinically-based pre- and post-clerkship examination). Teaching abilities of faculty and residents were rated by a global item on the post-clerkship evaluation. Faculty's ratings used only scores from prior to the study period; residents' ratings included those scores students gave during the study period. Multivariate analyses showed faculty's teaching ratings were a small but significant predictor of the increase in students' knowledge. Residents' teaching ratings did not predict an increase in students' knowledge. Attending faculty's clinical teaching ability has a positive and significant effect on medical students' learning.
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