Academic medicine : journal of the Association of American Medical Colleges
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Addressing the current fragmentation and lack of coordination of health care requires that health professionals be skilled and motivated towards interdisciplinary team care. The objectives of our program are to (1) enhance attitudes towards team health care and (2) improve group interaction skills among interdisciplinary health care learners. ⋯ Previous team-care training programs for health professionals have demonstrated difficulty in fostering effective attitudes and skills. During the planning and pilot year, we identified barriers to success that included (1) negative baseline attitudes toward interdisciplinary team care, especially among medical residents, (2) unrecognized assumptions and behaviors by learners regarding authority and power relationships within the team, and (3) specific concerns by learners regarding the effectiveness and efficiency of health care teams. We hope to demonstrate success through a program that includes direct examination of learners' attitudes and their origins in a safe environment, immediate feedback regarding group behaviors, case-based learning, and direct role exposure to a well-functioning interdisciplinary team.
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To introduce medical students to a healthy elderly population and present the health care challenges in this population. ⋯ The responses from students, senior mentors, and faculty have been overwhelmingly positive. Students have enjoyed the early clinical experience, senior mentors have enjoyed meeting and talking to the students, and the faculty are pleased with the ability to integrate classroom material into a clinical setting early in the curriculum. Difficulties have arisen as some of our senior mentors have become ill and in the coordination of schedules between senior mentors and students. The plan is to continue the program as a permanent part of the curriculum. The hope is that it will be seen as a model for increasing the focus on geriatrics and early clinical experiences in the curriculum.
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LCME has recently required that all graduating medical students learn about end-of-life care. This program describes the design and integration into an existing geriatrics clerkship of a palliative care module that teaches the foundations of end-of-life and palliative care to medical students. ⋯ Palliative care sessions are welcomed by the students, who traditionally have not received much teaching in this area. Even though students have learned about mechanisms regulating pain and other symptoms in the past, they have not learned to assess or treat symptoms in a systematic way. Students often have good questions about the decision-making, legal, and ethical issues that emerge for patients near the end of life. Thus, co-facilitation of physicians with ethicists presents both the practical clinical and the theoretical perspectives, and provides a good model for team teaching. In terms of teaching style, students are more involved and participatory when teachers use case vignettes as compared with slide presentations, even if they are case-based. When using role-plays to teach students how to communicate bad news, we found that students need to feel safe in that environment, need to know they can call for time out when necessary, and want to have seen one done before they are asked to do one.
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The University of Michigan Medical School is integrating into its curriculum the attitudes, knowledge, and skills that pertain to the care of older individuals using a defined set of core learning outcomes encompassing all four years. Students will demonstrate proficiency in these outcomes as a graduation requirement. We have developed an individualized, interactive, Web-based geriatrics portfolio to track the acquisition and mastery of these outcomes for students. ⋯ The geriatrics portfolio serves to identify and highlight geriatrics-related content across the four years. Its interactive features make it much more dynamic than a written transcript. Requiring proficiency in learning outcomes related to geriatrics for graduation will clearly convey to students that this information is critically important in their training to become physicians. The individualized evaluation summaries will prove useful to the student because self-directed learning opportunities can be targeted to address weak areas. Evaluation of performances will also aid program directors to appropriately modify the curriculum to address any deficiencies. This innovative Web-based approach to capture learning outcomes that are dispersed throughout a four-year curriculum may also find application in similar curricula (e.g., women's health and end-of-life care).
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Over half of American medical schools are currently engaged in significant curricular reform. Traditionally, evaluation of the efficacy of educational changes has occurred well after the implementation of curricular reform, resulting in significant time elapsed before modification of goals and content can be accomplished. We were interested in establishing a process by which a new curriculum could be reviewed and refined before its actual introduction. ⋯ This proactive approach to quality improvement added an evaluation point before the new curriculum was actually unveiled. The anticipatory planning process substantially aided the interdisciplinary developmental process, increased input into the first-year curriculum by clerkship directors, and identified problems that would have otherwise become apparent after implementation. We believe this model adds value to the curriculum planning process.