Academic medicine : journal of the Association of American Medical Colleges
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The authors explored the extent to which medical schools have established institutional and departmentalized educational objectives, by examining the accreditation databases, institutional self-studies, and site visit reports of 59 schools surveyed by the Liaison Committee on medical Education (LCME) in 1994-1996. In this study, the individual school was the unit of analysis, and the dependent variables were statements--in outcomes' terms--of institutional and departmental learning objectives. Objectives were classified as "robust" when they were expressed as measurable learning outcomes in the domains of knowledge and skills and behaviors. ⋯ Schools that paid attention to the explication of learning objectives were more likely to link specific institutional and departmentalized outcomes with methods of evaluating students, in turn guiding the content and methods of instruction. Schools with vapid objectives attracted 40% more accreditation citations for shortcomings in curricular management, course and clerkship quality, and the evaluation of student achievement, especially in the clinical skills domain. In the future, accreditors should focus more closely on this association.
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To identify previously unrecognized factors influencing medical students' career choices and to better characterize the effects of educational experiences, role models, and educational debt on career decisions. ⋯ Students' career decisions are complex, dynamic, and individualized processes. The use of qualitative measures helps bolster understanding of these processes by identifying new factors (such as mastery of knowledge) and by further characterizing known factors (such as role models and financial considerations). A comprehensive and valid understanding of students' career-decision making is necessary to develop successful strategies to sustain and encourage the choice of primary care careers.
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Comparative Study
A study of medical students' specialty-choice pathways: trying on possible selves.
To describe the decision-making processes reported by graduating medical students in choosing primary care (PC) or non-primary-care (NPC) specialties. ⋯ The process of specialty choice can be described usefully as a socially constructed process of "trying on possible selves" (i.e., projecting oneself into hypothetical career and personal roles). This may explain role models' exceptional influence in disproving negative stereotypes. Medical students' choices can best be facilitated by recognizing their needs to gain knowledge not only about specialty content, but also about practitioners' lives and the students' own present and possible selves.
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As the training of medical students and residents increasingly moves to ambulatory care settings, clerkship and program directors must find a way to use their limited resources to guide the development and evaluation of the quality of these ambulatory-based learning experiences. To evaluate quality, directors must first define, in operational and measurable terms, what is meant by the term "quality" as it is applied to ambulatory-based education. ⋯ They assert that quality is achieved through the interaction of an optimal learning environment, defined educational goals and positive outcomes, participant satisfaction, and cost-effectiveness. By describing the components of quality along with examples of measurable indicators, the authors provide a foundation for the evaluation and improvement of instructional innovations in ambulatory care education for the benefit of teachers, learners, and patients.