Transcript Slide 1
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 Disadvantages: Educational differences among sites Lecture time Attending interaction Resident teaching
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
Participants- 3 rd and 4 th 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
Participants: 145 medical students 66 Men, 79 Women 117 third-year, 28 fourth-year students
III. RESULTS (continued)
Comparison of sites for individual clerkships Quality Lecture time Attending interaction Resident teaching One-way ANOVA Correlations
Quality of Individual Clerkship Experiences
2.5
2 1.5
1 0.5
0 5 4.5
4 3.5
3 3.14
RESULTS
3.62
3.45
3.16
3.35
3.51
3.44
3.36
Surgery Medicine Pediatrics Ob/Gyn Neurology Psychiatry Ambulatory Medicine
Clerkship
Family Medicine
Individual Clerkship Results
PEDIATRICS
Quality of Pediatric Clerkship Experience by Site
6 5 4 3.88
3 2 3.15
1 0 UCLA/Oliveview 3.12
Harbor
Site
Cedars 3.3
Kaiser Sunset
PEDIATRICS
Amount of Lecture Time for Pediatrics Clerkship by Site
6 5 4 3 2 1 3.41
3.35
4.36
3.4
0 UCLA/Oliveview Harbor
Site
Cedars Kaiser Sunset
PEDIATRICS
Amount of Attending Interaction for Pediatrics Clerkship by Site
5 4.5
4 3.5
3 2.5
2 1.5
1 0.5
0 2.58
UCLA/Oliveview 2.41
3.08
3 Harbor
Site
Cedars Kaiser Sunset
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
SURGERY
Quality of Surgery Clerkship Experience by Site
5 4.5
4 3.5
3 2.5
2 1.5
1 0.5
0 3.12
CHS 3.12
3.33
3.11
2.58
3.36
Harbor Oliveview
Site
WVA Cedars Santa Monica
SURGERY
Amount of Lecture Time for Surgery by Site
2 1.5
1 0.5
0 5 4.5
4 3.5
3 2.5
2.83
CHS 3.41
2.86
3.07
2.37
2.54
Harbor Oliveview WVA
Site
Cedars Santa Monica
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)
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
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
NEUROLOGY
Quality of Neurology Clerkship Experience by Site
5 4.5
4 3.5
3 2.5
2 1.5
1 0.5
0 3 2.9
3.36
3.39
UCLA Oliveview
Site
Harbor WVA
NEUROLOGY
Amount of Resident Teaching for Neurology Clerkship by Site
6 1 0 3 2 5 4 2.85
2.96
3.45
3.48
UCLA Oliveview
Site
Harbor WVA
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
PSYCHIATRY
Amount of Attending Teaching Time or Psychiatry Clerkship by Site
6 5 1 0 4 3 2 2.19
3.86
3.09
3 2.5
UCLA Oliveview Harbor
Site
WVA Cedars
Psychiatry
General comments Little to no benefit of PBLs Organized didactics would be helpful “5 weeks is too long”
INTERNAL MEDICINE
Amount of Attending Interaction for Internal M edicine Clerkship by Site
6 5 4 3.49
3.22
3 2 1 2.92
3.06
2.74
2.38
0 CHS Harbor Oliveview WVA
Site
Cedars Kaiser Sunset
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)
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/GYN
Amount of Attending Interaction for Ob/Gyn Clerkship by Site
4.5
4 3.5
3 2.5
2 1.5
1 0.5
0 2.21
2.46
3.06
2.04
UCLA Oliveview
Site
Harbor Cedars
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)
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 MEDICINE
Quality of Ambulatory Medicine Clerkship Experience by Site
5 4.5
4 3.5
3 2.5
2 1.5
1 0.5
0 3 3.77
3.33
2.67
3.29
3.64
3.53
CHS Oliveview Harbor WVA
Site
Cedars Kaiser Sepulveda VA
AMBULATORY MEDICINE
Amount of Attending Interaction for Ambulatory Medicine Clerkship by Site
3 2 1 0 6 5 4 3.57
3.54
4.11
2.47
4.14
3.86
CHS Oliveview Harbor 3.6
WVA
Site
Cedars Kaiser Sepulveda VA
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)
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
RADIOLOGY
Quality of Radiology Clerkship Experience
5 4.5
4 3.5
3 2.5
2 1.5
1 0.5
0 2.72
2.25
2.33
2 Lecture Angel 1.81
Exposure on the Wards Teaching on the Wards Preparedness of Radiology Exam
Feature
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
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
Lack of clinical teaching Lack of exposure to health care systems Lack of ownership
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
Survey author: Liz Volkmann Web manager: Vivian Ng Survey contributors: Jon Marron, Wendy Liu, Kevin Koo Statistical analysis: Liz Volkmann Staff Collaborator: Sebastian Uijtdehaage