Transcript MENTORSHIP PROGRAM FOR MS1 STUDENTS WITH …

CLINICAL MENTORSHIP WITH
COMPUTER SUPPORT
David P. Yens ([email protected])
Elizabeth DiNapoli ([email protected])
Cheryl Evans ([email protected])
New York College of Osteopathic Medicine
New York Institute of Technology
Supported in part by a Predoctoral Training grant from
HRSA
PROBLEM
• A decreasing number of medical
school graduates are selecting
primary care careers and rural
practice.
PURPOSES
• Encourage more students to select primary
care by providing a mentorship experience
to first (and second) year medical students
with local or rural primary care physicians.
• Combine the humanity of the primary care
physician with technology to demonstrate
the responsibilities, rewards and benefits
of primary care and to obtain an
introduction to clinical medicine.
RATIONALE
• National data continue to indicated a decrease in the
number of medical school graduates selecting a
residency in primary care.
• NYCOM has typically had large percentage of
graduates entering primary care residencies (31%
selecting Family Practice from the class of 1999).
• However, for the class graduating in 2002, only 13%
selected a family practice residency!
• Yet, most applicants to NYCOM claim that they
desire a primary care career.
RATIONALE
• We believe that an exposure in the
MSI and II years to the advantages
and lifestyle of primary care will
reinforce the early interest in primary
care and Family Practice.
LITERATURE/BACKGROUND
• Many medical schools presently provide clinical
experiences, frequently in primary care settings,
during the preclinical phase of training.
• All schools participating in the Interdisciplinary
Generalist Curriculum Project (IGC) established
longitudinal clinical experiences in the first or second
year (Colwill, 1997). At a 1997 Association of
American Medical Colleges meeting all participants
in the IGC project reported excellent responses by
students - and preceptors - to an early clinical
preceptorship, but it was too early to assess results
(personal discussion). No recent literature has been
found regarding primary care medical mentorships.
PROJECT OBJECTIVES
• Establish a program where first and
second year medical students will spend a
half day in a primary care physician’s
office at least once every four weeks (local
track)
• Create a curriculum for monthly visits for
the two-year clinical program.
PROJECT OBJECTIVES
• Establish an upstate program where first
year medical students spend four weeks in
an upstate rural primary care physician’s
office during the summer following the
MS1 year.
• Create a curriculum for students in the
four week rural clinical program.
PROJECT OBJECTIVES
• Integrate computer activities into this
clinical program to provide an added
introduction to clinical medicine, to
introduce students to the environment of
the practice of primary care, and describe
where primary care fits into the medical
milieu.
STUDENT OBJECTIVES
• Through observation and interaction with their
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primary care Physician Mentor, the NYCOM Medical
student will:
Observe the delivery of medical treatment of
patients
Observe office/hospital functions and management
Observe diagnostic procedures and use of medical
equipment
Observe the interaction between healthcare team
members
STUDENT OBJECTIVES
• After adequate experience, the student
may be permitted to do history-taking
and possibly physical exams under the
direct supervision of the mentor,
depending upon the comfort level of
the mentor.
METHODS
• Provide a structured mentorship experience with a
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primary care physician starting in the first year of
medical school.
• Local year-long program
• Upstate summer program
Provide a comprehensive curriculum manual
Supplement the mentorship with computer-based
content
Foster continuation of the mentorship experience by
encouraging and facilitating the use of e-mail for
continuing communication.
• The basic assumption of this
project is that we can successfully
encourage students to select
primary care at an earlier point in
their training and maintain this
goal throughout their medical
training.
STRUCTURED LOCAL
MENTORSHIP EXPERIENCE
• Questionnaires created for students and
potential mentors to permit matching
and optimize compatibility
• Letters about the program sent to all
osteopathic primary care physicians in
the NYC area
• E-mails about the program sent to all 1st
year NYCOM students
• Respondents completed the
questionnaires
STRUCTURED LOCAL
MENTORSHIP EXPERIENCE
• All potential mentors and students
interviewed by the Mentor Coordinator
(Ms. DiNapoli). Expectations about the
program conveyed to both parties.
• Mentors and mentees matched
• Times of visits arranged by the mentors
and mentees
• Visits initiated and continue
STRUCTURED UPSTATE
MENTORSHIP EXPERIENCE
• Questionnaires created for students and potential
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mentors specially designed to address the rural
environment
Letters about the program sent to osteopathic primary
care physicians in New York north of Westchester County
As above, E-mails about the program sent to all 1st year
NYCOM students, respondents completed the
questionnaires, and all potential mentors and students
interviewed by the Mentor Coordinator. All potential
upstate mentors interviewed. Mentors and mentees
matched.
STRUCTURED UPSTATE
MENTORSHIP EXPERIENCE
• Mentors and mentees arranged starting dates with the
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Mentor Coordinator.
Students spent one month at the rural sites. Housing
was either provided or arranged. Students received a
stipend of $930 for the month.
Daily activities included learning about the physician’s
office and practice, learning to interview and perform
physical exams, rounding with the mentor in a hospital,
observing (and practicing) the use of osteopathic
manipulation, learning about the rural community and
rural medicine, etc.
COMPUTER AUGMENTATION
• A manual of information was prepared for both mentors
and mentees. Many Internet sites exist for topics to be
addressed in the mentorships. We provide references to
these sites.
• The manual has been converted to a Powerpoint
presentation that can be shared with mentors via a video
plus audio format, to be initiated during the summer.
• To encourage continuity of the mentorship, we expect
the mentor and student to maintain contact via e-mail.
Although the students are highly knowledgeable about
e-mail, many mentors use it only occasionally. We have
initiated training of mentors.
EVALUATION
• All participants in the project through
June, 2005 (5 Groups) were asked to
complete a questionnaire concerning
their attitudes about the program.
Results were tabulated and are
below.
RESULTS OF QUESTIONNAIRES COMPLETED BY 5 GROUPS
OF STUDENTS
STUDENT RESPONSES TO SELECTED ITEMS
LOCAL
Question
Period
Number of students/responses
20022003
20032004
RURAL
20042005
20022003
20032004
10/8
13/11
18/10
4/3
8/8
Felt comfortable working in mentor’s
office
100%
91%
100%
100%
88%
Learned as much as expected, or more
37%
73%
70%
66%
88%
Exceeded expectations
100%
64%
80%
100%
88%
Would strongly recommend to other
students
75%
91%
90%
100%
88%
Program very valuable
87%
91%
100%
100%
100%
Increase in self-confidence
Plan to continue in primary care
66%
75%
73%
70%
100%
88%
2004-2005
NO
DATA
YET
15
students
registered
RESULTS OF QUESTIONNAIRES COMPLETED BY 5
GROUPS OF MENTORS
MENTOR RESPONSES TO SELECTED ITEMS
LOCAL
Question
20022003
20032004
10/8
11/6
50%
As prepared as expected
RURAL
20022003
20032004
17/13
4/3
5/2
50%
31%
66%
0%
50%
50%
69%
33%
50%
Student showed a real interest in my
practice
83%
67%
100%
100%
50%
Felt student strongly enthusiastic about
primary care
50%
0%
8%
66%
0%
Felt student was enthusiastic about
primary care
50%
83%
23%
33%
50%
100%
0%
100%
50%
Period
Number of mentors/responses
Student better prepared than expected
20042005
Felt student had a strong interest in rural
practice
Felt well prepared to be mentor
83%
83%
100%
20042005
NO
DATA
YET
DISCUSSION
• The value of the project will be determined by
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the percentage of students participants who
enter primary care compared with those who did
not participate. It’s too early to determine this
yet.
Almost all students would strongly recommend
the program to other students.
69% of local and 100% of rural students
indicated plans to continue in primary care.
HOWEVER, self-selected sample.
The survey results indicate a strongly positive
response to the program from all groups.
However, a small number of students had time
problems or conflicts
DISCUSSION
• In the 3rd year of the project:
– Mentoring manuals were completed and distributed
this year, but 4 students and 1 mentor used the
manuals (9 mentors did not recall receiving
manuals).
– 3 students used internet as part of project.
– 1 student and 1 mentor communicated by e-mail
• NOTE that this is a volunteer program, which may
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limit the number of participants.
Long term goal – most students will participate
– Required activity or
– Elective with credit given
• In a new problem-based learning track, 30-40
MS1 students will participate in a mentorship
MS3 FOLLOWUPS
• Followups with 3rd year students from the rural component
found one (of 4) doing all rotations upstate and one doing
several upstate rotations; both were very positive about
the experience and felt they were more likely to select a
rural primary care practice. Rural mentees were more
likely to have a significant clinical exposure than local
mentees.
• Rural mentors were positive about the students they had
and would take more students if space is available. Rural
mentors willing to work with students are in demand for
clinical electives.
• Most mentors use e-mail but few have maintained contact
with students – something we need to emphasize in the
future.
REFERENCES
• Colwill, et.al. Modifying the Culture of Medical Education: the First
Three Years of the RWJ Generalist Physician Initiative. Acad Med
1997 Sept; 72(9), 745-53.
• See also:
– Cronau, H. & Haines, D.J. Medical Students Summer Externship
Program: Increasing the Number Matching in Family Practice. Med
Educ Online, 2004:9:3
– Veitia, M; McCarty, M; Kelly, P; Szarek, J; Harvey, H. The
Interdisciplinary Generalist Curriculum Project at Joan C. Edwards
School of Medicine at Marshall University. Acad Med 2001 Apr; 76(4
Suppi);S97-9.
– Ricer, RE; Fox, BC; Miller, KE. Mentoring for Medical Students
Interested in Family Practice. Fam Med 1995 Jun;27(6), 360-5.
• This project is funded in part by Title VII Grant # 1 D16 HP 00149-01 from
the Bureau of Health Professions, USPHS.