The trend toward increasing numbers of working women may alter the ways both men and women physicians structure their professional lives. The 1987 graduates of residency and fellowship programs at the University of Minnesota Medical School--Minneapolis were surveyed in June 1987 about professional plans and factors that led to their decisions. The women expected that their spouses would contribute half of their family's income, whereas the men expected that they would be largely responsible for their family's income. The married women with children planned on working fewer hours than did other physicians. Family structure may play an important role in preventing the convergence of men and women physicians' personal incomes or working hours.
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BACKGROUND. Increasing use of outpatient settings for clinical education raises the question of their effectiveness compared with that of inpatient settings. METHOD. At the University of Minnesota Medical School-Minneapolis in 1987–88, the 190 second-year students participated in a six-week tutorial rotation introducing them to clinical pediatrics: 52 (27%) were in hospital settings and 138 (73%) were in community outpatient settings. Almost all the students (178) evaluated their rotations by responding to both structured and open-ended questions, using a Likert scale for the structured questions. At the completion of the second year, all 190 students took an objective structured clinical examination (OSCE) that included five pediatrics stations. Student's t-test was used to compare (1) the mean ratings the hospital-based and community-based students gave their pediatrics rotations and (2) the mean scores earned by the two groups of students on the five pediatrics stations in the OSCE. RESULTS. There were no statistically significant differences between (1) the two groups' mean ratings of the clinical experience overall or of the quality of teaching or (2) the groups' mean scores on any of the OSCE stations. CONCLUSION. That the hospital-based and community-based students performed comparably on the OSCE and gave similar evaluations of their pediatrics rotations supports the use of community practitioners to provide students with their initial clinical training. Moreover, community-based teaching sites replicate situations in which most students will eventually practice medicine.
Objective: The addition of Web-based technology has increased the effectiveness and expanded the teaching modalities of a student peer-teaching program. Description: The Knowledge Co-op is a peer-teaching program at the University of Minnesota Medical School organized and administered by second-year medical and dental students to support first-year medical and dental students in their academic coursework.1 Its purpose is to provide alternative resources and teaching methods through large-group reviews, small-group and one-on-one tutoring, and practice lab practicals. In addition, we have recently incorporated Web-based technologies to increase access to Knowledge Co-op resources and expand current teaching modalities. A Web site has been created that contains schedules for all program activities, handouts used in review sessions, online practice practicals, and e-mail links to second-year student instructors and coordinators (the site can be viewed at ). Discussion: Web-based resources have become an important part of the Knowledge Co-op, serving a number of important purposes. The Internet allows better access to our resources, which greatly expands the number of students benefiting from the program. Remote access to the Web site allows students to budget their time better by using the program's study resources at their convenience, without actually attending program review sessions. Also, the e-mail links allow review session leaders and students to communicate more readily, a significant benefit because first- and second-year schedules vary greatly. The availability of resources developed by the Knowledge Co-op on the Web makes these resources readily accessible to students from other colleges and universities, thereby extending its use to peers and future colleagues. These Web-based resources can benefit not only medical and dental students but also other health professional students. Data have been collected on students' use and perceptions of the Web site. This site began operation in October 1999 and in only eight weeks had been visited more than 250 times. A focus group of first-year medical and dental students described the value and convenience of having Web-based access to study materials. They liked the Web-based anatomy practice practicals, which provided an alternate method for studying anatomy and feedback on their knowledge, and which resulted in greater comfort with taking the actual practical examination. The use of Web-based technology in medical education is increasing and is affordable and readily available to students. It can easily be incorporated into teaching curricula. The Knowledge Co-op Web site is an example of how innovations in technology can be used to facilitate peer tutoring and promote alternative teaching methods. The Web site also can serve as a model to other student-run programs for enhancing access to their resources for students locally as well as students at other schools.
Connie M. Parenti, M.D., Department of Medicine, and Ilene Harris, Ph.D., Office of Curriculum Affairs, University of Minnesota Medical School, Minneapolis
Purpose To identify the qualities and skills of exemplary and ideal pediatric hospitalist educators. Method The authors conducted a prospective, multi-institutional qualitative study from November 2008 through January 2009 in which they interviewed pediatric hospitalists who were identified as exemplary educators at three academic pediatric residency programs. They then conducted focus groups with residents and medical students who had recently worked with these hospitalists. Qualitative analysis was used to identify themes. Results All six hospitalists identified as exemplary participated. Among invited learners, 14/18 residents (78%) and 16/18 medical students (89%) participated. Together, the participants contributed 266 comments, which the authors categorized into 36 themes within the four domains of teaching skills, personal qualities, patient care skills, and role modeling. New qualities and skills—including self-reflection/insight, encouraging autonomy, time management, knowledge acquisition, and systems knowledge—and differences in perceptions among hospitalists, residents, and students were identified. Differences between the qualities and skills of actual exemplary hospitalist educators and perceptions of those of an ideal hospitalist educator were also identified. Conclusions Pediatric hospitalists in academic residency programs have unique opportunities to significantly affect the education of medical students and residents. This study validates and expands on prior studies of the qualities and skills needed to be a successful hospitalist educator. Researchers and educators designing faculty development programs to train more successful hospitalist educators may wish to target these qualities and skills as well as the differences in medical student and resident needs.
Changes in beginning medical students' preferred interview responses appear attributable to a course that emphasizes communication techniques for developing patient rapport. For each of five successive classes, pre/postcourse preferences were obtained for alternative response modes (categorized as understanding, probing, interpretive, supportive, and evaluative. Analysis indicated significant increases in students' preferences for understanding responses and decreases in preferences for evaluative responses (p less than .001). Changes are in the desired direction with respect to course goals, since rapport is generally enhanced by conveying understanding and refraining from premature evaluation. Effects on response preferences of some instructor characteristics are analyzed. Implications for health professions education and research are discussed.
To ensure adequate observation, supervision, and mentoring of trainees, long-term preceptorships or apprenticeships are being reestablished in medical education. Equivalence in academic performance has been demonstrated between longitudinal students in the Rural Physician Associate Program (RPAP), who spend 9 months in a rural community during their third year of medical school, and their peers who complete their clerkships at different hospitals and clinics (traditional). We qualitatively reviewed the end of session Objective Structured Clinical Examination (OSCE) for both groups and compared their performances.The high and low performers on four OSCE scenarios (cough, dysuria in a teen, preventive care in an older male, medication reconciliation) for two cohorts of students: longitudinal (n=47) and traditional primary care clerkship students (n=60) were selected for review. These 16 videotapes were reviewed independently by three researchers. The themes and subthemes were discussed over four meetings.Both high and low scoring longitudinal students demonstrated more consistent use of rapport building skills. Longitudinal students appeared to have an effective pattern in their patient interactions and were more rehearsed at explaining preventive care recommendations such as the pros and cons of the prostate-specific antigen (PSA) test. Traditional students displayed a more complete mastery of the adolescent interview and followed a mnemonic taught during lecture.Qualitative assessment of OSCE data reveals information not captured in the quantitative scores. In this study, longitudinal students demonstrated better mastery of rapport building and content knowledge and had an effective routine to their patient encounters not evident in the traditional students' scenarios.
