Diagnostic Reasoning by Expert Clinicians: What Distinguishes Them From Their Peers?

Objectives Expert clinicians (ECs) are defined in large part as a group of physicians recognized by their peers for their diagnostic reasoning abilities. However, their reasoning skills have not been quantitatively compared to other clinicians using a validated instrument. Methods We surveyed Internal Medicine physicians at the University of Iowa to identify ECs.

Investigating the validity of web-enabled mechanistic case diagramming scores to assess students' integration of foundational and clinical sciences.

As medical schools have changed their curricula to address foundational and clinical sciences in a more integrated fashion, teaching methods such as concept mapping have been incorporated in small group learning settings. Methods that can assess students' ability to apply such integrated knowledge are not as developed, however. The purpose of this project was to assess the validity of scores on a focused version of concept maps called mechanistic case diagrams (MCDs), which are hypothesized to enhance existing tools for assessing integrated knowledge that supports clinical reasoning.

Time-variable medical education innovation in context.

Background: Medical education is undergoing robust curricular reform with several innovative models emerging. In this study, we examined current trends in 3-year Doctor of Medicine (MD) education and place these programs in context.

Methods: A survey was conducted among Deans of U.

Web-Enabled Mechanistic Case Diagramming: A Novel Tool for Assessing Students' Ability to Integrate Foundational and Clinical Sciences.

Problem: As medical schools move from discipline-based courses to more integrated approaches, identifying assessment tools that parallel this change is an important goal.

Approach: The authors describe the use of test item statistics to assess the reliability and validity of web-enabled mechanistic case diagrams (MCDs) as a potential tool to assess students' ability to integrate basic science and clinical information. Students review a narrative clinical case and construct an MCD using items provided by the case author.

Design and rationale of the medical students learning weight management counseling skills (MSWeight) group randomized controlled trial.

Physicians have an important role addressing the obesity epidemic. Lack of adequate teaching to provide weight management counseling (WMC) is cited as a reason for limited treatment. National guidelines have not been translated into an evidence-supported, competency-based curriculum in medical schools.

The Impact of Using Mean Versus Mode When Assessing Resident Competency.

Background: The Accreditation Council for Graduate Medical Education Milestone Project was implemented in 2014 to standardize assessments and progression of residents. While it is recommended that milestones not be used as tools for direct assessments of resident competency, many programs have used or adapted milestone tools for this purpose.

Objective: We sought to explore use of the most frequent milestone level at which a resident was evaluated (ie, the mode), and compared this to the standard practice of using the arithmetic mean for summarizing performance.

Medical Emergency During Flight: A Team-Building Exercise.

Introduction: While teams are a central component in health care, many professionals who function in them have had little, if any, formal training on how to develop an effective team. Medical educators and trainers have used many different approaches to teach the basic skills and knowledge of team effectiveness and how team members can best interact with each other. To make team training more realistic, experiential exercises have been used.

An Investigation of the Generalizability of Medical School Grades.

Unlabelled: Construct/Background: Medical school grades are currently unstandardized, and their level of reliability is unknown. This means their usefulness for reporting on student achievement is also not well documented. This study investigates grade reliability within 1 medical school.

Dissection and dissection-associated required experiences improve student performance in gross anatomy: Differences among quartiles.

To promote student learning, educational strategies should provide multiple levels of engagement with the subject matter. This study investigated examination data from five first year medical gross anatomy class cohorts (692 students) to determine if enhanced student performance was correlated with learning through dissection in a course that used a rotating dissection schedule coupled with peer teaching and other associated experiences. When students performed two of five weekly dissections for a given unit, their average scores on both laboratory and written examinations tended to increase as compared to when they had completed only one week of dissection (P < 0.

Teaching Medical Students to Help Patients Quit Smoking: Outcomes of a 10-School Randomized Controlled Trial.

Background: Early in medical education, physicians must develop competencies needed for tobacco dependence treatment.

Objective: To assess the effect of a multi-modal tobacco dependence treatment curriculum on medical students' counseling skills.

Design: A group-randomized controlled trial (2010-2014) included ten U.

The integrated curriculum in medical education: AMEE Guide No. 96.

The popularity of the term "integrated curriculum" has grown immensely in medical education over the last two decades, but what does this term mean and how do we go about its design, implementation, and evaluation? Definitions and application of the term vary greatly in the literature, spanning from the integration of content within a single lecture to the integration of a medical school's comprehensive curriculum. Taking into account the integrated curriculum's historic and evolving base of knowledge and theory, its support from many national medical education organizations, and the ever-increasing body of published examples, we deem it necessary to present a guide to review and promote further development of the integrated curriculum movement in medical education with an international perspective. We introduce the history and theory behind integration and provide theoretical models alongside published examples of common variations of an integrated curriculum.

Assessing effective teaching: what medical students value when developing evaluation instruments.

Purpose: To investigate what criteria medical students would value and use in assessing teaching skills.

Method: Fourth-year medical students at the University of Iowa Carver College of Medicine enrolled in a teaching elective course are required to design and use an evaluation instrument to assess effective teaching. Each class uses a similar process in developing their instruments.

Developing future faculty: a program targeting internal medicine fellows' teaching skills.

Introduction: The increased demand for clinician-educators in academic medicine necessitates additional training in educational skills to prepare potential candidates for these positions. Although many teaching skills training programs for residents exist, there is a lack of reports in the literature evaluating similar programs during fellowship training.

Aim: To describe the implementation and evaluation of a unique program aimed at enhancing educational knowledge and teaching skills for subspecialty medicine fellows and chief residents.

Do preceptors with more rating experience provide more reliable assessments of medical student performance?

Background: Although the existing psychometric literature provides guidance on the best method for acquiring a reliable clinical evaluation form (CEF)-based score, it also shows that a single CEF rating has very low reliability.

Purpose: This study examines whether experience with rating students might act as a form of rater training and hence improve the quality of CEF ratings.

Methods: Preceptors were divided into two groups based on rater experience.

Medical school preadmission interviews: are structured interviews more reliable than unstructured interviews?

Background: The medical education research literature consistently recommends a structured format for the medical school preadmission interview. There is, however, little direct evidence to support this recommendation.

Purpose: To shed further light on this issue, the present study examines the respective reliability contributions from the structured and unstructured interview components at the University of Iowa.

Assessing implicit gender bias in Medical Student Performance Evaluations.

For medical schools, the increasing presence of women makes it especially important that potential sources of gender bias be identified and removed from student evaluation methods. Our study looked for patterns of gender bias in adjective data used to inform our Medical Student Performance Evaluations (MSPEs). Multigroup Confirmatory Factor Analysis (CFA) was used to model the latent structure of the adjectives attributed to students (n = 657) and to test for systematic scoring errors by gender.

Residents' attitudes about the introduction of a surgical skills simulation laboratory.

Background: As surgical education programs develop surgical skills laboratories, it will be important to do so in the most efficient, cost-effective manner.

Methods: We distributed a brief written survey to all general surgery residents at the University of Iowa Hospitals and Clinics regarding their perceptions of the usefulness of a surgical skills laboratory in training of both open and laparoscopic techniques. For the initial survey, we used analysis of variance to compare differences across groups.

Core clerkship directors: their current resources and the rewards of the role.

Purpose: To conduct a national multidisciplinary investigation assessing core clinical clerkships and their directors, variances in resources from national guidelines, and the impact of the clerkship director role on faculty members' academic productivity, advancement, and satisfaction.

Method: A multidisciplinary working group of the Alliance for Clinical Education (ACE), representing all seven core clinical disciplines, created and distributed a survey to clerkship directors at 125 U.S.

Resources and rewards for clerkship directors: how surgery compares.

Background: Clerkship directors (CDs) are key educators and active clinicians. In 2003, the Alliance for Clinical Education published standards for CD resources and responsibilities, but how reality compares is unknown.

Methods: Representatives from each core clinical disciplines' CD organizations created an electronic survey that CDs received in 2006-2007.

Defining and describing medical learning communities: results of a national survey.

Purpose: To investigate what is meant by learning community in medical education and to identify the most important features of current medical education learning communities.

Method: After a literature review, the authors surveyed academic deans of all U.S.

Patient-physician communication: informed consent for imaging-guided spinal injections.

Purpose: Historically, informed-consent forms have been developed for the purpose of educating patients. However, informed-consent forms can be very difficult to understand. The hypothesis of this study was that a method using diagrams would improve patient-physician communication without increasing the time required to obtain informed consent over the teach-the-teacher method, as well as over current standard informed-consent protocol.

Five-Year Experience: Reflective Writing in a Preclinical End-of-Life Care Curriculum.

Introduction: This paper examines the use of reflective writing in a preclinical end-of-life curriculum including comparison of the role and outcomes of out-of-class (OC) versus in-class (IC) writing.

Methods: Learners were required to complete one-page essays on their experiences and concerns about death and dying after attending a series of end-of-life care lectures. From 2002-2005, essays were completed OC and in 2006 and 2007 essays were completed during the first ten minutes of small group discussion sessions.