Browsing by Subject "Education, Medical"

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The 18-Month Curriculum: The Impact of Mixed Learning Clerkships
(2022-05) Kwon, Adelaide Jiwon; Sendelbach, Dorothy; Faulkner, Christopher; Tessnow, Alex
BACKGROUND: UT Southwestern implemented a new, 18-month, shortened pre-clerkship curriculum in the Fall of 2015 in order to increase the clerkship phase from 1 year to 18 months, beginning mid-second year. In keeping with this new curriculum schedule, it was necessary to combine MS2 and MS3 students on clerkships from January to June; during that time, both MS2 and MS3 students are on the same clerkship simultaneously, creating opportunities for informal near-peer learning. Each clerkship handles this mixing differently: some create mixed-year teams, others group students together with their peers, while still others do not create teams at all. OBJECTIVE: We are interested in determining the impact of mixing students on team dynamics, narrative assessments, and grades. HYPOTHESIS: Upperclassmen and underclassmen participating on the same clerkships in a mixed learning environment will report predominantly positive experiences but will have significant differences in their grades and narrative assessments compared to each other. METHODS: A tri-pronged approach was taken, looking at qualitative student perspectives, qualitative attending perspectives, and quantitative scores on de-identified student evaluations. In the first arm of the study, students in the classes of 2020 and 2021 were sent a voluntary survey seeking comments regarding their experiences on mixed clerkships and to indicate their interest in participating in a follow-up 30-minute focus group interview. Four purposeful focus groups of 4-5 students, two groups from each class, were interviewed to learn more about perceived advantages and disadvantages of mixed clerkships. Interviews were audio-recorded, transcribed, and coded for themes. Transcripts were validated by the interviewees and de-identified prior to analysis. In the second and third arms of the study, student evaluations from 2019 in the Internal Medicine, Pediatrics, and Psychiatry clerkships were gathered and de-identified. From these, 120 narrative assessments were randomly selected for qualitative analysis. Final grades and four scored skills were selected for quantitative analysis. Finally, de-identified quantitative data from 2015-2016, prior to the implementation of the 18-month curriculum, were analyzed for additional insights. RESULTS: In the first arm of the study, interviewees reported overall positive experiences with mixed clerkships. Common perceived advantages as an MS2 paired with MS3s included being able to ask "dumb" questions without being judged; being taught "practical" skills such as how to use the electronic medical record (EMR) and how to write a note; having fears allayed through candid discussions; and having a sense of camaraderie. Common advantages as an MS3 paired with MS2s included satisfaction in teaching MS2s and being motivated by MS2 enthusiasm. Perceived disadvantages were less commonly mentioned but still present, and mostly centered around fears of being compared by evaluators. In the second and third arms of the study, the mixed clerkships of Pediatrics and Psychiatry tended to show more significant differences in MS2 and MS3 evaluations than the non-mixed clerkship of Internal Medicine. However, this was highly nuanced, and there was some, but not consistent, division between differences observed in "learned" skills such as history-taking or note-writing and "inherent" skills such as professionalism or confidence. Comparison with students on the old curriculum also revealed significant differences with different MS2 and MS3 cohorts suggesting both positive and negative effects of the mixed learning environment on student evaluations. CONCLUSION: Overall, students reported more positive experiences and perceived advantages on mixed clerkships than negative experiences and disadvantages. However, attendings reported a higher proportion of significant differences between less and more experienced students on mixed clerkships. Despite this, the impact of cross-class comparison versus other factors, such as natural student improvement, contributing to these differences is unclear, and therefore mixed clerkships resulting from the 18-month curriculum have had a generally positive impact despite some negative effects. Further research, including research into other assessments of educational outcomes such as shelf exam scores as well as research into cross-clerkship comparisons, is needed to provide a fuller picture of the impact of these mixed clerkships.
Animating the LDL Receptor Pathway
(2007-05-23) Van Exel, Kimberly; Calver, Lewis E.
The main goal of this thesis was to animate the LDL receptor pathway for use during lectures and presentations. These animations show how cholesterol-carrying LDL binds with the LDL receptor to be endocytosed into the cell and utilized. The first objective was to create an animation, involving 2D, 3D, and protein data bank based images to educate graduate students during classroom lectures. The second objective was to include a diagrammatic illustration of the entire cycle. The third objective was to determine if showing the broad and narrow views simultaneously or going back and forth between the two would better educate the audience. Two presentations were created of the LDL receptor pathway in the two styles and then evaluated by a pool of biomedical students.
The Art of Observation: A Qualitative Analysis of Medical Students' Experiences
(2019-01-22) He, Bowen; Prasad, Smriti; Higashi, Robin; Goff, Heather
CONTEXT: Although the inclusion of arts in medical school curricula has garnered much attention, little is known about the effect of arts-based interventions on the behaviors, attitudes, and technical skills of students. The Art of Observation is an optional elective at UT Southwestern Medical Center in collaboration with educators from the Dallas Museum of Art. We utilized a qualitative approach to describe in-depth how engaging with art influences the development of medical students' observation skills and empathy. METHODS: We analyzed evaluations from 65 medical students who completed the course between 2015-2017. Evaluations contained open-ended questions that asked students to reflect upon their experiences and describe their perceptions, thoughts, and feelings after guided museum visits. Two investigators independently read all evaluations line-by-line and used open coding to generate a codebook, which was refined by consensus and discussed with a third investigator experienced in qualitative methodology. We then employed axial coding to identify sub-themes and discover relationships between the major themes. RESULTS: We report three main findings and several subthemes from the data: (1) Enhanced observation skills: by engaging with art and completing relevant activities, students developed the ability to synthesize a compelling narrative in addition to learning technical skills; (2) Improved physician socialization: students reported enhanced self-awareness, increased tolerance of ambiguity, and development of a humanistic view of medicine, key components of physician socialization; and (3) Reduction in burnout symptoms: students reported an enhanced sense of well-being after each session, which mitigates the process of burnout. CONCLUSIONS: Fine arts can be used to teach technical skills, stimulate personal reflection, and prevent burnout. A meaningful engagement with the arts can play an important role in developing physicians who are observant, empathetic, and more well-rounded.
Biomedical Innovation Manual for Medical Students
(2018-03-26) Sotman, Timothy; Rege, Robert; Beres, Alana; Barker, Blake
BACKGROUND: The UT Southwestern Biomedical Innovation program is modeled to a large degree after the Stanford Biodesign program. The program is based on the hypothesis that innovation can be learned, and it offers a step-by-step process which has been shown to result in successful new biomedical technologies. From a high level, the process involves starting with a broad list of needs in the healthcare sector, selecting a smaller number of these needs to focus on based upon criteria such as group capability, resources, and strategic fitness, devising a number of solutions to these needs, narrowing the number of solutions based upon feasibility, and then iteratively prototyping and testing the leading solution to develop a final working solution. Other academic institutions such as Johns Hopkins Center for Bioengineering and Design, Dukes Institute for Health Innovation, and University of Utah's Bench to Bedside have devised similar but distinct methodologies for teaching the skills involved in innovating new healthcare solutions and bringing those solutions to market. Since the passage of the Bayh-Dole Act in 1980, US universities have become increasingly involved in the business of technology transfer. Entire departments, such as UT Southwestern's Office of Technology Development have been formed for the purpose of protecting intellectual property and licensing it to existing companies or startup ventures. This has the benefit of increasing the chances that a technology with the potential to improve the lives of others will come to fruition while also serving as a source of revenue for universities. The financial and strategic importance of encouraging innovation and pursuing intellectual property and licensing agreements for US universities has become clear. The UT Southwestern Biomedical Innovation program hopes to encourage innovation at UT Southwestern Medical Center through the continued development of the Biomedical Innovation curriculum and organization. OBJECTIVE: Writing and distributing a primer on Biomedical Innovation to first year medical students will increase their confidence and competence as they embark on their first Biomedical Innovation projects. METHODS: Using Biodesign: The Process of Innovating Medical Technologies as a primary resource, an outline for a 10 chapter primer on medical device design for medical students was developed. Information from several primary resources and from local experts in medical technology development was collected and compiled into a short, accessible manual. Approaches and curricula from other medical schools were also incorporated. Efforts were made to introduce everything a medical student would need to know when embarking on her first medical technology design and development project. RESULTS AND CONCLUSIONS: A 45 page introductory manual targeted at first year medical students learning how to perform their first biomedical innovation program was written. The manual covers topics such as clinical observation, project management, brainstorming, prototyping, patents, and pursuing FDA approval for a medical device. It presents each of these topics at a level appropriate for medical students and includes information relevant to students at UT Southwestern (e.g how to access prototyping resources on campus). The resulting manual will improve the resources available to UT Southwestern medical students interested in Biomedical Innovation and will increase the long-term stability of the Biomedical Innovation program by forming a more permanent body of institutional knowledge and standardizing the curriculum from year-to-year.
Corruption in clinical research: what is it? -- and why it matters
(2019-12-10) Sadler, John Z.
Despite the seriousness of charging corruption in clinical research, the literature offers little about what corruption means in this setting. This lecture presents a technical/formal definition of 'corruption' in clinical research. I then present examples from the literature which illustrate clear-cut corruption, maybe cases, and non-corrupt deviations from good clinical research practices. I discuss clinical implications about evaluating clinical research quality as well as what corruption means for our evidence base of practice.
Defining professionalism in the digital age: barriers and opportunities
(2014-05-13) Farnan, Jeanne
The overwhelming popularity of Web 2.0 technologies, such as social networking sites, media sharing sites and blogging, has significantly changed the manner in which trainees interact with educators, colleagues, and the lay public. Individual and institutional representation, the absence of existing policies and the perception of the lay public are some of the salient issues that arise when considering the "digital images" displayed by trainees and faculty alike. Little guidance exists for medical educators on preventing misuse of digital media and ensuring standards for professional conduct. Similarly, the positive potential of these media, within medical education, are only beginning to be realized. While many of these issues are also faced by colleagues in other areas of higher education, medical educators and their institutions are faced with the additional challenge of ensuring that graduates exemplify the ideals of medical professionalism. This lecture will address educators' understanding of the currently available technology, the threats that they pose to trainee professionalism and strategies to protect the trainees' and the program or institutions' digital image.
Developing an Educational Resource for Increasing Long-Term Retention of Cerebellar Circuitry and Pathways Implementing the Principles of Enduring Understanding
(2010-01-12) Werkmeister, Robert Joseph; Krumwiede, Kimberly Hoggatt
This thesis focuses on implementing the educational model of enduring understanding as it applies to the visual arts and neuroscience. The thesis was designed around developing an interactive web-based flash program intended to aid in medical students‘ retention of cerebellar circuitry at specific instances in their medical education. It focused on the visual and textual organization laid out within the principles of enduring understanding. By using the first two facets of enduring understanding, explanation and interpretation, the program was designed to teach medical students about the cerebellum‘s structure and function. Both facets provided a framework for the organization of the text and design of the illustrations, two and three-dimensional animations and questions sections. Testing was performed on medical students at varying levels in their medical education for gaps in knowledge and usefulness. These groups included first, second, and fourth year medical students, as well as residents. Further research will test the programs effect on students‘ efficiency and aptitude. Such testing will demand medical students‘ involvement over four years of schooling to determine the programs full efficacy.
Development of the Liang Handover Assessment Tool for Simulation (L-HATS)
(2020-05-01T05:00:00.000Z) Liang, Tyler; Greilich, Philip; Phelps, Eleanor; Reed, W. Gary
INTRODUCTION: Clinical handovers are critical to patient safety and outcomes. Handover simulation prepares healthcare students for handoffs in the clinical setting upon graduation. UT Southwestern has developed a longitudinal handover educational curriculum in which student handovers will be assessed. Although valid and reliable tools exist for assessing clinical handovers, assessment tools adapted for the undergraduate simulation environment currently do not exist. Our objective was to develop a reliable and valid assessment tool that could be used by scholarly healthcare students to assess undergraduate simulated handovers throughout the longitudinal handover education curriculum. METHODS: A literature review was conducted to identify critical elements of high-quality, effective handovers. Following the tool's creation, we underwent several PDSA cycles to optimize the tool for medical student evaluation and ease of grading. Grader inclusion criteria were students who had completed the transition to clerkship (T2C) handover activity. A training curriculum was developed to train graders on proper use of the tool and to promote reliable grading with the tool. 62 pre-clinical student handovers were conducted in the simulation setting and recorded. The handovers were stratified into three levels (low, intermediate, and high quality), and 10 handovers were selected from each of the three levels for grading (30 handovers total). Each handover was scored by four clerkship medical students "graders". Two-way random effects intra-class correlation coefficients (ICC) were used to establish inter-rater reliability and inter-rater agreement among graders using the tool. Three external handover experts were used to establish the tool's validity using face validity. RESULTS: The product of this project is Liang Handover Assessment Tool for Simulation (L-HATS) which evaluated three domains: handover content, handover process, and language with a maximum score of 28. Two-way random effects ICC for agreement was 0.804, 95% CI [0.601, 0.906]. Two-way random effects ICC for reliability was 0.866, 95% CI [0.765, 0.930]. Three external handover experts have sufficiently validated the tool. CONCLUSIONS: The L-HATS had good to excellent inter-rater reliability and agreement. The L-HATS is the first reliable and valid handover assessment tool used for undergraduate simulation education. By using a two-way random effects model, the results suggest that the tool can be used in settings outside of the T2C handover simulation activity. Having good to excellent absolute agreement suggests that the tool is suitable for assigning grades. Future studies include comparing faculty vs student grading of handovers as well as evaluating the tool in the clinical setting.
Development of Video and Simulation-Based Communication Skills Learning: Responding to Emotions
(2021-05-01T05:00:00.000Z) Nguyen, Trung Tan; Siropaides, Caitlin; Sendelbach, Dorothy; Abraham, Reeni
PROBLEM: Responding appropriately to patients’ emotions and concerns is vital for excellent patient care and outcomes. There is a lack of training in this area, with the need to educate healthcare providers about how to appropriately respond to emotions. While communication skills training programs exist for undergraduate medical education, medical students often feel unprepared in responding to patients’ emotions INTERVENTION: A 90-minute small group exercise was developed for second-year pre-clinical students at a large United States medical school in Texas. The exercise consisted of faculty-facilitated small group discussion of two video examples of a patient encounter, comparing clinician responses to patient emotions. The exercise utilized a framework for identifying skills and patient impact of verbal expressions of empathy to different patient emotions. CONTEXT: This curriculum sought to demonstrate examples of strong patient emotions for preclerkship students, and introduce a framework of concrete communication skills that can positively impact a clinical encounter. Data was collected by questionnaires delivered immediately pre-session and post-session, as well as 3 months post-session. Survey questions assessed student perception of effectiveness of the exercise, student-reported preparedness and feeling equipped to perform various communication skills during clinical visits. Paired t-tests were performed and data analyzed for qualitative responses. OUTCOMES: The process evaluation yielded a positive subjective learner response to the exercise which was sustained at 3-month follow-up. The students (N=161 paired for the immediate pre- and post-survey) reported significant increases in knowledge and preparedness to recognize and appropriately respond to different patients’ emotions (P= 0.001). Qualitative data were also captured in the surveys. LESSONS LEARNED: This video-based small group discussion of skills to express verbal empathy is perceived by pre-clinical medical students to be beneficial, and to improve their knowledge and preparedness for using empathic skills in the future. There is a need for further investigation whether this type of communication skills training results in behavior change and is sustained long-term.
Doctor in Training: A Year of Medical Studies Abroad
(2012-03-27) Quintana, Andrea; Mihalic, Angela
Ms. Quintana spent a year visiting medical education clerkships in three different nations (Cambodia, Burkina Faso, and France), examining the systems and the roles of the students in each nation. She provides additional information to those considering an international clerkship in each of the nations, including basic information about the nation’s health care system, the culture, and where to live and what to bring.
Doctors need evolution the way engineers need physics, but they don't get it because of politics
(2018-09-11) Nesse, Randolph M.
[Note: The slides are not available from this event.] The past 25 years have seen many new applications of evolutionary biology in medicine. Some investigate why natural selection has left systems vulnerable, expanding medicine's perspective from that of a mechanic to that of an engineer. Others use phylogenetic methods to trace relationships among organisms, especially pathogens. These advances have inspired a score of books, new journals, a new scientific society, and undergraduate courses in most universities. However, no medical school teaches evolutionary biology the way other basic sciences are taught, so most doctors have misconceptions that are the equivalent of engineers believing in perpetual motion. Historical, practical, political and religious factors conspire to keep evolutionary biology separate from medicine. Clinical mistakes and slowed research progress result. Recognition of the problem and the opportunity are growing but solutions are likely to be piecemeal until a new generation of doctors assumes leadership positions.
Endobronchial Anatomy of the Trachea: An Interactive Learning Module for Residents and Fellows
(2011-12-15) Yang, Kristin M.; Krumwiede, Kimberly Hoggatt
The goal of this thesis was to create a useful teaching and review tool for endobronchial anatomy, made specifically for medical students, residents, fellows, and novice practitioners of bronchoscopy. The thesis question to be answered was "Can an interactive guide for tracheobronchial anatomy be created to help teach residents from an endobronchial point of view?" In response to this question, I created an interactive program that contained video, text, and narration. It was created to provide residents and fellows with an accessible and dynamic learning resource. Evaluations of the program showed a very positive reaction and indicated that the guide would be useful for both studying and as a prototype for other learning modules.
Erosion of empathy in medical trainees
(2015-10-02) Abraham, Reeni
Ethics of patient care: can we protect patients from ourselves?
(2013-10-25) Yarbrough, William, Jr.
Faculty growth, development, and sustenance in academic medicine: moving from merry-go-round to escalator
(2020-07-31) Renner, Christina
Grit & resilience in learners
(2017-06-09) Barker, Blake R.
Histology of the Female Reproductive System: An Interactive Educational Module
(2013-04-11) Gove, Mollie; Calver, Lewis E.; Diehl, Angela Marie; Hoffman, Barbara L.
"Histology of the Female Reproductive System: An Interactive Learning Module" is an interactive animated video project designed to address the need for a complete educational exploration of female reproductive histology for medical students and residents in Obstetrics and Gynecology. The content was developed by Dr. Barbara Hoffman and Dr. Kelley Carrick, and was designed to accompany the existing histology literature in McGraw-Hill’s Williams Gynecology textbook. The project features 18 video animations that present normal and pathological histology features set in an interactive interface. This interface offers primary and secondary menus, as well as an interactive illustration showing the complete female reproductive system. The module was evaluated by current UT Southwestern medical students and residents for its perceived educational value. After using the module, surveys on the efficacy of the project were completed by eleven students. Analysis showed that the project was considered a useful resource for understanding female reproductive histology.
How Learning Strategies and Academic Parameters Predict Medical Student Success
(2024-01-30) O'Connell, Michael; Badia, Rohit; Tellez, Juan; Cook, Grayden; Sachs, Arlene
BACKGROUND: Student scores on the Learning and Study Strategies Inventory (LASSI), an assessment of academic skills, have been shown in previous studies to be significantly different between U.S. medical students based on their scores in various examinations during the preclerkship curriculum. This study aimed to evaluate LASSI and other early academic performance markers for predicting the likelihood of shelf exam underperformance in third-year medical students. METHODS: A retrospective analysis of student-specific demographic information and medical school exam performance from 220 medical students from the University of Texas Southwestern was performed. Students were then categorized based on underperformance (score in <25th percentile) on each NBME shelf exam and statistical analysis was performed to identify predictors of shelf underperformance. RESULTS: For predicting Surgery shelf underperformance, pre-clerkship final exam average (PCA), STEP 1, and LASSI Time Management (TMT) were statistically significant in univariate analysis. Internal Medicine: PCA, STEP 1, LASSI Attitude (ATT), Test Strategies (TST), and TMT. Pediatrics: PCA and STEP 1 quartile. Obstetrics-Gynecology: PCA, STEP 1, and LASSI Anxiety (ANX), with ANX an independent predictor on multivariate analysis. Neurology: PCA, STEP 1, LASSI ANX, Information Processing (INP), TST, and average LASSI, with PCA, LASSI Concentration (CON), TMT, and ANX independent predictors on multivariate analysis. Family Medicine: PCA, STEP 1, LASSI ANX, TST, and Using Academic Resources (UAR), with PCA an independent predictor on multivariate analysis. Psychiatry: only STEP 1 was significant. CONCLUSION: In contrast to previous studies, no single LASSI scale was significantly associated with underperformance on all 7 NBME shelf exams. Univariate analysis identified several LASSI scales that correlated with NBME underperformance, but the drastic inter-clerkship heterogeneity makes use of these scales in early academic intervention impractical. Conversely, PCA was found to be strongly associated with shelf exam underperformance.
An Instructional Video to Teach the Anatomy, Classification, and Repair of a Fourth-Degree Perineal Laceration
(2007-12-18) Pietz, Jordan Taylor; Calver, Lewis E.
The goal of this thesis project was to create an instructional video for first-year obstetrics and gynecology residents to instruct them on the anatomy and procedural steps involved in the layered repair of a fourth-degree laceration. The video combines a wide array of media including illustrations, animations, video, and stills to cover three key points: a general overview of female pelvic anatomy, a classification of procedural degrees of perineal lacerations and steps for the repair with emphasis on anatomy and surgical principles. This project would be used as a supplemental resource to the textbook and hands-on training. These current resources have been shown to be insufficient for proper comprehension of this information, resulting in improper care of patients.
Lies, damned lies, and evaluations: the quest for "high value" feedback
(2022-01-21) Scielzo, Shannon; Kazi, Salahuddin