A mentoring program for underrepresented-minority students at the University of Rochester School of Medicine.

Mentoring underrepresented-minority (URM) students poses a special challenge because most medical schools have few URM faculty and many non-URM faculty hesitate to be mentors for URM students. Some medical students perform less well in the clinical years than would be expected from their pre-clinical performances. One factor is some students' difficulty in adapting to the culture of medicine, which mentors can help students overcome. The University of Rochester School of Medicine created the Medical Student Mentoring Program to address the needs of URM students and non-URM faculty who could be mentors. The program, offered in 1995-96 and 1996-97, trained mentors, created a bicultural support group for URM students, and provided structured mentoring. Interviews were conducted with faculty and students to identify critical areas that influence the success of URM students in their clinical years; URM faculty, residents, and advanced students shared their experiences with the program students at reflection group meetings. Mentors participated in an initial orientation. Of the 42 students eligible during 1995-1997, 30 participated and were assigned to 15 mentors. At the end of the program's first year, the students and mentors gave their reactions, and although there were some differences in their viewpoints, overall they considered the program useful. Non-URM faculty appreciated the support and guidance that allowed them to mentor URM students more effectively. The program ran formally for two years, and some of the mentoring relationships continued into the third year. Loss of funding and change in administrative leadership contributed to the ending of this program. Mentoring continues to be a priority at the medical center, and a new mentoring program has been developed for URM and non-URM medical students.     

Positioning a medical school for modern biomedical research: the department of genome sciences at the University of Washington School of Medicine.

The availability of genome sequences from a multitude of organisms, which began about a decade ago, has had enormous impact throughout the biomedical sciences. These sequence data have changed the way research studies are carried out and have led to the explosive growth of computational biology as an approach to analyze biological processes and evolution. In medicine, the completion of the human genome sequence has illuminated the function of many genes, facilitated the correlation of mutant genes to disease phenotypes, and provided a basis for the study of human variation.At the University of Washington, the two academic departments whose overall programs were most centrally affected by the sequencing revolution were Genetics and Molecular Biotechnology. These departments were fused in 2001 to form the Department of Genome Sciences in order to best exploit these developments and to become a prototype for the basic biomedical science department of the future. The department's goal is to address leading-edge questions in biology and medicine through the application of genetics, genomics, proteomics, and computational approaches to the increasing collection of known genome sequences and their encoded products. The authors review the events that led up to the founding of this department and discuss the initiatives that have been undertaken, which include the recruitment of faculty, the establishment of a new interdisciplinary graduate program, the continued development of an outreach program, and the construction of a building to house the department. Lessons learned in crafting this department are also discussed, as well as how these might apply to other medical schools.     

From concept to culture: the WWAMI program at the University of Washington School of Medicine.

Shortages of primary care physicians have historically affected rural areas more severely than urban and suburban areas. In 1970, the University of Washington School of Medicine (UWSOM) administrators and faculty initiated a four-state, community-based program to increase the number of generalist physicians throughout a predominantly rural and underserved region in the U.S. Northwest. The program developed regional medical education for three neighboring states that lacked their own medical schools, and encouraged physicians in training to practice in the region. Now serving five Northwest states (Washington, Wyoming, Alaska, Montana, and Idaho), the WWAMI program has solidified and expanded throughout its 30-year history. Factors important to success include widespread participation in and ownership of the program by the participating physicians, faculty, institutions, legislatures, and associations; partnership among constituents; educational equivalency among training sites; and development of an educational continuum with recruitment and/or training at multiple levels, including K--12, undergraduate, graduate training, residency, and practice. The program's positive influences on the UWSOM have included historically early attention to primary care and community-based clinical training and development of an ethic of closely monitored innovation. The use of new information technologies promises to further expand the ability to organize and offer medical education in the WWAMI region.     

Mentoring program for minority faculty at the University of Pennsylvania School of Medicine.

Research indicates that having a faculty mentor and being part of an active network of peers are critical ingredients of successful academic medicine careers. Minority physicians, however, often do not have mentors, and the problem is greatest for minority groups underrepresented in medicine. The University of Pennsylvania School of Medicine in 1994-1996 undertook to learn the extent of mentoring programs in its departments and divisions and to compare the experiences of underrepresented-minority faculty and others. The results were used to establish a system for mentoring and networking support for minority faculty members. Examining the reports of division and department heads on their formal mentoring programs, it was clear that these leaders considered a mentor essential for career development, but many reported having no systematic plan for mentors for junior faculty. In looking at the reported experiences of minority and non-minority assistant professors (matched for promotion track, department, appointment date, and, where possible, gender), it was found that approximately half of either group did not have mentors. As a result of this information, the school established a faculty development program to meet the faculty members' demonstrated needs: annual career development meetings with new minority faculty; assistance in identifying and assigning mentors; assistance in developing research skills; and monitoring of the retention of minority faculty. As experience with the program produces additional insights into the needs of minority faculty--and particularly of junior faculty--the program will be adjusted and expanded to meet these identified needs.     

Premedical enrichment program at East Carolina University School of Medicine.

The Summer Program for Future Doctors, which started in 1978 at East Carolina University School of Medicine, prepares underrepresented-minority (URM), disadvantaged, and nontraditional students for admission to medical school. The annual eight-week program, sponsored by the school's Academic Support and Counseling Center and funded by the school, is a two-pronged program targeting both premedical and pre-matriculating students. The program has 24 openings per year, with priority accorded to students matriculating at the medical school the following fall. The program covers learning strategies, test-taking skills, reading and comprehension tests, MCAT preparation, contemporary issues in the medical environment, scientific writing, communication skills, and medical school applications. Students who have demonstrated strong performances and consistent improvement in the summer program are likely to gain admission to medical school and perform satisfactorily, especially in their first year. Data collected from 1994-1997 indicate that of the 69 participants, 51 (74%) had applied to medical school, and 24 (47%) of them had been admitted, with 15 of these (63%) being URMs. In these four years of the program, there were twice as many women as men among the 69 participants, of which 60% were African Americans, 20% whites, 13% Asian Americans/Pacific Islanders, 3% Native Americans, and 2% Hispanics. Although most of these participants pursued medical education, 12 chose other health professions; 13 students were in or had completed graduate school in basic science programs; and seven had not yet completed their under graduate degrees, although most planned to apply to medical school within the next few years.     

Medical education research at the University of Washington School of Medicine: lessons from the past and potential for the future.

Faculty in the Department of Medical Education and Biomedical Informatics at the University of Washington School of Medicine received over $1.2 million in direct grant and contract support in 2003. In this case study, the authors provide some of the history and background of the evolution of the department's structure and its role in providing leadership in medical education research at the university, as well as regionally, nationally, and internationally. The authors offer their observations and reflections on what has helped and hindered the department's success, and end with some predictions on medical education research in the future. The University of Washington's five-state regional WWAMI educational program, establishing a single medical school for the states of Washington, Wyoming, Alaska, Montana, and Idaho, has been an important environmental influence on the direction of the department's educational and research activities. External support has helped the department to create the Northwest Consortium for Clinical Performance Assessment, the Center for Medical Education Research, the Teaching Scholars Program, and a Biomedical and Health Informatics graduate and fellowship training program, as well as a number of international programs.     

Academic promotion at a medical school. Experience at Johns Hopkins University School of Medicine

We studied promotions at Johns Hopkins University School of Medicine to determine whether clinician-teachers are less likely to be promoted or are promoted later in life than researchers and whether those who are promoted have more articles published than those who are not promoted. Over a five-year period, 93 percent of candidates for the rank of associate professor and 79 percent of the candidates for the rank of professor were promoted. There were no significant differences between clinical and research faculty members in terms of the probability that they would be promoted or their age at promotion to either associate professor or professor. Despite these findings, the responses to a questionnaire indicated that former faculty members perceived clinician-teachers as less likely than researchers to be promoted. Those who were promoted had had about twice as many articles published in peer-reviewed journals as those who were not promoted. We recommend improved counseling of medical school faculty members and more extensive discussion of the criteria for promotion and the chances of academic success.     

Evaluation of a communication skills program for first-year medical students at the University of Toronto

Background  

Effective doctor-patient communication has been linked to numerous benefits for both patient and physician. The purpose of this study was to evaluate the effectiveness of the University of Toronto's Therapeutic Communication Program (TCom) at improving first-year medical students' communication skills.     

Promoting research in medical education at the University of California, San Francisco, School of Medicine.

Over the past seven years, educational innovations and scholarship have flourished at the University of California, San Francisco, (UCSF) School of Medicine. Prior to 1998, there was no infrastructure to support educational research and yet a few faculty members published in medical education journals and were active in national professional associations. With the initiation of curriculum reform in 1998, a great deal of excitement about education was generated and innovative new educational programs were envisioned. These changes became opportunities for educational scholarship. With the development of an Office of Medical Education in 1997 and the Haile T. Debas Academy of Medical Educators in 2001, the infrastructure was in place to expand educational research and the scholarship of teaching. The components of this support include educational leadership, faculty development, the Teaching Scholars Program, the Office of Educational Research and Development, the Academy, a Fellowship in Medical Education Research, collaborative research, and extramural grants. As a result of these investments, the number of UCSF faculty members who are involved in educational research has increased significantly. There has been a four-fold increase in peer-reviewed articles published in medical education journals and a greater increase in the publication of educational abstracts, editorials, chapters, and books, plus presentations at U.S. professional association meetings. In this article, the authors describe the changes that have occurred at UCSF to achieve these results.     

Postbaccalaureate program at Wayne State University School of Medicine: a 30-year report.

In 1969, Wayne State University School of Medicine established the first postbaccalaureate program for medical students, with the focus on African American students whose applications to medical school had been rejected. The ten-month program was designed to improve students' scientific knowledge, academic skills, and personal adjustment and thereby ultimately to increase the number of African Americans enrolled in the school. The criteria included the quality of the student's high school, employment workload, parents' ability to assist financially, and several other factors. The school covered expenses, provided a living stipend, and guaranteed admission for students who attained a B average in the program. Consistent with the Bakke court decision, in 1979 the program eligibility was shifted to disadvantaged students irrespective of race or ethnicity; all other criteria remained unchanged. Until 1990 Wayne State University's program was the only one of its type. From 1969 to 1992, 214 African American students who could have graduated by 1997 had been admitted to the program: 192 (90%) of them attained a B average in the program and matriculated in the medical school, and 160 (83%) graduated. From 1978 (when the program was opened to all racial and ethnic groups) to 1992, 58 non-African American students who could have graduated by 1997 were been admitted to the program: 54 (93%) attained a B average and matriculated in the medical school, and 51 (94%) graduated. The program's success suggests that similar programs at more medical schools could have an immediate and substantial impact on the number of underrepresented-minority students who enter medical education and succeed.     

Training medical students in community health: a novel required fourth-year clerkship at the University of Rochester.

In 2004, community health became the fourth mission of the University of Rochester Medical Center, along with education, clinical care, and research. In that same year, a novel clerkship was added to the fourth-year curriculum that focuses on the "practice" of community health and preventive medicine. The goal is to offer intensive experiential training to develop skills in community health improvement by partnering with community agencies involved in health promotion and disease prevention. The learning objectives addressed include community health assessment, risk behavior change, assurance of personal health services, advocacy and policy change, environmental interventions, community organization and partnership building, and program evaluation. The clerkship involves three full days of didactic instruction at the beginning of a four-week period of program development and implementation. Each student chooses a project that focuses on a specific target population, then designs it and incorporates public health knowledge, skills, and attitudes learned during the didactic component. Course directors then mentor students during project implementation. Students can begin "longitudinal" experiences in their first or second years to fold into the required clerkship. Innovations include a novel Advocacy and Policy Change module, a highly rated Cultural Determinants of Health lecture, and a resource-based course Web site. The clerkship was initially offered as an elective, and it has since become a required course. In the clerkship to date, 340 students have launched hundreds of community-level interventions within various settings locally, nationally, and internationally. Evaluation efforts to date indicate that the clerkship has been received favorably by both faculty and students.     

Development and evaluation of a Research Project Program for medical students at the University of Calgary Faculty of Medicine.

This essay outlines the development and evaluation of the Research Project Program (RPP) ten years after its introduction into the medical curriculum at the University of Calgary. The RPP consists of two mandatory for-credit courses. Students have the option of conducting either two smaller independent research projects or one larger project over the two years. At the end of the second-year course the students complete an evaluation of the RPP in which they are asked to assess and comment upon various aspects of the program. The authors compared data available from years one (the class of 1990) and ten (the class of 2000) and found significant differences between the two classes' approaches to the RPP. Most of the class of 2000 (89%) carried out two-year independent in-depth research projects spanning a wide range of topics. Half of these projects involved individual collection and analyses of data using experimental methods; this represented a 2.25-fold increase over the first year of the program. In the class of 2000, 44% of students presented their results at a newly implemented research symposium; an additional 22% of students presented their results at local, national, or international meetings. Further, 59% of the class of 2000 had either submitted or were planning to submit their research for peer-reviewed publication. In contrast, none of the students of the class of 1990 formally presented their research, and only 11% planned to submit their research findings for publication. The RPP has evolved in the ten years since its implementation, but the authors believe the program continues to foster independent learning and analytic and problem-solving skills.     

The Master of Science in clinical epidemiology degree program of the Perelman School of Medicine at the University of Pennsylvania: a model for clinical research training

An innovative training program to provide clinical research training for clinicians was created in 1979 at the University of Pennsylvania School of Medicine, now the Perelman School of Medicine. The program's principal and continuing aim is to provide trainees mentored experiences and the training needed to become skilled independent investigators able to conduct clinical research and develop academic careers as independent clinical investigators.The authors identify the vision that led to the creation of the master of science in clinical epidemiology (MSCE) degree program and describe today's training program, including administration, oversight, participating faculty, and trainees. They also describe the program's core curriculum, elective options, seminars on ongoing research, training in the responsible conduct of research, professional development activities, and the development and completion of a closely mentored clinical research project.Approximately 35 new trainees enter the two- to three-year program annually. Funding is provided primarily by National Institutes of Health-funded training programs and supplemented by private industry, private foundations, and employee-based benefits. More than 500 individuals have received or are currently receiving training through the MSCE program. A large percentage of former trainees maintain full-time positions in academic medicine today.The authors identify some challenges that have been met and insights regarding funding, faculty, trainees, and curriculum. Ongoing challenges include recruiting trainees from some selected highly paid, procedure-oriented specialties, maintaining sufficient mentors for the continually increasing numbers of trainees, and distinguishing applicants who truly desire a primary research career from others.     

Medical humanities: a new undergraduate teaching program at the University of Geneva School of Medicine, Switzerland.

In 2001, a new program of medical humanities was initiated at the University of Geneva School of Medicine in Switzerland. Four mandatory seminars and one optional 2-week internship are offered to second-through fifth-year medical students. The program has four interdependent goals: contextualizing, developing personal reflection and judgment, encouraging imagination, and offering specific ways to improve the quality of the therapeutic relationship. The program is based on an integrated vision of the humanities and stimulates the students' imagination and reflection in a way that medical students should find useful. Three steps help teachers to build an integrated vision: familiarization, confrontation, and adjustment to the medical culture. The mandatory seminars are taught by a team consisting of a physician and a humanities teacher. All the physicians, department heads, and clinicians involved in each seminar actively collaborated. The medical humanities program is in the Bioethics Unit, which is housed in the Department of Community Health and Medicine with medical history and legal medicine. This intellectual, institutional, and physical proximity encourages informal dialogue and ensures a more coherent and unified vision of the different disciplines. In their assessments of the program, students stated that the seminars gave them food for thought and met their expectations. However, it is premature to draw conclusions from these assessments because the program is still in its infancy. The program strives to provide students with tools specific to the humanities so that they can strengthen their own judgment, listening skills, open-mindedness, creativity, and curiosity, attributes that are needed to ensure that the therapeutic relationship will be satisfying for both physicians and patients.     

A short course of dissection for second-year medical students at the School of Medicine of Padova

A "Short course of dissection" was introduced in 1999 for the second-year medical students at the University of Padova. The course aims to offer a direct experience of practical anatomy despite a shortage of time for anatomy courses and lack of availability of cadavers. The course is optional and is planned for 40 students, subdivided into eight working groups. It consists of five sessions on the following topics: the viscera of the male pelvis; the viscera of the female pelvis; the kidney, the testis and spermatic cord; the thorax and abdomen; the brain. Each session lasts 3 hours and is organized as follow: (A) Theory: Teacher: concise review of the systematic and topographic anatomy of the selected topic (20 min); Students: analysis of a dissection guide (20 min). (B) Practice: Students: identification of the viscera and vascular and nervous structures, through inspection and palpation (15 min); step-by-step dissection following the worksheet (80 min); presentation of the visceral blocks as prosections under a closed-circuit telecamera (anatomical variability) (30 min); Teachers and students: three-dimensional conceptualization tests (15 min). At the end of the 2000 and 2001 courses, a questionnaire was administered to the students and the results confirm the usefulness of dissection for developing a three-dimensional knowledge of anatomy. In our opinion the main guidelines in planning a short course of dissection are: (1) selection of the topics, aimed at allowing experience of the gross anatomy of single viscera, fascia and serosa as well as the evaluation of the topographical relationships between parts of different systems including the local vessels and nerves; (2) preparation of a worksheet, presenting in 10-15 points concise instructions for the step-by-step progression from inspection to palpation and dissection of the anatomical structures of the visceral block; (3) direct dissection, brief and selective, by students; (4) clinical correlation; (5) motivational teachers, who stimulate the active involvement of students in "learning by doing" and also "learning how to do".