Clerkships in Emergency Medicine

Planning for clerkships in emergency medicine (EM) can be stressful, prolonged, and challenging. Therefore, medical students should start planning for them early. In this article, we offer guidance regarding several issues pertinent to the EM clerkship, such as the best time to schedule one (or more) during medical school, the most appropriate institution or program to schedule it, the process of selecting and applying for the clerkship, and the number of EM clerkships to consider. We will explain why an EM clerkship should be scheduled between June and October and the reason that 2 EM clerkships at different sites are sufficient for the majority of students. Additionally, we emphasize that clerkships in emergency departments associated with EM residency programs or with reputations for outstanding student teaching tend to be most beneficial. Above all, students interested in EM should attempt to leave a great impression after completing their clerkships by providing stellar patient care, demonstrating enthusiasm at all times, and maintaining professionalism. In turn, they will gain knowledge and clinical experiences that should prove valuable in their future.     

A new method to evaluate clinical performance and critical incidents in anaesthesia: quantification of daily comments by teachers

We have found that the Clinical Anesthesia System of Evaluation (CASE) method provides information regarding clinical performance of residents and critical incidents that is not available from other sources. As a result, it expands the dimensions of the evaluation process and improves validity. In addition, the technique has helped address the concerns of many investigators. (1) It provides specific, real-time evaluations that permit early intervention, improve feedback and guide remediation; (2) it improves sampling techniques by increasing the breadth and volume of evaluators and settings; (3) it enhances the discriminatory power of the evaluation process; and (4) it improves documentation.     

Variability in doctors'' problem-solving as measured by open-ended written patient simulations

The uncertain validity of written simulations could be due to the difficulty in setting criteria for optimal performance. Usually criteria are set by definition of a limited number of 'correct answers' by a panel of experts reached through an open discussion. This is an artificial situation which entails mutual influence and forces the participants to respond to the necessity to reach a consensus. In the present report we describe an attempt to set 'correct answers' by the independent performance of 15 board-certified internists on four written simulations. There was a marked variability in responses due to legitimate differences in approach, to obvious errors in interpretation of the provided data and to possible differences between the expert behaviour in a real life and in a simulated setting. We believe that the criteria for acceptable performance on written clinical simulations should be determined by independent experts, rather than by a group consensus. Students who receive after the examination a compiled list of options selected by experts in response to the same questions may obtain a more realistic insight into the complexity of clinical problem-solving.     

The prevalence of binge drinking among primary care residents

Background: Over one quarter of American adults binge drink, resulting in significant alcohol-related morbidity and mortality. Although brief interventions can decrease patients' alcohol use, many physicians in training do not provide this service. This study examines the prevalence of binge drinking among primary care residents, and the association of resident drinking behaviors with addressing patients' hazardous alcohol use. Methods: Between July 2013 and August 2014, the authors surveyed all trainees in 6 primary care residency programs. The survey assessed self-reported frequency of binge drinking, confidence working with hazardous drinkers, and the performance of brief interventions when hazardous drinking was detected in patients. Results: 221 of 246 residents completed the survey (response rate 89.8%). Half of residents (109/221) reported at least one episode of binge drinking in the prior year, and 18% (39/221) reported binge drinking at least once a month. In multivariable analysis, monthly binge drinking was associated with male gender (OR 2.5, 95% CI 1.1–5.4) and year of training (OR 0.25 for Year 3 vs. Year 1, 95% CI 0.07–0.90). Few residents felt confident they could help patients cut down or quit alcohol, regardless of personal binge drinking history (19% for those who binged monthly, 24% for those who binged 1–11 times a year, and 27% for those who never binged, p for trend = 0.31). Performance of brief interventions did not vary by personal binge drinking history. Conclusions: Binge drinking is common among primary care residents. In addition to training residents to effectively intervene with hazardous drinkers, residency programs should address the high prevalence of binge drinking by their physicians in training.     

儿科临床实习教学的问题探讨

目的 探讨儿科临床实习教学中的常见问题及PBL结合多媒体教学模式对提高学生专业水平的影响.方法 选取2016年3月至6月于本院儿科临床实习的60名临床医学生为研究对象,随机分成对照组和观察组,各30例.对照组采用传统教学方法,观察组在对照组的基础上进行PBL(以问题为基础)结合多媒体教学模式,比较两组教学效果.结果 观察组经PBL结合多媒体教学的实习医学生[理论成绩(90.71±6.04),操作成绩(91.23±7.24)]课程考核成绩明显高于对照组[理论成绩(84.41±7.08),操作成绩(85.26±8.33)],差异均具有统计学意义(均P＜0.05);同时观察组实习医学生对教学满意度评价(满意度90.0％)明显高于对照组(满意度73.3％),差异有统计学意义(P＜0.05).结论 PBL结合多媒体教学在儿科临床实习教学中应用效果较好,能有效激发学生的学习兴趣,提高学生的自主学习能力,有利于其专业水平的提升,同时还可有效改善教学中存在的问题,提高教学质量和效率,值得在临床实习教学中进一步推广应用.     

反思性笔记在医学生临床实习教学中的意义

对某军医大学连续4年的临床医学实习生反思性笔记撰写活动进行回顾总结,探讨其在临床实习中对学员的促进作用,总结出通过反思性笔记的撰写,对于教学管理部门了解实习教学管理、促进医学生进行临床实习、临床资料的保存和推广都有重要的意义,是一种能够促进临床实习教学管理效果的手段,值得推广借鉴.     

The Associations Between Clerkship Objective Structured Clinical Examination (OSCE) Grades and Subsequent Performance

Construct: We investigated the extent of the associations between medical students' clinical competency measured by performance in Objective Structured Clinical Examinations (OSCE) during Obstetrics/Gynecology and Family Medicine clerkships and later performance in both undergraduate and graduate medical education. Background: There is a relative dearth of studies on the correlations between undergraduate OSCE scores and future exam performance within either undergraduate or graduate medical education and almost none on linking these simulated encounters to eventual patient care. Of the research studies that do correlate clerkship OSCE scores with future performance, these often have a small sample size and/or include only 1 clerkship. Approach: Students in USU graduating classes of 2007 through 2011 participated in the study. We investigated correlations between clerkship OSCE grades with United States Medical Licensing Examination Step 2 Clinical Knowledge, Clinical Skills, and Step 3 Exams scores as well as Postgraduate Year 1 program director's evaluation scores on Medical Expertise and Professionalism. We also conducted contingency table analysis to examine the associations between poor performance on clerkship OSCEs with failing Step 3 and receiving poor program director ratings. Results: The correlation coefficients were weak between the clerkship OSCE grades and the outcomes. The strongest correlations existed between the clerkship OSCE grades and the Step 2 CS Integrated Clinical Encounter component score, Step 2 Clinical Skills, and Step 3 scores. Contingency table associations between poor performances on both clerkships OSCEs and poor Postgraduate Year 1 Program Director ratings were significant. Conclusions: The results of this study provide additional but limited validity evidence for the use of OSCEs during clinical clerkships given their associations with subsequent performance measures.     

Alcohol Expectancies and the Personal and Parental Drinking Patterns of Women

ABSTRACT

Background and objectives: Successful employment outcomes for pregnant women result from a complex interplay between the woman, her employer, her prenatal care provider, laws and other influences.

Methods: A mail survey about management of employment during pregnancy was sent to directors of US residency programs that train prenatal care providers. Each physician was randomly assigned one of 4 vignette patients whose job involved prolonged standing, rotating shifts and lifting 40 lbs. Half the vignette patients had risk factors for preterm birth and half would have financial difficulty if placed on an unpaid antenatal leave.

Results: The 301 respondents estimated that they provide a written job restriction for 20% of their employed pregnant patients, although in 6 clinics the job restriction rate was 100%. For vignettes with preterm birth risk factors, 62.5% of physicians would always recommend a job restriction, 35.6% would do so sometimes, and 2.2% would rarely do so. When the vignette did not have risk factors for preterm birth, 21.5% of the physicians would always recommend a job restriction, 51.3% would do so sometimes, 25.9% would do so rarely and 1.3% would never do so. Economic factors were not associated with prescribing job restrictions. One in 5 of the residency programs provides no teaching on occupational health issues in pregnancy, and 65.1% provide 2 hours or less.

Conclusions: Variability in employment recommendations suggests that some women may not obtain the job modifications that they need, whereas others may be restricted unnecessarily. The limited curriculum time devoted to this topic may make it difficult to train physicians about complex employment issues during pregnancy.