Correlations of Family Medicine Clerkship Evaluations
and Objective Structured Clinical Examination Scores and Residency
Directors’ Ratings
Doug Campos-Outcalt, MD, MPA; Arlene Watkins,
EdD; John Fulginiti, PhD; Randa Kutob, MD; Paul Gordon, MD
Background and Objectives: This
study validated the evaluation methods used in a family medicine
clerkship by comparing students’ scores to how students are
rated in their first year of residency by residency directors.
The clerkship evaluations consisted of three components: problem
solving in small groups, clinical evaluations, and a final
examination. These components were combined to form a composite
clerkship score. Residency director ratings consisted of 20
individual scores and an overall average.
Methods: Scores received by students
in the clerkship were correlated with ratings by residency
directors given toward the end of the first year of residency.
The correlations between Objective Structured Clinical Examination
(OSCE) scores and residency directors’ ratings were used as
comparison.
Results: The composite clerkship score
correlated with the director’s rating, overall average, at
r=.278. The highest individual component correlation was achieved
by the clerkship final exam (r=.269). The total OSCE score
correlated with the director’s rating overall average at r=.304.
Conclusions: This study provides evidence
that, while not perfect, the family medicine clerkship evaluations
perform nearly as well as the OSCE as a predictor of how students
will be rated by their residency directors in their first
year of residency.
Educational Research and Methods
(Fam Med 1999;31(2):90-4.)
Didactic
Content and Teaching Methodologies on Required Allopathic
US Family Medicine Clerkships
L. Peter Schwiebert, MD; Cheryl B. Aspy,
PhD
Background and Objectives: Despite the increased
prominence of family medicine clerkships in required third-
and fourth-year clinical rotations in US allopathic medical
schools, the content of these clerkships varies markedly among
institutions, and there is little in the literature concerning
the current or desired content of family medicine clerkships.
This study explores the didactic content of a national sample
of required family medicine clerkships to assess what and how
this important aspect of clerkship curriculum is taught.
Methods: Using an original survey instrument, we surveyed
US medical schools through mailings and follow-up phone contacts.
We categorized free-form responses using a coding dictionary
specific to this study and computed descriptive statistics.
Results: Of 127 medical schools contacted, 105 (83%)
responded. Among respondents, 86 (82%) had a required family
medicine clerkship, 80% of them in the third year. Mean clerkship
length was 5.3 weeks (median=4 weeks), and the mean number of
didactic sessions was about 2 per week. Almost 80% of clerkships
had sessions in the broad area of family medicine, and prevention
was the most frequent individual topic, taught in 32 (37%) of
clerkships. Seventy-one percent of sessions used methodologies
other than lectures. The mean time devoted to teaching 24 of
the top 26 topics identified in the survey was between 1.2 and
3.1 hours/rotation, although case presentations and common problems
each averaged more than 7 hours on clerkships teaching these
topics.
Conclusions: This survey provided more detailed information
than previously available about the didactic content of required
US allopathic family medicine clerkships. The survey also documented
the lack of agreement among these clerkships on didactic content.
Most didactic sessions used interactive rather than lecture
format. The information from this first detailed survey provides
family medicine clerkship directors with national comparisons
of didactic content and methodology as a foundation for further
discussion.
Educational Research and Methods
(Fam Med 1999;31(2):95-100.)
Effects
of Viral Respiratory Disease Education and Surveillance on
Antibiotic Prescribing
Jonathan L. Temte, MD, PhD; Peter A. Shult,
PhD; Carol J. Kirk; John Amspaugh
Background and Objectives:
We describe a partnership between family practice residency
clinics and a state public health virology laboratory that
has produced comprehensive viral respiratory disease education
and surveillance. Family practice residents have been provided
with education on respiratory viruses and the results of ongoing
viral surveillance. The preliminary effects of this program
on antibiotic prescribing by senior residents are evaluated
in this paper.
Methods: We used a questionnaire to assess the acceptance
by family practice residents of the educational component
and the utility of ongoing viral surveillance. We used chart
review to evaluate rates of antibiotic prescribing and the
number of patients diagnosed per year with acute upper respiratory
infection and acute bronchitis by senior residents in 1992
(preexposure) and 1996 (postexposure).
Results: By the third year of training, most residents
(79%) reported receiving adequate training regarding common
viral respiratory diseases. Moreover, residents reported that
they were less likely to prescribe antibiotics to patients
presenting with respiratory infections when provided with
specific information on circulating viral pathogens. Antibiotic
prescribing in the postexposure group was 68% lower for upper
respiratory infection (URI) and 45% lower for a composite
of URI and bronchitis.
Conclusions: Education and monitoring of circulating
respiratory viruses can result in familiarity with common
disorders in primary care and reduce unnecessary antibiotic
use.
Educational Research and Methods
(Fam Med 1999;31(2):101-6.)
Teaching
Practice Management During Residency
Edward A. Rose, MD; Anne Victoria Neale,
PhD, MPH; Wasim A. Rathur, MD
Background and Objectives: Practice management
is a required component in family practice residency education.
A few studies have reported that recently graduated primary
care physicians indicated that their practice management training
was inadequate. Our study describes the current nature of
practice management education in family practice residencies
and the perceptions of residency directors about the effectiveness
of their program’s practice management curriculum.
Methods: Surveys were mailed to 421 family practice
residency directors, who were asked about their program’s
curriculum approach to teaching practice management, as well
as their evaluation of the effectiveness of the curriculum.
After two mailings, 213 surveys (51%) were returned.
Results: Eighteen percent of the respondents provided
less than the required 60 hours of practice management curricular
time. Residency directors indicated that managed care has
had a significant effect on their curriculum. Directors’ ratings
of the effectiveness of their curriculum were associated with
more curricular time and specifically with active learning
activities. Although directors reported that managed care
had affected how they teach practice management, managed care
penetration was not associated with perceived curriculum effectiveness.
Conclusions: Family practice residency
program directors described a variety of approaches to teaching
practice management. Active learning strategies seem to be
important curricular components, although further study is
needed about the most-effective methods to prepare physicians
for post-residency practice.
Educational Research and Methods
(Fam Med 1999;31(2):107-13.)
Evaluating
Programs for Recruiting and Retaining Community Faculty
Peg Boyle Single, PhD; Arnold Jaffe, PhD;
Robert Schwartz, MD
Background and Objectives: There is a
need to develop ambulatory care components within medical
schools and, accordingly, a need to recruit community faculty.
To assist in recruiting and retaining community faculty, this
study addresses factors influencing physicians’ decisions
to serve as preceptors. The study also examines the relative
value of incentives as rated by physicians in different primary
care specialties.
Methods: We surveyed community physicians affiliated
with a large, public teaching hospital. Physicians rated prior
experiences training students in ambulatory settings, plans
for serving as preceptors within the next year, and 7 incentives
for serving as preceptors.
Results: A path analysis indicated
that prior experiences and student influence on patient care
affected future decisions to serve as preceptors. Analysis
of the incentives for serving as preceptors indicated that
physicians rated receiving continuing medical education (CME)
credit the most favorably and financial compensation the least
favorably. Overall, family physicians assigned the highest
ratings to the incentives, and gynecologists gave the lowest
ratings.
Conclusions: This study produced a better
understanding of the factors influencing physicians’ decisions
to serve as preceptors. Physicians are more concerned about
students’ influence on patient care than they are about students’
influence on patient billings. In addition, preceptors preferred
receiving nonmonetary compensation, such as CME credit, rather
than receiving financial compensation. In addition, this study
suggests better ways to reward community physicians for their
service as preceptors. Community faculty should not be viewed
as a homogenous group. The results of this study suggest that
community physicians be provided with choices regarding the
incentives for and rewards associated with serving as preceptors.
Educational Research and Methods
(Fam Med 1999;31(2):114-21.)
Relationship
of Nutrition Knowledge and Obesity in Adolescence
Netra Thakur, MD; Frank D’Amico, PhD
Background: The prevalence of obesity
in adolescence is increasing. This study determined whether
a lack of nutrition knowledge is correlated with obesity in
adolescents.
Methods: We distributed a survey at three high schools
to 292 9th- through 12th-grade students. The questionnaire
examined the students’ nutrition knowledge, food-related behaviors,
and food preferences. The students’ body mass indices (BMI)
were calculated from self-reported weights and heights. Obesity
was defined as a BMI greater than the 85th percentile, using
criteria from the National Health and Nutrition Examination
Survey II.
Results: Of 292 students contacted, 289 returned the
survey. The population had a prevalence of obesity of 26%.
There were no significant differences in nutrition knowledge
between the obese and non-obese students with the exception
that obese students were better able to identify high-fiber
foods. In addition, obese students were more likely to report
infrequent meals with their family. Otherwise, there were
no significant differences in nutrition behaviors or food
preferences.
Conclusions: Overall nutrition knowledge
did not differ between obese and non-obese adolescents.
Clinical Research and Methods
(Fam Med 1999;31(2):122-7.)
Patterns
and Correlates of Tobacco Use Among Suburban Philadelphia
6th- Through 12th-grade Students
Karen Abrams, MD; Neil Skolnik, MD; James
J. Diamond, PhD
Background and Objectives: Tobacco use
among teenagers is increasing, even in the face of an understanding
of its harmful effects. Data suggest that tobacco use often
begins before entrance to eighth grade. This study examined
the prevalence of tobacco use among students in 6th grade
and compared it to the prevalence of tobacco use among 8th,
10th, and 12th graders in a northeastern suburban community
and to national data.
Methods: We used a survey that measured selected tobacco
and smokeless tobacco use, demographic variables, school-related
factors, and social influences on the use of tobacco products.
Results: Sixth-grade tobacco use existed but was minimal
compared to the rates seen in 8th, 10th, and 12th graders.
Only 1% of 6th graders reported they were current smokers,
compared with 41% of 12th graders. Risk factors for becoming
a smoker were smoking habits of parents, siblings, and friends.
Conclusions: Cigarette experimentation
and use begins as early as sixth grade and increases substantially
by eighth grade. Our data suggest that efforts toward primary
prevention of smoking should be pursued between sixth and
eighth grade.
Clinical Research and Methods
(Fam Med 1999;31(2):128-32.)
|
