Misbah K. Keen, MD, MBI, MPH

OBJECTIVE:
The Patient Centered Observation Form (PCOF) helps trainees identify and describe specific communication skills and enhance self-awareness about skill use. We studied the effectiveness and ease of use of the Improving Communication Assessment Program (ICAP), an online module that prepares trainees to use the PCOF.
METHODS:
Students, residents and medical educators viewed two videos (common and better skill use) of the same interaction and rated each video using the PCOF… Show more

OBJECTIVE:
The Patient Centered Observation Form (PCOF) helps trainees identify and describe specific communication skills and enhance self-awareness about skill use. We studied the effectiveness and ease of use of the Improving Communication Assessment Program (ICAP), an online module that prepares trainees to use the PCOF.
METHODS:
Students, residents and medical educators viewed two videos (common and better skill use) of the same interaction and rated each video using the PCOF. Video sequence was randomized. We assessed agreement with experts, ease of use, concepts learned, and areas of confusion.
RESULTS:
Trainees (211) achieved strong agreement (.83) with experts and were highly satisfied (mean 4.18 out of 5). Viewing the common video first produced higher agreement (.87 vs .79; ES=.4) with experts and greater satisfaction (4.36 vs 4.02, ES .4) than viewing the better video first. Trainees reported diverse areas of learning and minimal confusion.
CONCLUSION:
ICAP training to use the PCOF may facilitate teaching and assessment of communication skills and enrich training through peer observation and feedback. We offer several educational strategies.
PRACTICE IMPLICATIONS:
Learning to use the PCOF via the ICAP module may accelerate communication training for medical students, residents, medical educators and practicing clinicians. Show less

BACKGROUND AND OBJECTIVES:
Training partnerships between family medicine residencies (FMRs) and community health centers (CHCs) are a potential solution to the chronic problem of health workforce shortages in CHCs. We conducted a national survey to identify the barriers to training family medicine residents in CHCs.
METHODS:
We asked US family medicine residency directors to identify barriers to training residents in CHCs. Using grounded theory, three coders grouped responses by theme.… Show more

BACKGROUND AND OBJECTIVES:
Training partnerships between family medicine residencies (FMRs) and community health centers (CHCs) are a potential solution to the chronic problem of health workforce shortages in CHCs. We conducted a national survey to identify the barriers to training family medicine residents in CHCs.
METHODS:
We asked US family medicine residency directors to identify barriers to training residents in CHCs. Using grounded theory, three coders grouped responses by theme. We examined differences in barriers between residency programs that currently train in CHCs with programs that do not currently train in CHCs.
RESULTS:
A total of 51% (226/439) of residency program directors responded. Of these, 29% cited governance as a barrier to affiliation, 26% cited administrative complexity, 24% cited financial considerations, 21% cited leadership, and 18% cited access. Programs that trained in CHCs were more likely to cite financial considerations and administrative complexity than programs that did not train in CHCs.
CONCLUSIONS:
Governance and administrative complexity are the most commonly cited barriers to effective CHC-FMR partnerships. Financial consideration and leadership issues are also common barriers. Show less

BACKGROUND:
Research on the outcomes of pre-clinical curricula for clinical skills development is needed to assess their influence on medical student performance in clerkships.
OBJECTIVE:
To better understand the impact of a clinical-skills curriculum in the pre-clinical setting on student performance.
DESIGN:
We conducted a non-randomized, retrospective, pre-post review of student performance evaluations from 3rd-year clerkships, before and after implementation of a… Show more

BACKGROUND:
Research on the outcomes of pre-clinical curricula for clinical skills development is needed to assess their influence on medical student performance in clerkships.
OBJECTIVE:
To better understand the impact of a clinical-skills curriculum in the pre-clinical setting on student performance.
DESIGN:
We conducted a non-randomized, retrospective, pre-post review of student performance evaluations from 3rd-year clerkships, before and after implementation of a clinical-skills curriculum, the Colleges (2001-2007).
MAIN RESULTS:
Comparisons of clerkship performance data revealed statistically significant differences favoring the post-Colleges group in the Internal Medicine clerkship for 9 of 12 clinical-skills domains, including Technical Communication Skills (p < 0.023, effect size 0.16), Procedural Skills (p < 0.031, effect size 0.17), Communication Skills (p < 0.003, effect size 0.21), Patient Relationships (p < 0.003, effect size 0.21), Professional Relationships (p < 0.021, effect size 0.17), Educational Attitudes (p < 0.001, effect size 0.24), Initiative and Interest (p < 0.032, effect size 0.15), Attendance and Participation (p < 0.007, effect size 0.19), and Dependability (p < 0.008, effect size 0.19). Statistically significant differences were identified favoring the post-Colleges group in technical communication skills for three of six basic clerkships (Internal Medicine, Surgery, and Pediatrics).
CONCLUSIONS:
Implementation of a pre-clinical fundamental skills curriculum appears to be associated with improved clerkship performance in the 3rd year of medical school, particularly in the Internal Medicine clerkship. Similar curricula, focused on teaching clinical skills in small groups at the bedside with personalized mentoring from faculty members, may improve student performance. Continued efforts are needed to understand how to best prepare students for clinical clerkships and how to evaluate outcomes of similar pre-clinical skills programs. Show less