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1.  Improving education in primary care: development of an online curriculum using the blended learning model 
Lewin, Linda Orkin | Singh, Mamta | Bateman, Betzi L | Glover, Pamela Bligh
BMC Medical Education  2009;9:33.
Background
Standardizing the experiences of medical students in a community preceptorship where clinical sites vary by geography and discipline can be challenging. Computer-assisted learning is prevalent in medical education and can help standardize experiences, but often is not used to its fullest advantage. A blended learning curriculum combining web-based modules with face-to-face learning can ensure students obtain core curricular principles.
Methods
This course was developed and used at The Case Western Reserve University School of Medicine and its associated preceptorship sites in the greater Cleveland area. Leaders of a two-year elective continuity experience at the Case Western Reserve School of Medicine used adult learning principles to develop four interactive online modules presenting basics of office practice, difficult patient interviews, common primary care diagnoses, and disease prevention. They can be viewed at . Students completed surveys rating the content and technical performance of each module and completed a Generalist OSCE exam at the end of the course.
Results
Participating students rated all aspects of the course highly; particularly those related to charting and direct patient care. Additionally, they scored very well on the Generalist OSCE exam.
Conclusion
Students found the web-based modules to be valuable and to enhance their clinical learning. The blended learning model is a useful tool in designing web-based curriculum for enhancing the clinical curriculum of medical students.
doi:10.1186/1472-6920-9-33
PMCID: PMC2702356  PMID: 19515243
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2.  A Comparison of a Traditional Clinical Experience to a Precepted Clinical Experience for Baccalaureate-Seeking Nursing Students in Their Second Semester 
Ownby, Kristin | Schumann, Renae | Dune, Linda | Kohne, David
Nursing Research and Practice  2012;2012:276506.
The shortage of nursing faculty has contributed greatly to the nursing workforce shortage, with many schools turning away qualified applicants because there are not enough faculty to teach. Despite the faculty shortage, schools are required to admit more students to alleviate the nursing shortage. Clinical groups in which preceptors are responsible for student learning extend faculty resources. Purpose. To determine the effectiveness of an alternative clinical experience (preceptorship). Methods. quasi-experimental, randomized, longitudinal design. Students were randomized to either the traditional or precepted clinical group. The clinical experience was a total of 12 weeks. Groups were compared according to several variables including second semester exam scores, HESI scores, and quality and timeliness of clinical paperwork. Sample. Over a two-year period, seventy-one undergraduate nursing students in the second semester medical-surgical nursing course participated. 36 were randomized to the experimental group. The preceptors were baccalaureate-prepared nurses who have been practicing for at least one year. Setting. Two hospitals located in the Texas Medical Center. Statistical Analysis. Descriptive statistics and independent t-test. Results. There was no difference between the groups on the variables of interest. Conclusion. Students in the precepted clinical group perform as well as those in a traditional clinical group.
doi:10.1155/2012/276506
PMCID: PMC3346989  PMID: 22577535
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3.  Teaching Internal Medicine Residents Quality Improvement Techniques using the ABIM’s Practice Improvement Modules 
Oyler, Julie | Vinci, Lisa | Arora, Vineet | Johnson, Julie
Journal of General Internal Medicine  2008;23(7):927-930.
Summary
Introduction/aim
Standard curricula to teach Internal Medicine residents about quality assessment and improvement, important components of the Accreditation Council for Graduate Medical Education core competencies practiced-based learning and improvement (PBLI) and systems-based practice (SBP), have not been easily accessible.
Program description
Using the American Board of Internal Medicine’s (ABIM) Clinical Preventative Services Practice Improvement Module (CPS PIM), we have incorporated a longitudinal quality assessment and improvement curriculum (QAIC) into the 2 required 1-month ambulatory rotations during the postgraduate year 2. During the first block, residents complete the PIM chart reviews, patient, and system surveys. The second block includes resident reflection using PIM data and the group performing a small test of change using the Plan–Do–Study–Act (PDSA) cycle in the resident continuity clinic.
Program Evaluation
To date, 3 resident quality improvement (QI) projects have been undertaken as a result of QAIC, each making significant improvements in the residents’ continuity clinic. Resident confidence levels in QI skills (e.g., writing an aim statement [71% to 96%, P < .01] and using a PDSA cycle [9% to 89%, P < .001]) improved significantly.
Discussion
The ABIM CPS PIM can be used by Internal Medicine residency programs to introduce QI concepts into their residents’ outpatient practice through encouraging practice-based learning and improvement and systems-based practice.
doi:10.1007/s11606-008-0549-5
PMCID: PMC2517947  PMID: 18449612
Internal Medicine residents; quality improvement; practiced-based learning and improvement; systems-based practice; practice improvement module
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4.  Putting the (R) Ural in Preceptorship 
Jackman, Deirdre | Myrick, Florence | Yonge, Olive
Nursing Research and Practice  2012;2012:528580.
Rural nursing is recognized as a unique health care domain. Within that context, the preceptorship experience is purported to be an important approach to preparing safe and competent rural practitioners. Preceptorship is the one-to-one pairing of a nursing student with a professional nurse who assumes the mandate of teacher and role model in a designated clinical/contextual setting, in this case the rural setting. A research gap exists in the literature in which rural preceptorship is specifically explored. The purpose of this paper is to review preceptorship in relation to preparing nursing students specifically for the rural setting. Understanding how preceptorship as an educational model can prepare nursing students to transition to rural practice is an important endeavor. An authentic rural preceptorship may serve to influence the recruitment and retention needs for registered nurses in rural areas. A greater understanding of rural preceptorship serves to illustrate the appropriate support, socialization and contextual competence required to prepare nursing students for rural nursing practice. This paper's review may serve to highlight the research that currently exists related to rural preceptorship and where additional research can contribute to further understanding and development for authentic rural nursing preparation.
doi:10.1155/2012/528580
PMCID: PMC3368593  PMID: 22693664
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5.  Effect of the Inpatient General Medicine Rotation on Student Pursuit of a Generalist Career 
Arora, Vineet | Wetterneck, Tosha B | Schnipper, Jeffrey L | Auerbach, Andrew D | Kaboli, Peter | Wachter, Robert M | Levinson, Wendy | Humphrey, Holly J | Meltzer, David
Journal of General Internal Medicine  2006;21(5):471-475.
BACKGROUND
Entry into general internal medicine (GIM) has declined. The effect of the inpatient general medicine rotation on medical student career choices is uncertain.
OBJECTIVE
To assess the effect of student satisfaction with the inpatient general medicine rotation on pursuit of a career in GIM.
DESIGN
Multicenter cohort study.
PARTICIPANTS
Third-year medical students between July 2001 and June 2003.
MEASUREMENTS
End-of-internal medicine clerkship survey assessed satisfaction with the rotation using a 5-point Likert scale. Pursuit of a career in GIM defined as: (1) response of “Very Likely” or “Certain” to the question “How likely are you to pursue a career in GIM?”; and (2) entry into an internal medicine residency using institutional match data.
RESULTS
Four hundred and two of 751 (54%) students responded. Of the student respondents, 307 (75%) matched in the 2 years following their rotations. Twenty-eight percent (87) of those that matched chose an internal medicine residency. Of these, 8% (25/307) were pursuing a career in GIM. Adjusting for site and preclerkship interest, overall satisfaction with the rotation predicted pursuit of a career in GIM (odds ratio [OR] 3.91, P<.001). Although satisfaction with individual items did not predict pursuit of a generalist career, factor analysis revealed 3 components of satisfaction (attending, resident, and teaching). Adjusting for preclerkship interest, 2 factors (attending and teaching) were associated with student pursuit of a career in GIM (P<.01).
CONCLUSIONS
Increased satisfaction with the inpatient general medicine rotation promotes pursuit of a career in GIM.
doi:10.1111/j.1525-1497.2006.00429.x
PMCID: PMC1484782  PMID: 16704390
medical student; career interest; general internal medicine
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6.  The Diversity Issue Revisited: International Students in Clinical Environment 
Pitkäjärvi, Marianne | Eriksson, Elina | Pitkälä, Kaisu
ISRN Nursing  2012;2012:294138.
Background. Globalization within higher education leads to an increase in cultural and linguistic diversity in student populations. The purpose of this study was to explore culturally diverse health care students' experiences in clinical environment in Finland, and to compare them with those of native Finnish students' participating in the same program. Method. A cross-sectional survey was performed at 10 polytechnic faculties of health care in Finland. 283 respondents (148 international and 95 Finnish students) responded to items concerning clinical rotation. The survey included items grouped as dimensions: (1) welcoming clinical environment, (2) unsupportive clinical environment, (3) approach to cultural diversity, (4) communication, and (5) structural arrangements. Results. International students felt as welcome on their placements as Finnish students. Concerning structural arrangements set up to facilitate preceptorship and approach to cultural diversity in the learning environment, the two groups' opinions were similar. However, international students were more likely than Finnish students to experience their clinical learning environment as unsupportive (P < 0.001). In addition, their experiences of communication with the staff was poorer than that of their Finnish peers' (P = 0.04). Conclusions. Awareness of strategies that enhance understanding, acceptance, and appreciation of cultural and linguistic diversity in any health care setting are needed.
doi:10.5402/2012/294138
PMCID: PMC3324143  PMID: 22548188
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7.  Career choice of new medical students at three Canadian universities: family medicine versus specialty medicine 
Wright, Bruce | Scott, Ian | Woloschuk, Wayne | Brenneis, Fraser
CMAJ: Canadian Medical Association Journal  2004;170(13):1920-1924.
Background
Over the last 10 years the number of medical students choosing family medicine as a career has steadily declined. Studies have demonstrated that career preference at the time that students begin medical school may be significantly associated with their ultimate career choice. We sought to identify the career preferences students have at entry to medical school and the factors related to family medicine as a first-choice career option.
Methods
A questionnaire was administered to students entering medical school programs at the time of entry at the University of Calgary (programs beginning in 2001 and 2002), University of British Columbia (2001 and 2002) and University of Alberta (2002). Students were asked to indicate their top 3 career choices and to rank the importance of 25 variables with respect to their career choice. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach's alpha coefficients; biserial correlations between the factors and career choice were also calculated. A logistic regression was performed using career choice (family v. other) as the criterion variable and the factors plus demographic characteristics as predictor variables.
Results
Of 583 students, 519 (89%) completed the questionnaire. Only 20% of the respondents identified family medicine as their first career option, and about half ranked family medicine in their top 3 choices. Factor analysis produced 5 factors (medical lifestyle, societal orientation, prestige, hospital orientation and varied scope of practice) that explained 52% of the variance in responses. The 5 factors demonstrated acceptable internal consistency and correlated in the expected direction with the choice of family medicine. Logistic regression revealed that students who identified family medicine as their first choice tended to be older, to be concerned about medical lifestyle and to have lived in smaller communities at the time of completing high school; they were also less likely to be hospital oriented. Moreover, students who chose family medicine were much more likely to demonstrate a societal orientation and to desire a varied scope of practice.
Interpretation
Several factors appear to drive students toward family medicine, most notably having a societal orientation and a desire for a varied scope of practice. If the factors that influence medical students to choose family medicine can be identified accurately, then it may be possible to use such a model to change medical school admission policies so that the number of students choosing to enter family medicine can be increased.
doi:10.1503/cmaj.1031111
PMCID: PMC421719  PMID: 15210640
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8.  A Critique of the Undergraduate Nursing Preceptorship Model 
Sedgwick, Monique | Harris, Suzanne
Nursing Research and Practice  2012;2012:248356.
The preceptorship model is a cornerstone of clinical undergraduate nursing education in Canadian nursing programs. Their extensive use means that nursing programs depend heavily on the availability and willingness of Registered Nurses to take on the preceptor role. However, both the health service and education industries are faced with challenges that seem to undermine the effectiveness of the preceptorship clinical model. Indeed, the unstable nature of the clinical setting as a learning environment in conjunction with faculty shortages and inadequate preparation for preceptors and supervising faculty calls us to question if the preceptorship model is able to meet student learning needs and program outcomes. In a critical analysis of preceptorship, we offer a deconstruction of the model to advance clinical nursing education discourse.
doi:10.1155/2012/248356
PMCID: PMC3357587  PMID: 22649721
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9.  Extended Evaluation of a Longitudinal Medical School Evidence-Based Medicine Curriculum 
West, Colin P. | Jaeger, Thomas M. | McDonald, Furman S.
Journal of General Internal Medicine  2011;26(6):611-615.
ABSTRACT
BACKGROUND
Evidence-based medicine (EBM) is an important element of medical education. However, limited information is available on effective curricula.
OBJECTIVE
To evaluate a longitudinal medical school EBM curriculum using validated instruments.
DESIGN, PARTICIPANTS, MEASUREMENTS
We evaluated EBM attitudes and knowledge of medical students as they progressed through an EBM curriculum. The first component of the curriculum was an EBM “short course” with didactic and small-group sessions occurring at the end of the second year. The second component integrated EBM assignments with third-year clinical rotations. The 15-point Berlin Questionnaire was administered before the course in 2006 and 2007, after the short course, and at the end of the third year. The 212-point Fresno Test was administered before the course in 2007 and 2008, after the short course, and at the end of the third year. Self-reported knowledge and attitudes were also assessed in all three classes of medical students.
RESULTS
EBM knowledge scores on the 15-point Berlin Questionnaire increased from baseline by 3.0 points (20.0%) at the end of the second year portion of the course (p < 001) and by 3.4 points (22.7%) at the end of the third year (p < 001). EBM knowledge scores on the 212-point Fresno Test increased from baseline by 39.7 points (18.7%) at the end of the second year portion of the course (p < 001) and by 54.6 points (25.8%) at the end of the third year (p < 001). On a 5-point scale, self-rated EBM knowledge increased from baseline by 1.0 and 1.4 points, respectively (both p < 001). EBM was felt to be of high importance for medical education and clinical practice at all time points, with increases noted after both components of the curriculum.
CONCLUSIONS
A longitudinal medical school EBM was associated with markedly increased EBM knowledge on two validated instruments. Both components of the curriculum were associated with gains in knowledge. The curriculum was also associated with increased perceptions of the importance of EBM for medical education and clinical practice.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-011-1642-8) contains supplementary material, which is available to authorized users.
doi:10.1007/s11606-011-1642-8
PMCID: PMC3101983  PMID: 21286836
medical education; evidence-based medicine; medical school
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10.  Why would I choose a career in family medicine? 
Scott, Ian | Wright, Bruce | Brenneis, Fraser | Brett-MacLean, Pamela | McCaffrey, Laurie
Canadian Family Physician  2007;53(11):1956-1957.
OBJECTIVE
To describe the factors that medical students report influencethem to pursue careers in family medicine.
DESIGN
Qualitative study using focus groups and interviews and the results of surveys conducted at 3 different points in medical education.
SETTING
Three medical schools in western Canada: the University of British Columbia in Vancouver, the University of Calgary in Alberta, and the University of Alberta in Edmonton.
PARTICIPANTS
A total of 33 medical students.
METHOD
Students were surveyed during the first 2 weeks of their programs, at the end of their preclinical training, and again at the end of their clinical training on their interest in family medicine or other specialty areas. Focus groups and interviews were conducted to explore the reasons students gave for an emerging or final interest in family medicine as a career choice. A small cohort of students who stayed with another specialty choice or switched to another specialty from family medicine were also interviewed. Thematic content analysis was carried out.
MAIN FINDINGS
Students identified several important influences that were subdivided into pre–medical school, medical school, postgraduate training, and life-in-medicine influences. Many positive and negative aspects of family medicine were reported during the preclinical period. Clinical exposure was critical for demonstrating the positive aspects of family medicine. Postgraduate training, future practice, and nonpractice life considerations also influenced students’ career choices.
CONCLUSION
This study provides a qualitative understanding of why students choose careers in family medicine. Medical schools should offer high-quality family medicine clinical experiences, consider the potentially positive influence of rural settings, and provide early and accurate information on family medicine training and career opportunities. These interventions might help students make more informed career decisions and increase the likelihood that they will consider careers in family medicine.
PMCID: PMC2231492  PMID: 18000274
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11.  Evaluation of a Longitudinal Medical School Evidence-Based Medicine Curriculum: A Pilot Study 
West, Colin P. | McDonald, Furman S.
Journal of General Internal Medicine  2008;23(7):1057-1059.
Background
Evidence-based medicine (EBM) is increasingly taught in medical schools, but few curricula have been evaluated using validated instruments.
Objective
To evaluate a longitudinal medical school EBM curriculum using a validated instrument.
Design, Participants, Measurements
We evaluated EBM attitudes and knowledge of 32 medical students as they progressed through an EBM curriculum. The first part was an EBM “short course” with didactic and small-group sessions occurring at the end of the second year. The second part integrated EBM assignments with third-year clinical rotations. The validated 15-item Berlin Questionnaire was administered before the course, after the short course, and at the end of the third year.
Results
EBM knowledge scores increased from baseline by 2.8 points at the end of the second year portion of the course (p = .0001), and by 3.7 points at the end of the third year (p < .0001). Self-rated EBM knowledge increased from baseline by 0.8 and 1.1 points, respectively (p = .0006 and p < .0001, respectively). EBM was felt to be of high importance for medical education and clinical practice at all time points, peaking after the short course.
Conclusions
A longitudinal medical school EBM curriculum was associated with increased EBM knowledge. This knowledge increase was sustained throughout the curriculum.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-008-0625-x) contains supplementary material, which is available to authorized users.
doi:10.1007/s11606-008-0625-x
PMCID: PMC2517920  PMID: 18612744
medical education; evidence-based medicine; medical school
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12.  A metric-based analysis of structure and content of telephone consultations of final-year medical students in a high-fidelity emergency medicine simulation 
Henn, Patrick | Power, David | Smith, Simon D | Power, Theresa | Hynes, Helen | Gaffney, Robert | McAdoo, John D
BMJ Open  2012;2(5):e001298.
Objectives
In this study we aimed to analyse the structure and content of telephone consultations of final-year medical students in a high-fidelity emergency medicine simulation. The purpose was to identify any areas of deficiency within structure and content in the effective transfer of clinical information via the telephone of final-year medical students.
Design
An educational study.
Setting
Simulation centre in a medical school.
Participants
113 final-year medical students.
Primary and secondary outcomes
The primary outcome was to analyse the structure and content of telephone consultations of final-year medical students in a high-fidelity emergency medicine simulation. The secondary outcome was to identify any areas of deficiency within structure and content in the effective transfer of clinical information via the telephone of final-year medical students.
Results
During phone calls to a senior colleague 30% of students did not positively identify themselves, 29% did not identify their role, 32% did not positively identify the recipient of the phone call, 59% failed to positively identify the patient, 49% did not read back the recommendations of their senior colleague and 97% did not write down the recommendations of their senior colleague.
Conclusions
We identified a deficiency in our students skills to communicate relevant information via the telephone, particularly failure to repeat back and write down instructions. We suggest that this reflects a paucity of opportunities to practice this skill in context during the undergraduate years. The assumption that this skill will be acquired following qualification constitutes a latent error within the healthcare system. The function of undergraduate medical education is to produce graduates who are fit for purpose at the point of graduation.
doi:10.1136/bmjopen-2012-001298
PMCID: PMC3467639  PMID: 22983784
Medical Education & Training; Communication; Simulation; Patient Safety
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13.  Individualizing Instruction in Family Medicine Preceptorships 
Katerndahl, David A.
Canadian Family Physician  1984;30:939-942.
By tailoring the objectives, rate, content, strategy, and control of instruction to match each medical student's aptitudes, it is possible to increase his level of achievement and satisfaction. The preceptorship setting is ideally suited to such individualized instruction, which can best be accomplished by matching the student to a preceptor, and continually adjusting instruction during the preceptorship. However, any program of individualized instruction requires the medical school's support in terms of time, resources, and faculty development.
PMCID: PMC2154072  PMID: 21279048
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14.  Internal Medicine Clerkship Directors’ Perceptions About Student Interest in Internal Medicine Careers 
Hauer, Karen E. | Fagan, Mark J. | Kernan, Walter | Mintz, Matthew | Durning, Steven J.
Journal of General Internal Medicine  2008;23(7):1101-1104.
Background
Experienced medical student educators may have insight into the reasons for declining interest in internal medicine (IM) careers, particularly general IM.
Objective
To identify factors that, according to IM clerkship directors, influence students’ decisions for specialty training in IM.
Design
Cross-sectional national survey.
Participants
One hundred ten institutional members of Clerkship Directors in IM.
Measurements
Frequency counts and percentages were reported for descriptive features of clerkships, residency match results, and clerkship directors’ perceptions of factors influencing IM career choice at participating schools. Perceptions were rated on a five-point scale (1 = very much pushes students away from IM careers; 5 = very much attracts students toward IM careers).
Results
Survey response rate was 83/110 (76%); 80 answered IM career-choice questions. Clerkship directors identified three educational items attracting students to IM careers: quality of IM faculty (mean score 4.3, SD = 0.56) and IM rotation (4.1, SD = 0.67), and experiences with IM residents (3.9, SD = 0.94). Items felt most strongly to push students away from IM careers were current practice environment for internists (mean score 2.1, SD = 0.94), income (2.1, SD = 1.08), medical school debt (2.3, SD = 0.89), and work hours in IM (2.4, SD = 1.05). Factor analysis indicated three factors explaining students’ career choices: value/prestige of IM, clerkship experience, and exposure to internists.
Conclusions
IM clerkship directors believe that IM clerkship experiences attract students toward IM, whereas the income and lifestyle for practicing internists dissuade them. These results suggest that interventions to enhance the practice environment for IM could increase student interest in the field.
doi:10.1007/s11606-008-0640-y
PMCID: PMC2517945  PMID: 18612752
career choice; education, medical, undergraduate; medical students, workforce
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15.  A model for offering an International Medicine Seminar Course for US medical students: the 13-year experience of the New Jersey Medical School. 
Reza Najem, G.
Journal of the National Medical Association  1999;91(10):573-577.
An International Medicine Elective Seminar Course at the New Jersey Medical School (NJMS) was designed in 1985 to present a description of medical education, medical care systems, major global health problems, and intervention programs in other countries. Seminars are scheduled for nine weeks in the fall semester. At the end of each course, the medical students complete evaluations. Almost all (97%) students in 1997-1998 evaluated the course as either good (55%) or excellent (45%). Enrollment in the International Medicine Seminar Course increased from 12 medical students in 1985-1986 to 62 students in 1997-1998. An increasing number of students have applied for a fourth-year overseas International Medicine Elective. This and students' evaluations indicated that they have been motivated toward international medicine. The atmosphere of informal seminars and faculty interaction with students has characterized the course. It has made this model of teaching an ideal forum for medical students' professional growth. This course offers students the opportunity and insight to explore facets of their professional role not explicitly covered in the formal medical curriculum. The International Medicine Seminar Course is a self-supported model and can be adopted readily by other medical schools.
PMCID: PMC2608518  PMID: 10599189
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16.  Ethics, jurisprudence, and economics in the medical school curriculum. 
O'Neill, L. C. | Davidson, R. C. | Tupper, C. J. | Scherger, J. E. | Walsh, D. A.
Western Journal of Medicine  1990;153(5):557-558.
Medical ethics, medical jurisprudence, and medical economics are recognized as important components of a medical school curriculum. These subjects were introduced through a course given at the University of California, Davis, School of Medicine. Four aspects of the format and content of the course were instrumental to its success. Teaching principles of medical ethics within the context of jurisprudence and economics permitted the students to gain an understanding of the institutions and processes that act as positive and negative constraints on physicians' clinical and professional behavior. The course was offered during the fourth year following required clinical rotations so that all aspects of the course could be based on the clinical experiences of the students. It was presented in a continuing medical education format away from the normal teaching environment of first- and second-year classrooms and third-year clerkships. Finally, the course was designed by a multidisciplinary, multidepartmental planning group that included students.
PMCID: PMC1002623  PMID: 2260303
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17.  Preceptorship and Affirmation in the Intergenerational World of Nursing Practice 
Foley, Vicki | Myrick, Florence | Yonge, Olive
Nursing Research and Practice  2012;2012:572510.
Research has shown that while preceptorship offers a reality-oriented learning environment and facilitates competence of students, there are inherent rewards and stressors associated with the experience. Students and preceptors can be from different generations, and as such, they may often come to the learning space with differing values and expectations. The nature of the preceptorship experience in this intergenerational context was explored in a recent phenomenological study with seven preceptors and seven nursing students in an undergraduate nursing program in Eastern Canada. Overall the experience was found to be inclusive of three main themes: being affirmed, being challenged, and being on a pedagogical journey. In this paper we explore the first of these themes, being affirmed. Highlighting the positive aspects of the preceptorship experience in the intergenerational context is necessary to promote a culture of openness and respect for generational differences within clinical nursing practice settings and to improving the overall quality of the educational experience.
doi:10.1155/2012/572510
PMCID: PMC3384883  PMID: 22778943
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18.  Effects of Clinical Preceptorship on Career and Practice Site Choices 
Harris, Dona L. | Ebbert, Paul J.
Western Journal of Medicine  1983;138(2):276-279.
To evaluate the effects of primary care preceptorships on the choices of career site and specialization, graduates of the University of Utah School of Medicine, 1972 through 1975, were questioned. Most practicing physicians who elected preceptorship training rated the experiences as valuable, but not important enough to be required. Physicians based their decisions for an urban practice on medical factors; rural areas were chosen more for personal reasons. In addition, data showed that the size of the respondents' hometowns was not associated with their choice in the size of their practice site nor their specialty. Respondents also reported that their medical school training was deficient in preparing them for the economic and psychosocial aspects of medical practice. Many Utah graduates are participating as clinical faculty or as preceptors for medical institutions and indicated that for their particular communities family physicians, obstetricians-gynecologists and pediatricians are still needed.
PMCID: PMC1010720  PMID: 6837038
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19.  Family medicine as a career option 
Bethune, Cheri | Hansen, Penelope A. | Deacon, Diana | Hurley, Katrina | Kirby, Allison | Godwin, Marshall
Canadian Family Physician  2007;53(5):880-885.
OBJECTIVE
To track and describe career choice decisions of medical students as they progressed through their undergraduate training.
DESIGN
Quantitative survey of each class at 5 points during their undergraduate experience. Each survey collected qualitative descriptors of students’ current career choices.
SETTING
Faculty of Medicine at Memorial University of Newfoundland in St John’s.
PARTICIPANTS
Undergraduate medical students in each year from 1999 to 2006.
MAIN OUTCOME MEASURES
Number of students considering family medicine as a career option at 5 different data-collection points throughout the medical school curriculum.
RESULTS
Many students considered family medicine as a career choice early in their undergraduate experience. The number of students considering family medicine dropped significantly during the second year of the curriculum. This trend was consistent across all students surveyed. Although interest in family medicine as a career rebounded later in the curriculum, it never fully recovered.
CONCLUSION
A large percentage of medical students considered family medicine as a career choice when they entered medical school. The percentage dropped significantly by the end of the second year of training. Attention should be directed toward understanding how the undergraduate medical curriculum in the first 2 years can protect and cultivate interest in family medicine as a career choice.
PMCID: PMC1949175  PMID: 17872751
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20.  Predictors of Final Specialty Choice by Internal Medicine Residents 
Diehl, Andrew K | Kumar, Vineeta | Gateley, Ann | Appleby, Jane L | O'Keefe, Mary E
Journal of General Internal Medicine  2006;21(10):1045-1049.
BACKGROUND
Sociodemographic factors and personality attributes predict career decisions in medical students. Determinants of internal medicine residents' specialty choices have received little attention.
OBJECTIVE
To identify factors that predict the clinical practice of residents following their training.
DESIGN
Prospective cohort study.
PARTICIPANTS
Two hundred and four categorical residents from 2 university-based residency programs.
MEASUREMENTS
Sociodemographic and personality inventories performed during residency, and actual careers 4 to 9 years later.
RESULTS
International medical school graduates (IMGs) were less likely to practice general medicine than U.S. graduates (33.3% vs 70.6%, P<.001). Residents with higher loan indebtedness more often became generalists (P = .001). A corresponding trend favoring general internal medicine was observed among those who perceived General Internists to have lower potential incomes (69.0% vs 53.3%, P = .08). There was a trend for generalists to have lower scores on scales measuring authoritarianism, negative orientation to psychological problems, and Machiavellianism (0.05
CONCLUSION
Recruitment of IMGs may not increase the supply of General Internists. Prospects of lower income, even in the face of large debt, may not discourage residents from becoming generalists. If increasing generalist manpower is a goal, residencies should consider weighing applicants' personal attributes during the selection process.
doi:10.1111/j.1525-1497.2006.00556.x
PMCID: PMC1831640  PMID: 16836624
career choice; general internal medicine; health manpower; international medical graduates
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Vora, Nirali | Chang, Mina | Pandya, Hemang | Hasham, Aliya | Lazarus, Cathy
Medical Education Online  2010;15:10.3402/meo.v15i0.4896.
Introduction
Global health education is becoming more important for developing well-rounded physicians and may encourage students toward a career in primary care. Many medical schools, however, lack adequate and structured opportunities for students beginning the curriculum.
Methods
Second-year medical students initiated, designed, and facilitated a pass–fail international health elective, providing a curricular framework for preclinical medical students wishing to gain exposure to the clinical and cultural practices of a developing country.
Results
All course participants (N=30) completed a post-travel questionnaire within one week of sharing their experiences. Screening reflection essays for common themes that fulfill university core competencies yielded specific global health learning outcomes, including analysis of health care determinants.
Conclusion
Medical students successfully implemented a sustainable global health curriculum for preclinical student peers. Financial constraints, language, and organizational burdens limit student participation. In future, long-term studies should analyze career impact and benefits to the host country.
doi:10.3402/meo.v15i0.4896
PMCID: PMC2827262  PMID: 20186283
international health; preclinical students; medical education; student-initiated
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Henning, Marcus A. | Krägeloh, Christian | Moir, Fiona | Doherty, Iain | Hawken, Susan J.
Perspectives on Medical Education  2012;1(3):129-142.
International students form a significant proportion of students studying within universities in Western countries. The quality of life perceptions of international medical students in comparison with domestic medical students has not been well documented. There is some evidence to suggest that international medical students may have different educational and social experiences in relation to their domestic peers. This study investigates the levels of quality of life experienced by international and domestic students studying medicine. A total of 548 medical students completed the abbreviated version of the World Health Organization Quality of Life questionnaire. The focus of the analysis was to evaluate differences between international and domestic students in their early clinical years. The responses were analysed using multivariate analysis of variance methods. International medical students are experiencing lower social and environmental quality of life compared with domestic peers. International medical students in New Zealand have expressed quality of life concerns, which likely have an impact on their academic achievement, feelings of wellness, acculturation, and social adaptation. The findings reinforce the need for creating stronger social networks and accessible accommodation, as well as developing systems to ensure safety, peer mentorship and student support.
doi:10.1007/s40037-012-0019-y
PMCID: PMC3540361  PMID: 23316469
Quality of life; World Health Organisation; Medical students
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Goertzen, J | Stewart, M | Weston, W
CMAJ: Canadian Medical Association Journal  1995;153(2):161-168.
OBJECTIVE: To describe effective teaching behaviours of rural family medicine preceptors. DESIGN: Descriptive qualitative study using the critical incident technique. SETTING: Rural Manitoba community practices affiliated with the University of Manitoba's 8-week family medicine/community medicine rotation (clinical clerkship). PARTICIPANTS: All family medicine preceptors and fourth-year medical students involved in two family medicine rotations from Mar. 11 to June 14, 1991. During the first rotation all 12 students and 21 preceptors participated. During the second rotation 12 of the 13 students and 20 of the 21 preceptors participated. The overall response rate was 97%. OUTCOME MEASURES: Effective and less effective preceptor teaching behaviours. RESULTS: During 120 telephone interviews (48 with the students and 72 with the preceptors) 275 critical teaching incidents were elicited. Over 800 teaching behaviours were identified, and seven main categories describing effective teaching behaviours of preceptors were formed: (a) actively involves the student, providing adequate supervision and appropriate independence, (b) develops and fosters a supportive interpersonal relationship with the student to facilitate learning, (c) emphasizes problem solving and the understanding of general principles, (d) balances clinical and teaching responsibilities, (e) demonstrates clinical and professional competence, (f) uses an organized approach, including goal setting and summation, and (g) provides the student with ongoing feedback, assessments and evaluations. CONCLUSION: The teaching behaviours described in this study augment and corroborate findings from previous studies on clinical teaching and provide a better understanding of effective teaching behaviours. The findings suggest a curriculum for a faculty-development program for rural family medicine preceptors.
PMCID: PMC1338054  PMID: 7600467
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Brownfield, Elisha L. | Blue, Amy V. | Powell, Caroline K. | Geesey, Mark E. | Moran, William P.
Journal of General Internal Medicine  2008;23(7):1002-1005.
BACKGROUND
The synthesis of basic and clinical science knowledge during the clerkship years has failed to meet educational expectations.
OBJECTIVES
We hypothesized that a small-group course emphasizing the basic science underpinnings of disease, Foundations of Clinical Medicine (FCM), could be integrated into third year clerkships and would not negatively impact the United States Medical Licensure Examination (USMLE) step 2 scores.
DESIGN
In 2001–2002, all third year students met weekly in groups of 8–12 clustered within clerkships to discuss the clinical and basic science aspects of prescribed, discipline-specific cases.
PARTICIPANTS
Students completing USMLE step 2 between 1999 and 2004 (n = 743).
MEASUREMENTS
Course evaluations were compared with the overall institutional average. Bivariate analyses compared the mean USMLE steps 1 and 2 scores across pre- and post-FCM student cohorts. We used multiple linear regression to assess the association between USMLE step 2 scores and FCM cohort controlling for potential confounders.
RESULTS
Students’ average course evaluation score rose from 66 to 77 (2001–2004) compared to an institutional average of 73. The unadjusted mean USMLE step 1 score was higher for the post-FCM cohort (212.9 vs 207.5, respectively, p < .001) and associated with step 2 scores (estimated coefficient = 0.70, p < .001). Post-FCM cohort (2002–2004; n = 361) mean step 2 scores topped pre-FCM (1999–2001; n = 382) scores (215.9 vs 207.7, respectively, p < .001). FCM cohort remained a significant predictor of higher step 2 scores after adjustment for USMLE step 1 and demographic characteristics (estimated coefficient = 4.3, p = .002).
CONCLUSIONS
A curriculum integrating clinical and basic sciences during third year clerkships is feasible and associated with improvement in standardized testing.
Electronic supplementary material
The online version of this article (doi: 10.1007/s11606-008-0631-z) contains supplementary material, which is available to authorized users.
doi:10.1007/s11606-008-0631-z
PMCID: PMC2517913  PMID: 18612732
medical education; basic science; clinical training; medical student; USMLE
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Sičaja, Mario | Romić, Dominik | Prka, Željko
Croatian medical journal  2006;47(1):169-175.
Aim
To evaluate self-assessed level of clinical skills of graduating medical students at Zagreb University School of Medicine and compare them with clinical skill levels expected by their teachers and those defined by a criterion standard.
Method
The study included all medical students (n = 252) graduating from the Zagreb University School of Medicine in the 2004-2005 academic year and faculty members (n = 129) teaching clinical skills. The participants completed anonymous questionnaire listing 99 clinical skills divided into nine groups. Students were asked to assess their clinical skills on a 0-5 scale, and faculty members were asked to assess the minimum necessary level of clinical skills expected from graduating medical students, using the same 0-5 scale. We compared the assessment scores of faculty members with students’ self-assessment scores. Participants were grouped according to their descriptive characteristics for further comparison.
Results
The response rate was 91% for students and 70% for faculty members. Students’ self-assessment scores in all nine groups of clinical skills ranged from 2.2 ± 0.8 to 3.8 ± 0.5 and were lower than those defined by the criterion standard (3.0-4.0) and those expected by teachers (from 3.1 ± 1.0 to 4.4 ± 0.5) (P<0.001 for all). Students who had additional clinical skills training had higher scores in all groups of skills, ranging from 2.6 ± 0.9 to 4.0 ± 0.5 (P<0.001 for all). Male students had higher scores than female students in emergency (P<0.001), neurology (P = 0.017), ear, nose, and throat (P = 0.002), urology (P = 0.003), and surgery skills (P = 0.002). Teachers’ expectations did not vary according to their sex, academic position, or specialty.
Conclusion
Students’ self-assessed level of clinical skills was lower than that expected by their teachers. Education during clinical rotations is not focused on acquiring clinical skills, and additional clinical skills training has a positive influence on students’ self-assessed level of clinical skills. There was no consensus among teachers on the required level of students’ clinical skills.
PMCID: PMC2080370  PMID: 16489711
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