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1.  Feasibility and sustainability of an interactive team-based learning method for medical education during a severe faculty shortage in Zimbabwe 
BMC Medical Education  2014;14:63.
Background
In 2010, in the midst of the human immunodeficiency virus (HIV) epidemic in Zimbabwe, 69% of faculty positions in the Department of Medicine of the University of Zimbabwe College of Health Sciences (UZ-CHS) were vacant. To address the ongoing need to train highly skilled HIV clinicians with only a limited number of faculty, we developed and implemented a course for final-year medical students focused on HIV care using team-based learning (TBL) methods.
Methods
A competency-based HIV curriculum was developed and delivered to final-year medical students in 10 TBL sessions as part of a 12 week clinical medicine attachment. A questionnaire was administered to the students after completion of the course to assess their perception of TBL and self-perceived knowledge gained in HIV care. Two cohorts of students completed the survey in separate academic years, 2011 and 2012. Descriptive analysis of survey results was performed.
Results
Ninety-six of 120 students (80%) completed surveys. One hundred percent of respondents agreed that TBL was an effective way to learn about HIV and 66% strongly agreed. The majority of respondents agreed that TBL was more stimulating than a lecture course (94%), fostered enthusiasm for the course material (91%), and improved teamwork (96%). Students perceived improvements in knowledge gained across all of the HIV subjects covered, especially in challenging applied clinical topics, such as management of HIV antiretroviral failure (88% with at least a “large improvement”) and HIV-tuberculosis co-infection (80% with at least a “large improvement”).
Conclusions
TBL is feasible as part of medical education in an African setting. TBL is a promising way to teach challenging clinical topics in a stimulating and interactive learning environment in a low-income country setting with a high ratio of students to teachers.
doi:10.1186/1472-6920-14-63
PMCID: PMC3972960  PMID: 24678606
Team-based learning; TBL; Resource-limited; Medical education; NECTAR; MEPI; HIV
2.  Patient, Resident Physician, and Visit Factors Associated with Documentation of Sexual History in the Outpatient Setting 
ABSTRACT
BACKGROUND
Providers need an accurate sexual history for appropriate screening and counseling, but data on the patient, visit, and physician factors associated with sexual history-taking are limited.
OBJECTIVES
To assess patient, resident physician, and visit factors associated with documentation of a sexual history at health care maintenance (HCM) visits.
DESIGN
Retrospective cross-sectional chart review.
PARTICIPANTS
Review of all HCM clinic notes (n = 360) by 26 internal medicine residents from February to August of 2007 at two university-based outpatient clinics.
MEASUREMENTS
Documentation of sexual history and patient, resident, and visit factors were abstracted using structured tools. We employed a generalized estimating equations method to control for correlation between patients within residents. We performed multivariate analysis of the factors significantly associated with the outcome of documentation of at least one component of a sexual history.
KEY RESULTS
Among 360 charts reviewed, 25% documented at least one component of a sexual history with a mean percent by resident of 23% (SD = 18%). Factors positively associated with documentation were: concern about sexually transmitted infection (referent: no concern; OR = 4.2 [95% CI = 1.3–13.2]); genitourinary or abdominal complaint (referent: no complaint; OR = 4.3 [2.2–8.5]); performance of other HCM (referent: no HCM performed; OR = 3.2 [1.5–7.0]), and birth control use (referent: no birth control; OR = 3.0 [1.1, 7.8]). Factors negatively associated with documentation were: age groups 46–55, 56–65, and >65 (referent: 18–25; ORs = 0.1, 0.1, and 0.2 [0.0–0.6, 0.0–0.4, and 0.1–0.6]), and no specified marital status (referent: married; OR = 0.5 [0.3–0.8]).
CONCLUSIONS
Our findings highlight the need for an emphasis on documentation of a sexual history by internal medicine residents during routine HCM visits, especially in older and asymptomatic patients, to ensure adequate screening and counseling.
doi:10.1007/s11606-011-1711-z
PMCID: PMC3138976  PMID: 21523496
communication skills; medical education; aging; sexually transmitted disease; ambulatory care
3.  Charting the Road to Competence: Developmental Milestones for Internal Medicine Residency Training 
Background
The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project requires that residency program directors objectively document that their residents achieve competence in 6 general dimensions of practice.
Intervention
In November 2007, the American Board of Internal Medicine (ABIM) and the ACGME initiated the development of milestones for internal medicine residency training. ABIM and ACGME convened a 33-member milestones task force made up of program directors, experts in evaluation and quality, and representatives of internal medicine stakeholder organizations. This article reports on the development process and the resulting list of proposed milestones for each ACGME competency.
Outcomes
The task force adopted the Dreyfus model of skill acquisition as a framework the internal medicine milestones, and calibrated the milestones with the expectation that residents achieve, at a minimum, the “competency” level in the 5-step progression by the completion of residency. The task force also developed general recommendations for strategies to evaluate the milestones.
Discussion
The milestones resulting from this effort will promote competency-based resident education in internal medicine, and will allow program directors to track the progress of residents and inform decisions regarding promotion and readiness for independent practice. In addition, the milestones may guide curriculum development, suggest specific assessment strategies, provide benchmarks for resident self-directed assessment-seeking, and assist remediation by facilitating identification of specific deficits. Finally, by making explicit the profession's expectations for graduates and providing a degree of national standardization in evaluation, the milestones may improve public accountability for residency training.
doi:10.4300/01.01.0003
PMCID: PMC2931179  PMID: 21975701
4.  An Interactive Computer Kiosk Module for the Treatment of Recurrent Uncomplicated Cystitis in Women 
Journal of General Internal Medicine  2006;21(11):1156-1159.
OBJECTIVE
To validate and implement a computer module for the management of uncomplicated urinary tract infections (UTI).
PARTICIPANTS
Women age 18 to 64 years, with a previous UTI, voiding symptoms, and absence of complicating features (comorbidities, vaginal discharge, back pain, emesis, and fever/chills).
MEASUREMENTS
The computer module was validated against clinician diagnosis and urine culture. Following validation, the module was implemented in the urgent care clinic as a management option for women with suspected UTI; computer-directed therapy (CDT)-eligible women received antibiotic treatment without a clinician examination. Patient satisfaction with the module and return visits for UTI-related complaints were assessed.
RESULTS
In the validation study, 18 of 68 women (26%) were CDT-eligible. Clinicians diagnosed 17/18 CDT-eligible women with uncomplicated UTI. Sixty-seven percent of CDT-eligible women had a positive urine culture. Since implementation, 162 women have accessed the module, and 35% have received CDT. Ninety-eight percent (95% confidence interval: 95% to 100%) found the program easy to use and 95% (89% to 100%) would recommend it to friends/family. Two (4%) CDT-treated women had a return visit to our institution for a UTI-related illness within 2 weeks.
CONCLUSIONS
A computer module accurately identifies women with culture-confirmed, uncomplicated UTIs. Patients are highly satisfied with the module.
doi:10.1111/j.1525-1497.2006.00575.x
PMCID: PMC1831661  PMID: 16879705
urinary tract infection; cystitis; computer-assisted therapy; computer-assisted diagnosis; patient satisfaction
5.  Factors affecting medical students' selection of an internal medicine residency program. 
OBJECTIVE: To determine factors that influence medical student selection of internal medicine residency programs by ethnicity and gender. DESIGN/SETTING: A cross-sectional mailed survey of graduating medical students applying to four residency programs in 1999. MEASUREMENTS: A five-point (5=most important) Likert scale was used to evaluate factors and included 14 items on location characteristics, 20 on program features, six on recruitment, three on future plans and three on advising. RESULTS: Of 2,820 surveys, 1,005 were completed (36%). The most important factors to applicants were house staff morale (mean +/- SD, 4.5 +/- 0.7), academic reputation (4.5 +/-0.8), and positive interview experience (4.1 +/- 1.0). Women rated gender diversity of faculty (3.3 vs. 2.3, p=0.0001) and house staff (3.3 vs. 2.5, p=0.0001), location of residency program near spouse (4.2 vs. 3.9, p=0.0001) or spouse's job (3.8 vs. 3.5, p=0.0002) and emphasis on primary care (2.9 vs. 2.4, p=0.0001) more highly than men. Minority applicants were more likely than whites to identify the following factors as more important: ethnic diversity of patients (3.8 vs. 3.4, p=0.008), house staff (3.3 vs. 2.4, p<0.0001) and faculty (3.1 vs. 2.3, p<0.0001); service to the medically indigent (3.8 vs. 3.3, p=0.004); feeling of being wanted (3.8 vs. 3.4, p=0.002); and an academic environment supportive of ethnic minorities (3.5 vs. 2.3, p<0.0001). CONCLUSIONS: Location and program factors are most important in influencing decisions to choose a residency program. However, women and minority applicants also place significant importance on family and diversity factors. Programs need to consider differential factors in recruitment of diverse students.
PMCID: PMC2594785  PMID: 16296217
6.  A Cross-sectional Descriptive Study of Mentoring Relationships Formed by Medical Students 
To describe medical students' mentoring relationships and determine characteristics associated with having mentors, 232/302 (77%) of third- and fourth-year medical students at the University of California at San Francisco (UCSF) were surveyed. Twenty-six percent of third-year and 45% of fourth-year students had mentors. Most met their mentors during inpatient clerkships (28%), research (19%), or sought them on the basis of similar interests (23%). On multivariate analysis, students who performed research prior to (odds ratio [OR], 4.8; 95% confidence interval [95% CI], 1.4 to 16.7; P = .01) or during medical school (OR, 2.4; 95% CI, 1.1 to 5.6; P = .03) and students satisfied with advising from all sources at UCSF (OR, 1.8; 95% CI, 1.4 to 2.4; P < .001) were more likely to have mentors.
doi:10.1046/j.1525-1497.2003.20334.x
PMCID: PMC1494842  PMID: 12709098
mentors; questionnaires; education; medical; undergraduate

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