PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-14 (14)
 

Clipboard (0)
None

Select a Filter Below

Journals
Year of Publication
1.  Mentorship and pursuit of academic medicine careers: a mixed methods study of residents from diverse backgrounds 
BMC Medical Education  2014;14:26.
Background
Mentorship influences career planning, academic productivity, professional satisfaction, and most notably, the pursuit of academic medicine careers. Little is known about the role of mentoring in recruiting Black/African American and Hispanic/Latino residents into academia. The objective of this study was to assess the influence of mentoring on academic medicine career choice among a cohort of racially and ethnically diverse residents.
Methods
A strategic convenience sample of U.S. residents attending national professional conferences between March and July 2010; residents completed a quantitative survey and a subset participated in focus groups.
Results
Of the 250 residents, 183 (73%) completed surveys and 48 participated in focus groups. Thirty-eight percent of residents were white, 31% Black/African American, 17% Asian/other, and 14% Hispanic/Latino. Most respondents (93%) reported that mentorship was important for entering academia, and 70% reported having sufficient mentorship to pursue academic careers. Three themes about mentorship emerged from focus groups: (1) qualities of successful mentorship models; (2) perceived benefits of mentorship; and (3) the value of racial/ethnic and gender concordance. Residents preferred mentors they selected rather than ones assigned to them, and expressed concern about faculty using checklists. Black/African American, Hispanic/Latino, and female residents described actively seeking out mentors of the same race/ethnicity and gender, but expressed difficulty finding such mentors. Lack of racial/ethnic concordance was perceived as an obstacle for minority mentees, requiring explanation of the context and nuances of their perspectives and situations to non-minority mentors.
Conclusions
The majority of residents in this study reported having access to mentors. However, data show that the lack of diverse faculty mentors may impede diverse residents’ satisfaction and benefit from mentorship relationships compared to white residents. These findings are important for residency programs striving to enhance resident mentorship and for institutions working to diversify their faculty and staff to achieve institutional excellence.
doi:10.1186/1472-6920-14-26
PMCID: PMC3922304  PMID: 24512599
Residents; Postgraduate; Academic careers; Career choice; Diversity; Minority; Mentorship; Mentoring; Medical education
2.  Evaluation of a Multimodal, Distance Learning HIV Management Course for Clinical Care Providers in India 
Distance learning is an important tool for training HIV health workers. However, there is limited evidence on design and evaluation of distance learning HIV curricula and tools. We therefore designed, implemented, and evaluated a distance learning course on HIV management for clinical care providers in India. After course completion, participant scores rose significantly from a pretest (78.4% mean correct) compared with the posttest (87.5%, P < .001). After course completion, participants were more likely to be confident in starting an initial antiretroviral (ARV) regimen, understanding ARV toxicities, encouraging patient adherence, diagnosing immune reconstitution syndrome, and monitoring patients on ARV medications (P ≤ .05). All participants (100%) strongly agreed/agreed that they would recommend this course to others, and most of them (96%) strongly agreed/agreed that they would take a course in this format again. A pragmatic approach to HIV curriculum development and evaluation resulted in reliable learning outcomes, as well as learner satisfaction and improvement in knowledge.
doi:10.1177/1545109712451330
PMCID: PMC3856228  PMID: 22802357
HIV; distance learning; India; evaluation; Internet
3.  Efficacy of an internet-based tool for improving physician knowledge of chronic kidney disease: an observational study 
BMC Nephrology  2012;13:126.
Background
Early recognition and management of chronic kidney disease (CKD) are associated with better outcomes. Internal medicine residency should prepare physicians to diagnose and manage CKD.
Methods
To examine whether residency training and program characteristics were associated with CKD knowledge and investigate the effectiveness of an internet-based training module in improving CKD knowledge, we analyzed data from CKD training modules administered annually to U.S. internal medicine residents from July 1, 2005 to June 30, 2009. Baseline CKD knowledge was assessed using pre-tests. The modules’ effectiveness was evaluated by post-tests. Comparisons were performed using X2 tests and paired t-tests.
Results
Of 4,702 residents, 38%, 33%, and 29% were program year (PGY)-1, PGY-2, and PGY-3, respectively. Baseline CKD knowledge was poor, with mean pre-test scores of 45.1-57.0% across the four years. The lowest pre-test performance was on CKD recognition. Pre-test scores were better with higher training levels (P-trend < 0.001 except 2005–2006 [P-trend = 0.35]). Affiliation with a renal fellowship program or program location within a region of high end-stage kidney disease prevalence was not associated with better baseline CKD knowledge. Completion of the CKD module led to significant improvements from pre- to post-test scores (mean improvement 27.8% [SD: 21.3%] which were consistent from 2005 to 2009.
Conclusions
Knowledge of diagnosis and management of CKD improves during residency training but remains poor among graduating residents. Web-based training can be effective in educating physicians on CKD-related issues. Studies are needed to determine whether knowledge gained from such an intervention translates to improved care of CKD patients.
doi:10.1186/1471-2369-13-126
PMCID: PMC3536684  PMID: 23016990
Kidney disease; Education; Internet; Primary care
4.  Learner feedback and educational outcomes with an internet-based ambulatory curriculum: a qualitative and quantitative analysis 
BMC Medical Education  2012;12:55.
Background
Online medical education curricula offer new tools to teach and evaluate learners. The effect on educational outcomes of using learner feedback to guide curricular revision for online learning is unknown.
Methods
In this study, qualitative analysis of learner feedback gathered from an online curriculum was used to identify themes of learner feedback, and changes to the online curriculum in response to this feedback were tracked. Learner satisfaction and knowledge gains were then compared from before and after implementation of learner feedback.
Results
37,755 learners from 122 internal medicine residency training programs were studied, including 9437 postgraduate year (PGY)1 residents (24.4 % of learners), 9864 PGY2 residents (25.5 %), 9653 PGY3 residents (25.0 %), and 6605 attending physicians (17.0 %). Qualitative analysis of learner feedback on how to improve the curriculum showed that learners commented most on the overall quality of the educational content, followed by specific comments on the content. When learner feedback was incorporated into curricular revision, learner satisfaction with the instructive value of the curriculum (1 = not instructive; 5 = highly instructive) increased from 3.8 to 4.1 (p < 0.001), and knowledge gains (i.e., post test scores minus pretest scores) increased from 17.0 % to 20.2 % (p < 0.001).
Conclusions
Learners give more feedback on the factual content of a curriculum than on other areas such as interactivity or website design. Incorporating learner feedback into curricular revision was associated with improved educational outcomes. Online curricula should be designed to include a mechanism for learner feedback and that feedback should be used for future curricular revision.
doi:10.1186/1472-6920-12-55
PMCID: PMC3418189  PMID: 22788677
Online education; Curriculum development; Feedback; Learner satisfaction
5.  A Comparison of Online versus On-site Training in Health Research Methodology: A Randomized Study 
BMC Medical Education  2011;11:37.
Background
Distance learning may be useful for building health research capacity. However, evidence that it can improve knowledge and skills in health research, particularly in resource-poor settings, is limited. We compared the impact and acceptability of teaching two distinct content areas, Biostatistics and Research Ethics, through either on-line distance learning format or traditional on-site training, in a randomized study in India. Our objective was to determine whether on-line courses in Biostatistics and Research Ethics could achieve similar improvements in knowledge, as traditional on-site, classroom-based courses.
Methods
Subjects: Volunteer Indian scientists were randomly assigned to one of two arms.
Intervention: Students in Arm 1 attended a 3.5-day on-site course in Biostatistics and completed a 3.5-week on-line course in Research Ethics. Students in Arm 2 attended a 3.5-week on-line course in Biostatistics and 3.5-day on-site course in Research Ethics. For the two course formats, learning objectives, course contents and knowledge tests were identical.
Main Outcome Measures: Improvement in knowledge immediately and 3-months after course completion, compared to baseline.
Results
Baseline characteristics were similar in both arms (n = 29 each). Median knowledge score for Biostatistics increased from a baseline of 49% to 64% (p < 0.001) 3 months after the on-site course, and from 48% to 63% (p = 0.009) after the on-line course. For the on-site Research Ethics course, median score increased from 69% to 83% (p = 0.005), and for the on-line Research Ethics course from 62% to 80% (p < 0.001). Three months after the course, median gains in knowledge scores remained similar for the on-site and on-line platforms for both Biostatistics (16% vs. 12%; p = 0.59) and Research Ethics (17% vs. 13%; p = 0.14).
Conclusion
On-line and on-site training formats led to marked and similar improvements of knowledge in Biostatistics and Research Ethics. This, combined with logistical and cost advantages of on-line training, may make on-line courses particularly useful for expanding health research capacity in resource-limited settings.
doi:10.1186/1472-6920-11-37
PMCID: PMC3141795  PMID: 21682858
6.  Associations between quality indicators of internal medicine residency training programs 
BMC Medical Education  2011;11:30.
Background
Several residency program characteristics have been suggested as measures of program quality, but associations between these measures are unknown. We set out to determine associations between these potential measures of program quality.
Methods
Survey of internal medicine residency programs that shared an online ambulatory curriculum on hospital type, faculty size, number of trainees, proportion of international medical graduate (IMG) trainees, Internal Medicine In-Training Examination (IM-ITE) scores, three-year American Board of Internal Medicine Certifying Examination (ABIM-CE) first-try pass rates, Residency Review Committee-Internal Medicine (RRC-IM) certification length, program director clinical duties, and use of pharmaceutical funding to support education. Associations assessed using Chi-square, Spearman rank correlation, univariate and multivariable linear regression.
Results
Fifty one of 67 programs responded (response rate 76.1%), including 29 (56.9%) community teaching and 17 (33.3%) university hospitals, with a mean of 68 trainees and 101 faculty. Forty four percent of trainees were IMGs. The average post-graduate year (PGY)-2 IM-ITE raw score was 63.1, which was 66.8 for PGY3s. Average 3-year ABIM-CE pass rate was 95.8%; average RRC-IM certification was 4.3 years. ABIM-CE results, IM-ITE results, and length of RRC-IM certification were strongly associated with each other (p < 0.05). PGY3 IM-ITE scores were higher in programs with more IMGs and in programs that accepted pharmaceutical support (p < 0.05). RRC-IM certification was shorter in programs with higher numbers of IMGs. In multivariable analysis, a higher proportion of IMGs was associated with 1.17 years shorter RRC accreditation.
Conclusions
Associations between quality indicators are complex, but suggest that the presence of IMGs is associated with better performance on standardized tests but decreased duration of RRC-IM certification.
doi:10.1186/1472-6920-11-30
PMCID: PMC3126786  PMID: 21651768
program quality; Residency Review Committee; American Board of Internal Medicine Certifying Examination
7.  How to improve medical education website design 
BMC Medical Education  2010;10:30.
Background
The Internet provides a means of disseminating medical education curricula, allowing institutions to share educational resources. Much of what is published online is poorly planned, does not meet learners' needs, or is out of date.
Discussion
Applying principles of curriculum development, adult learning theory and educational website design may result in improved online educational resources. Key steps in developing and implementing an education website include: 1) Follow established principles of curriculum development; 2) Perform a needs assessment and repeat the needs assessment regularly after curriculum implementation; 3) Include in the needs assessment targeted learners, educators, institutions, and society; 4) Use principles of adult learning and behavioral theory when developing content and website function; 5) Design the website and curriculum to demonstrate educational effectiveness at an individual and programmatic level; 6) Include a mechanism for sustaining website operations and updating content over a long period of time.
Summary
Interactive, online education programs are effective for medical training, but require planning, implementation, and maintenance that follow established principles of curriculum development, adult learning, and behavioral theory.
doi:10.1186/1472-6920-10-30
PMCID: PMC2868857  PMID: 20409344
8.  Disseminated cryptococcosis with meningitis, peritonitis, and cryptococcemia in a HIV-negative patient with cirrhosis: a case report 
Cases Journal  2009;2:170.
Introduction
Cryptococcus neoformans is an encapsulated yeast that causes serious infections in immunocompromised populations. The majority of cases occur in HIV-infected individuals. Disseminated disease is uncommon, and very rarely includes peritonitis.
Case presentation
We report a case of a 41-year-old, HIV-negative, Caucasian man with alcoholic liver cirrhosis who presented with fever and seizure. Disseminated cryptococcosis with meningitis, peritonitis, and cryptococcemia was diagnosed, and despite adequate treatment the patient developed multi-system organ failure and eventually expired.
Conclusion
Disseminated cryptococcosis, particularly with peritonitis, is an uncommon manifestation of Cryptococcus neoformans infection. Liver cirrhosis serves as a risk factor for disseminated disease in HIV-negative patients. A high clinical suspicion and early initiation of therapy is needed to recognize and treat patients effectively.
doi:10.1186/1757-1626-2-170
PMCID: PMC2783126  PMID: 19946481
9.  Continuity Clinic Satisfaction and Valuation in Residency Training 
Journal of General Internal Medicine  2007;22(12):1704-1710.
Background
Internal Medicine residency training in ambulatory care has been judged inadequate, yet how trainees value continuity clinic and which aspects of clinic affect attitudes are unknown.
Objectives
To determine the value that Internal Medicine residents place on continuity clinic and how clinic precepting, operations, and patient panels affect its valuation.
Design and measurements
A survey on ambulatory care was developed, including questions on career choice and the value of clinical training experiences. Independent variables were Likert-scale ratings (1 = disagree strongly/no value; 3 = neutral; 5 = agree strongly/high value) on preceptors, patients, operations, and resident characteristics. Odds ratios and stepwise multivariate logistic regression with clustering were used to evaluate associations between clinic valuation and independent variables.
Subjects
Internal medicine residents at 3 residency programs.
Results
218 of 260 residents (83.8%) completed the survey. Resident ratings were highest on diversity of illness seen (4.1), medical record systems used (4.1), and contact with preceptors who were receptive to questions (4.8). Resident ratings were lowest on economic diversity of patients (2.7), interruptions from inpatient wards (3.1), and contact with preceptors who taught history and physical exam skills (3.5). High ratings on all precepting issues and nearly all operational issues were associated with valuing clinic. With multivariate analysis, high ratings of preceptors as role models were most strongly associated with valuing clinic (corrected relative risk 3.44). A planned career in general Internal Medicine was not associated with valuing clinic.
Conclusions
Satisfaction with preceptors, particularly as role models, and clinic operations correlate with the value residents place on continuity clinic.
doi:10.1007/s11606-007-0412-0
PMCID: PMC2219834  PMID: 17932723
ambulatory education; clinic; precepting; residency training
10.  A Ten-Month Program in Curriculum Development for Medical Educators: 16 Years of Experience 
BACKGROUND
Despite increased demand for new curricula in medical education, most academic medical centers have few faculty with training in curriculum development.
OBJECTIVE
To describe and evaluate a longitudinal mentored faculty development program in curriculum development.
DESIGN
A 10-month curriculum development program operating one half-day per week of each academic year from 1987 through 2003. The program was designed to provide participants with the knowledge, attitudes, skills, and experience to design, implement, evaluate, and disseminate curricula in medical education using a 6-step model.
PARTICIPANTS
One-hundred thirty-eight faculty and fellows from Johns Hopkins and other institutions and 63 matched nonparticipants.
MEASUREMENTS
Pre- and post-surveys from participants and nonparticipants assessed skills in curriculum development, implementation, and evaluation, as well as enjoyment in curriculum development and evaluation. Participants rated program quality, educational methods, and facilitation in a post-program survey.
RESULTS
Sixty-four curricula were produced addressing gaps in undergraduate, graduate, or postgraduate medical education. At least 54 curricula (84%) were implemented. Participant self-reported skills in curricular development, implementation, and evaluation improved from baseline (p < .0001), whereas no improvement occurred in the comparison group. In multivariable analyses, participants rated their skills and enjoyment at the end of the program significantly higher than nonparticipants (all p < .05). Eighty percent of participants felt that they would use the 6-step model again, and 80% would recommend the program highly to others.
CONCLUSIONS
This model for training in curriculum development has long-term sustainability and is associated with participant satisfaction, improvement in self-rated skills, and implementation of curricula on important topics.
doi:10.1007/s11606-007-0103-x
PMCID: PMC1852913  PMID: 17443374
curriculum development; faculty development
11.  Residents' Perceptions of Professionalism in Training and Practice: Barriers, Promoters, and Duty Hour Requirements 
BACKGROUND
The Accreditation Council for Graduate Medical Education duty hour requirements may affect residents' understanding and practice of professionalism.
OBJECTIVE
We explored residents' perceptions about the current teaching and practice of professionalism in residency and the impact of duty hour requirements.
DESIGN
Anonymous cross-sectional survey.
PARTICIPANTS
Internal medicine, neurology, and family practice residents at 3 teaching hospitals (n = 312).
MEASUREMENTS
Using Likert scales and open-ended questions, the questionnaire explored the following: residents' attitudes about the principles of professionalism, the current and their preferred methods for teaching professionalism, barriers or promoters of professionalism, and how implementation of duty hours has affected professionalism.
RESULTS
One hundred and sixty-nine residents (54%) responded. Residents rated most principles of professionalism as highly important to daily practice (91.4%, 95% confidence interval [CI] 90.0 to 92.7) and training (84.7%, 95% CI 83.0 to 86.4), but fewer rated them as highly easy to incorporate into daily practice (62.1%, 95% CI 59.9 to 64.3), particularly conflicts of interest (35.3%, 95% CI 28.0 to 42.7) and self-awareness (32.0%, 95% CI 24.9 to 39.1). Role-modeling was the teaching method most residents preferred. Barriers to practicing professionalism included time constraints, workload, and difficulties interacting with challenging patients. Promoters included role-modeling by faculty and colleagues and a culture of professionalism. Regarding duty hour limits, residents perceived less time to communicate with patients, continuity of care, and accountability toward their colleagues, but felt that limits improved professionalism by promoting resident well-being and teamwork.
CONCLUSIONS
Residents perceive challenges to incorporating professionalism into their daily practice. The duty hour implementation offers new challenges and opportunities for negotiating the principles of professionalism.
doi:10.1111/j.1525-1497.2006.00496.x
PMCID: PMC1924703  PMID: 16808778
medical education; residency; professionalism; work hours
12.  A Ten-Month Program in Curriculum Development for Medical Educators: 16 Years of Experience 
BACKGROUND
Despite increased demand for new curricula in medical education, most academic medical centers have few faculty with training in curriculum development.
OBJECTIVE
To describe and evaluate a longitudinal mentored faculty development program in curriculum development.
DESIGN
A 10-month curriculum development program operating one half-day per week of each academic year from 1987 through 2003. The program was designed to provide participants with the knowledge, attitudes, skills, and experience to design, implement, evaluate, and disseminate curricula in medical education using a 6-step model.
PARTICIPANTS
One-hundred thirty-eight faculty and fellows from Johns Hopkins and other institutions and 63 matched nonparticipants.
MEASUREMENTS
Pre- and post-surveys from participants and nonparticipants assessed skills in curriculum development, implementation, and evaluation, as well as enjoyment in curriculum development and evaluation. Participants rated program quality, educational methods, and facilitation in a post-program survey.
RESULTS
Sixty-four curricula were produced addressing gaps in undergraduate, graduate, or postgraduate medical education. At least 54 curricula (84%) were implemented. Participant self-reported skills in curricular development, implementation, and evaluation improved from baseline (p < .0001), whereas no improvement occurred in the comparison group. In multivariable analyses, participants rated their skills and enjoyment at the end of the program significantly higher than nonparticipants (all p < .05). Eighty percent of participants felt that they would use the 6-step model again, and 80% would recommend the program highly to others.
CONCLUSIONS
This model for training in curriculum development has long-term sustainability and is associated with participant satisfaction, improvement in self-rated skills, and implementation of curricula on important topics.
doi:10.1007/s11606-007-0103-x
PMCID: PMC1852913  PMID: 17443374
curriculum development; faculty development
13.  Effect of an Internet-based Curriculum on Postgraduate Education 
Journal of General Internal Medicine  2004;19(5 Pt 2):505-509.
We hypothesized that the Internet could be used to disseminate and evaluate a curriculum in ambulatory care, and that internal medicine residency program directors would value features made possible by online dissemination. An Internet-based ambulatory care curriculum was developed and marketed to internal medicine residency program directors. Utilization and knowledge outcomes were tracked by the website; opinions of program directors were measured by paper surveys. Twenty-four programs enrolled with the online curriculum. The curriculum was rated favorably by all programs, test scores on curricular content improved significantly, and program directors rated highly features made possible by an Internet-based curriculum.
doi:10.1111/j.1525-1497.2004.30097.x
PMCID: PMC1492333  PMID: 15109313
curriculum; computer-assisted instruction
14.  Online Instruction 
doi:10.1046/j.1525-1497.2002.20513.x
PMCID: PMC1495081  PMID: 12133150

Results 1-14 (14)