Back to " Meeting 2000"                                                                

Medical Students’ Ability to Self-Reflect Over Time

Michael Weissberg, M.D., Ann O’Brien Gonzales, Ph.D.

 Gwyn Barley, Ph.D.

University of Colorado School of Medicine

Denver, Colorado

Educational Goals & Objectives:

This study seeks to understand the ability of medical students to self-reflect over time regarding cultural beliefs, explanations, and self-treatments of primary care patients.  Three measures of students’ self-reflection were analyzed at the end of their third year.  Attendees will gain an understanding of which students became more competent, stayed the same, or declined in this ability over three years of medical education.

Description:

As educators, we assume that our students’ abilities to self-reflect, especially about cultural influences on themselves and on their patients, is an important attribute and one that should be encouraged.  Yet we do not know what the characteristics are of students who can self-reflect or whether this ability is a “state” or a “trait.”  Twice during our second year Human Behavior Course and once during our Psychiatry clerkship, students at the University of Colorado present and then write-up patients from a primary care practice.  As part of this exercise, we ask our students to “outline how the patient’s cultural beliefs, explanations and self-treatments have influenced the patient’s care” and how they and their primary care preceptor’s cultural beliefs have influenced the approach to the patient.  Furthermore, we suggest that students “indicate differences in culture and social status between the patient and themselves and the problems that these differences may cause in diagnosis and treatment.  Issues of religion and cultural background are appropriate here.”  We will report the characteristics of competent self-reflectors and which students improved, stayed the same, or declined in their ability to self-reflect.

RESEARCH IN MEDICAL EDUCATION

 Designing Educational Studies in Medical Education

LuAnn Wilkerson, Ed.D.

Senior Associate Dean for Medical Education

UCLA School of Medicine

Los Angeles, California

Just as clinical research allows the physician to combine patient care and scholarship, educational research offers the opportunity for the faculty member to combine teaching and scholarship.  This option is particularly important for faculty members in positions of educational leadership and for those in clinician-educator career tracks.  In this session, we will explore program evaluation as a form of disciplined inquiry¹ that draws its methods from a variety of fields. 

Too often we implement new educational approaches in our courses and clinical clerkships with little attention to the evaluation of their impact on students, faculty, patients, or other aspects of the curriculum.  Approaching this same situation as a scholar, we begin to wonder from the moment that a new program is considered how we will know what difference it has made for any number of stakeholders, such as students, patients, faculty members, and society at large.  As educational scholars, we want to know was the innovation implemented as planned?  What intended and unintended outcomes resulted from the innovation?  To what populations, settings, and situations can any identified effect be generalized? 

In asking these questions and others like them, we have expanded the purpose of our inquiry beyond the collection of data for programmatic improvement to include the generation of knowledge useful to persons in other settings.  Consider the folowing case and how you might design a study to determine its outcomes.

Case Study:  The Doctoring Curriculum

 At UCLA, a new sequence of three year-long courses was implemented in 1993 to assist students in developing the knowledge, attitudes, and skills needed to practice medicine within a biopsychosocial model of care.  Each year of the Doctoring curriculum² emphasizes ethical, legal and cultural issues embedded in a specific set of themes: 

Year 1             Communication skills, human development and behavior, culture

Year 2             Physical diagnosis skills, population medicine, health promotion

Year 3             Clinical decision making, health care economics, community health 

Course components include problem-based tutorials and a longitudinal preceptorship.  The curriculum requires a significant commitment of resources from the medical school, the departments of Medicine, Family Medicine, and Pediatrics, and physicians in the community.  As a result of increasing financial constraints, the Dean has asked the curriculum directors to evaluate the course.  In particular, he wants to know if students’ knowledge, attitudes, or skills about (a) prevention, (b) Patient-physician relationship, (c) history taking/physical examination, and (d) health economics will be different as a result of taking the courses. 

What type of study would you design to answer one or more of the Dean’s questions? 

How would you make this study of interest to a larger audience?

1.                   Shulman LS. Disciplines of inquiry in education: an overview.  In RM Jaeger (ed.), Complementary methods for research in education.  Washington, DC: American Educational Research Association, 1988.

2.                   Wilkes MS., Slavin SJ, & Usatine R. Doctoring:  A Longitudinal Generalistic Curriculum. Academic Medicine, 69: 191-193,1994.

Teaching Residents to Teach in One Easy Session

Jonathan Polan, M.D.

Cornell University – Weill Medical College

New York, New York

Objective: At the conclusion of this workshop, the participant will have acquired a method for teaching residents to teach medical students in a one-and-a-half hour session. 

Background: Residents, who are key clinical teachers of medical students, receive little or no training to be educators.  For several years, I have taught a one to one-and-a-half hour session on teaching medical students to the GY2 residents as part of their required summer didactic curriculum. 

Method: In this workshop I will briefly demonstrate my method by asking the participants to play the role of the residents.  I begin by asking the residents to recall their best and worst medical teachers and to share one anecdote about each (without identifying him or her).  This process evokes strong emotional memories and immediately convinces the group of the importance of their new role as teachers.  Often their examples of best or worst teachers are of residents, which heightens their awareness of their own potential impact on students.  As the residents tell their stories, I jot brief notes on the board in two columns, “best teacher” and “worst teacher,” accumulating a list of characteristics of each.  I then ask the group to deduce from the behaviors and qualities listed the most important attributes of the best teachers and the mistakes of the worst.  I help the residents recognize that most of the qualities of both the best and worst teachers that they themselves have identified are behaviors that they can choose to perform or avoid.  By this point in the exercise, the residents have essentially taught themselves the basics of how to teach.  I then give concrete advice on how to begin adopting new teaching behaviors, such as structuring their time with the students and giving feedback, and I provide them with a “quid pro quo,” i.e., what they can expect from the students in exchange for their teaching.  I conclude by offering myself as a resource for questions or problems that arise in their role as teachers, thus modeling the availability that I hope they will offer their students.  Residents receive a copy of the clerkship syllabus so that they can read the clerkship goals and objectives, and I have often given them the APA pamphlet on residents as teachers.  After the demonstration, the participants will discuss it and share their own methods.

Conclusion: I have the impression that this session creates high interest and motivation among the GY2s for teaching medical students.  Residents ask for more time on this topic and do call me throughout the year for advice on problems with students or to identify a particularly talented student, confirming my impression.  Ideally, this session should be followed by a midyear booster.

The “Good” Dr. Greene and the “Bad” Dr. Greene:

Using “ER” to Teach Psychotherapeutic Techniques

 to Clerkship Students

Dennis P. McNeilly, Psy.D., Steven P. Wengel, M.D.

University of Nebraska College of Medicine

Department of Psychiatry

Omaha, Nebraska

The presenters will acquaint participants with the seminar developed at the University of Nebraska Department of Psychiatry to address the challenge of teaching psychotherapy to medical students.  Participants will learn of a clerkship seminar that has stressed the practical application of psychotherapeutic techniques to difficult and/or psychiatric patients.  Specifically, the seminar incorporated clinical patient vignettes from television programs (such as “ER”) to illustrate patients who exhibited extremes of emotion and who may/may not meet full DSM-IV criteria for a personality disorder. 

Goals:

1.         To increase awareness of the advantages of using television clinical vignettes, popular to medical students (such as “ER”) to educate medical students on clerkship in psychiatry.

2.         To increase knowledge of the practical applications of psychotherapeutic techniques when teaching medical students on clerkship in psychiatry.

Objectives:  By the end of this presentation, participants will:

1.         Be aware of the authors’ experience of using clinical vignettes of popular television programs to increase medical students’ knowledge and skills of psychotherapeutic techniques when treating a difficult and/or personality disordered patient.

2.         Be able to describe the advantages and drawbacks of using clinical vignettes of popular television physicians and patients in teaching psychotherapy to medical students.

3.         Be able to identify and extract potentially useful clinical vignettes from popular television programs for inclusion into psychotherapy courses for medical students.

Method:

1)         Participants will view “ER” patients and physicians and be provided the opportunity to examine the significance of the dynamic meaning, their own countertransference, and ability to tolerate emotional interchanges with patients, and how they might be applicable to medical students’ similar experiences.

2)         Participants will also view “ER” patient vignettes in order to examine and apply Buckman’s Model for breaking bad news to patients who have recently undergone a significant loss (Buckman, 1992). 

Back to Meeting 2000 Table of Contents