Evaluating the third-year curriculum: Disparities in medical education among hospital sites

1. Evaluating the third-year curriculum: Disparities in medical education among hospital sites MEC Executive Committee Meeting July 13, 2007 David Geffen School of Medicine at UCLA

2. I. INTRODUCTION • Diverse clinical training opportunities • Advantages: Increased exposure • Disadvantages: Educational differences among sites • Lecture time • Attending interaction • Resident teaching

3. I. INTRODUCTION • Study Objectives: • Assess and compare the educational experience at training sites for different subspecialties • Receive student feedback regarding ways to improve the curriculum during the third year

4. II. METHODS • Participants- 3rd and 4th Year Medical Students invited to take confidential, anonymous online survey • Online survey- 130 questions assessing individual clerkship experiences • Design- Participants given 1 week to submit survey • Statistical analyses- One-way ANOVAs and correlations using SPSS

5. III. RESULTS • Participants: 145 medical students • 66 Men, 79 Women • 117 third-year, 28 fourth-year students

6. III. RESULTS (continued) • Comparison of sites for individual clerkships • Quality • Lecture time • Attending interaction • Resident teaching • One-way ANOVA • Correlations

7. RESULTS

8. Individual Clerkship Results

9. PEDIATRICS

10. PEDIATRICS

11. PEDIATRICS

12. Pediatrics • Cedars • Excellent and enthusiastic teaching by site directors and residents • Outpt clinics less helpful • “the best rotation of the year” • Excellent (albeit very long) lectures • Kaiser students attended these as well • Good variety of experiences (clinic, inpt, nursery, specialty clinics, etc.) • Extremely well-organized

13. SURGERY

14. SURGERY

15. Inpatient Surgery • Cedars • General surgery • Minimal teaching by housestaff/attendings, no guidance • Students not allowed to write notes/orders • Good exposure to variety of surgeries • Trauma Surgery • No hands-on experience, very little “true trauma” • Some students were not allowed to write notes/orders, some were “scutted out” all day • “this should not have been a surgery rotation”

16. Inpatient Surgery (continued) • Harbor • Great teaching by housestaff and attendings • Excellent lectures and conferences (particularly the student-directed ones) • Good learning on call nights • Excellent variety of cases • Significant amount of 1:1 time with attendings • Good continuity of care via clinic activities

17. Outpatient Surgery • General comments • Great introduction to subspecialty surgeries • “I now want to go into _________” • Excellent opportunity to “create your own rotation” • Very good way to find out when to refer to different subspecialists • Good teaching “as long as you showed interest” • Not enough time spent with any given subspecialty

18. NEUROLOGY

19. NEUROLOGY

20. Neurology • General comments • 3 weeks is too short • Excellent Monday lectures • Harbor • Good teaching faculty • OVH • Too many students per team, leading to limited pt interaction • Good teaching by residents/housestaff • CHS • Stroke team sees very little other than strokes • WVA • Good teaching by residents, but little to no interaction with and teaching from attendings

21. PSYCHIATRY

22. Psychiatry • General comments • Little to no benefit of PBLs • Organized didactics would be helpful • “5 weeks is too long”

23. INTERNAL MEDICINE

24. Internal medicine • Cedars • Excellent residents and resident teaching • Less interaction with attendings • Slower service allows more teaching; good lectures • Harbor • Good 1:1 interaction w/ attendings, but residents overworked leading to minimal resident teaching • Excellent breadth of exposure • Kaiser Sunset • Excellent organized didactics and conferences • Good teaching by “friendly residents,” though some residents less interested in teaching than others

25. Internal medicine (continued) • OVH • Fantastic teaching by housestaff and attendings • Significant 1:1 time with attendings • Good patient exposure and variety • Great pt continuity 2/2 f/u clinic responsibilities • CHS • Excellent teaching by attendings, less by housestaff 2/2 time constraints • Many complicated patients, can take away from learning • WVA • Great interaction w/ attendings • Mixed response to computer system, could use “orientation” • “great patient population”

26. OB/GYN

27. OB/GYN • Cedars • Typically good exposure, but many private pts can hinder this • Poor organization, poor/minimal teaching by many “catty residents,” attendings, and “temperamental” site director • Good prep for exam by site director but lectures prep for exam much more than general OB/GYN knowledge • CHS • Good exposure to a variety of cases • Some residents unfairly abusive of students

28. OB/GYN (continued) • Harbor • Good, friendly residents and attendings; good teaching • Need for more organized didactics • Long hours, but good amount of hands-on experience • OVH • Long hrs, frequent resident-on-resident abuse, which often filtered down to students • Good didactics but often late/poorly organized

29. AMBULATORY MEDICINE

30. AMBULATORY MEDICINE

31. Ambulatory Medicine • Cedars • Great experience at LA Free Clinic w/ good breadth • Harbor • Excellent attendings; significant autonomy • Kaiser-Sunset • Great pt exposure in urgent care clinic • King-Drew • Great variety but very busy, allowing for minimal teaching

32. Ambulatory Medicine (cont’d) • OVH • Good 1:1 interaction with attendings, good teaching • Sepulveda VA • Excellent autonomy (sometimes TOO much), continuity of care, 1:1 interaction with attendings • CHS • Good interaction w/ GIM attendings, good variety • Poorly organized, specialty clinics mostly shadowing • WVA • Very mixed responses

33. RADIOLOGY

34. Radiology • Structured radiology clerkship necessary • Lecturers often do not show up • Slides should be labeled to allow for reviewing after lecture • Poor correlation between material covered by radiology lectures and radiology exam questions • “the worst part of third year”

35. IV. RESULTS SUMMARY • Educational experience varies by clinical training site • Quality of the clerkship is strongly associated with: • Amount of lecture time • Amount of attending interaction • Amount of resident teaching

36. V. RESULTS AND THE CETF • Lack of clinical teaching • Lack of exposure to health care systems • Lack of ownership

37. V. RESULTS AND THE CETF • Lack of clinical teaching • Some sites with excellent teaching and/or didactics (ie, med @ OVH, peds @ Cedars, surg @ Harbor, neuro @ CHS) • Lack of exposure to health care systems • Best experiences are at various different sites • Across the board, students enjoyed variety • Lack of ownership • Methods in place in some rotations to promote continuity of care (ie, f/u med clinic @ OVH, surg clinic @ Harbor) • Some rotations severely lacking in ownership/autonomy (ie, surg @ cedars, amb med @ CHS

38. ACKNOWLEDGEMENTS • Survey author: Liz Volkmann • Web manager: Vivian Ng • Survey contributors: Jon Marron, Wendy Liu, Kevin Koo • Statistical analysis: Liz Volkmann • Staff Collaborator: Sebastian Uijtdehaage