Academic medicine : journal of the Association of American Medical Colleges
-
Comparative Study
The influence of teaching setting on medical students' clinical skills development: is the academic medical center the "gold standard"?
Many medical schools have revised their curricula to include longitudinal clinical training in the first and second years, placing an extra burden on academic teaching faculty and expanding the use of community-based preceptors for clinical teaching. Little is known about the impact of different learning settings on clinical skills development. ⋯ Students' early clinical skill development is not influenced by educational setting. Thus, using clinicians for early clinical training in any of these settings is appropriate.
-
How to train competent and compassionate physicians has assumed a new urgency. The authors propose that these concerns be approached by radically restructuring the medical school curriculum in ways that place facts and skills within the context of ethics and values. ⋯ Such changes are both timely and necessary. Although they will be difficult to accomplish, they offer an opportunity for medical educators to foster the development of physicians with the range attributes that this new century demands.
-
The authors report the development of a new metric for distributing university funds to support faculty efforts in education in the department of internal medicine at the University of Kansas School of Medicine. In 2003, a committee defined the educational value unit (EVU), which describes and measures the specific types of educational work done by faculty members, such as core education, clinical teaching, and administration of educational programs. The specific work profile of each faculty member was delineated. ⋯ The EVU metric resulted in a dramatic realignment of university funding for educational efforts in the department of internal medicine. The metric was easily understood, quickly implemented, and perceived to be fair by the faculty. By aligning specific salary support with faculty's educational responsibilities, a foundation was created for applying mission-based incentive programs.
-
Handoffs involve the transfer of rights, duties, and obligations from one person or team to another. In many high-precision, high-risk contexts such as a relay race or handling air traffic, handoff skills are practiced repetitively to optimize precision and anticipate errors. In medicine, wide variation exists in handoffs of hospitalized patients from one physician or team to another. ⋯ Four major barriers to effective handoffs were identified: (1) the physical setting, (2) the social setting, (3) language barriers, and 4) communication barriers. The authors conclude that irrespective of local context, precise, unambiguous, face-to-face communication is the best way to ensure effective handoffs of hospitalized patients. They also maintain that the handoff process must be standardized and that students and residents must be taught the most effective, safe, satisfying, and efficient ways to perform handoffs.