Reporting From the 2005 AAMC Annual Meeting:
November 4-9, 2005, Washington DC

Hot Topics:
Global medicine, Cultural competency, Clinician-educator tracks/rewarding faculty for teaching, Simulation labs, Professionalism, Assessment/evaluation – at all levels

See full program and presenter contact information at the AAMC Website:
http://www.aamc.org/meetings/annual/2005/programbyday/start.htm

Reports from the following sessions:

1. Practical Applications of Simulation In Medical School
2. Vision Beyond the Boundaries: Innovative Practices of Independent Academic Medical Centers
3. AAMC Focus Session, Institute for Improving Medical Education. Beyond Flexner: The Redesign of Clinical Education
4. MPH Programs in U.S. Medical Schools
5. Helping Faculty Turn Educational Activities into Scholarship
6. RIME Invited Address: Stephen Spear, Ph.D., Senior Fellow, Institute of Healthcare Improvement, Cambridge, MA.
7. Does the Recognition of Faculty Have to be a Win/Lose Proposition?
8. Mini-Workshop: The Educational Impact of Assessment – Getting Feedback Right
9. RIME Oral Abstract Presentations: Professionalism
10. OSR Loan Consolidation/Legislative Update
11. ERAS Update
12. AMCAS 101
13. Issues in Developing a National Method for Initiating Criminal Background Checks
14. Numbers, Reports, Trends: the 2005 applicant pool
15. Stereotype Threat
16. Racial Identification and Reclassification and the Impact on Academic Medicine
17. Measuring Outcomes of Pipeline Partnership Programs
18. Online Chat in Medical School Admissions
19. GIA Public Affairs Master Class – Developing Effective Messages for Difficult Issues
20. OSR/ORR Joint Plenary Session: The Cost of Creating Doctors
21. OSR Plenary Session: Evaluation of Medical Students: Use of Pass/Fail
22. OSR Breakout Session: Affecting Curricular Change
23. SACME Plenary: Research in CME
24. RIME Symposium Presentation: Best Evidence Medical Education
25. ABIM Foundation Presentation: Portfolioing Professionalism
26. GEA/GSA Session: Medical Student Competencies in Geriatrics: What and Where should the bar be?
27. GIA Public Relations and Marketing Master Class: Improving Access to Leadership
28. Careers in Medicine: Career Guidance and the Web: A Joining of Forces

Thanks to the following for contributing reports:

• Linda Heun, Ph.D.
• John R. Gimpel, DO, MEd
• Barbara M. Kriz, PhD
• Tom Levitan, MEd
• Nancy Cioffari

The speakers discussed the emerging use of mechanical simulators in their respective programs. The spectrum of simulators range from the part-task, procedural type (e.g. limb for suturing or other dexterity training), to the robotic simulators utilized for crises management and teamwork training, to the full body immersive simulators and virtual reality simulators where learners can interview the “patient,” etc. The incorporation of simulators into medical education helps to meet the following challenges and professional mandates: 1) an enhanced focus on patient safety, 2) standardization of clinical training experiences that are available “on demand,” and not dependant on which patients are available or “on the service,” 3) ethical imperative -students not “doing their first procedure on ward patients,” but becoming more familiar with the procedures in an environment that is “safe” (for the learners and the patients), 4) efficiency in a new era -can increase amount of information given in less time, 5) the changing role of the physician, including the skills necessary to work effectively in interdisciplinary teams, and, 6) providing formative feedback to learners in moving towards a culture of improvement and to improve self-directed learning. In addition, and perhaps most importantly, the use of simulators seems to add that affective component to the learning, as students feel the emotional “ups and downs” of providing the care (laughter, disappointment, etc.), which seems to be most important in their retention of the knowledge and skills, as well as for their overall development and learning. “It's not about the technology!”

While funding for high-tech simulation centers can be challenging, partnering with industry, government, etc. via the use of the simulation centers for the training of other professionals, including firefighters, paramedics, and other groups can help to provide the resources needed to operate these centers cost-effectively, and has been done on a national level (Israel) and on a regional level (Miami), among other places. Early outcomes studies are very encouraging, though further work needs to be done. Higher fidelity simulators may eventually become the standard for summative assessment at the end of residency training, for example, but it is unlikely that part-task or robotic simulators will be incorporated into high-stakes testing on a national level (i.e. National Board examinations) within the next few years.

Reported by:
John R. Gimpel, D.O., M.Ed.
Vice President for Clinical Skills Testing
National Board of Osteopathic Medical Examiners

back to top

2. Vision Beyond the Boundaries: Innovative Practices of Independent Academic Medical Centers

1. Edward T. Bope, M.D., Program Director, Family Medicine and
   Pamela J. Boyers, M.D., Director of Medical Education,
   Riverside Methodist Hospital, Columbus OH,
   Establishing a Center for Medical Education and Innovation
   
   They described the layout of this very impressive new simulation center which opened in June 2005. It focuses on graduate medical education and CME and is driven in part by the pressure for improved outcomes, a safer healthcare system and a need for more multidisciplinary education. The center comprises approximately 20,000 square feet. Some of the features are a virtual hospital area (including OR and ICU), a clinical skills area (with microvascular and laparoscopy labs, as well as conventional exam rooms), a conference space and break-out rooms interconnected by computer to other areas of the center. It is adaptable for large scale exercises such as disaster training. Many simulation models are utilized and the center is staffed by individuals with expertise in a variety of areas (surgery techs, IT specialists, etc) who have been given additional training to become medical simulation technicians. While focusing on building teamwork among the residents, technicians, house staff and attendings, the center has attracted the interest of many outside groups for CME programs, firefighter training, etc.
    
2. Carl Patow, M.D.,
   Executive Director of the HealthPartners Institute for Medical Education (IME)
   Minneapolis, MN
   

   The IME is a non-profit institute for medical education affiliated with the University of Minnesota and Regions Hospital. In response to the Institute of Medicine (IOM) report “Crossing the Quality Chasm” the IME essentially did a self-study to see how it measured up and then engaged a process of continuous quality improvement. The IOM proposed that health care should be safe, effective, patient centered, timely, efficient, and equitable. The IME re-prioritized its educational activities accordingly, focusing on clinical priorities, innovation, leadership commitment, and measurement of improvements in patient care. Some of the innovations/changes included: adoption of ten “principles for patients first”; development of a faculty/resident handbook that promoted a transparent and honest relationship between faculty members, residents, and patients and that emphasized patient safety, efficient care, and professionalism; developing faculty mini-contracts based on time spent in teaching; increased use of simulations for teaching of both technical and interview skills; frequent dissemination of useful reviews of literature, clinical “pearls,” etc, and selection of CME programs based on the new priorities.

Reported by:
Barbara M. Kriz, Ph.D.
Associate Dean for Preclinical Education and Research
Touro University College of Osteopathic Medicine

back to top

3. AAMC Focus Session, Institute for Improving Medical Education. Beyond Flexner: The Redesign of Clinical Education

The focus in medical training has turned from predominantly inpatient settings to more ambulatory and rural centers. This session looked at two programs that have innovative approaches to providing clerkship training in these settings.

1. Speaker: David J. Steele, Ph.D., Director,
   Office of Medical Education,
   Florida State University College of Medicine
   Tallahassee, FL
   
   

   Students do their first 2 years at the main campus in Tallahassee. The curriculum is clinically rich and intensive. In years 3 and 4 the students are placed throughout Florida.

   Experienced community based physicians, rather than residents, provide most of the training. Year 3 is over 70% ambulatory, includes a standard clerkship core, but also includes a 3-week community medicine rotation which takes place in settings such as health departments, homeless shelters, crisis centers, etc. A longitudinal doctoring course takes place throughout the entire year. It entails one day per week, with half the day consisting of didactic material covering identical objectives at all training sites and the other half day consisting of a longitudinal clinic where chronically ill patients are seen. There is a formative OSCE mid-way through year 3 and a summative OSCE at the end of year 3. Year 4 focuses more on critically ill patients, and advanced rotations in FM, IM, geriatrics, others, and electives. More time is spent in the hospital. Students log all encounters on a PDA; this helps to verify compliance with the LCME requirement that experiences be comparable across different sites. The major challenges have been identification, selection, and credentialing of faculty. A lot of faculty development is required.
2. speakers: David A. Hirsh, M.D., Instructor, and Barbara Ogur, M.D., Director of Program
   Harvard Medical School
   Harvard-Cambridge Integrated Clerkship Pilot:
   
   Third year traditional clerkship curriculum replaced with a “continuity of care” curriculum. Eight students are enrolled in the pilot program, which is in its second year. Students are organized into teams and each team has a cohort of patients, selected by the faculty (with patient consent) so that they represent a spectrum of patients across disciplines and specialties, likely to allow students to meet desired learning objectives. The students follow the patients longitudinally through all phases of diagnosis and treatment, all services, through any hospitalizations, and including follow-up after discharge. Cases are assigned in an order that is likely to provide an ascending level of academic and patient care challenge. If a student is with one patient and another of that student's patients has a return visit, there is a “triage” system to determine which patient the student should see and which should be assigned to another member of the student team. The program is intended to emphasize whole patient care, and to promote ideals of professionalism and connection with patients. Compared with students not in the program, these students do report an increased feeling of connection with their patients, greater self-awareness, and a greater responsibility for their own learning. Students on the program also perform slightly better on NBME shelf exams and retain the information longer, suggesting there are no major gaps in content knowledge. Fourth year apparently follows a more traditional model and also involves more teaching by residents.

Reported by:
Barbara M. Kriz, Ph.D.
Associate Dean for Preclinical Education and Research
Touro University College of Osteopathic Medicine

back to top

4. MPH Programs in U.S. Medical Schools

Moderator: Rika Maeshiro, M.D., M.P.H., Assistant Vice President, Division of Medical Education, AAMC

1. Laura Rasar King, MPH, Executive Director,
   Council on Education for Public Health (CEPH)
   

   Ms. King gave an overview of the difference between programs and schools of public health, as well as of the functions and operations of CEPH. There are currently 37 accredited schools and 64 accredited programs in public health, with another 14 or so in the application phase. Over 50% of the programs are in a school of medicine. A school of public health must offer the MPH in all 5 core fields, the Dr. P.H. in at least 3 fields, and have a minimum faculty of around 25 FTE (this is not an absolute number, but is considered fairly close). Also, a school must be at the highest level of independence, comparable to other such units, within the university or college, and it must have a dean.

   A program in public health, on the other hand, may offer either a generalist MPH or an MPH in any one or more specializations. A Dr.P.H. may, but does not need to be offered. A program exists within another academic unit of the college or university, and the program director reports to the dean of that unit.

   Schools of public health are eligible for some cooperative agreements and grant opportunities with the CDC and HRSA, as well as other benefits that are not available to programs. This comes about through membership in the national association for schools of public health.

   Both schools and programs have the same basic curricular requirements for the MPH (5 core courses, minimum of 42 units of coursework overall) as well as research and community service requirements.

2. Sally Sutphen, M.Sc., M.P.H., Coordinator,
   Preventive Medicine Program,
   SUNY Upstate Medical University,
   Syracuse, NY
   

   Considerations on starting an MPH program. First and foremost, it is very important to have the support of institutional leaders.

   Questions to ask: Will this be a stand alone degree? Will it be made available to faculty and staff or just to health professions students? If it is a dual degree program, credit can be shared across programs. For example, epidemiology is a course that might be taught to both health professions (M.D. or other) and M.P.H. students. It is important that the content satisfy the requirements of the MPH program in order to be accepted by CEPH, however; for example, an undergraduate epidemiology course will not suffice.

   Will the program be free-standing or within an existing school? If the former, start-up is more expensive and intra-university collaborations may be hampered. On the other hand, research awards are kept within the department and expectations of faculty are clear. If the program is in an existing department or school, there may already be some faculty and policies in place. It is important, however, that the program have some autonomy and faculty dedicated to the program, including its research and service components. There is a potential negative of competing “masters” and expectations.

   If there are existing courses, do they fit with the MPH goals and programmatic timing? Is there a need to alternate evening and daytime courses, for example, in alternate years, so that everyone who is interested has access to the necessary courses?

   Expenses and other considerations: faculty, classrooms, practicum (which must be off-site), practicum coordinator; research opportunities for students and mentors; start-up; indirect costs.

   Revenues sources and other considerations: outside funding, gifts, tuition: how much is kept within the program? Is MPH revenue proportional to the number of students enrolled? How are indirect costs from grants recovered? Do dual degree students pay? (Students in existing programs pay anywhere from 0% to 100%.) Do faculty who want to obtain the degree pay? Should an MPH program be self-supporting?

   How many tracks should be offered? Each additional concentration requires at least 3 FTE. Offering more tracks may attract more students.
3. Laura Schweitzer, Ph.D., Vice Dean,
   College of Medicine,
   SUNY Upstate Medical University,
   Syracuse, NY
   

   Why would institutional leaders support the creation of an MPH program?

   Students: joint programs are attractive to students who care about the interplay between individual and community health;

   Public mission: this is a way to pay back to the community and to train future leaders; serve the underserved and high risk populations.

   Research agenda: MPH programs, with their strength in epidemiology and biostatistics, and their requirement to be engaged in research, help to infuse the spirit of scholarship and scientific inquiry throughout the institution;

   Cutting edge health care: areas such as preventive medicine, bioterrorism, informatics, infectious disease, electronic medical records are all domains that are grounded, in part, in public health.

   Enhanced teaching programs: in fields such as epidemiology, biostatistics, environmental health, genetics, policy and planning, research design. Promotion of life-long learning. Also, ACGME requires that medical students receive training in basic public health areas.

   Increased funding: tuition can be lucrative; there are grants available (although some are limited to schools as opposed to programs of public health).

4. Alice LeBlanc, M.P.H., Dean of Students,
   LSU Health Science Center
   

   Ms. LeBlanc shared the experience of going through CEPH accreditation as a program and then as a school, all within an unusually short time. They were only able to do this because they already had many faculty and many grants (primarily because LSU handles much of the public health activities that are normally done by a state department of public health). LSU had phenomenal support from the chancellor and is in a state that ranks at the bottom in terms of community health education; thus there was a tremendous need.

   So, LSU is not a typical example. However, good advice included: ask for what you need (from the administration) up front – it is harder to get more later!

Some other tips, from the Q&A that followed this session:

If you are opening the MPH to med students, require them to complete at least some courses (maybe 12 units) before accepting them into the program. They may be very enthusiastic at first, but not be able to sustain the effort of doing two programs simultaneously.

There are a variety of plans for dual degree (MD/MPH or DO/MPH) programs:

4 years, with MPH done at night; 4 + 1 years, with MPH done between two of the MD or DO years; 5 years, with capstone done at the end, etc. Most of the programs are small (over 20 students would be a very large program) and attrition is fairly high.

Credit sharing is permitted and there is no hard and fast limit on the number of units. However, the Executive Director of CEPH stated that 12 units is probably the upper limit of what is actually feasible, and 9 is getting close. It is most important to demonstrate that the competencies are being met for both programs.

Reported by:
Barbara M. Kriz, Ph.D.
Associate Dean for Preclinical Education and Research
Touro University College of Osteopathic Medicine

back to top

5. Helping Faculty Turn Educational Activities into Scholarship

Moderator : Janet P. Hafler, Ed.D., M.Ed., Associate Director, Faculty Development,
Harvard Medical School;
Presenters:
Ruth-Marie E. Fincher, M.D., Vice-Dean for Academic Affairs,
Medical College of Georgia;
Frederick H. Lovejoy II, M.D., Program Director for Residency Training,
Children's Hospital/Boston University Medical Center Program;
Jeff Morzinski, Ph.D., Director,
Medical College of Wisconsin

Considerations for the discussion: What is scholarship? What evidence can faculty list and how can it be evaluated? What resources might be available to a faculty member on campus and what needs to be developed? What can dept chairs do to help faculty?

What is scholarship? It is a reasoned, reflective process, a method to acquire new knowledge from a specific activity, and the knowledge needs to be communicated to others. Scholarship must be public, susceptible to review and evaluation, and accessible for exchange and use by others.

There are levels of progression. Educational activity…to scholarly activity…to scholarship of the activity. An incomplete list of the educational activities in which faculty may be engaged includes: curriculum development; teaching; assessment; mentoring; administration. Any of these can be turned into scholarship.

Example:

Educational Activities – can be listed: what we do, when, how much, etc.

Scholarly Approach – collecting data to measure how we are doing, in order to improve what we do.

Scholarship – sharing findings of our improved method, locally or broader. (Note: how widely something has to be disseminated/published seems to be of varying importance depending on the institution; this group was more strongly in favor of traditional peer review and publication criteria– a group presenting at a later seminar was not so strict about this).

Role of chair/mentor: to encourage faculty: ask them what in their educational activities are they really passionate about? What studies could be done to improve that work further? Guide them toward the best mentors or reviewers of those studies to help move the work along.

What could be listed as evidence of scholarship?

• AAMC's new MedEdPortal is a mechanism for peer review, paralleling that for traditional research
• Abstracts at meetings, locally or more widely – there has to be a measurable outcome that can be shared; shows that the work endures
• Peer-reviewed papers
• Invited presentations
• Workshops, seminars

Volume and quality of work is important – it shows consistency

How can evidence of educational scholarship be evaluated: portfolios – include all activities and all evidence of scholarship.

All work is better if it is peer-reviewed – a syllabus, a case presentation, etc.

What can department chairs and deans do to support the faculty:

1. Enhance the status of education - value it as you do clinical productivity and traditional research; set clear expectations; set an example; use outside forces (LCME, accreditation bodies) effectively
2. Enhance the process of promotion; set expectations; enhance the importance of education; institute regular (annual) evaluations, with feedback and remediation; RP committees need to value education
3. Allocate financial resources for education and faculty development
4. Build infrastructure: educators can't work in isolation; bring in medical education specialists; bring groups together for discussions and encourage them to be self-critical; hold educational retreats; encourage critical analysis of each others' work before it is released for publication; assemble mentor groups
5. Empower faculty; advocate for them; put them in touch with others who can help them

Reported by:
Barbara M. Kriz, Ph.D.
Associate Dean for Preclinical Education and Research
Touro University College of Osteopathic Medicine

back to top

6. RIME Invited Address: Stephen Spear, Ph.D.,
Senior Fellow, Institute of Healthcare Improvement,
Cambridge, MA.

Dr. Spear is an economist who spoke about the lessons that can be learned from successful corporations, most notably Toyota and Alcoa, and applied to the healthcare system. In fact these lessons can be applied to any organization, large or small. The lessons can be summarized in 4 points:

1. Design the work to reveal problems;
2. Contain and solve problems immediately;
3. Share the knowledge; stress collaborative problem solving;
4. Develop in others the capability (organizational culture) to maintain this process: design, improvement, knowledge sharing.

There must be top-down and down-up sharing simultaneously.

Successful organizations are excited, even energized, by having problems, so they can solve them, and they are never satisfied that the work is done.

Reported by:
Barbara M. Kriz, Ph.D.
Associate Dean for Preclinical Education and Research
Touro University College of Osteopathic Medicine

back to top

7. Does the Recognition of Faculty Have to be a Win/Lose Proposition?

Moderator: Nancy S. Searle, Ed.D. Director,
Baylor College of Medicine;
Discussant: C. Darrell Jennings, M.D., Associate Dean for Academic Affairs,
University of Kentucky College of Medicine,
Lexington, KY.

What are the assumptions underlying rewards for educational efforts and do they work positively or negatively: rewards may include money, publications, awards, increased leadership positions (advancement), greater popularity, and others.

University of Kentucky: teaching was under-rewarded; definitely third on the list after traditional (bench top or clinical research and patient care). This was, in part, because they found it difficult to quantitate (relate in the usual way to dollars brought in) or evaluate the quality of the teaching effort. They found that excellent teachers were leaving if they were not promoted. Research was always valued more, although it was never said publicly. Clinical income was a major funding source for the university. The fact that the percentage of available grants designated for education is low and the amounts available are low was a problem. There was increasing load and pressure on the teachers, without the usual rewards.

In response, the university developed the Master Educator Program, began to acknowledge educational excellence, and developed fixed benchmarks against which the faculty were measured. Awards are given (not monetary, but public acknowledgment, including both personal certificates and permanent institutional plaques; money does not seem to be the major factor of importance to the faculty in this regard). These awards are used by the RP committee, although informally. There are no limits on the number of times a faculty can win the award. This system does not replace student awards. They feel that the program has elevated the importance of excellent teaching and morale among the faculty.

Baylor has developed a Faculty Excellence Award program, in response to a similar set of challenges. Faculty assemble a mini-portfolio, according to published guidelines. A mentor to guide them in the development of this portfolio is very helpful, and Baylor has built a strong faculty development program, which includes providing examples of excellent portfolios on-line.

The university uses an NIH-like study section to review the portfolios. Award recipients are given a three-year membership in an Academy of Medical Education, which provides various additional programs, opportunities, and benefits.

Reported by:
Barbara M. Kriz, Ph.D.
Associate Dean for Preclinical Education and Research
Touro University College of Osteopathic Medicine

back to top

8. Mini-Workshop: The Educational Impact of Assessment – Getting Feedback Right

Organizer: Julian Archer, MBChB,
National Foundation Assessment Project, Sheffield, UK;
Faculty: Helena Davies, MBChB, M.D., Consultant in Medical Education,
Sheffield Children's Hospital;
John J. Norcini, Ph.D., President and CEO,
FAIMER, Philadelphia, PA;
Dame Lesley Southgate, DBe, DSc.,
St. George's Hospital Medical School, London, UK.

Download the slides for this presentation, as well as a handout which includes forms used for the case-based discussion assessment tool and examples of student feedback
PDF File: Assessment Getting Feedback Right (627k, 16 pages)

This mini-workshop focused on a program that has been instituted in the UK as a response to a need to help doctors develop and improve their levels of professionalism. All graduates go into a 2 year program in which they are assessed by a number of techniques, all of which allow for feedback – a CQI approach intended to help everyone improve (as well as to identify those doctors in particular difficulty). The case-based discussion tool and peer assessment tool were the focus of this workshop.

Workshop attendees reviewed a number of cases of feedback being given to both good performers and to physicians in difficulty as well as the evaluation forms that are used. One of the assessment tools used in the program involves residents submitting several cases for potential review by the preceptor. A preceptor will have regular meetings with the resident; at each meeting the preceptor chooses one of the submitted cases and reviews it with the resident. We viewed a videotape of a young resident who had submitted a case involving suspected child abuse, her concerns about whether she had handled it correctly, etc. We critiqued the feedback that was given by the preceptor: was it too gentle? too harsh? accurate? sufficiently in depth? etc.

Notes by Linda Heun, PhD:

-presenters commented that, while there was research on the impact of feedback on problem learners, there were no studies on ‘good students trying to get better'

-Following suggestions for communicating negative feedback were offered: 1) give the learner something specific in writing to take away-bad news, as at the doctor's office, usually means poor listening/remembering, 2) Sequence your feedback from praise, negative feedback that many, including the student if possible, agree on, then other negative feedback, 3) cluster like things as a first step to avoid overloading the learner with many pieces of negative feedback, and 4) Preview the news with comment such as, “the news today is not good and I'm here to help you work through the issues.

Reported by:
Barbara M. Kriz, Ph.D.
Associate Dean for Preclinical Education and Research
Touro University College of Osteopathic Medicine

back to top

9. RIME Oral Abstract Presentations: Professionalism

Moderator: Peggy J. Wagner, Ph.D., Director, Clinical Skills Center, Medical College of Georgia School of Medicine, Augusta, GA

1. Peer, Self, and Preceptor Evaluation of Student Professionalism in a Well Physician Course
   Speaker: Peter H. Harasym, Ph.D.,
   University of Calgary, Calgary, AB
   

   They tested the reliability of a 360° evaluation (self, peer, preceptor) in a Well Physician course. Used a questionnaire with 27 items covering various aspects of ability, professionalism, personal well-being etc. Participation was voluntary.

   Self-evaluation was most stringent, peer most lenient. Statistical analysis showed good reliability. They did identify one or two participants with some problem areas.

   Next step is to see if the result is stable. Will test in clerkships, using peers, preceptors, other members of health care team.
2. What You See is What You Do: Students Witnessing Professional Behavior in the Operating Room.
   Speaker: Saundra E. Curry, M.D.,
   Columbia University College of Physicians and Surgeons, New York, NY
   

   Students were asked to observe behavior in the OR and categorize it as “good” or “bad” – used a coding system (ref: Ginsburg). They documented the category of who was interacting (e.g., attending, resident, student), and with whom (each other, patients), but without names. This was on an anesthesiology rotation. In interactions within the health care team, residents had more good than bad (including with each other); anesthesiologists more good than bad, attendings more bad than good (including with each other), surgeons more bad than good. With patients everyone had more good than bad interactions.

   The “bad” interactions were especially in the areas of communication and respect among health care professionals. Both of these areas were “good,” in relation to patients, however. Seventy-five percent of the bad interactions were initiated by attending physicians.

   Question: are the juniors (i.e., the residents) at risk for mimicking the behavior of their attendings? No data yet, but some early observations suggest this is the case.
3. Medical Student Professionalism: Are We Measuring the Right Behaviors?
   Speaker: Michael A. Ainsworth, M.D., Associate Dean for Regional Medical Education
   University of Texas Medical Branch School of Medicine, Galveston, TX
   

   Issues: it is a challenge to define professionalism; peers and teachers are sometimes reluctant to report unprofessional behavior; some do not believe that professionalism can be taught. What are early signs of unprofessional behavior: failure to fill out course evaluations? failure to report immunizations data? There is evidence (Papadakis, et al) that early unprofessional behaviors can predict future problems, e.g., reports to medical licensure boards).

   This university implemented the Early Concern Note Project, which documented 3 categories of behaviors. Records were kept separate from the academic records of the students. Categories were: integrity/professional responsibility; pursuit of excellence/insight into own limitations; and personal interactions. Five years of data (disciplinary reports) on students were compared with state data on categories under which physicians received citations. Results:

   In the integrity/professionalism category, 75% of notes on students were for behaviors such as failure to turn in course evaluations, abuses of privilege, attendance, and substance abuse. This compared with 79% of physician citations for behaviors such as failure to maintain records, failure to maintain CME requirements, abuse of physician privileges, and substance abuse.

   In the pursuit of excellence/awareness of limitations category: 6% of the student notes were examples of students' lack of awareness of their own inadequacies or for seeking to achieve only minimum standards. In this category, notes on physicians were for deviation from standard of care or for over-prescribing.

   In the category of personal interactions: 16% of notes on students were for arrogance, abusive behavior, or other examples of poor group interaction. Notes on doctors were for the same types of behaviors.

   Conclusion: there are common themes between the two groups.

   Remediation for students: Some had favorable reactions to confrontation and being held accountable, if it was done in a supportive manner; others learned to adapt without really changing. Access to counseling was provided for those with substance abuse.

   How concerns were collected: confidentially, by paper or email. Concerns were collected in one office. They could be submitted by anyone – students, staff, faculty. No mandatory penalties. Student would be called to a conference, typically, if there were 2-3 reports, but it could occur with just one if the concern was deemed to be sufficiently serious.

4. Does Gender Affect Professionalism Ratings?
   Speaker: Anita Navarro, M.Ed., Director, Curriculum Office,
   Virginia Commonwealth University School of Medicine, Richmond, VA
   

   Eight items categorized as indicative of professionalism were rated for several clerkships. There was internal validity, but considerable variability across clerkships. Females received higher professionalism evaluations than males overall, but the differences were not dramatic. Most significant differences were in ob/gyn and pediatrics.

5. Outstanding Professionalism and the Opposite: The Resident View.
   Speaker: Kimberly S. Ephgrave, M.D., Associate Dean for Student Affairs and Curriculum,
   University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA
   

   Residents rated faculty members, using a 20 question instrument, that covered the following categories: altruism, honor and integrity, caring/compassion/communication, respect for others, responsibility, and accountability. The ratings utilized a 7 point scale, with 7 being best. There was great variability in the result. However, overall, most faculty, and certainly the best faculty, were: well prepared for clinical responsibilities, interacted well with patients, answered questions, listened well, and showed respect to all. Their best characteristics were being prepared and putting patients first.

   Faculty overall were not as good at asking for assistance or being aware of their own limitations. The worst characteristics were not being tactful, not listening, not being aware of limitations, not giving credit or inspiring trust.

Reported by:
Barbara M. Kriz, Ph.D.
Associate Dean for Preclinical Education and Research
Touro University College of Osteopathic Medicine

back to top

10. OSR Loan Consolidation/Legislative Update

Julie Fresne, AAMC office of student financial aid and
David Moore, AAMC office of government relations.

This session summarized the current situation in congress regarding funding for student financial aid in general and medical school in particular. AAMC staff have reached much the same conclusion as AACOM staff – that there are likely to be significant difficulties caused by proposed changes to the federal budget to meet the special needs of disaster relief, the potential flu epidemic, the war, and tax cuts. Relative to loan consolidation and fixed vs. variable rates, the AAMC has not taken a position on the House or Senate versions proposed in Reauthorization at this time due to the unpredictability of interest rates.

Reported by:
Tom Levitan, M.Ed.
VP for Research and Application Services
American Association of Colleges of Osteopathic Medicine (AACOM)

back to top

11. ERAS Update

Lanny Close, MD, Columbia College of Physicians and Surgeons and B. Renee Overton, AAMC

Presenters reviewed current and historical data on placement in post-graduate medical education. AAMC has the ability to provide extensive data to its colleges showing what happens to students based on a comprehensive system of data collection. Specific data are available in a publication from AAMC.

Reported by:
Tom Levitan, M.Ed.
VP for Research and Application Services
American Association of Colleges of Osteopathic Medicine (AACOM)

back to top

12. AMCAS 101

Stephen Fitzpatrick, Kelly Begatto, Kate Peske, and Michelle Sparacino, AAMC

The presentation was a comprehensive overview of the AMCAS process for both candidates and for colleges. Such an overview might be useful for our meeting to provide more information to admissions staff as well as faculty members and deans who serve on admissions committees. Especially interesting was an explanation of the investigations process when discrepancies are identified between student provided information and information from other sources.

Reported by:
Tom Levitan, M.Ed.
VP for Research and Application Services
American Association of Colleges of Osteopathic Medicine (AACOM)

back to top

13. Issues in Developing a National Method for Initiating Criminal Background Checks

Presentors included deans of student affairs and admissions and faculty members from four medical schools

Each of the presenters reviewed her/his institution's approach to criminal background checks. Some are being more proactive that others. Even those institutions that have initiated the process on their own seemed interested in a process to be developed and implemented by AAMC that would initiate the check on the student's first acceptance to medical school producing a background check that would be acceptable to any/all medical schools that might accept the student. Areas for work to bring such a product to completion center mainly around standardizing the information to be included in the background check so that even the most stringent state requirements will be met. There were good ideas for AACOMAS to consider as we move forward on a background check

Reported by:
Tom Levitan, M.Ed.
VP for Research and Application Services
American Association of Colleges of Osteopathic Medicine (AACOM)

back to top

14. Numbers, Reports, Trends: the 2005 applicant pool

Gwen Garrison and other AAMC research staff

The presenter linked applicant data from the AMCAS data base to other data available about the population of students graduating from undergraduate colleges to demonstrate new pools of students who might be courted for medical school admission. Many admissions staff members actually challenged the premise of the presentation, that medical schools should be recruiting more actively among biological sciences graduates, suggesting that this cohort was in this major specifically to apply to medical school and that the colleges would do better to recruit in other areas where students are not necessarily thinking about medical school. This approach is similar to the one being taken by AACOM research staff – more intensive mining of the applicant data base to identify trends to guide medical school recruiting

Reported by:
Tom Levitan, M.Ed.
VP for Research and Application Services
American Association of Colleges of Osteopathic Medicine (AACOM)

back to top

15. Stereotype Threat

Joshua Aronson, NYU and Ellen Julian, AAMC

Aronson discussed the Stereotype Threat theory first advanced by Claude Steele, Stanford psychologist. The gist of stereotype threat is that because it is “common knowledge” that Black and Latino students score poorly on standardized tests, they will score poorly. They will meet the expectation and live out the stereotype. Steele and Aronson have empirically proved the theory through various experiments although there is still much discussion about its truth. The concept is certainly one that should be presented to medical school admissions committee that will have to decide for themselves whether it should influence their decisions.

Reported by:
Tom Levitan, M.Ed.
VP for Research and Application Services
American Association of Colleges of Osteopathic Medicine (AACOM)

back to top

16. Racial Identification and Reclassification and the Impact on Academic Medicine

Bruce Ballard, Weill School of Medicine, Marilyn Becker, University of Minnesota Medical School, Laura Castillo-Page and Gwen Garrison, AAMC

What started as an overview of changes in the federally mandated system for identifying the categories for identifying student race and ethnicity turned into a free-form opportunity to discuss the various reasons that medical education has for not attracting minority students. Many of the participants were minority program officers and identified issues with the absence of minority group members in medicine to serve as role models, the stereotyping by admissions committee members and students themselves, the lack of knowledge by pre-health professions advisors and questions about the meaningful commitment of deans to minority enrollment.

Reported by:
Tom Levitan, M.Ed.
VP for Research and Application Services
American Association of Colleges of Osteopathic Medicine (AACOM)

back to top

17. Measuring Outcomes of Pipeline Partnership Programs

Ella Cleveland and Laura Castillo-Page, AAMC

A problem with this session is that few of the pipeline programs collect data in a systematic way to allow the measurement of outcomes. We need to be looking more at what we might do, if only we knew what went on.

Reported by:
Tom Levitan, M.Ed.
VP for Research and Application Services
American Association of Colleges of Osteopathic Medicine (AACOM)

back to top

18. Online Chat in Medical School Admissions

Robert Ruiz and Daniel Remick, University of Michigan SOM, John Schriner and Jill Harman, Ohio University COM

Two major medical schools described their approaches to using online chat and discussion forum tools to improve the yield of admitted students in the admissions process. For these two colleges the results are quite positive and very cost effective

Reported by:
Tom Levitan, M.Ed.
VP for Research and Application Services
American Association of Colleges of Osteopathic Medicine (AACOM)

back to top

19. GIA Public Affairs Master Class – Developing Effective Messages for Difficult Issues

Lea Thompson, Health Issues Reporter from Dateline / NBC News, and Cindy DiBiasi from CD-Communications

Numerous tips for schools and hospitals who are interviewed by reporters about happy or unfortunate stories at their institutions or who offer stories for publication were provided. Simple and direct language, honesty backed by facts, communicating feelings and showing compassion were key. Interestingly, a test performed by a UCLA professor narrowed messages down to three components: content – 7%; voice tone – 38%; and body language – 55%. They suggest not to go off the record or to say "no comment" in interviews as these comments can be taken misinterpreted and taken out of context. As a sideline, only 1 in 1,000 stories presented to Dateline are accepted.

Reported by:
Nancy Cioffari
Vice President for Finance & Administration
American Association of Colleges of Osteopathic Medicine

back to top

20. OSR/ORR Joint Plenary Session: The Cost of Creating Doctors

Moderator: Deborah Powell, MD Panelists: Michael Weitekamp, MD, MHA, Kenneth Simons, MD

Powell opened with the statement that medical school tuition is greatly increasing because funding is declining and not under the school's control. The increases are well out of proportion to expected physician future income, meaning that soon people will not be able to sustain loan payback

Weitekamp provided input from the perspective of a Chief Medical Officer

• Acknowledge that we have to subsidize the medical education program
• Managed care is a fact of life and here to stay
• Payments will be tied to performance, probably in 5 years
• Information is becoming strategic (internet is bringing democratization)
• 80/20 rule: 20% account for 80% of cost
• Will need new management techniques focusing on chronic care
• Workforce concerns focus on the lack of nurses; docs will be shifted around
• Cost drives the debate
• Physician salaries aren't what drives health care costs-if docs worked for free, it would only lower costs by 15%
• We function in a global economy
• Must focus on how we will pay for long term care??

Simons provided input from the perspective of a dean and quoted Aldous Huxley: “Facts don't cease to exist because they're ignored”

• In cost accounting it is difficult to assign incremental costs
• We have to balance present versus future needs in resource allocation
• Difficult to match resources with goals
• Must work in multi-year business cycles
• Resident generation of $$ is almost a wash considering supervision time

Reported by:
Linda Heun, Ph.D. <meded@aacom.org>
Vice President for Medical Education
American Association of Colleges of Osteopathic Medicine

back to top

21. OSR Plenary Session: Evaluation of Medical Students: Use of Pass/Fail

Presenters: Joseph Fantone, Joseph Gonnella, and Donald Melnik

Fantone addressed the question, is pass/fail good for the practice of medicine

-reported that the University of Michigan moved from traditional grading to P/F for years 1 and 2; and H(honors), HP(high pass),P(pass),F(fail) for years3and 4

for the following reasons: promote collaborative learning, accommodate students with diverse educational background and encourage self-directed learning

• Four-tier system for years ¾ was used to identify top students for competitive residency programs and provide external motivation to study.
• Under new system student performance very good; USMLE well above mean; students matched and performed well
• Student outcomes: M1 students happy; M2-4-decreased attention to clinical skills and social/behavioral science; difficult transition to independent learning of year 3; and increased perceptions of subjective grading in clinical years
• 2003-the UofM wanted to more students toward professional maturity; create conducive learning environment; look at links between assessment and motivation
• want students to internalize and integrate learning and move toward intrinsic motivation for learning
  • Research indicates that positive performance feedback, choice and autonomy enhance intrinsic motivation; while, competition and external rewards diminish it
  • 4-level pros are 1) it identifies top students and 2) strong motivation to study;
  • 4-level cons are 1) emphasizes grades over learning and 2) dependency on faculty, 3) individual over team work and 4) negative impact on learning environment
• Residency Directors want (ranked) M3 grades, boards step 1; Mr grads, letters of recommendation

Current Assessment: Years 1 and 2 are PF with no ranking. We are preserving and adding rigor to 3 4-level; and mentoring students to demonstrate in personal areas of excellence(e.g research, clinical skills)

Outcomes: faculty control freaks don't like it.

Gonnella stressed that faculty want numbers; yet they say they want to foster learning and asked ‘why the hypocrisy'? Answer: They don't want to spend the time to know students-greatest contribution is mentoring and figuring out how to measure professionalism - need to get to know students on daily basis and provide information; you reduce student stress by explaining the value of the information you collect

-Evaluation is an essential obligation of faculty-need to measure achievement; some students need help and early help is better - so faculty can't only focus on end results (i.e. Boards)

-Educational resource can be allocated on a fair based when we define the degree of academic achievement on a numeric grading system

-He felt bad when he retired because school moved to P/F; so he collected data on students -formed deciles of students to answer research questions about what predicted learning and found

-Year 1 is predictive of year 2; also predictive of year 3; also predictive of clerkships; also of class rank; also Step 1 and Step 2; also Step 3

- If we go to P/F, we lose data. We must help students deal specifically with their weaknesses; call them all pass is unfair to students, especially at the prices we charge them. Note that first year grades also predict failure in Step 1!!! How do you know which students need to study and which don't; it's unprofessional not to tell the truth; ; also predicts late graduation; dismissal; also predict knowledge and interpersonal skills/attitudes- where did we get the position that knowledge is inversely related to IPC skills? There is no proof!

-Effective grading provides valuable information that should be used for mentoring.

Conclusions:

Further, data refutes suggestion that basic sciences are not relevant to later clinical performance; no support for suggestions that grades lead to stress. Lack of information leads to stress

Melnick

• focused on score reporting for external exams, not med school score reporting
• Since 1915, use quantitative measures; trying to assess excellence; dialogue of p/f isn't new - at each juncture, numerical scores retained!
• USMLE 1992; new comprehensive exam; minimum competency for licensure; partnership with state licensing; new dialogue about score reporting
• student orgs (students are not of one mind) AMA supported p/f; deans split, Council of Academic Society strongly against

Favor arguments: USMLE designated for licensure; not useful predictors of clinical form; resident directors misuse scores

Counter: predicts performance on specialty exams; scores reasonably precision

Measurement Considerations: validity, reliability, results (consequences)

Validity: if scores not stable, wouldn't report them-they are

Skill tests scores aren't that precise-still collecting data – when we have data about stability, we may report (Step 2 Committee)

Do scores have utility? There is a relationship between scores and clinical performance Tamblyn 1998, 2002: conclusion clinical practice practices - looked at symptom-relief prescriptions versus disease-specific in inappropriate prescribing ( Quebec licensing exam)

Melnick conclusions: scores are meaningful and useful

How are score used?

• Students: score reporting is stimulus to study (trying to include all relevant competencies)
• Schools/faculty - teach to the test
• Residency directors misuse scores; little evidence of this (the plural of anecdote isn't data); what would they use in the absence of grades?
• -Will be discussed again and again. Individual Preference would be a grading system that only included pass; “I don't enjoy my 360 review (uncomfortable, but helpful data - better than saying 'you're still employed")

Reported by:
Linda Heun, Ph.D. <meded@aacom.org>
Vice President for Medical Education
American Association of Colleges of Osteopathic Medicine

back to top

22. Breakout Session: Affecting Curricular Change

Faculty Perspective: Jess Mandel; Student Perspective: Danielle Waldrop

Download the handout for this presentation, which includes notes
PDF File: Curricular Change – Faculty Perspective (158k, 6 pages)

Final Missing slides on Faculty Perspective below:

Reported by:
Linda Heun, Ph.D. <meded@aacom.org>
Vice President for Medical Education
American Association of Colleges of Osteopathic Medicine

back to top

23. SACME Plenary: Research in CME

The following CME research questions emerges from CME directors review of the Institute for the Improvement of Medical Education Report regarding using principles of adult learning (see http://www.aamc.org/meded/iime/about.htm for information about report).

1. How do you measure self-directed learning?
2. Can self-directed learning be taught or do you have to be born with it?
3. If we can teach self-directed learning, how can we support it across the continuum?
4. How can schools partner to encourage the application of adult learning principles across the continuum?
5. How do we coordinate across the continuum by themes (e.g. professionalism)?
6. To what extent should/is CME self-directed?
7. What competencies are appropriate for each level of medical education UME, GME, and CME?
8. What other organizational frameworks can be used to coordinate education across the continuum?

Reported by:
Linda Heun, Ph.D. <meded@aacom.org>
Vice President for Medical Education
American Association of Colleges of Osteopathic Medicine

back to top

24. RIME Symposium Presentation: Best Evidence Medical Education

Ron Harden introduced the topics review process used by the BEME group, followed by two outcome presentations by topic review leaders (see attached pdf of BEME Topic Review Groups and more information and the topic reviews at http://www.bemecollaboration.org/topics.htm ) The notes below are from Fred Wolf's critique of the process and recommendations for future reviews.

-Most of the critiques of the reviews stem from Wolf's observation that the medical education primary research needs to get better! Overall, he urged reviews that make their synthesis free from bias by including the raw data. Reviews should include: 1) results of reviewed studies that are similar, 2) best estimate of effect, 3) how precise the estimate is, and 4) how dissimilarities are best explained. He suggested that the problem with most reviews are one or more of the following: 1) selective inclusion of research studies, 2) differently weighted articles, 3) failure to look at dependant variables, and 4) failure to look at moderating variables. Review/meta analysis could be improved by 1) more well-designed prospective research studies, 2) better research questions, 3) more appropriate outcome measures, and 4) thoughtful and pragmatic development of comparative groups of subjects.

-Wolf then addressed the question, ‘why don't we get variance in outcomes'. He indicated that you need to design studies in ways to maximize variances and yet medical education is designed to do the opposite. We screen out most of the variance in subjects through the admissions process. His recommendation in this regard is to use quasi-randomization by randomly selecting ½ of the subjects' pretest outcomes and ½ of the posttest scores to form two cohorts of students. Further, he suggested that journals need to reinforce the standards of good research by not accepting articles that don't meet the standards. He referenced two standards for doing/reviewing research: the Consort Statement for Quantitative Research (see http://www.aegastro.es/Publicaciones/Consorts/CONSORT01.pdf and the Trend Statement for Qualitative Research (see http://www.aegastro.es/Publicaciones/Consorts/CONSORT01.pdf)

Worthy of note: Mark Albanese commented from the audience that Academic Medicine my stop accepting single institution medical education studies.

He concluded with the following suggestions:

1. link your research to theory, basic and applied
2. make careful use of nomenclature
3. develop criteria to form comparative groups
4. be sure the context of the main variable is a feature
5. be aware of the grey (unpublished) literature

Reported by:
Linda Heun, Ph.D. <meded@aacom.org>
Vice President for Medical Education
American Association of Colleges of Osteopathic Medicine

back to top

25. ABIM Foundation Presentation: Portfolioing Professionalism

Presenters: Richard Cruess, Sylvia Cruess, and Marcia Day-Childress

Presenters suggested that the reason that we need to directly focus on professionalism is that it is threatened because the health care system doesn't support it. To counter this 1) the cognitive piece must be taught explicitly and active reflection must be encouraged through the use of portfolios. The role of the portfolio is the collection of materials that demonstrates that learning has occurred. The purposes of portfolio use include 1) enhancing learning, 2) having learners take the responsibility for learning, 3) improving a direct relationship between students and faculty, and 4) promoting continuity along the learning continuum. It includes formative documents that promotes reflection and feedback and summative documents that reflect achievement in behavior and attitudes.

Effective use of portfolios requires mentoring that maximizes appropriate content, provides feedback and opportunity for self reflection. Portfolios should not be evaluated in a summative manner. The book, Measuring Medical Professionalism, by Stern was highly recommended.

Reported by:
Linda Heun, Ph.D. <meded@aacom.org>
Vice President for Medical Education
American Association of Colleges of Osteopathic Medicine

back to top

26. GEA/GSA Session: Medical Student Competencies in Geriatrics: What and Where should the bar be?

Presenters: Rosanne Leipzig, Evelyn Granieri, Lisa Granville, and Rainier Soriano

Comments by presenters: there is greater focus on geriatric education today because of the expanding knowledge base about this patient population and the expanding number of elderly. 55& of allopathic student surveyed last year reported adequate instruction was received in this area (Heun note: 78.6% of osteopathic students report satisfaction with instruction in this area.).

Vocabulary differs (e.g. competencies, proficiencies, milestones, learning objectives) but schools involved in the Hartford Foundation Grants through 2007 (learn more at http://www.umassmed.edu/ome/grants/hartford.cfm ) are using the term Critical Learning Objectives to stand for demonstrable, measurable and criterion-based objectives that are being developed for each level of medical education. The objectives are designed to be cumulative into advanced training, really important for patient care, the minimum number possible, and ones that any training program could accomplish without additional expense.

Note: the Florida State Program was discussed (includes our Nova Southeast COM).

Interesting points:

• when people get older, lots of medical stuff happens
• lots of problematic older stuff happens because of inappropriate pediatric care
• really well older adults don't need geriatricians

Reported by:
Linda Heun, Ph.D. <meded@aacom.org>
Vice President for Medical Education
American Association of Colleges of Osteopathic Medicine

back to top

27. GIA Public Relations and Marketing Master Class: Improving Access to Leadership

Presenters: Claire Bassett and Sue Jablonski (both vice presidents at their medical schools)

Download the handout for this presentation:
PDF File: Improving Access to Leadership (562k, 12 pages)

While this is aimed at PR personnel getting a seat at the leadership table, it is pertinent to the rest of us and contains really good advice.

Reported by:
Linda Heun, Ph.D. <meded@aacom.org>
Vice President for Medical Education
American Association of Colleges of Osteopathic Medicine

back to top

28. Careers in Medicine: Career Guidance and the Web: A Joining of Forces

Presenter: George Richard

Download the handout for this presentation, including notes:
PDF File: Careers in Medicine (151k, 6 pages)

Reported by:
Linda Heun, Ph.D. <meded@aacom.org>
Vice President for Medical Education
American Association of Colleges of Osteopathic Medicine

back to top