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

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

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

II.METHODS  Participants- 3 rd and 4 th 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

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

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

RESULTS

Individual Clerkship Results

PEDIATRICS

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

SURGERY

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”

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

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

NEUROLOGY

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

PSYCHIATRY

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

INTERNAL MEDICINE

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

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”

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

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

AMBULATORY MEDICINE

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

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

RADIOLOGY

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”

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

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

V. RESULTS AND THE CETF  Lack of clinical teaching Some sites with excellent teaching and/or didactics (ie, OVH, Cedars, Harbor, 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 OVH, surg Harbor) Some rotations severely lacking in ownership/autonomy (ie, cedars, amb CHS

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