The Center for Medical Education Research

Department of Medical Education

University of Washington School of Medicine

Health Resources and Services Administration

Bureau of Health Professions

Grant Number 5 U76 MB00001-03

Principal Investigator Fredric M. Wolf, PhD

(Previous Principal Investigator David M. Irby, PhD)

September, 1998

SUMMARY OF PROJECTS AND PUBLICATIONS

The purpose of the Center for Medical Education Research (CMER) is to conduct policy oriented research on medical education with a focus on primary care education and career selection, and minority enrichment programs; to train medical education researchers, and to translate research into practical improvements in medical education.

Five research projects were funded since CMER’s inception in 1994.

1. The influence of educational programs and role models on students’ primary care career choice.

2. Development of a specialty preference inventory for admissions procedures.

3. Evaluation of minority enrichment programs:

a. Classification system for evaluating minority enrichment programs.

b. Participation in academic and research enrichment programs and entry into medical school of under represented minority students.

c. Motivations to become a physician of under-represented minority college students.

4. Teaching compassion and respect to housestaff in general internal medicine.

5. Quality and cost of ambulatory education

The center also conducted a national invitational conference, New Models for Ambulatory Education, held in Leavenworth, Washington, August, 1996.

Funded Research Projects

Project 1: The Influence of Educational Programs and Role Models on Students' Primary Care Career Choice (collaborative with UNC)

Summary

Using multiple surveys, focus groups, and academic databases, this study examines career choice, role models, and educational experiences. A survey of 298 fourth year medical students at UW and UNC reveals that the strongest predictor of primary care career choice is the students' primary care values (holism, continuity of care, and prevention). Role models had a strong or decisive influence on the career choices of over half of the students. Of the 444 role models identified by the students, 54% were in primary care specialties, and 46% were in other specialties. The most frequently mentioned characteristics of these role models were personal characteristics such as kindness (30%), enthusiasm (17%), and knowledge (14%).

The specific questions addressed include the following, plus 1.a. below:

1. How and when do students learn about specialties and make informed choices?

2. What are the most influential factors that affect students’ career choices?

3. Are there educational experiences that impact students’ decisions to choose generalist careers?

4. Are there faculty members, preceptors, and/or residents (who serve as positive role models or mentors) who affect students' decisions to choose primary care specialties?

Results

Ambrozy DM, Irby DM, Bowen JL, Burack JH, Carline JD, Stritter FT. Role models’ perceptions of themselves and their influence on students’ specialty choices. Academic Medicine 1997; 72: 1119-1121.

Burack JH, Irby DM, Carline JD, Ambrozy DM, Ellsbury KE, Stritter FT. A study of medical students’ specialty choice pathways: Trying on possible selves. Academic Medicine 1997; 72:534-541.

Ellsbury KE, Burack JH, Irby DM Stritter FT, Ambrozy DM, Carline JD, Guo J, Schaad DC. The shift to primary care: Emerging influences on specialty choice. Academic Medicine (supplement) Sept/Oct. 1996; 71(10): S16-18.

Ellsbury KE, Carline JD, Irby DM, Stritter FT. Influence of third-year clerkships on medical student specialty preferences. Advances in Health Science Education (in press).

Haapanen KJ, Ellsbury KE, Schaad DC. Gender differences in the perceptions of mentorship among first andsecond-year medical students. Academic Medicine, July 1996.

Phillips TJ, Rosenblatt RA, Schaad DC, Cullen TJ. The long term impact of an innovative family physician pathway on the specialty and location of graduates: Thirty years later. (under review, Academic Medicine).

Stritter FT, Bowen JL, Irby DM, Burack JH, Ellsbury K, Ambrozy DM, Althouse L, Carine JD, Guo J, Schaad D. Medical students’ perceptions of role models’ influence on career choice. 1997 (in preparation).

1.a. Why don’t rural students apply to medical school?

Data has been collected from forty-nine students from rural towns attending Washington State University. Data has been entered, and initial analysis has been completed. A literature review has been completed. A draft of the report should be completed by January of 1999.

Results

UW medical student research paper: Mitchell, B. Career influence towards health care careers of rural college students. Forthcoming, 1998.

Project 2: Development of a Specialty Preference Inventory for Admissions Procedures

Summary

The purpose of this study is to develop a specialty preference inventory that can be used by medical schools to identify future primary care physicians, and by medical students to make informed choices. Preliminary results of matriculating and graduating students indicates that students eventually entering primary care specialties respond differently on the inventory at matriculation than those who go into other specialties. While students who match in primary care fields do not change from matriculation to graduation, students who match in specialty/subspecialty fields do change. Thus, the clinical curriculum does change the perceptions of those going into specialty/subspecialty fields.

Results

Brock D, Schaad DC, Guo J, Irby DM, Hunt DD, Sampson W. The Washington primary care interest inventory: Reliability, validity, and predictive capabilities. Academic Medicine, December, 1998.

Running titles for articles in progress: 1)The interaction of student and patient gender on the desirability of seeking health care form family physicians. Schaad DC, Brock DM, Bruce CS, Hunt DD, Irby DM. 2) Curricular impacts on the desirability of seeking health cre: Differentials between male and female medical students. Schaad DC, Brock DM, Hunt DD, Irby DM. 3) Gender differences in the perception of psychosocial complints of patients: Schaad DC, Brock dm, Olson J, Hunt DD, Irby DM.

UW medical student research paper: Weber, K. Assessing changes in admission policies with the Washington primary care interest inventory. September, 1996.

Project 3: Classification and Evaluation of Minority Enrichment Programs for Health Sciences Career Development

a. Classification system for evaluating minority enrichment programs.

Summary

Ninety-nine medical schools sponsoring high school minority enrichment programs that included: research apprenticeships (78), recruitment (56), career development (38), multi-focused summer programs (30), high school partnerships (21), and tutorial assistance (17).

One hundred and twenty-one medical schools conducted college level programs for under-represented minorities. These programs included: research apprenticeships (28); articulation or pathway programs assuring entrance to medical school for qualified college students (20); motivational programs without academic content (21); tutorial programs (5); diversified summer programs that included academic as well as motivational aspects (58), and MCAT preparation programs (9).

The educational models underlying these programs were unclear and the literature does not provide sufficient information to judge the educational appropriateness or success of the programs. A number of representative programs have been identified for further analysis in the coming year.

Results

Carline J, Patterson D, Davis L, Irby D. Precollege enrichment programs intended to increase the representation of minorities in medicine. Academic Medicine. 1998; 73:288-298.

Carline JD, Patterson D, Davis L. Enrichment programs for undergraduate college students intended to increase the representation of minorities in medicine. Academic Medicine. 1998; 73:299-312.

Carline JD, Detweiler L, Garcia C. Evaluating high school enrichment programs for minorities. Presented at the Division of Minority Health, Education, and Prevention, Association of American Medical Colleges, Washington D.C., October 1995.

b. Participation in academic and research enrichment programs and entry into medical school of under represented minority students.

Summary

A total of 227 under-represented minority applicants were interviewed for admission to the UW School of Medicine from 1993-95. Ninety-seven (43%) had participated in some type of enrichment or research program. Women received higher scores than men and higher Verbal Reasoning Scores, which were associated with higher interview scores. Participation in any type of enrichment program, GPA and MCAT scores had no effect on the rating given an applicant during the interview. Participation in either a general academic enrichment program or a research apprenticeship did not confer any special advantage to applicants in the admission decision and was not related to the interview score.

Results

Carline JD, Hunt DD, Patterson DG, Garcia C. Participation in academic and research enrichment programs and entry into medical school of under represented minority applicants. Academic Medicine (in press).

c. Motivations of under-represented minority college students to become a physician

Summary

Eighty five college students involved in the UW 1995 MMEP Summer Program participated in eight focus group interviews. The sources of motivation to become a physician frequently includes the inspiration of physician role models, experience of sickness in the family or self, and the perception of a lack of health care workers who understand the needs and concerns of ethnic communities. Barriers to the goal of becoming a physician included specific aspects of the practice of medicine that were distasteful (e,g, malpractice), community expectations that either women should not attempt to become professionals or that by becoming physicians they would be removing themselves from the ethnic community. There were significant differences in responses among ethnic groups.

Results

MMEP PRE-POST MCAT TESTS

During the summer of 1998, over five hundred under-represented minority college students participated in the Robert Wood Johnson sponsored Minority Medical Education Program at seven medical schools. They completed a practice Medical College Admission Test (MCAT) at the beginning and end of the summer program. CMER staff scored these test and provide reports to individual students as well as summary reports to sites. Initial results indicated minor improvements in Physical Science and Biological Science scores, with more substantive improvements in Verbal Reasoning. This scoring service will be continued next summer, under a contract with the Association of American Medical Colleges (AAMC). Ellen Julian, Vice President of the AAMC for the MCAT has agreed to supply more accurate rules for transformation of the raw scores into appropriate scaled scores.

COE EVALUATION

Dr. Carline was awarded a contract in 1997 from the Division of Disadvantaged Assistance (DDA), BrHP, HRSA, to conduct a national evaluation of the Centers of Excellence (COE) Program. A report on the quality of information contained in COE progress reports submitted to the DDA has been completed. The evaluation methodology has been designed, and currently is being tested with six sites. Implementation of the evaluation will occur in March of 1999, with a final report expected in July of 1999.

UDOC EVALUATION

The UDoc Program of the University of Washington for high school students, sponsored through a Partnerships for Health Professions Education of the DDA is currently being evaluated by CMER staff. The overall evaluation includes a planned tracking of participants through high school, college and into graduate school, an assessment of attitudes and knowledge about health care professions, and an evaluation of the quality of the program itself.

Running title of article in progress: Motivations of under represented minority college students for a career in medicine; describing perceived barriers and benefits. Carline, JD

Project 4: Teaching Compassion and Respect to Housestaff in General Internal Medicine.

Summary

The purpose of this study is to describe attending physicians' beliefs about the teaching of attitudes, problematic housestaff behaviors, and techniques to address them. Qualitative data were collected for three teams on a general internal medicine inpatient teaching service using:

1. observation of attending and work rounds;

2. interviews;

3. an attitude survey;

4. a think aloud structured task; and

5. chart review.

Attendings appear to have few conscious strategies for fostering positive attitudes toward patients. They assess suspect resident actions by measuring them against beliefs about themselves, the resident, the social context, and appropriate professional and pedagogic roles. Actions perceived as potentially threatening to patient care demand a response. But rather than confront them explicitly, attendings tend to avoid, downplay, rationalize, or medicalize them.

Results

Burack JH, Irby DM, Carline JD, Root RK, Larson EB. Teaching compassion and respect: Attending physician’s responses to problematic behaviors. Journal of General Internal Medicine (forthcoming, 1999).

Project 5: Quality and Cost of Ambulatory Education

Summary

This study seeks to identify the quality of educational interactions in ambulatory settings and relate these interactions to program models, learning outcomes, student career preferences, and costs. The latter is being provided by partnering with the research team headed by Jim Boex, MBA, at North Eastern Ohio University College of Medicine. Boex has a contract with the Bureau of Health Professions to conduct a national study of the costs of ambulatory medical education.

Results

Boex J, Boll A, Franzini L, Hogan A, Meservey P, Rubin R, Seifer S. Ambulatory primary care training: costs and challenges. Under review, Journal of the American Medical Association, 1998.

Skeff KM, Bowen JL, Irby DM. Protecting time for teaching in the ambulatory care setting. Academic Medicine, 1997; 72:694-7.

Boex JR, Boll A, Hogan A Meservey P, Rubin R, Seifer S. Assessing ambulatory care training: Costs, methods, and quality in New York state, report to the New York State Department of Health.

Hogan A, Franzini L, Boex JR, Boll A, Meservey P, Rubin R, Seifer S. Estimating the cost of primary care training in ambulatory settings (being submitted to the Journal of Health Economics.

Seifer S, Boex JR, Boll A, Hogan A, Meservey P, Rubin R. Health professions education in ambulatory settings: a national survey of ambulatory sites and their educational sponsors. Submitted to Academic Medicine.

Seifer S, Kim S. A comparative analysis of accreditation requirements for ambulatory health professions education. (submitted to Academic Medicine in October, 1998)

Icicle Creek Ambulatory Care Conference

Ambulatory education was a high priority agenda item arising out of both the first and second national conferences on research in medical education sponsored by the Bureau for Health Professions and AAMC. Building upon the work of these conferences and David Irby’s review of the literature on ambulatory education, the two Centers for Medical Education Research (UW and UNC) conducted a national, invitational conference titled: New Models for Ambulatory Education. It was held in Leavenworth, Washington in August, 1996. During the conference, 30 medical educators, clinicians, and public policy experts discussed the application of educational research and theory to ambulatory care education, designed innovative educational programs, developed faculty development strategies, established a prioritized research agenda, and proposed public policy recommendations. Outcomes of this conference include over a dozen peer reviewed papers published in Academic Medicine and other medical journals, a dozen faculty development workshops on teaching in the ambulatory setting, and numerous presentations at national professional meetings.

The conference was funded by the Health Resources and Services Administration Bureau of Health Professions, and by Pharmacia and UpJohn.

Publications

Ambrozy D, Irby D, Bowen J, Burack J, Carline J, Stritter F. Role models’ perceptions of themselves and their influence on students’ specialty choices. Academic Medicine, 1997; 72:1119-1121.

*Anderson W, Carline J, Ambrozy D, Irby D. Faculty development for ambulatory care education. Academic Medicine, 1997;72:1072-1075.

Boex J, Boll A, Franzini L, Hogan A, Meservey P, Rubin R, Seifer S. Ambulatory primary care training: costs and challenges. Under review, Journal of the American Medical Association, 1998.

Boex JR, Boll A, Hogan A Meservey P, Rubin R, Seifer S. Assessing ambulatory care training: Costs, methods, and quality in New York state, report to the New York State Department of Health.

*Bowen J, Stearns J, Dohner C, Blackman J, Simpson D. Defining and evaluating quality for ambulatory care educational programs. Academic Medicine, 1997;72:506-510.

*Bowen JL. Adapting residency training, training adaptable residents. Western Journal of Medicine, 1998; 168:371-77.

*Bowen JL, Carline JD. Learning in the social context of ambulatory care clinics. Academic Medicine, 1997; 72: 1878-190.

*Bowen JL and Irby DM. Evaluating the quality of ambulatory care teaching settings: a thematic review of the literature. 1998 (in preparation).

*Bowen JL, Stearns J, Dohner C, Blackman J, Simpson DE. Defining and evaluation quality for ambulatory care education programs. Academic Medicine, 1997; 72: 506-10.

Brock D, Schaad D, Guo J, Irby D, Hunt D, Sampson W. The Washington primary care interest inventory: reliability, validity, and predictive capabilities. Academic Medicine,. (in press).

Burack JH, Irby D, Carline J, Ambrozy D, Ellsbury K, Stritter F. A study of medical students’ specialty choice pathways: trying on possible selves. Academic Medicine, 1997; 72:534-541.

Carline J, Patterson D, Davis L, Irby D. Precollege enrichment programs intended to increase the representation of minorities in medicine. Academic Medicine, 1998;73:288-298.

Carline J, Patterson D, Davis L. Enrichment programs for undergraduate college students intended to increase the representation of minorities in medicine. Academic Medicine,. 1998; 73:299-312.

Connors K, Seifer S, Sebastian J, Cora-Bramble D, Hart R. Interdisciplinary collaborations in service-learning: lessons from the health professions. Michigan Journal of Commmunity Service Learning. 1996; Fall:113-127.

Connors K, Seifer S. Overcoming a century of town-gown relations: redefining relationships between communities and academic health centers. Expanding Boundaries. Vol. II, no. 1.

Connors K, Seifer S (co-editors). Partnership Perspectives. Vol 1, Issue 1. San Francisco: Community-Campus Partnerships for Health, 1998.

*DaRosa DA, Dunnington GL, Stearns J, Ferenchick G, Bowen JL, Simpson DE. Ambulatory teaching “lite”: less clinic time, more educationally fulfilling. Academic Medicine, 1997; 72:358-61.

Ellsbury KE, Burack HH, Irby DM Stritter ft, Ambrozy D, Carline JD, Jie G, Schaad Dc. The shift to primary care: emerging influences on specialty choice. Academic Medicine, (supplement) Sept/Oct. 1996; 71(10): S16-18.

Ellsbury K, Carline J, Irby D, Stritter F. Influence of third-year clerkships on medical student specialty preferences. Advances in Health Science Education (in press).

*Ferenchick G, Simpson D, Blackman J, DaRosa D, Dunnington G. Strategies for efficient and effective teaching in the ambulatory care setting. Academic Medicine, 1997; 72:277-280.

Gordon, M. Cutting the gordian knot: a two-part approach to the evaluation and professional development of residents. Academic Medicine,. 1997;72:876-880.

*Gruppen L. Implications of cognitive research for ambulatory care education. Academic Medicine,. 1997;72:117-120.

Haapanen KJ, Ellsbury KE, Schaad DC. Gender differences in the perceptions of mentorship among first and second-year medical students. Academic Medicine, July 1996.

Hogan A, Franzini L, Boex JR, Boll A, Meservey P, Rubin R, Seifer S. Estimating the cost of primary care training in ambulatory settings (submitted to the Journal of Health Economics.

Irby D. Introduction, Ideas for Medical Education. Academic Medicine, 1997;72:30-31.

Irby D. Introduction, Ideas for Medical Education. Academic Medicine, 1997;72:116.

Irby D. Introduction, Ideas for Medical Education. Academic Medicine,. 1997;72:186.

Irby D, Simpson D. Introduction, Ideas for Medical Education. Academic Medicine, 1997;72:357.

Irby D. Introduction, Ideas for Medical Education. Academic Medicine, 1997;72:600.

Irby D. Introduction, Ideas for Medical Education. Academic Medicine, 1997;72:693.

Irby D. Introduction, Ideas for Medical Education. Academic Medicine. 1997;72:765.

Irby D. Introduction, Ideas for Medical Education. Academic Medicine. 1997;72:875.

Irby D. Introduction, Ideas for Medical Education. Academic Medicine. 1997;72:972.

Irby D. Introduction, Ideas for Medical Education. Academic Medicine. 1997;72:1071.

Irby D, Hekelman F. Future directions for research on faculty development. Family Medicine 1997;29:287-289.

Kurth R, Irigoyen M, Schmidt, H. A model to structure student learning in ambulatory care settings. Academic Medicine, 1997;72:601-606.

McGee S, Irby D. Teaching in the outpatient clinic: practical tips. Journal of General Internal Medicine, 1997;12(Supplement 2)S34-40.

Pinsky L, Irby D. “If at first you don’t succeed”: Using failure to improve teaching. Academic Medicine, 1997;72:973-976.

Seifer S, Connors K (co-editors). A resource guide to community-responsive models in health professions education. San Francisco: Center for Health Professions, 1997.

Seifer S. Service-Learning: Community-campus partnerships for health professions education. Academic Medicine, 1998;73:273-277.

Seifer S. Recent and emerging trends in undergraduate medical education: curricular responses to a rapidly changing health care system. Western Journal of Medicine, 1998;168(5):400-411.

Seifer S, Hermanns K, Lewis J (co-editors). Service-learning in medical education. Washington, DC:American Association of Higher Education. (forthcoming in 1998)

Seifer S, Maurana C (co-editors). Principles of good partnerships between communities and higher educational institutions. Journal of Interprofessional Care. (forthcoming in 1998)

Seifer S, Kim S. A comparative analysis of accreditation requirements for ambulatory health professions education. (submitted to Academic Medicine in October, 1998)

Simpson D, Irby D. Introduction, Ideas for Medical Education. Academic Medicine, 1997; 72:276.

Simpson D, Irby D. Introduction, Ideas for Medical Education. Academic Medicine, 1997; 72:505.

Skeff K, Bowen J, Irby D. Protecting time for teaching in the ambulatory care setting. Academic Medicine, 1997;72:694-697.

*Smith CS, Irby D. The roles of experience and reflection on ambulatory care education. Academic Medicine, 1997;72:32-35.

Usatine R, Nguyen K, Randall J, Irby D. Four exemplary preceptors’ strategies for efficient teaching in managed care settings. Academic Medicine, 1997;72:766-769.

Wilkerson L, Irby D. Strategies for effective change in teaching practices: a comprehensive approach to faculty development. Academic Medicine, 1998;73:387-396.

*Wilkerson L and Sarkin R. Arrows in the quiver: evaluation of a workshop on ambulatory teaching. Academic Medicine, 1997; Vol. 73 (in press).

* denotes articles written as part of the Icicle Creek Ambulatory Care Education Conference of 1996 that was sponsored by the Centers for Medical Education Research at the UW and UNC.

University of Washington Medical Student Research Papers

Bruce, Corey. “The interaction of medical student gender and patient gender on the desirability to initially approach a family physician for a variety of physician and psychosocial complaints,” August, 1996.

Mitchell, Blake. “Career influence towards health care careers of rural college students,” forthcoming 1998.

Olson, Jennifer. “Gender differences in the perception of psychosocial complaints of patients.”

Weber, K. “Assessing changes in admission policies with the Washington primary care interest inventory.” September, 1996.