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Otolaryngology exposure in a longitudinal integrated clerkship setting.

ABSTRACT: Although 20-40% of primary care complaints are Otolaryngology-Head and Neck Surgery (OtoHNS) related, little emphasis is placed on OtoHNS instruction at the undergraduate medical education level. An OtoHNS clerkship rotation is not required at most Canadian medical schools. Furthermore, at institutions offering an OtoHNS rotation, less than 20% of students are able to complete a placement. Given that a large percentage of medical students in Canada will pursue primary care as a career, there remains a gap in providing OtoHNS clinical training. During the longitudinal integrated clerkship at the Northern Ontario School of Medicine (NOSM), students are assigned to one of 14 sites, and not all have access to an otolaryngologist. This study looks to quantify the level of exposure students are receiving in OtoHNS at NOSM and to assess their comfort level with diagnosing and treating common otolaryngologic conditions.A structured 13-item survey was administered to second, third and fourth year medical students at NOSM.A majority (67.9%) of medical students surveyed had not observed an otolaryngologist. Furthermore, most students (90.6%) reported receiving very little OtoHNS classroom based and clinical instruction during medical school.A discrepancy exists between the quantity and breadth of OtoHNS training received in undergraduate medical education and the volume of OtoHNS encounters in primary care practice. Although geographic dissemination of students in the distributed learning model may be a challenge, strategies such as standardized objectives and supplemental electronic resources may serve to solidify clinical knowledge.

SUBMITTER: Scott GM

PROVIDER: S-EPMC5504570 | biostudies-other | 2017 Jul

REPOSITORIES: biostudies-other

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Project description:Background Longitudinal Integrated Clerkships (LICs) are innovative educational models that allow medical student continuity with patients, preceptors, colleagues, and health care systems. Given their benefits, the number of LICs continues to increase. We share a pilot model for an ophthalmology LIC curriculum at the University of Colorado School of Medicine targeted for students to see patients through transitions of care. Methods A needs assessment was performed including literature search, interviews with expert faculty, and a precurricular student questionnaire. Based on our findings, we developed a pilot two-part curriculum consisting of an introductory lecture and a half-day clinical experience designed to integrate patient eye care into the LIC model. At the end of the year, students completed a questionnaire assessing attitude, confidence, and knowledge. Precourse data were collected from students in the academic year (AY) 2018/2019 to aid with the needs assessment. Postcourse data were collected after completion of the curriculum from students in AY 2019/2020. Data from questionnaire were intended to improve our curricular experience. Results Our curriculum was piloted between the 2019 and 2020 AY. The completion rate of our curriculum was 100%. The questionnaire response rate was 90% in pre- and postcurricular groups ( n =15/17 and n =9/10, respectively). Hundred percent of students from both groups responded that it is "very important"/"important" for all physicians to be able to identify when ophthalmology referral is indicated. After the intervention, there were significant differences in the rate of students responding that they were "confident" diagnosing acute angle-closure glaucoma (36 vs. 78%, p =0.04), treating a chemical burn (20 vs 67%, p =0.02), and diagnosing viral conjunctivitis (27 vs. 67%); 90% of students reported increased confidence in longitudinal care of patients in the eye clinic. Conclusions Medical students believe in the importance of ophthalmic education regardless of their specialty of choice. We present a pilot model to introduce ophthalmology within an LIC model. Future studies with a larger sample are needed to determine the impact of this model in terms of knowledge acquisition and relationship between curriculum and ophthalmology interest among students. Our curriculum can be adapted to other underrepresented specialties in the medical school curriculum and is easily exportable to other LICs.

Project description:BackgroundLongitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts. LICs use educational continuity to benefits students' clinical learning and professional identity formation. Patient-centered care is a core component of medical professionalism in the West. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship in East Asia. We aimed to investigate patients' perceptions of longitudinal relationships with the LIC students within Taiwan's Confucian cultural and social context.MethodsWe invited patients or their family members who were cared for longitudinally by a LIC student to participate in the study. Participating patients or their family members undertook semi-structured interviews. We analyzed data qualitatively using a general inductive approach to identify themes in the patients' descriptions of their experiences interacting with the LIC students.ResultsTwenty-five patients and family members participated in interviews: 16 patients and 9 family members. Qualitative analysis of interview transcripts identified three themes from patients' experience receiving care from their LIC students: care facilitation, companionship, and empathy. To provide care facilitation, LIC students served as a bridge between the physicians and patients. Students served patients by reminding, consulting, tracking disease progression, and researching solutions for problems. To provide companionship, students accompanied patients interpersonally like a friend or confidant who listens and provides a presence for patients. To provide empathy, patients reported that students showed sincere concern for patients' experience, feelings, and mood.ConclusionIn our study, Taiwanese patients' perspectives of LIC students suggested the value of care facilitation, companionship, and empathy. We discuss these themes within the context of Confucian culture and the Taiwanese context of care.

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Otolaryngology exposure in a longitudinal integrated clerkship setting.

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