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   2016| September-December  | Volume 29 | Issue 3  
    Online since April 11, 2017

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Creating a longitudinal database in medical education: Perspectives from the pioneers
Rashmi A Kusurkar, Gerda Croiset
September-December 2016, 29(3):266-270
DOI:10.4103/1357-6283.204214  PMID:28406113
The Jefferson Longitudinal Study of Medical Education (JLSME) is the longest running database in medical education and covers the collection and measurement of background, learning, performance, and psychosocial variables before, during, and after medical school. Recently, our research group at VU University Medical Center School of Medical Sciences launched a longitudinal study in medical education, called the “Student Motivation and Success Study.” While setting up this study, we faced many challenges and learning about the JLSME helped us gain a fresh perspective on our work. We interviewed Drs. Joseph Gonnella and Mohammadreza Hojat, the leaders of the JLSME, and present their experiences verbatim in this article and summarize the lessons we learned as tips for others. We conclude that by establishing a longitudinal database, medical educators can test and ensure the quality of the doctors they produce, justify curricular reforms, participate in a continuing inquiry into their educational practices, and produce more generalizable research findings.
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Dr. Donald Pathman

September-December 2016, 29(3):170-170
DOI:10.4103/1357-6283.204231  PMID:28406099
  - 1,487 233
Assessment of community-based training of medical undergraduates: Development and validation of a competency-based questionnaire
Hemant Deepak Shewade, Kathiresan Jeyashree, Selvaraj Kalaiselvi, Chinnakali Palanivel, Krishna Chandra Panigrahi
September-December 2016, 29(3):244-249
DOI:10.4103/1357-6283.204218  PMID:28406109
Background: The global shift toward competency-based education and assessment is also applicable to community-based training (CBT) of undergraduate medical students. There is a need for a tool to assess competencies related to CBT. This study aimed to develop a tool that uses a competency-based approach to evaluate CBT of medical undergraduates. Methods: A preliminary draft of the questionnaire was prepared by the investigators based on a conceptual framework. Using the Delphi technique, this draft was further developed by a specialist panel (n = 8) into a self-administered questionnaire. After pretesting with students, it was administered to medical undergraduates (n = 178) who had recently completed Community Medicine. Item analysis and exploratory factor analysis were performed under which principal component analysis was used. Reliability was assessed by calculating Cronbach's alpha, convergent validity by correlating the scores with Community Medicine university examination scores, and construct validity by describing percentage variance explained by the components. Results: A 74-item questionnaire developed after the Delphi technique was further abridged to a 58-item questionnaire. Cronbach's alpha of 74 and 58-item questionnaires were 0.96 and 0.95, respectively; convergent validity was 0.07 and 0.09, respectively; and percentage variance explained by the components were 69.3% and 70.1%, respectively. Agreement between scores of both versions was 0.76. Discussion: The authors developed a questionnaire which can be used for competency-based assessment in community-based undergraduate medical education. It is a valuable addition to the existing assessment methods and can guide experts in a need-based design of curriculum and teaching/training methodology.
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Effectiveness of cross-cultural education for medical residents caring for burmese refugees
Megan Song McHenry, Kavitha Nutakki, Nancy L Swigonski
September-December 2016, 29(3):250-254
DOI:10.4103/1357-6283.204217  PMID:28406110
Background: Limited resources are available to educate health professionals on cultural considerations and specific healthcare needs of Burmese refugees. The objective of this study was to determine the effectiveness of a module focused on cross-cultural considerations when caring for Burmese refugees. Methods: A brief educational module using anonymously tracked pre- and post-intervention, self-administered surveys was developed and studied. The surveys measured pediatric and family medicine residents' knowledge, attitudes, and comfort in caring for Burmese refugees. Paired t-tests for continuous variables and Fisher's exact tests for categorical variables were used to test pre- and post-intervention differences. We included open-ended questions for residents to describe their experiences with the Burmese population. Results: The survey was available to 173 residents. Forty-four pre- and post-intervention surveys were completed (response rate of 25%). Resident comfort in caring for Burmese increased significantly after the module (P = 0.04). Resident knowledge of population-specific cultural information increased regarding ethnic groups (P = 0.004), appropriate laboratory use (P = 0.04), and history gathering (P = 0.001). Areas of improved resident attitudes included comprehension of information from families (P = 0.03) and length of time required with interpreter (P = 0.01). Thematic evaluation of qualitative data highlighted four themes: access to interpreter and resources, verbal communication, nonverbal communication, and relationship building with cultural considerations. Discussion: A brief intervention for residents has the potential to improve knowledge, attitudes, and comfort in caring for Burmese patients. Interventions focused on cultural considerations in medical care may improve cultural competency when caring for vulnerable patient populations.
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A survey-based study of emotional intelligence as it relates to gender and academic performance of medical students
Ashwini P Aithal, Naveen Kumar, Prasaniya Gunasegeran, Sivagamy M Sundaram, Lim Zhen Rong, Sujatha P Prabhu
September-December 2016, 29(3):255-258
DOI:10.4103/1357-6283.204227  PMID:28406111
Background: Emotional intelligence (EI) refers to the composite set of capabilities that enable a person to identify, assess, understand, and control emotions of oneself and others. This study was conducted to assess trait EI, to examine possible differences in the EI level of medical students in terms of gender, and to investigate the correlation between EI of medical students and their academic performance. Methods: We used a cross-sectional survey consisting of a self-assessment questionnaire distributed to 200 undergraduate medical students after informed consent. Subjects responded on a five-point Likert scale. Data obtained were examined using descriptive frequencies, percentages, and correlations and analyzed with SPSS software. Results: Sixty-five percent of medical students had high EI. EI was significantly higher in females (72.27± 8.84) compared to males (67.47± 15.43) (P = 0.007). There was a positive correlation between EI and academic performance (r = 0.51). Discussion: EI is a necessary component of medical students' skill sets to ensure that they are not only knowledgeable and academically competent in medical school but will also succeed in the future as quality healthcare professionals. There should be a balance between intelligence quotient and EI in students' learning processes to ensure success both personally and professionally. Students with good EI tend to be skilled at interpreting emotions; skills which, in turn, will add on to their performance in medical training and patient care.
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Co-Editors' Notes 29:3
Michael Glasser, Donald Pathman
September-December 2016, 29(3):164-166
DOI:10.4103/efh.EfH_44_17  PMID:28406096
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Everything is learning
Ranabir Pal
September-December 2016, 29(3):271-272
DOI:10.4103/1357-6283.204211  PMID:28406114
  - 1,270 132
Medical student journals: Critical to the development of physician-scientists
Ibrahim Saleh Al-Busaidi
September-December 2016, 29(3):273-274
DOI:10.4103/1357-6283.204220  PMID:28406115
  - 1,375 163
Accredited social health activists epitomize rural social change and Women's empowerment in India
Madhavi Bhargava
September-December 2016, 29(3):275-276
DOI:10.4103/efh.EfH_113_16  PMID:28406116
  - 1,808 185
Beyond flexner alliance: Social mission in health professions education
Arthur Kaufman
September-December 2016, 29(3):277-278
DOI:10.4103/efh.EfH_345_16  PMID:28406117
  - 1,408 172
Obituary - Dr. Rogayah Ja'afar
Michael Glasser
September-December 2016, 29(3):169-169
DOI:10.4103/efh.EfH_39_17  PMID:28406098
  - 1,556 1,387
Medication calculation and administration workshop and hurdle assessment increases student awareness towards the importance of safe practices to decrease medication errors in the future
Darlene Wallace, Torres Woolley, David Martin, Roy Rasalam, Maria Bellei
September-December 2016, 29(3):171-178
DOI:10.4103/efh.EfH_312_14  PMID:28406100
Background: Medication errors are the second most frequently reported hospital incident in Australia and are a global concern. A “Medication Calculation and Administration” workshop followed by a “hurdle” assessment (compulsory task mandating a minimum level of performance as a condition of passing the course) was introduced into Year 2 of the James Cook University medical curriculum to decrease dosage calculation and administration errors among graduates. This study evaluates the effectiveness of this educational activity as a long-term strategy to teach medical students' essential skills in calculating and administering medications. Methods: This longitudinal study used a pre- and post-test design to determine whether medical students retained their calculation and administration skills over a period of 4 years. The ability to apply basic mathematical skills to medication dose calculation, principles of safe administration (Part 1), and ability to access reference materials to check indications, contraindications, and writing the medication order with correct abbreviations (Part 2) were compared between Year 2 and 6 assessments. Results: Scores for Parts 1, 2 and total scores were nearly identical from Year 2 to Year 6 (P = 0.663, 0.408, and 0.472, respectively), indicating minimal loss of knowledge by students in this period. Most Year 6 students (86%) were able to recall at least 5 of the “6 Rights of Medication Administration” while 84% reported accessing reference material and 91% reported checking their medical calculations. Discussion: The “Medication Calculation and Administration” workshop with a combined formative and summative assessment – a “hurdle” – promotes long-term retention of essential clinical skills for medical students. These skills and an awareness of the problem are strategies to assist medical graduates in preventing future medication-related adverse events.
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Emotional intelligence: A unique group training in a hematology-oncology unit
Tamar Tadmor, Niva Dolev, Dina Attias, Ayalla Reuven Lelong, Amnon Rofe
September-December 2016, 29(3):179-185
DOI:10.4103/1357-6283.204221  PMID:28406101
Background: Emotional intelligence (EI) is increasingly viewed as one of the important skills required for a successful career and personal life. Consequently, efforts have been made to improve personal and group performance in EI, mostly in commercial organizations. However, these programs have not been widely applied in the health field. The aim of this study is to assess the impact of a unique special EI interventional process within the framework of an active hematology-oncology unit in a general hospital. Methods: This investigation employed a pre- and post-training design using the Bar-On Emotional Quotient Inventory (EQ-i) measure of EI, both before and after completion of training 10 months later. The training included personal and group EI assessments and 10 EI workshops, each 2 weeks apart and each lasting approximately 2 h. Results were compared to a control group of medical staff who did not undergo any EI training program during the same time period. Results: Average total Bar-On EQ-i level at baseline for the group was 97.9, which increased significantly after the interventional process to a score of 105.6 (P = 0.001). There were also significant increases in all five main EQ-i scales, as well as for 12 of the 15 subscales. In contrast, the control group showed no significant differences in general EI level, in any of the five main scales or 15 EI subscale areas. Discussion: This pilot study demonstrated the capability of a group intervention to improve EI of medical staff working in a hematology-oncological unit. The results are encouraging and suggest that the model program could be successfully applied in a large-scale interventional program.
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Strong correlations between empathy, emotional intelligence, and personality traits among podiatric medical students: A cross-sectional study
Kurtis Bertram, John Randazzo, Nathaniel Alabi, Jack Levenson, John T Doucette, Peter Barbosa
September-December 2016, 29(3):186-194
DOI:10.4103/1357-6283.204224  PMID:28406102
Background: The ability of health-care providers to demonstrate empathy toward their patients results in a number of positive outcomes improving the quality of care. In addition, a provider's level of emotional intelligence (EI) can further the doctor–patient relationship, stimulating a more personalized and comprehensive manner of treating patients. Furthermore, personality traits of a clinician may positively or negatively influence that relationship, as well as clinical outcomes. This study was designed to evaluate empathy levels in podiatric medical students in a 4-year doctoral program. Moreover, this study aimed to determine whether EI, personality traits, and demographic variables exhibit correlations with the observed empathy patterns. Methods: This cross-sectional study collected data using an anonymous web-based survey completed by 150 students registered at the New York College of Podiatric Medicine. There were four survey sections: (1) demographics, (2) empathy (measured by the Jefferson Scale of Physicians' Empathy), (3) EI (measured by the Assessing Emotions Scale), and (4) personality traits (measured by the NEO-Five-Factor Inventory-3). Results: Empathy levels were significantly correlated with EI scores (r = 0.62, n = 150, P< 0.0001). All the five domains of personality were also shown to correlate with empathy scores, as well as with EI scores. With respect to demographics, Asian-American students had lower mean empathy scores than students of other races (P = 0.0018), females had higher mean empathy scores compared to men (P = 0.001), and undergraduate grade point average correlated with empathy scores in a nonmonotonic fashion (P = 0.0269). Discussion: When measuring the variables, it was evident that there was a strong correlation between empathy, EI, and personality in podiatric medical students. Given the suggested importance and effect of such qualities on patient care, these findings may serve as guidance for possible amendments and warranted curriculum initiatives in medical education.
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Remote-online case-based learning: A comparison of remote-online and face-to-face, case-based learning - a randomized controlled trial
Peter Nicklen, Jenny L Keating, Sophie Paynter, Michael Storr, Stephen Maloney
September-December 2016, 29(3):195-202
DOI:10.4103/1357-6283.204213  PMID:28406103
Background: Case-based learning (CBL) is an educational approach where students work in small, collaborative groups to solve problems. Computer assisted learning (CAL) is the implementation of computer technology in education. The purpose of this study was to compare the effects of a remote-online CBL (RO-CBL) with traditional face-to-face CBL on learning the outcomes of undergraduate physiotherapy students. Methods: Participants were randomized to either the control (face-to-face CBL) or to the CAL intervention (RO-CBL). The entire 3rd year physiotherapy cohort (n = 41) at Monash University, Victoria, Australia, were invited to participate in the randomized controlled trial. Outcomes included a postintervention multiple-choice test evaluating the knowledge gained from the CBL, a self-assessment of learning based on examinable learning objectives and student satisfaction with the CBL. In addition, a focus group was conducted investigating perceptions and responses to the online format. Results: Thirty-eight students (control n = 19, intervention n = 19) participated in two CBL sessions and completed the outcome assessments. CBL median scores for the postintervention multiple-choice test were comparable (Wilcoxon rank sum P = 0.61) (median/10 [range] intervention group: 9 [8–10] control group: 10 [7–10]). Of the 15 examinable learning objectives, eight were significantly in favor of the control group, suggesting a greater perceived depth of learning. Eighty-four percent of students (16/19) disagreed with the statement “I enjoyed the method of CBL delivery.” Key themes identified from the focus group included risks associated with the implementation of, challenges of communicating in, and flexibility offered, by web-based programs. Discussion: RO-CBL appears to provide students with a comparable learning experience to traditional CBL. Procedural and infrastructure factors need to be addressed in future studies to counter student dissatisfaction and decreased perceived depth of learning.
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Institutionalized physical activity curriculum benefits of medical students in Colombia
Gustavo Tovar, Gabriel López, Milcíades Ibáñez, Ricardo Alvarado, Felipe Lobelo, John Duperly
September-December 2016, 29(3):203-209
DOI:10.4103/1357-6283.204212  PMID:28406104
Background: Health authorities internationally have recommended implementing physical activity and exercise for health training programs within the curriculum of medical schools. The purpose of this evaluation was to determine the changes in physical fitness and health (Fitnessgram criteria) of a sports medicine and physical activity course implemented for 3rd year students in a private medical school in Bogotá, Colombia. Methods: Intervention was targeted to 13 medical student cohorts. Cardiovascular endurance (20 m shuttle run test), speed (20 m sprint), strength (push-ups and curl-ups in 30 s), and flexibility (sit and reach) were evaluated at the beginning and end of the school semester. It was a 54 semester-hour intervention (3 h/week), with 37 h (69%) of directed group-based physical exercise. Results: Five hundred and twenty-four students were evaluated with an average age of 20 ± 1.4 years; 341 (65.1%) were women. In all the fitness tests for men and women, a significant increase was found. The prevalence of a healthy cardiorespiratory capacity went from 47.8% to 89.1% in women (P < 0.001) and from 54.6% to 83.1% in men (P < 0.001). Body mass index and weight increased in both sexes. Discussion: The results of the current study showed that a 54 h physical activity course within the medicine curriculum had a positive impact on health-related fitness indicators in Colombian medical students.
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Patients' feelings about the presence of medical students in a New Teaching Hospital in Southwestern Nigeria
Philip Babatunde Adebayo, Stephen Olabode Asaolu, Adeolu Oladayo Akinboro, Adeseye Abiodun Akintunde, Olawale Adebayo Olakulehin, Olugbenga Edward Ayodele
September-December 2016, 29(3):210-216
DOI:10.4103/1357-6283.204222  PMID:28406105
Background: This study aimed to evaluate how patients feel about the introduction of medical students into a former general hospital transformed to a teaching hospital in southwestern Nigeria and to also assess the extent to which they are willing to involve medical students in the management of their conditions. Methods: In a descriptive cross-sectional study, a sample of 251 randomly selected patients were interviewed using a pretested questionnaire that assessed patients' demography, patients' acceptance of and reaction to the involvement of medical students in their clinical care including the specific procedures the patients would allow medical students to perform. Results: Two hundred and fifty-one patients with mean age ± standard deviation of 37.33 ± 19.01 (age range = 16–120 years; M:F = 1:1.26) were recruited between January 01 and March 31, 2013. Most patients (86.5%) preferred to be treated in a teaching hospital and were comfortable with medical students as observers (83.7%) and serving as the doctors' assistant (83.3%) during common diagnostic procedures. Men were more willing to have invasive procedures such as insertion of urinary catheter (56.6% vs. 43.4%, P = 0.001). Acceptability of medical students (such as willingness of patients to have students read their medical notes) was significantly higher in nonsurgical specialties than in surgical specialties (77.5% vs. 22.5%, P< 0.001). Factors associated with a positive disposition include age >40 years, male gender, and higher level of education as well as consultation in nonsurgical specialties (P = 0.001). Discussion: Medical students are well received into this new teaching hospital setting. However, there is a need for more education of younger, less educated female patients of surgical subspecialties so that they can understand their importance as irreplaceable partners in the training of medical students.
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Using forum play to prevent abuse in health care organizations: A qualitative study exploring potentials and limitations for learning
A Jelmer Bruggemann, Alma Persson
September-December 2016, 29(3):217-222
DOI:10.4103/1357-6283.204215  PMID:28406106
Background: Abuse in health care organizations is a pressing issue for caregivers. Forum play, a participatory theater model, has been used among health care staff to learn about and work against abuse. This small-scale qualitative study aims to explore how forum play participants experience the potentials and limitations of forum play as an educational model for continued professional learning at a hospital clinic. Methods: Fifteen of 41 members of staff of a Swedish nephrology clinic, primarily nurses, voluntarily participated in either one or two forum play workshops, where they shared experiences and together practiced working against abuse in everyday health care situations. Interviews were conducted after the workshops with 14 of the participants, where they were asked to reflect on their own and others' participation or nonparticipation, and changes in their individual and collective understanding of abuse in health care. Results: Before the workshops, the informants were either hesitant or very enthusiastic toward the drama-oriented form of learning. Afterward, they all agreed that forum play was a very effective way of individual as well as collective learning about abuse in health care. However, they saw little effect on their work at the clinic, primarily understood as a consequence of the fact that many of their colleagues did not take part in the workshops. Discussion: This study, based on the analysis of forum play efforts at a single hospital clinic, suggests that forum play can be an innovative educational model that creates a space for reflection and learning in health care practices. It might be especially fruitful when a sensitive topic, such as abuse in health care, is the target of change. However, for the effects to reach beyond individual insights and a shared understanding among a small group of participants, strategies to include all members of staff need to be explored.
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Evaluating the use of twitter as a tool to increase engagement in medical education
Basia Diug, Evie Kendal, Dragan Ilic
September-December 2016, 29(3):223-230
DOI:10.4103/1357-6283.204216  PMID:28406107
Background: Social media is regularly used by undergraduate students. Twitter has a constant feed to the most current research, news and opinions of experts as well as organisations. Limited evidence exists that examines how to use social media platforms, such as Twitter, effectively in medical education. Furthermore, there is limited evidence to inform educators regarding social media's potential to increase student interaction and engagement. Aim: To evaluate whether social media, in particular Twitter, can be successfully used as a pedagogical tool in an assessment to increase student engagement with staff, peers and course content. Methods: First year biomedical science students at Monash University completing a core public health unit were recruited into the study. Twitter-related activities were incorporated into the semester long unit and aligned with both formative and summative assessments. Students completed a structured questionnaire detailing previous use of social media and attitudes towards its use in education post engagement in the Twitter-specific activities. Likert scale responses compared those who participated in the Twitter activities with those who did not using student's t-test. Results: A total of 236 (79.4%) of invited students participated in the study. Among 90% of students who reported previous use of social media, 87.2% reported using Facebook, while only 13.1% reported previous use of Twitter. Social media was accessed most commonly through a mobile device (49.1%). Students actively engaging in Twitter activities had significantly higher end-of-semester grades compared with those who did not [Mean Difference (MD) = 3.98, 95% CI 0.40, 7.55]. Students perceived that the use of Twitter enabled greater accessibility to staff, was a unique method of promoting public health, and facilitated collaboration with peers. Discussion: Use of social media as an additional, or alternate, teaching intervention is positively supported by students. Specific use of micro-blogs such as Twitter can promote greater student-staff engagement by developing an ongoing academic conversation.
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Specialty preferences and motivating factors: A national survey on medical students from five uae medical schools
Mahera Abdulrahman, Maryam Makki, Sami Shaaban, Maryam Al Shamsi, Manda Venkatramana, Nabil Sulaiman, Manal M Sami, Dima K Abdelmannan, AbdulJabbar M.A Salih, Laila AlShaer
September-December 2016, 29(3):231-243
DOI:10.4103/1357-6283.204225  PMID:28406108
Background: Workforce planning is critical for being able to deliver appropriate health service and thus is relevant to medical education. It is, therefore, important to understand medical students' future specialty choices and the factors that influence them. This study was conducted to identify, explore, and analyze the factors influencing specialty preferences among medical students of the United Arab Emirates (UAE). Methods: A multiyear, multicenter survey of medical student career choice was conducted with all five UAE medical schools. The questionnaire consisted of five sections. Chi-squared tests, regression analysis, and stepwise logistic regression were performed. Results: The overall response rate was 46% (956/2079). Factors that students reported to be extremely important when considering their future career preferences were intellectual satisfaction (87%), work–life balance (71%), having the required talent (70%), and having a stable and secure future (69%). The majority of students (60%) preferred internal medicine, surgery, emergency medicine, or family Medicine. The most common reason given for choosing a particular specialty was personal interest (21%), followed by flexibility of working hours (17%). Discussion: The data show that a variety of factors inspires medical students in the UAE in their choice of a future medical specialty. These factors can be used by health policymakers, university mentors, and directors of residency training programs to motivate students to choose specialties that are scarce in the UAE and therefore better serve the health-care system and the national community.
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Doctors of tomorrow: An innovative curriculum connecting underrepresented minority high school students to medical school
Jordan Derck, Kate Zahn, Jonathan F Finks, Simanjit Mand, Gurjit Sandhu
September-December 2016, 29(3):259-265
DOI:10.4103/1357-6283.204219  PMID:28406112
Background: Racial minorities continue to be underrepresented in medicine (URiM). Increasing provider diversity is an essential component of addressing disparity in health delivery and outcomes. The pool of students URiM that are competitive applicants to medical school is often limited early on by educational inequalities in primary and secondary schooling. A growing body of evidence recognizing the importance of diversifying health professions advances the need for medical schools to develop outreach collaborations with primary and secondary schools to attract URiMs. The goal of this paper is to describe and evaluate a program that seeks to create a pipeline for URiMs early in secondary schooling by connecting these students with support and resources in the medical community that may be transformative in empowering these students to be stronger university and medical school applicants. Methods: The authors described a medical student-led, action-oriented pipeline program, Doctors of Tomorrow, which connects faculty and medical students at the University of Michigan Medical School with 9th grade students at Cass Technical High School (Cass Tech) in Detroit, Michigan. The program includes a core curriculum of hands-on experiential learning, development, and presentation of a capstone project, and mentoring of 9th grade students by medical students. Cass Tech student feedback was collected using focus groups, critical incident written narratives, and individual interviews. Medical student feedback was collected reviewing monthly meeting minutes from the Doctors of Tomorrow medical student leadership. Data were analyzed using thematic analysis. Results: Two strong themes emerged from the Cass Tech student feedback: (i) Personal identity and its perceived effect on goal achievement and (ii) positive affect of direct mentorship and engagement with current healthcare providers through Doctors of Tomorrow. A challenge noted by the medical students was the lack of structured curriculum beyond the 1st year of the program; however, this was complemented by their commitment to the program for continued longitudinal development. Discussion: The authors propose that development of outreach pipeline programs that are context specific, culturally relevant, and established in collaboration with community partners have the potential to provide underrepresented students with opportunities and skills early in their formative education to be competitive applicants to college and ultimately to medical school.
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Reviewers of education for health
Michael Glasser, Donald Pathman, Payal Bansal, Gaurang Baxi
September-December 2016, 29(3):167-168
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