Curricular Innovation

Educational Research Day

Sample Abstracts

Title
Teaching Medical Students about Health Care of the Homeless

Authors
Sharad Jain, M.D.; David Buchanan, M.D.

Purpose
Providing medical care for homeless patients requires a specific set of knowledge and skills that are not routinely taught in traditional medical school curricula. In addition, there are no structured opportunities for students to rotate through clinics serving the homeless during their clinical years. Our objective was to create an elective for students to learn innovative strategies in caring for homeless patients, work with community role models, and encourage future altruism through positive clinical experiences with the homeless.

Methods
The course is a two-week clinical elective offered yearly to fourth-year medical students and consists of a lecture series, clinical work, and site visits; enrollment is limited to four students. Lectures include discussions of medical issues common in homeless populations as well as discussions on overcoming challenges encountered in caring for homeless patients. The lectures place an emphasis on providing realistic approaches to these conditions that incorporate the patients’ social context. Students gain clinical experience by rotating through clinics which provide medical care to homeless persons. Students also work with experienced faculty to provide outreach to people living in the street. They participate in site visits to learn examples of innovative ways to provide care to this population.

Evaluation
This course has been offered for three years, and nine students have completed it. Student feedback about the course has been uniformly positive, with all students giving the course an "outstanding" rating in all domains using our institution's standard evaluation form. All students "strongly agreed" with the statements: "This course has provided me with role models in the health profession," and "This course has taught me innovative ways in which care can be delivered to indigent patients."

During the second and third years, knowledge-based tests consisting of multiple choice questions were administered on the first and last day of the course. These tests were also administered to a control group of students who expressed interest in the course but were unable to enroll due to space constraints. Mean knowledge scores at baseline were 59.8 for the intervention group and 63.2 for the control group. Following the course, the intervention group mean knowledge score increased to 80.0, while the group mean for the control group was 59.2 (p<0.001).

Conclusions
An elective to teach fourth-year students about caring for homeless patients was well received by these students and achieved significantly higher post-test knowledge scores than a control group of students. In the future, we plan to assess student attitudes toward caring for the underserved and to incorporate elements of this course into the core curriculum.

Title
Longitudinal Clinical Experience

Authors
Margo Vener, M.D., M.P.H.; Maria Wamsley, M.D.; Cynthia Irvine, M.Ed.

Objectives
Students will be able to:

1. Demonstrate knowledge and skills to provide effective outpatient care;
2. Experience continuity of clinical practice;
3. Perform independent history and physical exams and formulate assessment and plans;
4. Describe the importance of both multispecialty and multidisciplinary approaches to care.

Description

Methodology
Third-year students (137 total) were placed with preceptors in a variety of practice settings: private practice, academic practice, public health clinics, and HMO.

Students were required to attend at least 24 sessions during Blocks 2-6 (9 months).

Sessions were one-half day per week in a primary care or specialty setting.

Evaluation
A five-point Likert scale was administered to students about the LCE experience, the role of their preceptor as a mentor, the impact of the LCE experience on their interest in ambulatory care, and the impact of LCE on required clerkships.

All preceptors were sent a survey as to whether they felt they were able to provide adequate experience in ambulatory care and whether they could give adequate experience in continuity of care in the LCE.

Discussion
Although many medical schools offer the opportunity for third-year students to participate in continuity experiences, virtually all of them limit that experience to primary care settings. This year for the first time UCSF offered students the option of working with a primary care or a specialist physician in an outpatient continuity practice. Students were asked to rank their placement preferences and most were placed in one of their top two choices. Many students recruited their own preceptors as well. Fifty-five percent of students were placed with primary care physicians, and 45 percent were placed with specialist physicians.

Overall, the initial feedback from both students and preceptors involved in the LCE has been quite positive. The vast majority (>95 percent) of preceptors responded that they felt able to provide adequate experience in ambulatory care. Of these, 65 percent felt able to offer adequate experience in providing continuity of care. Students found the LCE experience valuable (80 percent) and a large number felt that their preceptor was a role model and mentor (>90 percent). The majority of students (82 percent) felt that LCE did not affect or improved their clerkship performance. Open-ended comments were extremely positive as well. This poster will review in more depth the goals and objectives of the LCE and review initial feedback from preceptors and students.