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Integrating research, medical informatics, evidence based medicine and population health in the medi

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Title: Integrating research, medical informatics, evidence based medicine and population health in the medi


1
Integrating research, medical informatics,
evidence based medicine and population health in
the medical curriculum Evidencing outcomes in a
new generation of medical doctors
  • Myrna Borges, M.D. Sandra Chinapen, Ph.D.
    Griselle Burgos, MPH
  • Irvin Maldonado, Ph.D. Martha E. García, M.D.
    Alvaro Pérez, M.D.

San Juan Bautista School of Medicine,
Caguas, PR, 00725, USA
2
Background and Significance
  • Medical education has experienced remarkable
    changes and challenges during the last years as
    consequence of rapid evolution of knowledge, and
    social and health care transformations.

3
Background and Significance
  • Experts in medical education through
    international panels have studied and recommended
    necessary adjustments in the contents, structure,
    delivery and outcomes assessment methods of the
    academic program. (AAMC 1998-2006, MSCHE 2003)

4
Background and Significance
  • These recommendations include but are not limited
    to
  • integration of basic and clinical sciences,
  • use of active learning formats,
  • put emphasis on information literacy,
  • principles relevant to the behavioral and social
    aspects of health and disease,
  • reinforcement of the life long learning skills.

5
Background and Significance
  • A contemporary issue in medical education is also
    the inclusion of basic and clinical research into
    the medical curriculum, from undergraduate to
    graduate courses.(AAMC 2001)

6
Background and Significance
  • A lot of medical programs around the world have
    developed different approaches directed to
    strengthen the research competence in their
    curriculum.
  • Electives or summer courses have been the most
    common choice adopted. Combined programs, MD/PhD,
    MD/MPH, are intended to provide scientific
    physicians, as an elite group crucial for the
    translational research, but could leave a wide
    group of physicians without direct contact with
    the scientific method.

7
Background and Significance
  • SJBOM following recommendation from agencies and
    expert panels, as well as, giving organization to
    initial approaches from the faculty, the SJBSM
    began a process of curriculum adjustment on 2003.
  • This new approach defines five emphases
  • medical knowledge,
  • clinical skills,
  • professionalism,
  • research and information literacy and
  • community awareness.

8
How we did it?
  • Research, information literacy and evidence-based
    medicine have been integrated trough the four
    years. During the academic program students learn
    and apply the fundamentals of basic and clinical
    research by means of a research project intended
    to answer a community health problem.
  • The full proposal was implemented with the
    entering class in 2004. This process has been
    attuned according to the assessment results.

9
How we did it?
  • Outcomes assessment
  • In courses
  • Critical review of literature reports, observer
    ratings, written reports, concept maps, evidence
    based medicine reports, brochure contest
    (checklist), sequential development of a research
    proposal (research question first semester
    background and significance hypothesis and
    objectives second semester methodology -third
    semester full proposal submission and
    approval-fourth semester and practical experience
    third year).
  • In Program
  • Portfolios, finished proposals, research papers
    published (peer reviewed poster presentation,
    oral communication or academic journal), number
    of faculty involved graduation questionnaire.

10
Research and information literacy through out the
medical program at SJBSOM
4th yr.
3rd yr.
2nd yr.
1st yr.
ELECTIVE CLERKSHIP IN RESEARCH
PRACTICE EXPERIENCE
CLINICAL RESEARCH CLERKSHIP PRACTICE EXPERIENCE
INTRODUCTION TO RESEARCH RESEARCH QUESTION
Evidence based medicine Critical review of litera
ture Journal club primer Concepts maps Brochure
contest COMMUNITY MEDICINE AND RESEARCH I BAC
KGROUND AND SIGNIFICANCE Biostatic Epidemiology
Population base research Evidence based medicine
COMMUNITY MEDICINE AND RESEARCH II HYPOTHESIS,
OBJECTIVES AND METHODS Epidemiology Population b
ased research Epiinfo Evidence based medicine
CLINICAL RESEARCH FINAL PROPOSAL
SUBMITTED Translational research Evidence based
medicine
11
Results
  • Outcomes Assessment at Program Level
  • The number of students actively involved in
    research projects has notoriously increased in
    comparison with previous years, with a
    statistically significant difference during the
    last two years (p

12
Percentage of students participating in research
during medical school
13
Distribution of research works by topics (ICD-10)
14
Results
  • Outcomes Assessment at Program Level
  • A significant percent of graduates (60 both in
    2006 and 2007) reported to consider adequate the
    instruction on information literacy, evidence
    based medicine, literature reviews/critiques and
    interpretation of clinical data and research
    reports during the medical program.

15
Results
  • Outcomes Assessment at Program Level
  • A high percent of graduates (82 for 2006 and 90
    for 2007) expressed confidence about the acquired
    knowledge and skills to use sophisticated
    searches of medical information databases.

16
I am confident that I have the appropriate
knowledge and skills to ..
17
Results
  • Outcomes Assessment at Program Level
  • 87 of graduates in 2006 and 95 in 2007,
    expressed confidence in the acquired knowledge
    and skills to critically review a published
    research report.

18
Results
  • Outcomes Assessment at Program Level
  • A rising percent of graduate expressed their
    career intention as full time researcher or
    academic, both in the basic and clinical
    sciences. This intention was greater in the 2007
    class. (27)

19
How extensively do you expect to be involved in
research during your medical career?
20
Results
  • Outcomes Assessment at Program Level
  • The number of graduates expecting to be involved
    in research activities during their career
    increased significantly in 2007 (87), including
    a 5 of graduates who expect dedicating
    exclusively to research activities.

21
Trends in academic involvement into information
literacy and research 2000-2008
22
Results
  • Outcomes Assessment at Course Level
  • Formative and summative assessment methods used
    in the evaluation of research projects along the
    first years during the proposal development have
    evidenced accomplishment of learning goals.

23
Assessment inventory by course and year level
24
Conclusions
  • According to the results there is a significant
    evidence of accomplishment of institutional goals
    concerning research emphasis in the curriculum.
  • The results show a great impact of our model in
    all the indicators evaluated faculty
    involvement, student participation in projects
    and publishing, student attitudes toward research
    and new knowledge and tools, graduate intention
    to be involved in research during future life.

25
Conclusions
  • Our work is directed to attuned and improve the
    assessment tools, as well as, the methods of
    delivery, faculty and course/clerkship
    coordinators involvement in the process.
  • The use of formative assessment has allowed
    improving final summative results of the research
    proposal. Also decreases student's anxiety with
    the evaluation.

26
Conclusions
  • The most difficult component according to
    evaluations in the protocol design corresponds to
    support ideas and expected results. Organization,
    structure and presentation have obtained the best
    evaluations.
  • In the final research project, evaluation by
    proctor has been slightly better than evaluation
    of the written component. In this case,
    supporting and discussing ideas represent the
    greater challenge to students.

27
Future ..
  • Increase the value of all indicators, specially
    Number of publications by students
  • Develop a Master program in Medical Research for
    MD. (5-10 years from now)

28
References
  • Friedman CP, Corn M, Frisse M, et al. (1998).
    Report II - Contemporary Issues in Medicine
    Medical Informatics and Population Health.
    Washington, D.C. Association of American Medical
    Colleges.
  • Danforth WH, Korn D, Tuckson RV et al. (1999).
    Clinical Research Summit project/ Clinical
    Research A National Call to Action. Washington,
    D.C. Association of American Medical Colleges,
    Division of Biomedical and Health Sciences
    Research.
  • Berns KI, Berlin R, Cardozo D et al. (2001).
    Report IV - Contemporary Issues in Medicine
    Basic Science and Clinical Research. Washington,
    D.C. Association of American Medical Colleges.
  • Meyer RE, Ball MJ, Chute CG, Cimino J et al.
    (2003). Information Technology Enabling Clinical
    Research. Washington, D.C. Association of
    American Medical Colleges.
  • Developing Research Communication Skills
    Guidelines for Information Literacy in the
    Curriculum. (2003). Philadelphia, PA. Middle
    States Commission on Higher Education.
  • Fink L. Dee (2003). Creating Significant Learning
    ExperiencesAn Integrated Approach to Designing
    College Courses San Francisco Jossey-Bass.
  • Gabbe SG, Riordan MC, Brimhall DC, Alpern RJ et
    al. (2006) Promoting Translational and Clinical
    Science The Critical Role of Medical Schools and
    Teaching Hospitals. Report of the AAMCs Task
    Force II on Clinical Research. Washington, D.C.,
    Association of American Medical Colleges (AAMC).
  • LCME STANDARD ED-17-A The curriculum must
    introduce students to the basic principles of
    clinical and translational research, including
    how such research is conducted, evaluated,
    explained to patients, and applied to patient
    care. (New standard approved by the LCME in
    February 2007 effective July 1, 2008)

29
Acknowledgements
  • We would like to acknowledge the support of the
    President/Dean, Administration, our colleagues
    and the students, our final goal..
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