1. Basics of Clinical Medicine Lecture Series:
A Novel Student/Resident Directed Learning Initiative
Paul Manhas, M.D., Richard Giovane, M.D., Paul Strickland, M.S.
Jennifer Clem, M.D., Drake Lavender, M.D., Catherine Skinner, M.D.
The University of Alabama
INTRODUCTION
RESULTS
DISCUSSION
The Basics of Clinical Medicine is a resident- initiated lecture series where University of Alabama Family Medicine resident physicians present the complex diagnostic process to 3rd and 4th-year medical students emphasizing:
differential-guided history-taking
physical examination
work-up and treatment 
This series was implemented to facilitate the transition from basic science to clinical medicine.
The primary objective was to facilitate students’ abilities to correctly identify a disease process from a patient’s presenting symptoms by minimizing their focus on traditional, systems-based history taking.
In essence, skills and techniques that resident physicians accumulated in their clinical practice were shared with student learners at a much earlier stage in their training.
There was an average of 19 students present for each lecture.
Thirty MS3 and 11 MS4 attended at least once, with 25 MS3s attending more than once and 16 MS3s attending more than half of the lectures.
19 students responded to the pre-series survey (12 MS3, 7 MS4) and 22 responded to the post-series survey (11 MS3, 11 MS4).
14 students completed the pre-survey questions on board exam knowledge while 5 students completed the post-survey.
There was an increase in student knowledge from before the lecture series. (M=67.53, N=14, SD=11.79) to after (M=74.86, N=5, SD=6.84).
Amongst MS3s, there was an increase in the level of interest in a career in family medicine from before the lecture series (M=3.08, N=12, SD=1.38) to after (M=3.36, N=11, SD=1.63).
There was an overall increase in the mean confidence level from before (M=3.03, N=17, SD=0.78) to after (M=3.92, N=20, SD=0.84) the lecture series. The mean confidence level for each lecture topic increased from before to after the lecture series.
Family medicine residents who participated in the series were satisfied with the project.
The post survey results reflect improved student comfort level in taking a focused history, developing differential diagnoses and working through case based problems.
The data suggest a positive correlation with knowledge gained and lecture attendance.
In this sample, there was an increased interest in family medicine among third year medical students.
The results suggest that our case-based, student driven curriculum supports third and fourth year medical students’ abilities to transition from basic science to clinical medicine.
Limitations to this program evaluation include:
A small sample size.
The entire sample size did not complete both pre- and post-surveys which precludes analyzing within subjects change over time.
FUTURE DIRECTIONS
PROJECT GOALS
METHODS
Pre-Series
Response
Post-Series Response
Difference
Mean N M SD
Knowledge component (percent correct) 14
67.53
11.79 5
74.86
6.84
7.33
Interest in a career in family medicine 12
3.08
1.38 11
3.36
1.63
0.28
Overall confidence (average of all confidence responses) 17
3.03
0.71 20
3.92
0.84
0.89
Lecture Topics
Shortness of breath
Confidence completing H&P 19
3.53
1.02
4.00
0.47
Confidence forming a DDx
3.32
3.95
0.95
0.63
Chest pain 18
3.67
1.09
4.10
0.91
0.43
3.29
0.92
4.15
0.88
0.86
Hyperglycemia
3.00
3.85
0.99
0.85
0.97
3.90
0.90
Abdominal pain
0.77
0.33
3.28
0.83
4.05
Syncope
3.33
1.03
0.67
3.17
0.96
Sepsis
2.56
0.98
1.44
2.61
0.78
1.29
Fluid/electrolyte abnormalities
2.39
3.60
1.00
1.21
Confidence managing repletion of fluid/electrolytes
1.83
0.79
3.35
1.52
1) Create an open, group-based learning environment:
Facilitate a stress-free environment to discuss ideas with their colleagues.
Emphasize group-based learning to mimic the collaborative effort observed on wards.
2) Support differential guided evaluation:
Aid in the transition from classroom learning to ward performance by introducing differential-guided history taking skills.
Demonstrate a more intuitive and comprehensive way to navigate from a patient’s history to ordering pertinent labs and imaging.
3) Strengthen student examination and clinical preparation:
Aim to prepare students for their future examinations and clinical rotations.
4) Increase family medicine recruitment:
Aim to increase awareness and interest in Family Medicine as a career.
All 3rd- and 4th-year medical students at the Tuscaloosa campus were invited to participate in the pre- and post-lecture series survey regardless of their attendance of the lectures.
The surveys contained:
Items assessing student confidence completing patient care tasks related to each lecture topic on a five-point Likert scale.
Items assessing interest in a career in family medicine rated on a five-point Likert scale.
35-item board exam-style test to assess knowledge related to each lecture topic.
Qualitative data was gathered on the post-survey to assess students’ thoughts on the curriculum and to determine improvements for future iterations of the lecture series.
Only data from 3rd-year students were utilized for analysis of interest in a career in family medicine.
SPSS was utilized for statistical analysis to compare pre- and post-series scores on each topic.
FUTURE CONSIDERATIONS
A second lecture series is being planned for Spring of The goal will be to prepare 4th year medical students to transition to internship.
Pre- and post-surveys will be modified to include less knowledge questions in hopes of attaining a higher response rate.