RESULTS: The program has been functioning for one year, and is a valued educational experience according to feedback from the trainees. The students have had excellent attendance, while residents have needed greater encouragement to attend the sessions. Faculty participation has been excellent, as the sessions provide greater opportunity to teach than is possible during busy clinic hours. An additional benefit has been the increased interaction of learners from the variety of disciplines represented. The timing of the report has not interfered with clinic operations. CONCLUSION: Our ambulatory morning report enhances the quality of clinical education and is a valued addition to the ambulatory rotation. Plans are being discussed to include trainees from other clinical teaching sites. Future implementation should include prospective evaluation of impact on knowledge, attitudes, and the use of evidence in patient care. OBJECTIVES: As part of our HRSA-funded primary care grant, we increased the longitudinal ambulatory care requirement for our categorical internal medicine residents. With an increasing proportion of our residents having this ambulatory care experience in the community, we felt the need to determine whether the educational experience for these residents is comparable to that of residents in a more traditional hospital-based clinic setting. We developed a new evaluation tool to assess the experiences of residents in these two settings. METHODS: In developing our Evaluation of Continuity Preceptor and Site instrument, we sought to assess those aspects of the resident's experience most important for optimal ambulatory education in both community and hospital-based sites. The evaluation instrument is divided into a group of questions concerning the preceptor and another group of questions regarding the ambulatory site. The 15 preceptor items include questions about role modeling, supervision, teaching and an overall rating. The 18 site items include questions about office systems (patient flow, medical records, billing), patient characteristics, continuity of care and an overall rating. Items were rated on a 5-point Likert scale, assessing frequency of preceptor and site attributes, using terms varying from never/almost never to always/ almost always. RESULTS: The instrument was piloted and yielded good internal consistency (Cronbach's alpha .88 for preceptor items and .83 for site items). The survey was then distributed to all categorical residents semiannually for two years. The response rate was 82%, and 132 surveys were analyzed. When tested for differences using the Mann ± Whitney test, the group mean scores for site items were significantly higher for the community sites as compared to the hospital-based clinic site (4.08 vs 3.72; P=0.001). The group mean scores for the preceptor items were higher for the clinic-based faculty as compared with the community preceptors (4.58 vs 4.44), but the difference was not significant (p = 0.08). Site items rated higher by residents in the community included questions about exposure to a broad range of patients (p = 0.001) and to a full range of patient problems (p = 0.07). Residents in the hospital-based clinic felt they had a higher level of responsibility for their patients (p < 0.001) and they rated their preceptors slightly higher in providing explanations and asking questions to enhance learning (p = 0.13). CONCLUSION: Internal medicine residents are being increasingly assigned to community sites for their longitudinal ambulatory care experience. In our survey, we found that residents in the community rated site items higher and residents in the hospital-based clinic rated preceptor items slightly higher. Awareness of the differences between the two types ambulatory care experiences is important for planning future ambulatory educational activities. OBJECTIVES: A web-based modular curriculum for information literacy was developed to support evidence-based clinical practice and refine residents' skills for preparing professional conference presentation materials. This curriculum was designed to fill the gaps in informatics knowledge necessary to subsequent assignments supporting an Evidence Based Medicine (EBM) residency curriculum. METHODS: To assess readiness and assure curricular relevance, baseline data is gathered concerning essential EBM and information literacy skills. The initial one month curriculum consists of four two-hour class sessions supported by hands-on instruction and maintained on the open residency website. Content focuses on current and future informatics practice issues, orientation to significant information resources, emerging technology developments related to clinical practice, EBM searching strategies for the general Internet and quality medical sources, overview of quality patient education materials, government websites, and time saving shortcuts for common technology applications including browsers, word processing and presentation programs. The team of people who support and maintain this curriculum include a variety of Internal Medicine content experts, the medical librarian, a nursing informatics webmaster, and a research specialist. RESULTS: The initial series of courses is completed within the first three months of the first post-graduate year. Continued exposure to EBM skill usage and the website is required during all three years of the resident's outpatient clinic via topic sessions. Final assignments of the second and third residency years include a digital presentation of a clinical topic in an Internal Medicine research forum conference. CONCLUSION: Integration of information literacy skills into a residency curriculum must consider variations in learning curves and the need for changes in approaches to traditional problem solving techniques in clinical practice. Clinical faculty and residents need support and encouragement to adapt existing processes to include EBM approaches in daily practice. Traditional dogma states that a shift in institutional thinking may be needed to provide conveniently accessible Internet resources on the practice units and in the residency work areas. However, providing a readily accessible set of instructions and relevant EBM resources via a residency website removes barriers to implementation of evidenced based clinical practice for residents and attending physicians. The ACGME/ABMS vision is the integration of life-long learning for physicians with the maintenance of Board certification. Their collective goal is to ensure that physicians are better prepared to provide compassionate, appropriate, and effective patient care in the changing health care environment. DESCRIPTION OF PROGRAM/INTERVENTION: Purpose: Using this background as a framework, the ABIM Clinical Competence Program is exploring ways to foster self-reflection, self-assessment, and continuing professional development among internal medicine residents and subspecialty fellows throughout their training. Through a newly developed tool and template, the use of a portfolio designed and maintained by the physician, may facilitate achieving this goal and serve to chronicle medical professionalism. FINDINGS TO DATE: What Comprises A Portfolio?: Multidimensional, qualitative and quantitative, portfolios encompass a broad spectrum of activity from definitive learning goals, performance assessment and reviews, to personal narratives and community service. KEY LESSONS LEARNED: Conclusion: The professional portfolio is the tangible culmination of one's acquired and applied knowledge, learning experiences, and unique opportunities for self-assessment and self-reflection. The portfolio remains the practical and intellectual property of the creator. Through the creation of a portfolio, physicians are empowered to gain better insight into their own goals, personal and professional growth. and career development. We summarize our needs assessment of unique MD/MBA competencies and the integrated 5-year curriculum created in response to these needs. OBJECTIVES OF PROGRAM/INTERVENTION: Our goals were to 1) identify unique MD/MBA competencies through the input of private sector and academic physician leaders; and 2) develop new curricular opportunities to meet these needs. DESCRIPTION OF PROGRAM/INTERVENTION: Through a structured process, an advisory board comprised of 14 health care leaders identified six competency areas critical to MD/MBA graduates: clinician leadership skills in business environments, common business components of public and private health care delivery, a historical perspective on the US health care delivery infrastructure, the role of public policy in shaping health care delivery, an internal framework for ethical organizational decisionmaking and a population perspective in health care planning. These MD/MBA competencies represent additional skills required by graduates beyond the core competencies of each degree independently. During the first three years students complete all the standard MD curricular activities. MD students apply for the MD/ MBA Program during their third year. Once accepted, students spend the fourth year completing the entire core and some elective requirements in the Business school. The fifth year curriculum was developed as a summation year, integrating the two Schools' curricula while explicitly addressing the unique dual degree competencies. Fifth year curricular elements include a management component integrated into standard clinical electives, a broadened range of electives in other Schools within the University such as Public Health, an evening Physician Leadership Colloquia Series, and a clinically oriented field study/research experience. Students completed an evaluation that covered both School's core competencies as well as the unique dual degree competencies using a Likert scale. Information was also elicited about students' short and long term plans. FINDINGS TO DATE: All six members of the first cohort completed evaluations. Overall the curriculum addressed the majority of the unique MD/MBA competencies with a mean score of 3.0 or higher. Two competencies need further emphasis: developing an ethical framework for organizational decisionmaking (2.8) and an application of physician leadership skills in business environment (2.5 STATEMENT OF PROBLEM OR QUESTION: Statement of the Problem: Professional behavior is often not a structured topic in the standard medical school curriculum. Much of the socialization for medical professionals occurs in what we refer to as the hidden curriculum. Frequently medical students may not have the understanding of what is considered appropriate professional behavior, yet they are exposed to positive and negative role models from which they may choose to emulate. OBJECTIVES OF PROGRAM/INTERVENTION: Objectives: Our goal was to develop curriculum that begins to address some issues around the socialization that occurs for medical students during their clinical years of training. The purpose is to provide an informal, safe environment for students to discuss issues of professional behavior to which they are exposed during their third year of medical school. Information obtained from these gatherings is used to modify the experiences the students have during clinical training. In addition it serves the purpose of allowing students to share experiences with their colleagues. DESCRIPTION OF PROGRAM/INTERVENTION: Description: In a course entitled``The Hidden Curriculum'', junior medical students are divided into groups of 12 and have 6 scheduled meetings during the academic year with two facilitators (a faculty member and a senior medical student). For each session, the facilitators are provided with 2 to 3 questions concerning a variety of topics. Some of the topics include balance of professional and personal life, perceived medical student abuse and career goal exploration. A written summary report is generated from all of the data gathered from the small groups. The summary report is distributed to the clerkship directors, students and several of the Deans involved in medical student education. FINDINGS TO DATE: Findings to Date: Medical student experiences are generally positive but they are continually exposed to some negative role models. The results from the curriculum thus far have lead to creating a more formal evaluation of professional behavior. In some instances specific individuals have received feedback concerning egregious behavior. Students view this as a very positive experience, finally allowing them a format that facilitates critical feedback about their experiences. KEY LESSONS LEARNED: Key Lessons Learned: Medical students rarely receive formal training on what appropriate professional behavior entails. In many circumstances they do not feel comfortable providing honest, critical feedback to their superiors. Evaluation of professional behavior should be done in a more formal manner, addressing appropriate knowledge, skills and attitudes just as we do with clinical performance. OBJECTIVES OF PROGRAM/INTERVENTION: Conduct a workshop with residents using patients with life-threatening illness in order to: 1) educate residents about how to communicate bad news to patients and 2) change residents' attitudes about communicating bad news and maintaining hope for patients. DESCRIPTION OF PROGRAM/INTERVENTION: Four patients with cancer from the Wellness Community were recruited to participate in a 2 hour resident workshop on giving bad news to patients. The curriculum included patients using their own diagnoses and histories as the role play scenarios. Residents were instructed to give bad news as they usually do, then feedback from the patients, discussion about the role play and about the method as described by Buckman ensued. A second role play using the learned concepts was conducted and final debrief occurred. Prior to the workshop, residents completed an 11 item questionnaire about actions to be taken during the communication of bad news, with a similar post-test being used at the end of the workshop. FINDINGS TO DATE: Twenty-five residents participated, with 15 (60%) completing pre and post tests. Attitudes toward ensuring hope is conveyed to patients (p < 0.05), starting the discussion by ascertaining the patient's understanding of the condition (p < 0.01), and encouraging the patient to express his/her feelings (p < 0.01) all significantly improved with the use of the workshop. Most of the improvement occurred in residents with previous training. KEY LESSONS LEARNED: A role play workshop using untrained patients with cancer can significantly improve residents' attitudes about giving bad news. Volunteers are without cost to the institution, and have a positive influence in such workshops. Residents who are previously trained may hold counterproductive attitudes, and therefore all residents should participate in workshops using role play by actual patients about giving bad news. is predicated on the belief that humanism and professionalism come to students and others through understanding a number of core concepts and relationships complemented by self-reflection. The concepts, which have been described by ABIM's Project Professionalism, include ideas of integrity, respect and others; the relationships include those with patients and families and with other health care professionals. Talking Medicine offers a consistent (every other week for 10 weeks) opportunity to share experiences in small groups (6 ± 8), facilitated by two preceptors in a format driven by students' experiences. Although the focus is on students' experiences, readings are provided on basic topics and contexts in humanism and professionalism (e.g. end of life care, mistakes, spirituality in medicine, and boundaries between patients and doctors). FINDINGS TO DATE: Talking Medicine began in summer, 2000 and half of the third year class has taken it. We surveyed students (total 54, response rate 63%) and found 94% felt "very" or "somewhat" comfortable in the course. 73% of students reported that the course increased their "connectedness" to classmates and 61% favored it occuring during all rotations. 59% reported that their interest in caring for patients improved and 53% reported their interest in internal medicine as a field improved. Answers to open-ended questions highlighted the importance of Talking Medicine as a forum to connect with others Ð both students and faculty. KEY LESSONS LEARNED: These results suggest Talking Medicine may be most effective in helping classmates connect to and learn from each other, thereby setting a foundation for changes in how they interact with patients. STATEMENT OF PROBLEM OR QUESTION: End-of-life care is assuming increasing importance within medical education curricula. Traditional teaching methods may be inadequate to address the emotional, interpersonal, and spiritual aspects of palliative care. The performing arts offer an innovative approach to teach medical trainees in these essential but under-emphasized domains. OBJECTIVES OF PROGRAM/INTERVENTION: We instituted a program using the dramatic arts to foster empathy for the terminally ill person's experience of illness, and selfreflection with regard to personal practices in caring for dying persons. DESCRIPTION OF PROGRAM/INTERVENTION: The Wit Educational Initiative uses professional readings of the Pulitzer-Prize winning play``Wit'' at medical training sites throughout North America. "Wit" narrates the personal and medical care experience of a patient dying from metastatic ovarian cancer. Medical students, housestaff, and ancillary providers attend readings of the play followed by structured discussions of the play's themes. Program participants are asked to complete a survey evaluating the program's acceptability and relevance. FINDINGS TO DATE: To date, 9 of 14 program sites have returned surveys. An estimated 44% (614/1385) of program attendees completed the survey and 43% of respondents were medical students or residents. Eighty-four percent of trainees were emotionally moved``a great deal'' or``pretty much'' by the performance, (mean = 4.3; 1 =``not at all'', 5 =``a great deal'') and 64% reported that the play portrayed the emotions of dying patients in an``entirely real'' or`v ery real'' manner (mean = 4.3). Of trainees who provide direct patient care, 75% reported that the program was``extremely relevant'' or``very relevant'' to the care they provide (mean = 4.0). The program encouraged attendees to reflect on specific aspects of palliative care including helping patients live as long as possible (mean = 3.8, 1 =``not much at all'', 5 =``very much''), talking about prognosis (mean = 4.4), addressing physical pain (mean = 4.4), addressing emotional and spiritual suffering (mean = 4.4), and talking with patients about treatment wishes (mean = 4.4). The majority of trainees rated the program a more useful training tool than didactic lectures on palliative care (83%), journal article readings (85%), and bedside rounds (57%). KEY LESSONS LEARNED: The dramatic arts foster awareness of the patient experience of illness that is relevant to the care trainees provide terminally ill persons. Many trainees feel such experiences are more useful approaches to palliative care training than traditional educational methods. Medicine has partnered with a not-for-profit managed care organization, AvMed Health Plan, Inc. Students visit the administrative offices of AvMed where presentations cover general concepts of MC, physician profiling, practice guidelines, outcome management, and disease management programs. Students also``round'' in AvMed's four major departments; Pre-Authorization, Disease Management, Member Services, and Physician Services where they witness the daily operations of the health plan. A 14 item survey (5-point Likert scale) was completed by students at the beginning of the 2nd year, the beginning of the 3rd year and again immediately before (pre) and after (post) the day at the AvMed MCO. FINDINGS TO DATE: The program has been evaluated favorably by more than 200 thirdyear medical students. There were no significant differences between mean responses at the beginning of the 2nd year of school and the beginning of the 3rd year (t-test). Of the 14 items, 8 responses were neutral and 6 were negative towards MC. The responses to the pre-seminar survey were also not different from the responses at the beginning of the 2nd or 3rd years. However, post-seminar responses showed significant (p < .05) changes favorable towards MC for 7 items and > 20% of respondents abandoned their negative attitude towards MC for 5 survey items (e.g. MCO's have potential to improve quality, MCO's provide better care than the traditional system, I understand how MC functions). STATEMENT OF PROBLEM OR QUESTION: America's health care system is undergoing dramatic transformation in care management. Most medical schools, however, have not updated their curricula to prepare graduates for practice in this changing environment. OBJECTIVES OF PROGRAM/INTERVENTION: Strategies to enhance student acquisition of the knowledge, skills, values and attitudes needed to practice in intensely managed and integrated health care systems; fostering partnerships between academic centers and appropriate health care organizations; enhancing interdisciplinary primary care education in ambulatory/ community-based settings. DESCRIPTION OF PROGRAM/INTERVENTION: Project requirements include: leadership among departments/divisions of general medicine, general pediatrics and family medicine; cooperation of participating partner organizations; and establishment of learning objectives in nine content areas: health systems financing, economics, organization and delivery; evidence-based medicine; ethics; communication skills; leadership; quality measurement; systems-based care; medical informatics, and wellness and prevention. Instruction is required for all students in their clinical years, and must begin no later than the third year. FINDINGS TO DATE: The UME-21 projects within internal medicine include: Incorporating medical students in continuous quality improvement (CQI) measurements in community practices; students' use of palm pilots to monitor disease prevalence and adherence to practice guidelines in office settings; office-based instruction in physical diagnosis; web-based learning integrated into medical clerkships; utilization of simulated patients into medicine clerkships; interdisciplinary primary care clerkships; incorporation of managed care organization physicians and evidence-based medicine into medical clerkships; and epidemiology in community settings. KEY LESSONS LEARNED: With strong leadership from general internists and their colleagues, U.S. medical schools are responding creatively to the challenges of curricular innovations in this national demonstration project.