RESULTS: The MD group had proportionally more women and started medical school 2 years later than either MD/Ph.D. group(p < .05). The MD/Ph.D. clinic students (n=20) were significantly more confident than the MD students (n=49) about their skills in every category of the questionnaire (history and general competencies, readiness to function as a doctor, physical exam, diagnosis and treatment) (p < . 05). They were more confident than the MD/Ph.D. nonclinic students (n=13) First-year students' perceptions of necessary professional skills focused upon behaviors relative to their current roles in their educational experience. The patient care related issues identified by students such as patient confidentiality and knowledge of limitations appeared to be appropriate for their level of training. Applying the ABIM format to the survey results shows that the majority of responses fall into the categories of excellence (dedication to learning), honor and integrity (honesty), and respect for others (respect). Presenting first-year students with a professionalism curriculum that is primarily focused upon patient-care related issues may not be as relevant as professionalism issues more closely related to their current level of training. Addressing issues such as dedication to learning, honesty, and respect may increase the relevance of professionalism to pre-clinical students. We are using this work to develop identify students' perceptions of stage-appropriate professional skills and behaviors to devise stage-appropriate educational interventions to teach professionalism. METHODS: Faculty members participated in a pre ± post study of a faculty development program consisting of three 90-minute interactive seminars teaching evaluation, feedback, and One-Minute Preceptor microskills. Audiotapes were collected of ambulatory teaching encounters with 3rd year medical students before and after the intervention. The audiotapes were transcribed and coded by individuals blind to the identity of the teachers and learners. Transcripts were coded using the Teacher Learner Interactive Assessment System, a qualitative tool designed to comprehensively code all utterances into mutually exclusive categories. Ten percent of audiotapes were double coded to assess inter-rater agreement. Written surveys after each encounter assessed learner, teacher, and patient satisfaction. Learner and teacher perceptions of the amount and quality of several aspects of the encounter, including feedback, were also evaluated. RESULTS: Nine teachers and 64 third year medical students participated, providing 45 encounters before and 48 encounters after the seminars. 17,859 utterances were coded. Coders achieved a high degree of agreement (Spearman's rho > 0.8). In the baseline encounters, 17% of teacher utterances were some form of feedback, predominantly (92%) minimal feedback statements such as "right" or "I agree". Only 8% of feedback utterances were specific and none were interactive. Most (91%) of the feedback was positive. After the faculty development workshops, the amount and quality of feedback increased; teachers were more likely to provide feedback (OR 1.21; 95% CI 1.07 ± 1.36) and that feedback was nearly twice as likely (OR 2.08; 95% CI 1.45 ± 2.99) to be specific. Subjectively, teachers reported a higher likelihood of allowing students to present their own plans (p = 0.004) and of providing specific feedback to students (p = 0.004) after the intervention. Students also reported greater ability to present their own plans (p = 0.02) and rated the encounters as more successful (p = 0.003 Results are presented as univariate descriptive statistics and using Pearsonchi ± square tests to assess the statistical significance of differences in proportions between groups on categorical variables. The level of significance for all tests was 0.05. All analyses were performed using SAS statistical software, version 6.11 (SAS Institute, Cary, NC, 1995) . RESULTS: A total of 55 of the 61 graduating third year residents were surveyed. Over their three years of training, residents reported caring for a median of two patients who died in outpatient primary care, and 10 patients who died during inpatient rotations. In addition, they reported caring for a median of only 3 patients who they felt might have had a life expectancy of 6 ± 12 months. They reported median``little/poor'' EOL teaching from faculty, and``little/ poor'' support from resident colleagues in their EOL clinical care. Only 6% rated oncology rotations as``relevant or helpful in learning about EOL care;'' only 10% rated intensive care rotations as helpful; and only 27% rated geriatrics rotations as educationally beneficial. CONCLUSION: These results suggest that residents are meaningfully and intensively involved in the care of remarkably few terminally ill patients, and when they are, these teaching opportunities are too often being squandered. They suggest that we must improve EOL education in acute inpatient settings, capitilizing on the opportunities to teach residents around the dying patients that they currently care for. They further suggest that we must increase residents' experience in EOL patient care in community settings, targeting primary care clinics, home care, nursing home and hospice services. PURPOSE: Although the ability to work with and interpret numbers is vital to patient care, little is known about the numeracy skills of health care professionals. To facilitate mastery of numeracy in medicine, we sought to (1) assess the numeracy skills of first-year medical students, and (2) determine how different risk presentations affect student ability to compare and calculate treatment benefits. METHODS: We surveyed 62 first-year medical students who were attending a seminar on risk communication. Students were asked to (1) answer three questions assessing their ability to handle numbers in a non-health setting (non-health numeracy; i.e. Imagine that we flip a fair coin 1000 times-what is your best guess about how many times the coin would come up heads?), (2) state which of two drug treatments for a hypothetical disease Y provided more benefit, and (3) calculate the effect of drug treatment for a patient with a given baseline risk of disease. Risk information was presented to each student in one of four randomly allocated risk formats-relative risk reduction (RRR), absolute risk reduction (ARR), number needed to treat (NNT), or a combination of all three of these risk presentation formats (COMBO). Students' abilities to compare and calculate drug treatment benefits were stratified according the number of correct answers they gave to the non-health numeracy questions: 0 or 1 correct=minimal numeracy, 2 correct=moderate numeracy, 3 correct=advanced numeracy. RESULTS: Fourteen (23%) students incorrectly answered one or more non-health numeracy questions. Lower non-health numeracy skills correlated with lower health numeracy skills. While more than 90% of students with advanced (n=48) or moderate (n=11) non-health numeracy skills correctly stated which of two treatments provided more benefit, only 33% of students with minimal (n=3) non-health numeracy skills correctly did so (p = 0.03). Similarly, 71% of students with advanced non-health numeracy skills, but only 36% with moderate and 0% with minimal non-health numeracy skills correctly calculated the effect of drug treatment on a given baseline risk of disease (p < 0.01). Regardless of the risk presentation format, students were able to correctly state which of two treatments provided more benefit (range 81 ± 93%). When asked to calculate the effect of drug treatment on a given baseline risk of disease, however, students had significantly more difficulty when risk was presented as NNT (25% answered correctly, compared to 75% for all other presentations; p=0.01). CONCLUSION: First-year medical students with lower non-health numeracy skills demonstrated less skill in estimating both relative and exact treatment benefits. For all students, information presented as NNT was interpreted less successfully than information presented in other risk formats. If these findings persist through training, educators may need to de-emphasize NNT relative to other formats that communicate the same information more successfully. Step 1 scores were available for 355 students (91%). Average total OSCE score was 59 6. Average Step 1 score was 234 17. Correlation coefficient for the total OSCE score with USMLE Step 1 score was 0.41 (p < 0.0001). In the linear regression model (R square = 0.52), 5 of the 16 station scores were significant (P < 0.05) predictors of USMLE Step 1 score, as were MCAT biological sciences and physical sciences sub-scores. The 5 predictive stations (alcoholism and abdominal exam, arthritis, calf pain, lung exam, and skin exam) were weighted toward identification of abnormalities (28% of all items on the 5 predictive stations, as compared with 17% of all 16 OSCE stations) and differential diagnosis (32% versus 19%). CONCLUSION: An OSCE in physical diagnosis taken by second-year medical students is correlated with scores on the USMLE Step 1 exam, with OSCE skills that foreshadow the clinical clerkships (identification of abnormality and development of differential diagnoses) most predictive of USMLE scores. This correlation suggests predictive validity of the OSCE and supports its use in identifying students who need remedial education. This OSCE provides an additional measure to predict students' success on subsequent national board exams. PURPOSE: Community-based experiences can help prepare medical students for addressing disparities in health care. Clerkship management and instruction can be difficult with multiple community-based teaching sites. To help address this challenge we have been developing Webbased components for our internal medicine clerkship. To date these components include forms evaluating the clerkship and individual preceptors, an interactive patient logbook with real-time faculty access to completed logs, clerkship calendar and, on a pilot basis, the ACP/ASIM clinical problem solving cases. This study addressed 1) if students were able to conveniently access these components from all of our six community-based campuses, each with multiple hospitals and clinics, 2) students' acceptance of these web-based components, 3) the efficiency gains of Webbased data collection and clerkship management. METHODS: We appended questions concerning the ease of accessing the Web-based components and students' preference for this format on the clerkship feedback form. Students completing the ACP/ASIM cases filled out a Web-based survey. Efficiency gains were based on comparison with the former paper-based evaluation system. RESULTS: To date we received feedback from 87 students who completed the third year basic and fourth year advanced internal medicine clerkship. 91% of the students indicated they had convenient access to the web-based components. 77% of the students preferred Web-based to paper evaluation forms while 60% preferred Web-based to paper logbooks. All eight students completing the ACP/ASIM cases found them useful or extremely useful and only one encountered any technical difficulty. CONCLUSION: Our students appeared to have little difficulty accessing the web-based components of the clerkship even though they were in a variety of community-based settings with no special provisions for Internet access. Students clearly preferred the Web-based to paper evaluation forms. While on the whole they preferred Web-based logbooks, they were less enthusiastic. The concerns they expressed to a large extent reflected design problems with the new system. Many of these have been resolved. The Web-based feedback forms and logbook dramatically streamlined the process of collating the data and producing feedback reports. These now take less than an hour to prepare and avoid the time consuming and error prone task of transcribing data from paper forms. Pilot results evaluating the use of the ACP/ASIM cases in the clerkship curriculum are encouraging and suggest these cases could provide a valuable adjunct learning experience. For the next academic year we plan to develop two Web-based instructional modules and a more comprehensive clerkship management system that provides additional real-time feedback to students and preceptors.