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Journal of Cancer Education

, Volume 29, Issue 1, pp 167–174 | Cite as

Making Better Doctors: A Survey of Premedical Interns Working as Health Coaches

  • M. Zarin-Pass
  • J. Belkora
  • S. Volz
  • L. Esserman
Article

Abstract

We operate a decision support program in a medical center in San Francisco. In this program, postbaccalaureate, premedical interns deliver decision and communication, aids to patients. We asked whether working in this program helped these premedical interns develop key physician competencies. To measure physician competencies, we adopted the standards of the Accreditation Committee on Graduate Medical Education (ACGME), which accredits residency programs in the USA. The ACGME competencies are patient care, medical knowledge, practice-based learning, interpersonal and communication skills, professionalism, and systems-based practice. We developed a survey for our program alumni to rate themselves on a scale from 0 (none) to 100 (perfect) on each competency, before and after their time in our program. The survey also solicited free-text comments regarding each competency. In June 2012, we e-mailed all 47 alumni a link to our online survey and then analyzed responses received by July 15, 2012. We visually explored the distributions of ratings and compared medians. We selected the most specific and concrete comments from the qualitative responses. Respondents (21/47 or 45 %) reported that their participation in Decision Services increased their competencies across the board. Qualitative comments suggest that this is because students accompanied patients on their clinic journeys (seeing multiple facets of the systems of care) while also actively facilitating patient physician communication. Providing decision support can improve self-ratings of crucial physician competencies. Educators should consider deploying premedical and medical students as decision support coaches to increase competencies through experiential learning.

Keywords

Premedical interns Health coaches ACGME Competencies Medical education Decision aids Communication aids Shared decision making Patient advocacy 

Notes

Acknowledgments

The authors thank the patients and physicians who have participated in our program over the years. We thank the alumni of our program for participating in this study. The premedical internship program is administered by Meredith Buxton, PhD, with assistance from Natalie Cox, MA. We are very grateful to the staff at the Fishbon Library at UCSF. Thank you to Pat O’Sullivan for suggesting the use of the retrospective pretest design. Dr. Belkora wishes to thank the leaders of the Teaching Scholars Program at UCSF for their mentorship. Thank you to Lauren Stupar who helped to format this manuscript for publication.

We received funding support for this project from the Informed Medical Decisions Foundation, the Boebel Family Leadership Development Program at the UCSF Breast Care Center, and the UCSF School of Medicine. The funders did not otherwise influence the study.

Ethical Approval

We applied for and received exempt status from the University of California San Francisco Committee on Human Research.

References

  1. 1.
    Belkora JK, Loth MK, Volz S, Rugo HS (2009) Implementing decision and communication aids to facilitate patient-centered care in breast cancer: a case study. Patient Educ Couns 77(3):360–368. doi: 10.1016/j.pec.2009.09.012 CrossRefPubMedGoogle Scholar
  2. 2.
    Belkora JK, Teng A, Volz S, Loth MK, Esserman LJ (2011) Expanding the reach of decision and communication aids in a breast care center: a quality improvement study. Patient Educ Couns 83(2):234–239. doi: 10.1016/j.pec.2010.07.003 CrossRefPubMedGoogle Scholar
  3. 3.
    Belkora J, Loth M, Chen D, Chen J, Volz S, Esserman L (2008) Monitoring the implementation of consultation planning, recording, and summarizing in a breast care center. Patient Educ Couns 73(3):536–543. doi: 10.1016/j.pec.2008.07.037 PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Belkora JK, Loth MK, Chen DF, Chen JY, Volz S, Esserman LJ (2008) Monitoring the implementation of consultation planning, recording, and summarizing in a breast care center. Patient Educ Couns 73(3):536–543. doi: 10.1016/j.pec.2008.07.037 PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Bevis KS, Straughn JM Jr, Kendrick JE, Walsh-Covarrubias J, Kilgore LC (2011) Morbidity and mortality conference in obstetrics and gynecology: a tool for addressing the 6 core competencies. J Grad Med Educ 3(1):100–103. doi: 10.4300/JGME-D-10-00093.1 PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Campbell A, Sullivan M, Sherman R, Magee WP (2011) The medical mission and modern cultural competency training. J Am Coll Surg 212(1):124–129. doi: 10.1016/j.jamcollsurg.2010.08.019 CrossRefPubMedGoogle Scholar
  7. 7.
    Cooke M, Irby DM, O’Brien BC, Carnegie Foundation for the Advancement of Teaching (2010) Educating physicians: a call for reform of medical school and residency. 1st Aufl. The preparation for the professions series. Jossey-Bass, San Francisco, CAGoogle Scholar
  8. 8.
    Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L (2006) Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA: J Am Med Assoc 296(9):1094–1102. doi: 10.1001/jama.296.9.1094 CrossRefGoogle Scholar
  9. 9.
    Douvoyiannis M, Litman N, Belamarich PF, Goldman DL (2011) A survey of current and past pediatric infectious diseases fellows regarding training. BMC Med Educ 11:72. doi: 10.1186/1472-6920-11-72 PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Education, Accreditation Council for Graduate Medical (2011) Common Program RequirementsGoogle Scholar
  11. 11.
    Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H et al (2010) Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 376(9756):1923–1958. doi: 10.1016/S0140-6736(10)61854-5 CrossRefPubMedGoogle Scholar
  12. 12.
    Henry SG, Holmboe ES, Frankel RM (2013) Evidence-based competencies for improving communication skills in graduate medical education: a review with suggestions for implementation. Med Teach 35(5):395–403. doi: 10.3109/0142159X.2013.769677 CrossRefPubMedGoogle Scholar
  13. 13.
    Hodges BD, Lingard L, Anderson B (2012) The question of competence: reconsidering medical education in the twenty-first century. Cornell University Press, New YorkGoogle Scholar
  14. 14.
    How to use the Turnip Graph Engine in STATA. http://www.vaoutcomes.org/downloads/Turnip_README.pdf. Accessed June 6 2013
  15. 15.
    Howard G, Ralph K, Gulanick N, Maxwell S, Nance D, Gerber S (1979) Internal invalidity in pretest-posttest self-report evaluations and a re-evaluation of retrospective pretests. Appl Psychol Meas 3(1):1–23CrossRefGoogle Scholar
  16. 16.
    Lurie SJ, Mooney CJ, Lyness JM (2009) Measurement of the general competencies of the accreditation council for graduate medical education: a systematic review. Acad Med 84(3):301–309. doi: 10.1097/ACM.0b013e3181971f08 CrossRefPubMedGoogle Scholar
  17. 17.
    Moyer CA, Arnold L, Quaintance J, Braddock C, Spickard A 3rd, Wilson D, Rominski S, Stern DT (2010) What factors create a humanistic doctor? A nationwide survey of fourth-year medical students. Acad Med 85(11):1800–1807. doi: 10.1097/ACM.0b013e3181f526af CrossRefPubMedGoogle Scholar
  18. 18.
    Pratt CC, McGuigan WM, Katzev AR (2000) Measuring program outcomes: using retrospective pretest methodology. Am J Eval 21(3):341–349. doi: 10.1177/109821400002100305 CrossRefGoogle Scholar
  19. 19.
    Relyea-Chew A, Talner LB (2011) A dedicated general competencies curriculum for radiology residents development and implementation. Acad Radiol 18(5):650–654. doi: 10.1016/j.acra.2010.12.016 CrossRefPubMedGoogle Scholar
  20. 20.
    Sepucha KR (2002) Consultation planning to help breast cancer patients prepare for medical consultations: effect on communication and satisfaction for patients and physicians. J Clin Oncol 20(11):2695–2700. doi: 10.1200/jco.2002.10.068 CrossRefPubMedGoogle Scholar
  21. 21.
    Sepucha KR, Belkora JK, Tripathy D, Esserman LJ (2000) Building bridges between physicians and patients: results of a pilot study examining new tools for collaborative decision making in breast cancer. J Clin Oncol Off J Am Soc Clin Oncol 18(6):1230–1238Google Scholar
  22. 22.
    Shepard ME, Sastre EA, Davidson MA, Fleming AE (2012) Use of individualized learning plans among fourth-year sub-interns in pediatrics and internal medicine. Med Teach 34(1):e46–51. doi: 10.3109/0142159X.2012.638013 CrossRefPubMedGoogle Scholar
  23. 23.
    Stata Corp (2007) Stata Statistical Software: Release 10. StataCorp LP, College StationGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • M. Zarin-Pass
    • 1
  • J. Belkora
    • 1
  • S. Volz
    • 1
  • L. Esserman
    • 1
  1. 1.University of California, San FranciscoSan FranciscoUSA

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