Barbara Ogur - Academia.edu (original) (raw)
Papers by Barbara Ogur
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2006
New England Journal of Medicine, 2007
The Clinical Teacher, 2008
Teaching and Learning in Medicine, 2012
Medical Education, 2014
This study was intended to determine if previously identified educational benefits of the Harvard... more This study was intended to determine if previously identified educational benefits of the Harvard Medical School (HMS) Cambridge Integrated Clerkship (CIC) endure over time. The authors' earlier work compared the 27 graduates in the first three cohorts of students undertaking the CIC with a comparison group of 45 traditionally trained HMS students; CIC graduates emerged from their clerkship year with a higher degree of patient-centredness and felt more prepared to deal with numerous domains of patient care. Between April and July 2011, at 4-6 years post-clerkship, the authors asked these original study cohorts to complete an electronic survey which included measures used in the original study. The authors also reviewed data from the National Residency Match Program to compare career paths in the two groups. The response rate was 62% (42/68). The immediate post-clerkship finding that CIC students held more patient-centred attitudes was sustained over time (p < 0.035). Reflecting retrospectively on their clerkship experiences, CIC graduates continued to report that their clerkship year had better prepared them in a wide variety of domains. Graduates of the CIC attained awards and published papers at the same rates as peers, and were more likely to engage in health advocacy work. Both groups chose a wide range of residency programmes. Among those expressing a preference, no CIC graduates said they would choose a traditional clerkship, but 6 (27%) of the traditionally trained graduates said they would choose a longitudinal integrated clerkship. This paper indicates that benefits of longitudinal integrated clerkship training are sustained over time across multiple domains.
Medical Education, 2012
Traditional block clerkship (BC) structures may not optimally support medical student participati... more Traditional block clerkship (BC) structures may not optimally support medical student participation in the workplace, whereas longitudinal integrated clerkship (LIC) structures seem more conducive to students' active engagement in patient care over time. Understanding the ways in which these two clerkship models influence students' roles and responsibilities can inform clinical learning programme design. This was a multicentre qualitative study. We conducted semi-structured interviews with LIC and BC medical students at three institutions early and late in the core clinical year to explore their experiences with patients and the roles they served. Using the framework of 'workplace affordances', qualitative coding focused on students' roles and qualities of the learning environment that invited or inhibited student participation. We compared transcripts of early- and late-year interviews to assess students' changing roles and conducted discrepant case analysis to ensure that coding fit the data. Fifty-four students participated in interviews. They described serving three major roles in clinical care that respectively involved: providing support to patients; sharing information about patients across health care settings, and functioning in a doctor-like role. Both LIC and BC students served in the providing support and transmitting information roles both early and late in the year. By contrast, LIC students commonly served in the doctor-like role in managing their patients' care, particularly late in the year, whereas BC students rarely served in this role. Continuity in settings and in supervisors, and preceptors' endorsement of students' legitimate role afforded opportunities for students to participate actively in patient care. Although both LIC and BC students reported serving in important roles in supporting their patients and sharing information about their care, only LIC students consistently described opportunities to grow into a doctor role with patients. The high level of integration of LIC students into care systems and their deeper relationships with preceptors and patients enhanced their motivation and feelings of competence to provide patient-centred care.
Academic Medicine, 2009
The third year of medical school, in which students traditionally receive their first immersion i... more The third year of medical school, in which students traditionally receive their first immersion into hospital-based clinical medicine, often results in a degradation of attitudes toward medicine and patient care. The authors present data collected in the 2005-2006 academic year from a pilot program aimed at enhancing this experience, thereby enabling students to resist these negative influences. Thirty-two Harvard Medical School students, who spent their entire principal clinical experience (PCE) at one of three clinical sites (PCE group), completed the Patient-Practitioner Orientation Scale (PPOS), a measure of patient-centered attitudes, at the beginning of the year. They completed the PPOS again at year's end as well as the Community, Curriculum, and Culture (C3) hidden curriculum measure of patient-centered clinical experiences. Their responses on these measures were compared with those of a traditional-rotation control group that moved from site to site. At the beginning of the year, no PPOS differences were found within PCE groups or between PCE and control students. Traditional students' attitudes became significantly less patient-centered at year's end, whereas PCE students' attitudes did not change. PCE students reported more support for their patient-centered behaviors, and, across all students, C3 scores and changes in PPOS scores were significantly correlated. Innovations in clinical education may help inoculate medical students against the degradation of attitudes. Although this research was a test of a small pilot program, the consistent pattern of findings across those clinical sites and educational models studied provides suggestive evidence that the oft-cited negative impacts of the principal clinical year are not inevitable.
Academic Medicine, 2012
Clerkship experiences that structure student-teacher continuity may promote learning differently ... more Clerkship experiences that structure student-teacher continuity may promote learning differently than brief student-teacher relationships. The authors compared students' successful and unsuccessful teaching experiences in brief and longitudinal relationships. A multicenter, qualitative interview study was conducted in 2009-2010 of students in two clerkship models that provide different durations of student-teacher relationships. Each student described a successful and unsuccessful teaching relationship early and late in the core clerkship year. Questions explored teachers' strategies and behaviors and students' efforts to improve unsuccessful relationships. Interview transcripts were coded to identify major themes. Fifty-four students completed interviews. Students in brief relationships struggled to be known; students in longitudinal relationships felt respected as learners and partners. Teaching strategies differed in the two relationship durations. Questioning about factual knowledge was common in brief relationships; collaborative knowledge sharing and application to patients occurred in longitudinal relationships. Hierarchy characterized brief relationships. Longitudinal students experienced evolving expectations in response to their growing skills and contributions. Only students in longitudinal relationships described successfully intervening to improve unsuccessful relationships; students in brief relationships felt powerless. Clerkship students in brief relationships learn to adapt to teachers' preferences and questioning to facilitate their participation and knowledge acquisition; longitudinal students experience collaborative interactions focused on their development as care providers. In longitudinal relationships, students gain confidence to influence their own learning and modify circumstances to meet their learning needs. These findings suggest that medical students' clinical experiences may be enhanced by deliberately structuring longitudinal attachments to supervisors.
Academic Medicine, 2007
The Harvard Medical School-Cambridge Integrated Clerkship (HMS-CIC) is a redesign of the principa... more The Harvard Medical School-Cambridge Integrated Clerkship (HMS-CIC) is a redesign of the principal clinical year to foster students' learning from close and continuous contact with cohorts of patients in the disciplines of internal medicine, neurology, obstetrics-gynecology, pediatrics, and psychiatry. With year-long mentoring, students follow their patients through major venues of care. Surgery and radiology also are taught longitudinally, grounded in the clinical experiences of a cohort of patients and in a brief immersion experience working directly with an attending surgeon. Students participate in weekly, case-based tutorials integrating instruction in the basic sciences with training to address the common and important issues in medicine, as identified by national organizations. In addition, they participate in a social science curriculum that focuses on self-reflection, communication skills, ethics, population sciences, and cultural competence. In the pilot year (July 2004 to July 2005), HMS-CIC students performed at least as well as traditional students in tests of content knowledge and skills, as measured by National Board of Medical Examiners (NBME) Subject Exams and the fourth-year Objective Structured Clinical Exam, and they scored higher on a year-end comprehensive clinical skills self-assessment examination, suggesting that they retained content knowledge better. From surveys, HMS-CIC students were much more likely to see patients before diagnosis and after discharge and to receive feedback and mentoring from experienced faculty than were their traditionally educated peers. HMS-CIC students expressed more satisfaction with their curriculum and felt better prepared to cope with the professional challenges of patient care, such as being truly caring, involving patients in decision making, and understanding how the social context affects their patients.
Academic Medicine, 2009
Integrated clinical clerkships represent a relatively new and innovative approach to medical educ... more Integrated clinical clerkships represent a relatively new and innovative approach to medical education that uses continuity as an organizing principle, thus increasing patient-centeredness and learner-centeredness. Medical schools are offering longitudinal integrated clinical clerkships in increasing numbers. This report collates the experiences of medical schools that use longitudinal integrated clerkships for medical student education in order to establish a clearer characterization of these experiences and summarize outcome data, when possible. The authors sent an e-mail survey with open text responses to 17 medical schools with known longitudinal integrated clerkships. Sixteen schools in four countries on three continents responded to the survey. Fifteen institutions have active longitudinal integrated clerkships in place. Two programs began before 1995, but the others are newer. More than 2,700 students completed longitudinal integrated clerkships in these schools. The median clerkship length is 40 weeks, and in 15 of the schools, the core clinical content was in medicine, surgery, pediatrics, and obstetrics-gynecology. Eleven schools reported supportive student responses to the programs. No differences were noted in nationally normed exam scores between program participants and those in the traditional clerkships. Limited outcomes data suggest that students who participate in these programs are more likely to enter primary care careers. This study documents the increasing use of longitudinal integrated clerkships and provides initial insights for institutions that may wish to develop similar clinical programs. Further study will be needed to assess the long-term impact of these programs on medical education and workforce initiatives.
Medical education, 2012
Longitudinal integrated clerkships (LICs) are established, rapidly growing models of education de... more Longitudinal integrated clerkships (LICs) are established, rapidly growing models of education designed to improve the core clinical year of medical school using guiding principles about workplace learning and continuity. This study is the first to report data from direct observations of workplace learning experiences of students on LICs and traditional block clerkships (BCs), respectively. This multi-institution study used an observational, work-sampling methodology to compare LIC and BC students early and late in the core clinical year. Trained research assistants documented students' activities, participation (observing, with assistance, alone), and interactions every 10 minutes over 4-hour periods. Each student was observed one to three times early and/or late in the year. Data were aggregated at the student level and by in-patient or out-patient setting for BC students. One-way analysis of variance (anova) was used to compare two groups early in the year (LIC and BC student...
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2006
New England Journal of Medicine, 2007
The Clinical Teacher, 2008
Teaching and Learning in Medicine, 2012
Medical Education, 2014
This study was intended to determine if previously identified educational benefits of the Harvard... more This study was intended to determine if previously identified educational benefits of the Harvard Medical School (HMS) Cambridge Integrated Clerkship (CIC) endure over time. The authors' earlier work compared the 27 graduates in the first three cohorts of students undertaking the CIC with a comparison group of 45 traditionally trained HMS students; CIC graduates emerged from their clerkship year with a higher degree of patient-centredness and felt more prepared to deal with numerous domains of patient care. Between April and July 2011, at 4-6 years post-clerkship, the authors asked these original study cohorts to complete an electronic survey which included measures used in the original study. The authors also reviewed data from the National Residency Match Program to compare career paths in the two groups. The response rate was 62% (42/68). The immediate post-clerkship finding that CIC students held more patient-centred attitudes was sustained over time (p < 0.035). Reflecting retrospectively on their clerkship experiences, CIC graduates continued to report that their clerkship year had better prepared them in a wide variety of domains. Graduates of the CIC attained awards and published papers at the same rates as peers, and were more likely to engage in health advocacy work. Both groups chose a wide range of residency programmes. Among those expressing a preference, no CIC graduates said they would choose a traditional clerkship, but 6 (27%) of the traditionally trained graduates said they would choose a longitudinal integrated clerkship. This paper indicates that benefits of longitudinal integrated clerkship training are sustained over time across multiple domains.
Medical Education, 2012
Traditional block clerkship (BC) structures may not optimally support medical student participati... more Traditional block clerkship (BC) structures may not optimally support medical student participation in the workplace, whereas longitudinal integrated clerkship (LIC) structures seem more conducive to students' active engagement in patient care over time. Understanding the ways in which these two clerkship models influence students' roles and responsibilities can inform clinical learning programme design. This was a multicentre qualitative study. We conducted semi-structured interviews with LIC and BC medical students at three institutions early and late in the core clinical year to explore their experiences with patients and the roles they served. Using the framework of 'workplace affordances', qualitative coding focused on students' roles and qualities of the learning environment that invited or inhibited student participation. We compared transcripts of early- and late-year interviews to assess students' changing roles and conducted discrepant case analysis to ensure that coding fit the data. Fifty-four students participated in interviews. They described serving three major roles in clinical care that respectively involved: providing support to patients; sharing information about patients across health care settings, and functioning in a doctor-like role. Both LIC and BC students served in the providing support and transmitting information roles both early and late in the year. By contrast, LIC students commonly served in the doctor-like role in managing their patients' care, particularly late in the year, whereas BC students rarely served in this role. Continuity in settings and in supervisors, and preceptors' endorsement of students' legitimate role afforded opportunities for students to participate actively in patient care. Although both LIC and BC students reported serving in important roles in supporting their patients and sharing information about their care, only LIC students consistently described opportunities to grow into a doctor role with patients. The high level of integration of LIC students into care systems and their deeper relationships with preceptors and patients enhanced their motivation and feelings of competence to provide patient-centred care.
Academic Medicine, 2009
The third year of medical school, in which students traditionally receive their first immersion i... more The third year of medical school, in which students traditionally receive their first immersion into hospital-based clinical medicine, often results in a degradation of attitudes toward medicine and patient care. The authors present data collected in the 2005-2006 academic year from a pilot program aimed at enhancing this experience, thereby enabling students to resist these negative influences. Thirty-two Harvard Medical School students, who spent their entire principal clinical experience (PCE) at one of three clinical sites (PCE group), completed the Patient-Practitioner Orientation Scale (PPOS), a measure of patient-centered attitudes, at the beginning of the year. They completed the PPOS again at year's end as well as the Community, Curriculum, and Culture (C3) hidden curriculum measure of patient-centered clinical experiences. Their responses on these measures were compared with those of a traditional-rotation control group that moved from site to site. At the beginning of the year, no PPOS differences were found within PCE groups or between PCE and control students. Traditional students' attitudes became significantly less patient-centered at year's end, whereas PCE students' attitudes did not change. PCE students reported more support for their patient-centered behaviors, and, across all students, C3 scores and changes in PPOS scores were significantly correlated. Innovations in clinical education may help inoculate medical students against the degradation of attitudes. Although this research was a test of a small pilot program, the consistent pattern of findings across those clinical sites and educational models studied provides suggestive evidence that the oft-cited negative impacts of the principal clinical year are not inevitable.
Academic Medicine, 2012
Clerkship experiences that structure student-teacher continuity may promote learning differently ... more Clerkship experiences that structure student-teacher continuity may promote learning differently than brief student-teacher relationships. The authors compared students' successful and unsuccessful teaching experiences in brief and longitudinal relationships. A multicenter, qualitative interview study was conducted in 2009-2010 of students in two clerkship models that provide different durations of student-teacher relationships. Each student described a successful and unsuccessful teaching relationship early and late in the core clerkship year. Questions explored teachers' strategies and behaviors and students' efforts to improve unsuccessful relationships. Interview transcripts were coded to identify major themes. Fifty-four students completed interviews. Students in brief relationships struggled to be known; students in longitudinal relationships felt respected as learners and partners. Teaching strategies differed in the two relationship durations. Questioning about factual knowledge was common in brief relationships; collaborative knowledge sharing and application to patients occurred in longitudinal relationships. Hierarchy characterized brief relationships. Longitudinal students experienced evolving expectations in response to their growing skills and contributions. Only students in longitudinal relationships described successfully intervening to improve unsuccessful relationships; students in brief relationships felt powerless. Clerkship students in brief relationships learn to adapt to teachers' preferences and questioning to facilitate their participation and knowledge acquisition; longitudinal students experience collaborative interactions focused on their development as care providers. In longitudinal relationships, students gain confidence to influence their own learning and modify circumstances to meet their learning needs. These findings suggest that medical students' clinical experiences may be enhanced by deliberately structuring longitudinal attachments to supervisors.
Academic Medicine, 2007
The Harvard Medical School-Cambridge Integrated Clerkship (HMS-CIC) is a redesign of the principa... more The Harvard Medical School-Cambridge Integrated Clerkship (HMS-CIC) is a redesign of the principal clinical year to foster students' learning from close and continuous contact with cohorts of patients in the disciplines of internal medicine, neurology, obstetrics-gynecology, pediatrics, and psychiatry. With year-long mentoring, students follow their patients through major venues of care. Surgery and radiology also are taught longitudinally, grounded in the clinical experiences of a cohort of patients and in a brief immersion experience working directly with an attending surgeon. Students participate in weekly, case-based tutorials integrating instruction in the basic sciences with training to address the common and important issues in medicine, as identified by national organizations. In addition, they participate in a social science curriculum that focuses on self-reflection, communication skills, ethics, population sciences, and cultural competence. In the pilot year (July 2004 to July 2005), HMS-CIC students performed at least as well as traditional students in tests of content knowledge and skills, as measured by National Board of Medical Examiners (NBME) Subject Exams and the fourth-year Objective Structured Clinical Exam, and they scored higher on a year-end comprehensive clinical skills self-assessment examination, suggesting that they retained content knowledge better. From surveys, HMS-CIC students were much more likely to see patients before diagnosis and after discharge and to receive feedback and mentoring from experienced faculty than were their traditionally educated peers. HMS-CIC students expressed more satisfaction with their curriculum and felt better prepared to cope with the professional challenges of patient care, such as being truly caring, involving patients in decision making, and understanding how the social context affects their patients.
Academic Medicine, 2009
Integrated clinical clerkships represent a relatively new and innovative approach to medical educ... more Integrated clinical clerkships represent a relatively new and innovative approach to medical education that uses continuity as an organizing principle, thus increasing patient-centeredness and learner-centeredness. Medical schools are offering longitudinal integrated clinical clerkships in increasing numbers. This report collates the experiences of medical schools that use longitudinal integrated clerkships for medical student education in order to establish a clearer characterization of these experiences and summarize outcome data, when possible. The authors sent an e-mail survey with open text responses to 17 medical schools with known longitudinal integrated clerkships. Sixteen schools in four countries on three continents responded to the survey. Fifteen institutions have active longitudinal integrated clerkships in place. Two programs began before 1995, but the others are newer. More than 2,700 students completed longitudinal integrated clerkships in these schools. The median clerkship length is 40 weeks, and in 15 of the schools, the core clinical content was in medicine, surgery, pediatrics, and obstetrics-gynecology. Eleven schools reported supportive student responses to the programs. No differences were noted in nationally normed exam scores between program participants and those in the traditional clerkships. Limited outcomes data suggest that students who participate in these programs are more likely to enter primary care careers. This study documents the increasing use of longitudinal integrated clerkships and provides initial insights for institutions that may wish to develop similar clinical programs. Further study will be needed to assess the long-term impact of these programs on medical education and workforce initiatives.
Medical education, 2012
Longitudinal integrated clerkships (LICs) are established, rapidly growing models of education de... more Longitudinal integrated clerkships (LICs) are established, rapidly growing models of education designed to improve the core clinical year of medical school using guiding principles about workplace learning and continuity. This study is the first to report data from direct observations of workplace learning experiences of students on LICs and traditional block clerkships (BCs), respectively. This multi-institution study used an observational, work-sampling methodology to compare LIC and BC students early and late in the core clinical year. Trained research assistants documented students' activities, participation (observing, with assistance, alone), and interactions every 10 minutes over 4-hour periods. Each student was observed one to three times early and/or late in the year. Data were aggregated at the student level and by in-patient or out-patient setting for BC students. One-way analysis of variance (anova) was used to compare two groups early in the year (LIC and BC student...