Zakowski LJ, Seibert S, Van Eyck S, Skochelak S, Dodd S, and Albanese, M. Can specialists and generalists teach clinical skills to second-year medical students with equal effectiveness? Acad Med 77:1030-1033, 2002. Reviewed by William G. Wilson, MD, University of Virginia
Zakowski LJ, Seibert S, Van Eyck S, Skochelak S, Dodd S, and Albanese, M. Can specialists and generalists teach clinical skills to second-year medical students with equal effectiveness? Acad Med 77:1030-1033, 2002.
Reviewed by William G. Wilson, MD, University of Virginia
Given the increasing emphasis on small group instruction in medical schools, course and clerkship directors frequently need to rely on a wide range of the clinical faculty to staff these sessions. In this study from the University of Wisconsin Medical School, generalists or specialists were randomly assigned to teach physical diagnosis to a small group of 2nd year medical students for each of two separate semesters. All group leaders were asked to attend an orientation session and were provided with a detailed outline of the objectives and activities of each session. Although the faculty groups in this study did include "general" pediatricians, pediatric specialists were not included. The teaching effectiveness was then determined by the performance of students on an OSCE at the end of the semester, by the students' evaluations of the preceptors as teachers, and by the self-evaluation of the preceptors. On two of the three measures (OSCE scores of the students and evaluations of the preceptors by students), there was no statistical difference between the teaching effectiveness of the specialists and that of the generalists. The only differences that reached statistical significance were in the self-assessment of the instructors; the specialists expressed less confidence in their teaching of the cardiovascular and pulmonary exams than did their generalist colleagues.
The students in both sets of groups did quite well on their OSCE, with mean scores of 93.8% (generalist groups) and 93.5% (specialist groups). This may indicate that the instruction was indeed comparable, but could also mean that the OSCE was not particularly rigorous. Nevertheless, this study does demonstrate the application of "outcomes-based" research in medical education. Perhaps an increased emphasis on faculty development among the specialists group leaders would help diminish their apparent lack of confidence in their ability to teach certain portions of the physical examination.
(We have a running debate at our school as to whether students can learn general pediatrics if they primarily work on a specialty floor or office. Do you think students can learn general pediatrics if they spend most of their time with specialists and specialty patients? Do you assign students to specialists for the bulk of their outpatient training? Do you assign students to specialty inpatient services for the bulk of their inpatient experience? Steve Miller)