Journal of Cancer Education
ISSN: 0885-8195 (Print) 1543-0154 (Online) Journal homepage: https://www.tandfonline.com/loi/hjce20
The effect of breast clinic participation on the education of third‐year medical students Frederick L. Greene MD To cite this article: Frederick L. Greene MD (1992) The effect of breast clinic participation on the education of third‐year medical students , Journal of Cancer Education, 7:3, 233-235 To link to this article: https://doi.org/10.1080/08858199209528173
Published online: 01 Oct 2009.
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Citing articles: 2 View citing articles
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J. Cancer Education. Vol. 7, No. 3, pp. 233-235, 1992 Printed in the U.S.A. Pergamon Press Ltd.
0885-8195/92 $5.00 + .00 © 1992 American Association for Cancer Education
THE EFFECT OF BREAST CLINIC PARTICIPATION ON THE EDUCATION OF THIRD-YEAR MEDICAL STUDENTS* FREDERICK L. GREENE, MD† Abstract—Traditional methods of teaching concepts of breast disease to medical students have included didactic lectures, patient interviews and examinations in the hospital, and patient-directed rounds with housestaff and attendings. From 1980 to 1987, third-year students at the University of South Carolina School of Medicine participated in these educational experiences and were tested at the conclusion of the eight-week surgical core rotation, utilizing written and oral examinations. Beginning in July 1987, students began participating in a defined weekly Diagnostic Breast Clinic which included in-depth instruction in patient examination techniques, mammographic interpretation, and treatment planning. Results of oral and written examinations, specifically regarding knowledge of breast cancer, were compared between the early and later periods. Significantly improved performance was noted in students exposed to a defined breast clinic experience and strongly supports the integration of specific cancer clinic experiences in undergraduate medical education.
INTRODUCTION The traditional approach to the clinical clerkship in surgery is to provide the thirdyear medical student with didactic information, experience on patient rounds, and opportunities to interact in the operating room. These traditional patient-oriented encounters, which include history-taking, physical examination, and interaction in decisions regarding treatment planning, have undergone marked changes in recent years as a trend toward outpatient care and limitation of inpatient medical student experience continues. In order to supplement traditional inpatient experience for the medical student, it has been necessary to depend more recently on well-defined and goaloriented educational opportunities in the ambulatory care setting. Specific specialty clinics, such as those dealing with breast disease, have emerged in academic centers, but the impact on medical student education of rotation
through these clinics has not been fully determined. This study assesses the impact of rotating through a structured breast clinic on third-year medical students during their traditional core surgical experience. MATERIALS AND METHODS
To assess the effect of a breast clinic experience during the M-III rotation in general surgery, results of standard written and oral examinations were reviewed retrospectively from 1981 through 1991 at the University of South Carolina (USC) School of Medicine. The Diagnostic Breast Clinic began at Richland Memorial Hospital, the major teaching hospital of the University of South Carolina School of Medicine, in 1987 and, therefore, from 1987 through June of 1991, this clinic was available for the rotation of medical students on the surgical service (Table 1). During an eight-week rotation on the surgical service, an M-III student has an opportunity to work in the Diagnostic Breast Clinic for four weeks *Presented, in part, at the annual meeting of the and spends one afternoon a week in the clinic. American Association for Cancer Education, Baltimore, During a three-hour clinic, held once a week, MD, December 6, 1991. †Professor of Surgery, University of South Carolina each student evaluates three to four patients School of Medicine. as primary interviewer and examiner and Reprint requests to: Frederick L. Greene, MD, Two "consults" on at least three additional patients Medical Park, Suite 402, Columbia, SC 29203.
233
F. L. GREENE
234
Table 1. Experience of third-year surgery students in breast clinic (BC) Date 1980-87 1987-89 1989-91
No. of students
Experience
241 students (Group I) 90 students (Group II) 91 students (Group III) 131 students (Group IV)
No BC BC No BC BC
by listening to other students' presentations, by witnessing examinations, needle aspirations or biopsies, and interpreting mammograms. Each student presents his or her patients to the Chief Surgical Resident or Attending Surgeon who directs the clinic. To ensure appropriate involvement, the Attending Surgeon discusses student participation with each patient and is present when examinations are performed. All students, regardless of gender, are instructed to have a nurse chaperone present for each examination. Because of the differentiation in inpatient teaching rotations, only one-half of the M-III students had an opportunity to rotate through the Diagnostic Breast Clinic during the period, July 1987 through June 1989. Beginning in July 1989 and extending through the study period ending in June 1991, all students rotating through the surgical service had an opportunity to attend the weekly Diagnostic Breast Clinic. Using ongoing testing methods, including standard oral exams given by surgical attendings and chief residents, the National Board of Medical Examination "Shelf" Test in Surgery, and a multiple-choice examination developed by the USC Department of Surgery faculty, and using test results comparison was made between students rotating in the Breast Diagnostic Clinic after July 1987 and students who rotated through the surgical service prior to this date. Third-year medical students having their surgical rotation between June 1980 and June 1987, were given a standard exposure to both benign and malignant breast disease through didactic lecture, inpatient experiences, and outpatient follow-up in a traditionally defined "surgery clinic."
RESULTS From June 1980 through June 1987, 241 M-III (Group I) students rotated through the surgical service. At the conclusion of an eightweek rotation as third-year clinical clerks on surgery, students took standard written and oral examinations. Retrospective review of questions relating to both benign and malignant breast disease showed that the students attained an average of 65% accuracy when questions relating to breast disease were analyzed (Table 2). The oral examinations during this seven-year period were administered by faculty members in the Department of Surgery and the make-up of the faculty was sufficiently constant to assure continuity of questioning throughout each M-III rotation. Review of faculty grading of oral exams correlated well with a 60% to 65% accuracy rate achieved on the written examinations during this time frame. From July 1987 through July 1989, 181 students rotated through the third-year surgical rotation. During this period, students on the trauma service did not have the opportunity to rotate through the breast clinic. A total of 90 (Group II) students rotated through the Breast Diagnostic Clinic during July 1987 to June 1989, while 91 (Group III) students did not have an opportunity for this clinic involvement. Review of examination results comparing this cohort of M-III students showed that the 91 students having no breast clinic involvement continued to have a 65% overall accuracy rate in questions relating to breast disease. Those students with a breast clinic experience showed an accuracy rate above 85% with specific improvement in responses during oral examinations indicating
Table 2. Results of third-year student testing in relation to breast clinic experience Date
No. of students
Testing accuracy (°/b)
1980-87 1987-89 1987-89 1989-91
241 (Group I) 90 (Group II) 91 (Group III) 131 (Group IV)
65 85 65 88
Education in the breast clinic
to faculty examiners an increased in-depth appreciation regarding overall treatment decisions. A third group of students attended the Breast Diagnostic Clinic between July 1989 and June 1991. This group of 131 students (Group IV) represented all M-III students rotating through the surgical service. Review of test results from written and oral material indicated an accuracy level that averaged 88% when specific questions regarding breast disease were analyzed. DISCUSSION The goal of the third-year rotation on a surgical service is to introduce surgical concepts from various disciplines to the M-III student to assure that he or she will gain a better understanding of the diagnostic and therapeutic approach to surgical illness as well as gain some understanding of the circumstances during which surgical intervention is indicated. Traditional approaches to achieve these goals have centered on formal lectures, inpatient teaching rounds, individual sessions with senior residents and attendings, operating room interaction, and follow-up of patients in the setting of the "multi-specialty" surgical clinic. As the impetus for ambulatory care and outpatient surgical procedures has increased during recent years, a detrimental effect has occurred in that traditional avenues of student/patient interaction have eroded. Preoperative assessment and treatment planning are not possible when students are not given the opportunity to approach these issues in a defined, cohesive manner. The development of a Diagnostic Breast Clinic, which can serve as a major teaching opportunity for third-year students, can take the place of traditional inpatient interaction and has been shown by this study to enhance the accuracy of response rates during formal student testing. More important, however, students have an opportunity to see the results of learning from patients in the same setting where they then become patient educators in strategies regarding dietary counseling, breast
235
self-examination, and the benefits of mammographic screening. These experiences support the goals of integrating learning which helps the neophyte physician become an effective decision maker.1 During the weekly Breast Diagnostic Clinic at the University of South Carolina School of Medicine, our third-year medical students have had an opportunity to become members of a team approach toward breast disease and have had the opportunity to see the effect and benefits of consultation with senior residents and attendings regarding treatment planning. The student has the opportunity in this setting to take a direct hands-on approach by examining patients, participating in outpatient diagnostic procedures such as cyst aspiration and fine-needle aspiration, and realizes the advantage of personally reviewing imaging studies relative to breast disease rather than simply reading the interpreter's report. By reinforcing these concepts, our medical students have not only improved their overall didactic responses to problems of breast disease but, as shown by the results of oral examinations, have gained a true appreciation for the total concept of management in the treatment of breast problems. The approach to medical student education, especially in this age of ambulatory care, must be toward greater use of our clinics as teaching laboratories. Development of oncology-related ambulatory climes in the undergraduate medical student setting also offsets the reduction seen in teaching oncologyrelated subjects in the traditional classroom setting.2 The results of this study support the concept of developing specialty clinics to enhance teaching and understanding of human malignancy. REFERENCES 1. O'Donnell JF, Baron JA: A strategy to teach medical decision making within a medical school curriculum. J Cancer Educ 6:123-128, 1991. 2. Kuske RR. Strategies for maintaining oncology curriculum time amid pressures to cut classroom hours. J Cancer Educ 6:69-72, 1991.
ISSN: 0885-8195 (Print) 1543-0154 (Online) Journal homepage: https://www.tandfonline.com/loi/hjce20
The effect of breast clinic participation on the education of third‐year medical students Frederick L. Greene MD To cite this article: Frederick L. Greene MD (1992) The effect of breast clinic participation on the education of third‐year medical students , Journal of Cancer Education, 7:3, 233-235 To link to this article: https://doi.org/10.1080/08858199209528173
Published online: 01 Oct 2009.
Submit your article to this journal
Article views: 3
View related articles
Citing articles: 2 View citing articles
Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=hjce20
J. Cancer Education. Vol. 7, No. 3, pp. 233-235, 1992 Printed in the U.S.A. Pergamon Press Ltd.
0885-8195/92 $5.00 + .00 © 1992 American Association for Cancer Education
THE EFFECT OF BREAST CLINIC PARTICIPATION ON THE EDUCATION OF THIRD-YEAR MEDICAL STUDENTS* FREDERICK L. GREENE, MD† Abstract—Traditional methods of teaching concepts of breast disease to medical students have included didactic lectures, patient interviews and examinations in the hospital, and patient-directed rounds with housestaff and attendings. From 1980 to 1987, third-year students at the University of South Carolina School of Medicine participated in these educational experiences and were tested at the conclusion of the eight-week surgical core rotation, utilizing written and oral examinations. Beginning in July 1987, students began participating in a defined weekly Diagnostic Breast Clinic which included in-depth instruction in patient examination techniques, mammographic interpretation, and treatment planning. Results of oral and written examinations, specifically regarding knowledge of breast cancer, were compared between the early and later periods. Significantly improved performance was noted in students exposed to a defined breast clinic experience and strongly supports the integration of specific cancer clinic experiences in undergraduate medical education.
INTRODUCTION The traditional approach to the clinical clerkship in surgery is to provide the thirdyear medical student with didactic information, experience on patient rounds, and opportunities to interact in the operating room. These traditional patient-oriented encounters, which include history-taking, physical examination, and interaction in decisions regarding treatment planning, have undergone marked changes in recent years as a trend toward outpatient care and limitation of inpatient medical student experience continues. In order to supplement traditional inpatient experience for the medical student, it has been necessary to depend more recently on well-defined and goaloriented educational opportunities in the ambulatory care setting. Specific specialty clinics, such as those dealing with breast disease, have emerged in academic centers, but the impact on medical student education of rotation
through these clinics has not been fully determined. This study assesses the impact of rotating through a structured breast clinic on third-year medical students during their traditional core surgical experience. MATERIALS AND METHODS
To assess the effect of a breast clinic experience during the M-III rotation in general surgery, results of standard written and oral examinations were reviewed retrospectively from 1981 through 1991 at the University of South Carolina (USC) School of Medicine. The Diagnostic Breast Clinic began at Richland Memorial Hospital, the major teaching hospital of the University of South Carolina School of Medicine, in 1987 and, therefore, from 1987 through June of 1991, this clinic was available for the rotation of medical students on the surgical service (Table 1). During an eight-week rotation on the surgical service, an M-III student has an opportunity to work in the Diagnostic Breast Clinic for four weeks *Presented, in part, at the annual meeting of the and spends one afternoon a week in the clinic. American Association for Cancer Education, Baltimore, During a three-hour clinic, held once a week, MD, December 6, 1991. †Professor of Surgery, University of South Carolina each student evaluates three to four patients School of Medicine. as primary interviewer and examiner and Reprint requests to: Frederick L. Greene, MD, Two "consults" on at least three additional patients Medical Park, Suite 402, Columbia, SC 29203.
233
F. L. GREENE
234
Table 1. Experience of third-year surgery students in breast clinic (BC) Date 1980-87 1987-89 1989-91
No. of students
Experience
241 students (Group I) 90 students (Group II) 91 students (Group III) 131 students (Group IV)
No BC BC No BC BC
by listening to other students' presentations, by witnessing examinations, needle aspirations or biopsies, and interpreting mammograms. Each student presents his or her patients to the Chief Surgical Resident or Attending Surgeon who directs the clinic. To ensure appropriate involvement, the Attending Surgeon discusses student participation with each patient and is present when examinations are performed. All students, regardless of gender, are instructed to have a nurse chaperone present for each examination. Because of the differentiation in inpatient teaching rotations, only one-half of the M-III students had an opportunity to rotate through the Diagnostic Breast Clinic during the period, July 1987 through June 1989. Beginning in July 1989 and extending through the study period ending in June 1991, all students rotating through the surgical service had an opportunity to attend the weekly Diagnostic Breast Clinic. Using ongoing testing methods, including standard oral exams given by surgical attendings and chief residents, the National Board of Medical Examination "Shelf" Test in Surgery, and a multiple-choice examination developed by the USC Department of Surgery faculty, and using test results comparison was made between students rotating in the Breast Diagnostic Clinic after July 1987 and students who rotated through the surgical service prior to this date. Third-year medical students having their surgical rotation between June 1980 and June 1987, were given a standard exposure to both benign and malignant breast disease through didactic lecture, inpatient experiences, and outpatient follow-up in a traditionally defined "surgery clinic."
RESULTS From June 1980 through June 1987, 241 M-III (Group I) students rotated through the surgical service. At the conclusion of an eightweek rotation as third-year clinical clerks on surgery, students took standard written and oral examinations. Retrospective review of questions relating to both benign and malignant breast disease showed that the students attained an average of 65% accuracy when questions relating to breast disease were analyzed (Table 2). The oral examinations during this seven-year period were administered by faculty members in the Department of Surgery and the make-up of the faculty was sufficiently constant to assure continuity of questioning throughout each M-III rotation. Review of faculty grading of oral exams correlated well with a 60% to 65% accuracy rate achieved on the written examinations during this time frame. From July 1987 through July 1989, 181 students rotated through the third-year surgical rotation. During this period, students on the trauma service did not have the opportunity to rotate through the breast clinic. A total of 90 (Group II) students rotated through the Breast Diagnostic Clinic during July 1987 to June 1989, while 91 (Group III) students did not have an opportunity for this clinic involvement. Review of examination results comparing this cohort of M-III students showed that the 91 students having no breast clinic involvement continued to have a 65% overall accuracy rate in questions relating to breast disease. Those students with a breast clinic experience showed an accuracy rate above 85% with specific improvement in responses during oral examinations indicating
Table 2. Results of third-year student testing in relation to breast clinic experience Date
No. of students
Testing accuracy (°/b)
1980-87 1987-89 1987-89 1989-91
241 (Group I) 90 (Group II) 91 (Group III) 131 (Group IV)
65 85 65 88
Education in the breast clinic
to faculty examiners an increased in-depth appreciation regarding overall treatment decisions. A third group of students attended the Breast Diagnostic Clinic between July 1989 and June 1991. This group of 131 students (Group IV) represented all M-III students rotating through the surgical service. Review of test results from written and oral material indicated an accuracy level that averaged 88% when specific questions regarding breast disease were analyzed. DISCUSSION The goal of the third-year rotation on a surgical service is to introduce surgical concepts from various disciplines to the M-III student to assure that he or she will gain a better understanding of the diagnostic and therapeutic approach to surgical illness as well as gain some understanding of the circumstances during which surgical intervention is indicated. Traditional approaches to achieve these goals have centered on formal lectures, inpatient teaching rounds, individual sessions with senior residents and attendings, operating room interaction, and follow-up of patients in the setting of the "multi-specialty" surgical clinic. As the impetus for ambulatory care and outpatient surgical procedures has increased during recent years, a detrimental effect has occurred in that traditional avenues of student/patient interaction have eroded. Preoperative assessment and treatment planning are not possible when students are not given the opportunity to approach these issues in a defined, cohesive manner. The development of a Diagnostic Breast Clinic, which can serve as a major teaching opportunity for third-year students, can take the place of traditional inpatient interaction and has been shown by this study to enhance the accuracy of response rates during formal student testing. More important, however, students have an opportunity to see the results of learning from patients in the same setting where they then become patient educators in strategies regarding dietary counseling, breast
235
self-examination, and the benefits of mammographic screening. These experiences support the goals of integrating learning which helps the neophyte physician become an effective decision maker.1 During the weekly Breast Diagnostic Clinic at the University of South Carolina School of Medicine, our third-year medical students have had an opportunity to become members of a team approach toward breast disease and have had the opportunity to see the effect and benefits of consultation with senior residents and attendings regarding treatment planning. The student has the opportunity in this setting to take a direct hands-on approach by examining patients, participating in outpatient diagnostic procedures such as cyst aspiration and fine-needle aspiration, and realizes the advantage of personally reviewing imaging studies relative to breast disease rather than simply reading the interpreter's report. By reinforcing these concepts, our medical students have not only improved their overall didactic responses to problems of breast disease but, as shown by the results of oral examinations, have gained a true appreciation for the total concept of management in the treatment of breast problems. The approach to medical student education, especially in this age of ambulatory care, must be toward greater use of our clinics as teaching laboratories. Development of oncology-related ambulatory climes in the undergraduate medical student setting also offsets the reduction seen in teaching oncologyrelated subjects in the traditional classroom setting.2 The results of this study support the concept of developing specialty clinics to enhance teaching and understanding of human malignancy. REFERENCES 1. O'Donnell JF, Baron JA: A strategy to teach medical decision making within a medical school curriculum. J Cancer Educ 6:123-128, 1991. 2. Kuske RR. Strategies for maintaining oncology curriculum time amid pressures to cut classroom hours. J Cancer Educ 6:69-72, 1991.
