CLINICAL MENTORSHIP WITH CLINICAL MENTORSHIP WITH COMPUTER SUPPORTCOMPUTER SUPPORT

David P. Yens David P. Yens ((dyens@nyit.edudyens@nyit.edu))

Elizabeth DiNapoli Elizabeth DiNapoli ((edinapol@nyit.eduedinapol@nyit.edu))

Cheryl EvansCheryl Evans ( (cevans2@nyit.educevans2@nyit.edu))

New York College of Osteopathic New York College of Osteopathic MedicineMedicine

New York Institute of TechnologyNew York Institute of Technology

Supported in part by a Predoctoral Training grant Supported in part by a Predoctoral Training grant from HRSAfrom HRSA

PROBLEMPROBLEM

• A decreasing number of medical A decreasing number of medical school graduates are selecting school graduates are selecting primary care careers and rural primary care careers and rural practice.practice.

PURPOSES PURPOSES

• Encourage more students to select Encourage more students to select primary care by providing a mentorship primary care by providing a mentorship experience to first (and second) year experience to first (and second) year medical students with local or rural medical students with local or rural primary care physicians.primary care physicians.

• Combine the humanity of the primary care Combine the humanity of the primary care physician with technology to demonstrate physician with technology to demonstrate the responsibilities, rewards and benefits the responsibilities, rewards and benefits of primary care and to obtain an of primary care and to obtain an introduction to clinical medicine.introduction to clinical medicine.

RATIONALERATIONALE

• National data continue to indicated a decrease National data continue to indicated a decrease in the number of medical school graduates in the number of medical school graduates selecting a residency in primary care. selecting a residency in primary care.

• NYCOM has typically had large percentage of NYCOM has typically had large percentage of graduates entering primary care residencies graduates entering primary care residencies (31% selecting Family Practice from the class of (31% selecting Family Practice from the class of 1999). 1999).

• However, for the class graduating in 2002, only However, for the class graduating in 2002, only 13% selected a family practice residency! 13% selected a family practice residency!

• Yet, most applicants to NYCOM claim that they Yet, most applicants to NYCOM claim that they desire a primary care career. desire a primary care career.

RATIONALERATIONALE

•We believe that an exposure in We believe that an exposure in the MSI and II years to the the MSI and II years to the advantages and lifestyle of advantages and lifestyle of primary care will reinforce the primary care will reinforce the early interest in primary care and early interest in primary care and Family Practice.Family Practice.

LITERATURE/BACKGROUNDLITERATURE/BACKGROUND• Many medical schools presently provide clinical Many medical schools presently provide clinical

experiences, frequently in primary care settings, experiences, frequently in primary care settings, during the preclinical phase of training.during the preclinical phase of training.

• All schools participating in the Interdisciplinary All schools participating in the Interdisciplinary Generalist Curriculum Project (IGC) established Generalist Curriculum Project (IGC) established longitudinal clinical experiences in the first or longitudinal clinical experiences in the first or second year (Colwill, 1997). At a 1997 Association second year (Colwill, 1997). At a 1997 Association of American Medical Colleges meeting all of American Medical Colleges meeting all participants in the IGC project reported excellent participants in the IGC project reported excellent responses by students - and preceptors - to an responses by students - and preceptors - to an early clinical early clinical preceptorship, but it was too early to preceptorship, but it was too early to assess results assess results (personal discussion). No recent (personal discussion). No recent literature has been found regarding primary care literature has been found regarding primary care medical mentorships.medical mentorships.

PROJECT OBJECTIVESPROJECT OBJECTIVES

• Establish a program where first and Establish a program where first and second year medical students will second year medical students will spend a half day in a primary care spend a half day in a primary care physician’s office at least once every physician’s office at least once every four weeks (local track)four weeks (local track)

• Create a curriculum for monthly Create a curriculum for monthly visits for the two-year clinical visits for the two-year clinical program. program.

PROJECT OBJECTIVESPROJECT OBJECTIVES

• Establish an upstate program where Establish an upstate program where first year medical students spend first year medical students spend four weeks in an upstate rural four weeks in an upstate rural primary care physician’s office during primary care physician’s office during the summer following the MS1 year.the summer following the MS1 year.

• Create a curriculum for students in Create a curriculum for students in the four week the four week ruralrural clinical program. clinical program.

PROJECT OBJECTIVESPROJECT OBJECTIVES

• Integrate computer activities into Integrate computer activities into this clinical program to provide an this clinical program to provide an added introduction to clinical added introduction to clinical medicine, to introduce students to medicine, to introduce students to the environment of the practice of the environment of the practice of primary care, and describe where primary care, and describe where primary care fits into the medical primary care fits into the medical milieu.milieu.

STUDENT OBJECTIVESSTUDENT OBJECTIVES

• Through observation and interaction with Through observation and interaction with their primary care Physician Mentor, the their primary care Physician Mentor, the NYCOM Medical student will: NYCOM Medical student will:

• Observe the delivery of medical treatment of Observe the delivery of medical treatment of patientspatients

• Observe office/hospital functions and Observe office/hospital functions and management management

• Observe diagnostic procedures and use of Observe diagnostic procedures and use of medical equipment medical equipment

• Observe the interaction between healthcare Observe the interaction between healthcare team membersteam members

STUDENT OBJECTIVESSTUDENT OBJECTIVES

•After adequate experience, the After adequate experience, the student may be permitted to do student may be permitted to do history-taking and possibly physical history-taking and possibly physical exams under the direct supervision exams under the direct supervision of the mentor, depending upon the of the mentor, depending upon the comfort level of the mentor.comfort level of the mentor.

METHODSMETHODS

• Provide a structured mentorship experience Provide a structured mentorship experience with a primary care physician starting in the with a primary care physician starting in the first year of medical school. first year of medical school.

•Local year-long programLocal year-long program

•Upstate summer programUpstate summer program

• Provide a comprehensive curriculum manualProvide a comprehensive curriculum manual

• Supplement the mentorship with computer-Supplement the mentorship with computer-based content based content

• Foster continuation of the mentorship Foster continuation of the mentorship experience by encouraging and facilitating the experience by encouraging and facilitating the use of e-mail for continuing communication.use of e-mail for continuing communication.

•The basic assumption of this The basic assumption of this project is that we can project is that we can successfully encourage successfully encourage students to select primary care students to select primary care at an earlier point in their at an earlier point in their training and maintain this goal training and maintain this goal throughout their medical throughout their medical trainingtraining..

STRUCTURED STRUCTURED LOCALLOCAL MENTORSHIP EXPERIENCEMENTORSHIP EXPERIENCE

•Questionnaires created for students Questionnaires created for students and potential mentors to permit and potential mentors to permit matching and optimize compatibilitymatching and optimize compatibility

•Letters about the program sent to Letters about the program sent to all osteopathic primary care all osteopathic primary care physicians in the NYC areaphysicians in the NYC area

•E-mails about the program sent to E-mails about the program sent to all 1all 1stst year NYCOM students year NYCOM students

•Respondents completed the Respondents completed the questionnairesquestionnaires

STRUCTURED STRUCTURED LOCALLOCAL MENTORSHIP EXPERIENCEMENTORSHIP EXPERIENCE

•All potential mentors and students All potential mentors and students interviewed by the Mentor interviewed by the Mentor Coordinator (Ms. DiNapoli). Coordinator (Ms. DiNapoli). Expectations about the program Expectations about the program conveyed to both parties.conveyed to both parties.

•Mentors and mentees matched Mentors and mentees matched •Times of visits arranged by the Times of visits arranged by the

mentors and menteesmentors and mentees•Visits initiated and continueVisits initiated and continue

STRUCTURED STRUCTURED UPSTATEUPSTATE MENTORSHIP EXPERIENCEMENTORSHIP EXPERIENCE

• Questionnaires created for students and potential Questionnaires created for students and potential mentors specially designed to address the rural mentors specially designed to address the rural environmentenvironment

• Letters about the program sent to osteopathic primary Letters about the program sent to osteopathic primary care physicians in New York north of Westchester care physicians in New York north of Westchester CountyCounty

• As above, E-mails about the program sent to all 1As above, E-mails about the program sent to all 1stst year NYCOM students, respondents completed the year NYCOM students, respondents completed the questionnaires, and all potential mentors and students questionnaires, and all potential mentors and students interviewed by the Mentor Coordinator. All potential interviewed by the Mentor Coordinator. All potential upstate mentors interviewed. Mentors and mentees upstate mentors interviewed. Mentors and mentees matched.matched.

STRUCTURED STRUCTURED UPSTATEUPSTATE MENTORSHIP EXPERIENCEMENTORSHIP EXPERIENCE

• Mentors and mentees arranged starting dates with Mentors and mentees arranged starting dates with the Mentor Coordinator.the Mentor Coordinator.

• Students spent one month at the rural sites. Students spent one month at the rural sites. Housing was either provided or arranged. Students Housing was either provided or arranged. Students received a stipend of $930 for the month. received a stipend of $930 for the month.

• Daily activities included learning about the Daily activities included learning about the physician’s office and practice, learning to interview physician’s office and practice, learning to interview and perform physical exams, rounding with the and perform physical exams, rounding with the mentor in a hospital, observing (and practicing) the mentor in a hospital, observing (and practicing) the use of osteopathic manipulation, learning about the use of osteopathic manipulation, learning about the rural community and rural medicine, etc.rural community and rural medicine, etc.

COMPUTER AUGMENTATIONCOMPUTER AUGMENTATION

• A manual of information was prepared for both A manual of information was prepared for both mentors and mentees. Many Internet sites exist for mentors and mentees. Many Internet sites exist for topics to be addressed in the mentorships. We topics to be addressed in the mentorships. We provide references to these sites.provide references to these sites.

• The manual has been converted to a Powerpoint The manual has been converted to a Powerpoint presentation that can be shared with mentors via a presentation that can be shared with mentors via a video plus audio format, to be initiated during the video plus audio format, to be initiated during the summer.summer.

• To encourage continuity of the mentorship, we expect To encourage continuity of the mentorship, we expect the mentor and student to maintain contact via e-mail. the mentor and student to maintain contact via e-mail. Although the students are highly knowledgeable Although the students are highly knowledgeable about e-mail, many mentors use it only occasionally. about e-mail, many mentors use it only occasionally. We have initiated training of mentors.We have initiated training of mentors.

EVALUATIONEVALUATION

• All participants in the project All participants in the project through June, 2005 (5 Groups) through June, 2005 (5 Groups) were asked to complete a were asked to complete a questionnaire concerning their questionnaire concerning their attitudes about the program. attitudes about the program. Results were tabulated and are Results were tabulated and are below.below.

RESULTS OF QUESTIONNAIRES COMPLETED BY 5 GROUPS OF STUDENTS

STUDENT RESPONSES TO SELECTED ITEMS

QuestionQuestion LOCALLOCAL RURALRURAL

PeriodPeriod2002-2002-20032003

2003-2003-20042004

2004-2004-20052005

2002-2002-20032003

2003-2003-20042004

2004-20052004-2005

Number of students/responsesNumber of students/responses 10/810/8 13/1113/11 18/1018/10 4/34/3 8/88/8

NO NO DATA DATA YETYET

15 15 students students registereregistere

dd

Felt comfortable working in mentor’s Felt comfortable working in mentor’s officeoffice 100%100% 91%91% 100%100% 100%100% 88%88%

Learned as much as expected, or moreLearned as much as expected, or more 37%37% 73%73% 70%70% 66%66% 88%88%

Exceeded expectationsExceeded expectations 100%100% 64%64% 80%80% 100%100% 88%88%

Would Would stronglystrongly recommend to other recommend to other studentsstudents 75%75% 91%91% 90%90% 100%100% 88%88%

Program very valuableProgram very valuable 87%87% 91%91% 100%100% 100%100% 100%100%

Increase in self-confidenceIncrease in self-confidence66%66%

Plan to continue in primary carePlan to continue in primary care 75%75% 73%73% 70%70% 100%100% 88%88%

RESULTS OF QUESTIONNAIRES COMPLETED BY 5 GROUPS OF MENTORS

MENTOR RESPONSES TO SELECTED ITEMS

QuestionQuestion LOCALLOCAL RURALRURAL

PeriodPeriod

2002-2002-20032003

2003-2003-20042004

2004-2004-20052005

2002-2002-20032003

2003-2003-20042004

2004-2004-20052005

Number of mentors/responsesNumber of mentors/responses 10/810/8 11/611/6 17/1317/13 4/34/3 5/25/2

NO NO DATA DATA YETYET

Student better prepared than expectedStudent better prepared than expected50%50% 50%50% 31%31% 66%66% 0%0%

As prepared as expected As prepared as expected 50%50% 50%50% 69%69% 33%33% 50%50%

Student showed a real interest in my Student showed a real interest in my practicepractice 83%83% 67%67% 100%100% 100%100% 50%50%

Felt student strongly enthusiastic about Felt student strongly enthusiastic about primary careprimary care 50%50% 0%0% 8%8% 66%66% 0%0%

Felt student was enthusiastic about Felt student was enthusiastic about primary careprimary care 50%50% 83%83% 23%23% 33%33% 50%50%

Felt student had a strong interest in rural Felt student had a strong interest in rural practicepractice 100%100% 0%0%

Felt well prepared to be mentor Felt well prepared to be mentor 83%83% 83%83% 100%100% 100%100% 50%50%

DISCUSSIONDISCUSSION• The value of the project will be determined The value of the project will be determined

by the percentage of students participants by the percentage of students participants who enter primary care compared with who enter primary care compared with those who did not participate. It’s too those who did not participate. It’s too early to determine this yet. early to determine this yet.

• Almost all students would strongly Almost all students would strongly recommend the program to other students.recommend the program to other students.

• 69% of local and 100% of rural students 69% of local and 100% of rural students indicated plans to continue in primary care. indicated plans to continue in primary care. HOWEVER, self-selected sample. HOWEVER, self-selected sample.

• The survey results indicate a strongly The survey results indicate a strongly positive response to the program from all positive response to the program from all groups. groups.

• However, a small number of students had However, a small number of students had time problems or conflictstime problems or conflicts

DISCUSSIONDISCUSSION

• In the 3In the 3rdrd year of the project: year of the project:– Mentoring manuals were completed and distributed Mentoring manuals were completed and distributed

this year, but 4 students and 1 mentor used the this year, but 4 students and 1 mentor used the manuals (9 mentors did not recall receiving manuals (9 mentors did not recall receiving manuals).manuals).

– 3 students used internet as part of project.3 students used internet as part of project.– 1 student and 1 mentor communicated by e-mail1 student and 1 mentor communicated by e-mail

• NOTE that this is a volunteer program, which NOTE that this is a volunteer program, which may limit the number of participants. may limit the number of participants.

• Long term goalLong term goal – most students will participate – most students will participate– Required activity orRequired activity or– Elective with credit givenElective with credit given

• In a new problem-based learning track, 30-40 In a new problem-based learning track, 30-40 MS1 students will participate in a mentorshipMS1 students will participate in a mentorship

MS3 FOLLOWUPSMS3 FOLLOWUPS • Followups with 3Followups with 3rdrd year students from the rural year students from the rural

component found one (of 4) doing component found one (of 4) doing allall rotations upstate rotations upstate and one doing several upstate rotations; both were very and one doing several upstate rotations; both were very positive about the experience and felt they were more positive about the experience and felt they were more likely to select a rural primary care practice. Rural likely to select a rural primary care practice. Rural mentees were more likely to have a significant clinical mentees were more likely to have a significant clinical exposure than local mentees.exposure than local mentees.

• Rural mentors were positive about the students they Rural mentors were positive about the students they had and would take more students if space is available. had and would take more students if space is available. Rural mentors willing to work with students are in Rural mentors willing to work with students are in demand for clinical electives.demand for clinical electives.

• Most mentors use e-mail but few have maintained Most mentors use e-mail but few have maintained contact with students – something we need to contact with students – something we need to emphasize in the future.emphasize in the future.

REFERENCESREFERENCES

• Colwill, et.al. Modifying the Culture of Medical Education: Colwill, et.al. Modifying the Culture of Medical Education: the First Three Years of the RWJ Generalist Physician the First Three Years of the RWJ Generalist Physician Initiative. Initiative. Acad MedAcad Med 1997 Sept; 1997 Sept; 7272(9), 745-53.(9), 745-53.

• See also:See also:– Cronau, H. & Haines, D.J. Medical Students Summer Externship Cronau, H. & Haines, D.J. Medical Students Summer Externship

Program: Increasing the Number Matching in Family Practice. Program: Increasing the Number Matching in Family Practice. Med Educ OnlineMed Educ Online, 2004:9:3, 2004:9:3

– Veitia, M; McCarty, M; Kelly, P; Szarek, J; Harvey, H. The Veitia, M; McCarty, M; Kelly, P; Szarek, J; Harvey, H. The Interdisciplinary Generalist Curriculum Project at Joan C. Interdisciplinary Generalist Curriculum Project at Joan C. Edwards School of Medicine at Marshall University. Acad Med Edwards School of Medicine at Marshall University. Acad Med 2001 Apr; 76(4 Suppi);S97-9.2001 Apr; 76(4 Suppi);S97-9.

– Ricer, RE; Fox, BC; Miller, KE. Mentoring for Medical Students Ricer, RE; Fox, BC; Miller, KE. Mentoring for Medical Students Interested in Family Practice. Fam Med 1995 Jun;27(6), 360-5.Interested in Family Practice. Fam Med 1995 Jun;27(6), 360-5.

• This project is funded in part by Title VII Grant # This project is funded in part by Title VII Grant # 1 D16 HP 00149-1 D16 HP 00149-01 from the Bureau of Health Professions, USPHS.01 from the Bureau of Health Professions, USPHS.