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Collecting more data to better assess medical education

David Nierenberg, M.D., is very proud of a recent letter inviting DMS to contribute a paper to the journal Academic Medicine. Dartmouth will be one of only eight schools worldwide represented in an upcoming issue on medical education research.

Dartmouth's inclusion in this select group, says Nierenberg, senior associate dean for medical education, is based on "a track record of productivity. DMS authors have contributed a number of excellent papers to Academic Medicine." (See the preceding story for an example.)

Nierenberg's newest project demonstrates why a journal devoted to medical education is taking note of Dartmouth. A custom-built program called DMEDS (Dartmouth Medical Encounter Documentation System), will allow his team to record students' clinical experiences in rich detail. The classroom part of a medical education can be structured and measured fairly easily. But because clinical education takes place in a variety of settings, it's much harder to track what students learn in their encounters with patients.

Ease: DMS has been tracking such encounters for some time, using a system called ClinEdDoc. It's the ease and sophistication of D-MEDS that sets it apart. ClinEdDoc has been used only in three outpatient clerkships and is limited in the information it can gather. Nierenberg says if the systems were cars, ClinEdDoc would be a basic model with stick shift and a small engine, while DMEDS has automatic transmission and a more powerful engine. The "engineers" who developed D-MEDS included DMS clerkship and course directors, curriculum experts, students, computer experts, and librarians, plus a software company from Boston.

Broad: "D-MEDS takes advantage of all we've learned from ClinEdDoc," Nierenberg says, "but it can be used in all clerkships, rather than just the three outpatient ones, and it can track student learning in six broad areas of competency, rather than just one or two."

D-MEDS will assess students' progress in the six areas of competency now required of residents: medical knowledge; clinical skills; communication; professionalism; self-assessment of learning; and systems practice (the big picture of health care). As far as Nierenberg knows, DMEDS is the first system to track these in medical students.

It was launched in January with three pilot programs, and by July it will be used in all clerkships. To use D-MEDS, students build a personal database of patients they've seen. They don't record patient names but enter medically relevant data such as age, gender, symptoms, diagnosis, and treatment. There are also text boxes where a student can document, for example, that she stayed an hour beyond the end of her shift to care for a patient returning from surgery. Another section allows students to record skills learned and interactions with preceptors. The data can be entered on any computer or a hand-held device like the one pictured above.

Medical students are notoriously pressed for time, but Nierenberg says logging an encounter takes only two to three minutes. "Initially, students are going to be concerned about the extra time," he admits. "But once they get used to it, it will become part of the routine."

Todd Burdette, a fourth-year student who helped develop DMEDS, agrees that "once the system gets up and running, and the students have a record of their patient encounters to use in their residency interviews, they will see the value of the effort."

Data: Benefits from the project will accrue at many levels. Since students can track their own progress, says Nierenberg, they'll be able to make appropriate adjustments— for example, choosing to see a patient with asthma if they know they haven't yet done so. Clerkship directors can use the data to create more balanced programs. And it will be an asset for the Medical School in preparing for periodic accreditation reviews.

At press time, Nierenberg was designing an assessment form for the pilot D-MEDS programs— and also, no doubt, looking ahead to the new research papers it will make possible.

Catherine Tudish

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