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Integrating occupational health into the medicine clerkship using problem-based learning
R K Sokas1, D Diserens, M A Johnston
1Department of Medicine, George Washington University, Washington, DC 20037.
Objective:
To improve medical students' ability and willingness to obtain occupational histories from their patients.
Participants:
General medicine faculty and internal medicine teaching residents, who participated as instructors, and medical students during their required internal medicine clerkships.
Setting:
The primary teaching hospitals of two medical schools.
Design:
During alternate months, students participated in problem-based sessions that included occupational health objectives (intervention) or attended the standard small-group didactic sessions (control). Process evaluations were collected from students and faculty in the intervention group following each session. Outcome evaluation was performed using chart audit and multiple-choice testing to compare the intervention and control groups.
Intervention:
Intervention students participated in at least one problem-based session incorporating occupational aspects of disease into clinical internal medicine. Instructors received information packets and materials but had no other expertise in occupational medicine.
Measurements And Main Results:
The great majority of ratings on the process evaluations showed that the students were "moderately" to "extremely" interested in the session attended. No student rated any session to be a "waste of time," and over 90% of students would recommend the session being evaluated to a friend. Chart audit showed that students in the intervention group recorded slightly more occupational information than did those in the control group (an average of 2.97 vs. 2.37 pieces of information, p = 0.06). When the most commonly documented data (employment status and job title) were ignored, the difference between group means (1.1 vs. 0.91) was significant (p = 0.03), suggesting that intervention students were more likely to probe further into a patient's occupational history. Both groups of students collected less occupational information from women than from men (t = 3.22, p = 0.0035). Multiple-choice tests revealed no difference between the two groups in overall medical knowledge or occupational medicine knowledge.
Conclusions:
Problem-based learning with specific occupational content is well accepted by students and modestly improves their occupational history taking.