Student Survey Subcommittee Report for the LCME Self Study Task Force

Executive Summary:

The Student Survey Subcommittee of the LCME Institutional Self-Study Task Force met several times during the fall of 2004 to develop an instrument to survey the student body on its satisfaction with numerous elements of student life here on campus.   These topics ranged broadly, encompassing the curriculum in each of the four years to other aspects of campus life and the curriculum.  The survey was constructed by the student group, then refined, and edited again.  With the help of Steve Arenberg of the Strategic Planning office, the survey was administered online during mid-February 2005.  An initial email was sent to each of the classes.  Additional emails encouraging student participation were sent out at the end of the first week, at the beginning of the second week, and at the end of the second week.  Access to the website was pasted on each email reminder.  Announcements to the Pre-Clinical Year classes were made a number of times each week.  All together, 94 first years, 88 second years, 61 third years and 77 fourth years took the survey.  This constituted 67% of the student body and was considered a success. 

The majority of the survey was a modified Likert-type scale with a number of free answer sections for student feedback.  General satisfaction was measured by the percent of students answering with a 4 or 5 (Very Satisfied) on a 1-5 Very Dissatisfied to Very Satisfied scale.  An answer of 3 was qualified as indifference.  Most notably, general satisfaction with the clinical years was high at 77.4% of third and fourth year respondents answering either 4 or 5.  Students are confident in their abilities to take histories, perform physical examinations, interpret lab results and direct their own learning outside of the hospital.  Overall, the impression among the fourth year class is that the hospital prepares them well for internship.  The current system for teaching of Clinical Skills during the second year also was received well by the student body.  During the 1^st year, Immunology was considered an excellent class by much of the student body, as was satisfaction with Organ Systems.  Computer-based support, particularly Blackboard, is well liked by students.

Primary concerns regarding the educational experience ranged but could be classified into 4 categories.

1. Facilities
   1. Call Rooms:  There is a notable lack of call rooms for medical students such that students can often be found sleeping in the Doctor’s Lounge or in unused patient beds.
   2. Study Space:  The available space is limited or outdated.  Library hours are considered too short and the Pre-Clinical Teaching Building does not offer enough options for a comfortable learning environment.  Rooms are dark with uncomfortable seating.
   3. The Doctor’s Lounge:  While located centrally, does not offer separate gender changing rooms, nor bathrooms.  The facilities are often dirty and the bathroom needs renovation/reconstruction.  It is not cleaned often enough.  It needs more computers and phones. 
   4. Computers in the IRC:  While a number of new computers were installed in the renovated IRC during the summer of 2002, demand for these computers have increased enough that the 1^st and 2^nd year classes note a need for more.  It is noted that these computers are shared with the graduate school.
2. Curriculum
   1. Physician and Society, while discussions are often interesting and educational, the class ranks amongst the lowest in satisfaction during the all four years.
   2. Developmental Biology is received poorly across all classes for being  inappropriately taught for a medical education.  Students complain about the subject being a list or collection of genes.  The embryology is repeated again during anatomy.
   3. Pre-Clinical advising is not well received.  Many students never know who their advisors are.  Peer Mentoring is also non-existent.  The Big Sib program often serves little use to incoming students.
3. Evaluations
   1. Students do not feel that clinical evaluations measure their performance often enough.
   2. Evaluations often are not returned in a timely manner.  Sometimes these evaluations are returned 4-6 months after the course ends.
4. Student Services
   1. UHS—Oftentimes, it is difficult to get appointments at UHS.  Their billing system is confusing.
   2. Health Insurance—cost is expensive compared to students’ perception of use of the system.  More options should be available.  Limited access to Mental Health services noted.
   3. Parking Options 1^st and 2^nd year are limited.  Students who park close to campus rather than pay fees have safety issues.

It is recognized that the administration is currently working to improve and gathering student opinion on a number of these topics besides the current planned curriculum reform. 

• The Medical Student Society (MSS) was contacted regarding the availability of call rooms for medical students and whether or not this was an issue.  Space currently existing on campus is being looked into.  It is encouraged that some space in the new buildings planned for completion in 2008 be used for this purpose.
• Dean Nichols has met with MSS regarding study space on campus.  A number of alternative spaces have been discussed, along with a proposal for what students envision as a quality study area.  Many students will not study at Hopkins because of the poor hours at the library and the drab environment of the PCTB.  Plans for a new medical school building should encompass student opinion.  An increased number of computers in the PCTB would be appreciated, especially as the curriculum expands to take advantage of computer and internet resources.
  • Wireless internet and printing should be made available when possible.
  • Reports of some small group discussions in PCTB not having enough chairs.  Chairs are old and uncomfortable in general.  Should be replaced to make PCTB a better place to congregate and/or study.
  • Lighting should be improved wherever possible.
  • Lounge in PCTB does not have couches, places to rest.
• Plans are in place for an Outpatient Center Study Center and have been discussed with MSS.
• Would recommend having a Computer center in Weinberg and/or the Outpatient center similar to the one on Blalock 4.
• The Doctor’s Lounge in the hospital should be renovated.  Would recommend 6-8 computers and 4 phones versus current 2 computers and 1 phone.  It should have more limited access.  It should not have to serve as a call room except in an emergency. 
• The “Genes-to-Society” Curriculum Revision has had student input throughout.  A meeting in early April is planned to discuss the current plans with the student body. 
  • Clinical Skills should be started in the first year.  This will increase student confidence and could reduce burden during Second Year.  Could also be used to teach and reinforce skills needed for procedures.
  • AIME/Clinical Skills/Physician and Society should be better coordinated.
• It is recommended that courses such as developmental biology and others be revised such in a way as to maximize clinical relevance whenever possible.  This is important across all pre-clinical classes, even those well received by the student body. 
• Physician and Society should be restructured and modified to maximize benefit across the four years. 
  • Perhaps a two-year rotating curriculum during the clinical years to decrease repeat discussions.
  • Actual community visits during 1^st year when schedule is more friendly.  Could have a rotation of community visits (jail, EBMC, Matilda Koval, methadone clinics, suburban health practice, KKI, etc.) to expose students to varying aspects of what physicians encounter.  This would enhance later discussions and could substitute for paper requirement, which is universally disliked.
  • Increase structure of class.  Increase law, ethics, health policy.
  • Make small groups as small as possible. 
  • Shorten or eliminate written assignments
• Implement a faculty development program for faculty and residents to improve teaching on clinical rotations and make experiences uniform for all students.  Faculty and residents should be encouraged to include medical students at every possible opportunity.
• Dean Koenig, along with several members of MSS, has developed a new clinical advising system that should be implemented within the next year.  It is hoped that this will replace the old system.
  • Associated with this, students would like a centralized resource that will help them find summer research positions/externships and inform them of international medicine opportunities.

Overall satisfaction with the basic clinical curriculum was high at 77.4%.  Currently, the curriculum is divided into 7 “basic” courses:  Medicine, Surgery, Pediatrics, Psychiatry/Neurology/Ophthalmology, Obstetrics/Gynecology, Emergency Medicine, and Ambulatory Medicine.

Emergency Medicine was the highest ranked course with a satisfaction level of 80.2%.  The course features a weekly lecture series and the opportunity to choose shifts at both Hopkins and Bayview.  When asked about exceptionally high quality clerkships, a number of students commented on Emergency Medicine.  Students enjoyed the freedom of scheduling, the high level of involvement in patient care, the friendly atmosphere, autonomy, high volume of patients, and the ability to do procedures.  There was not one negative comment in question 5, which addressed exceptionally low quality clerkships.   

Internal Medicine had a satisfaction level of 75.0%.  The rotation features a month at Johns Hopkins on an inpatient service and a month at either Bayview or Sinai.    As a rotation, Medicine was described as “particularly well run.”  Its “breadth of exposure” was praised.   A number of students mentioned the “excellent clinicians and teachers” and “excellent residents.”  At Bayview, one student “was welcomed as a new member in the medical community and my views and opinions were highly valued.”  Teaching during rounds was praised a number of times as were didactic sessions.  The ECG course was noted to be “fantastic.”  Criticism was directed towards some interactions with the house staff and the grading system—“makes success a near impossibility.”  It is clearly stated at the beginning of the rotation that the vast majority of students will get a Pass.  The problem with this is that other rotations give High Pass as the mean grade.

Neurology followed with a satisfaction level of 74.2%.  It is currently approximately a 4 week rotation with 3 weeks of inpatient service or consult service and a week of outpatient Neurology.  Students enjoyed the variety of inpatient and outpatient care seen—a week of outpatient medicine is built into the course.  Students felt “very welcome” by the attendings and residents.  There was much “personal attention.”  The course director, David Newman-Toker, was highlighted for his “great advances” and teaching ability. The call schedule was also praised.  Students leave by 10pm on call nights.  Some criticism was aimed at the fact that certain inpatient services are too focused.  For example, the stroke team only learns about stroke.  Students on the consult service see a broader range of patients. 

Pediatrics had a 67.6% satisfaction rating.  Students spend roughly one month on an inpatient service and one month on an outpatient service.  A number of students commented on the team atmosphere and the high quality residents they encountered.  The outpatient experience at Bayview was highlighted, as it offered both an outpatient portion and an ER portion.  There was good patient exposure.  Students criticized the “lack of autonomy” on the inpatient service.  Again, this was contrasted with the outpatient month.

Psychiatry is a one month rotation where students spend one month on an inpatient or consult service.  Its satisfaction rating was 63.5%.  The teaching and didactic components were praised as being broad and strong because of “dedicated, purposeful” faculty.  Criticism was directed at the system of assigning students to a specialized psych ward—that the patient population in such a situation was not diverse enough.  For example, motivated behavior unit almost exclusively sees substance abuse patients, or schizophrenia.  Students on the general psych ward, Meyer 3, made positive comments.

Surgery had a satisfaction rating of 62.1%.  Like Medicine, it was generally seen as a well run rotation with a good didactic series.  Residents were seen as “encouraging” and teaching much of the time, but also like Medicine, there was some criticism directed towards residents who did not teach.  OR time was criticized as “low yield” by some.

Ambulatory Medicine had a satisfaction rate of 59.1%.  While the lecture series and course organization was rated as high amongst students who answered, the individual preceptors were “hit or miss” according to students.  Overall, students who criticized the course criticized their preceptors.  Students commented that the course should be more “uniform” in nature.  It was commented that since some faculty are not Hopkins employed, they are volunteering their time—and that partially because of this that faculty do not have the same ability or desire to teach.

Obstetrics/Gynecology had a satisfaction rating of 53.8%.  It is a six week rotation based at either Hopkins or another outpatient site in Baltimore and surrounding environs.  Reviews regarding resident acceptance of medical students as part of the team were mixed.  From reading the subjective evaluations, it appears as though Ob/Gyn is less friendly to students compared to other rotations.  Students wanted to feel more involved in patient care.  Students wanted to be evaluated by attendings that had more interaction with them.  The intro lecture series at the beginning of the course was not well received.  

Ophthalmology was the lowest rated course at 44.9%.  The class is structured into a week of lectures with 3-4 half days of clinical experience.  The main complaint:  students wanted more clinical exposure versus 6 days of lecture.

The only rotation that did not have a negative comment was Emergency Medicine.  This is an excellent accomplishment considering the diverse group of students taking the survey.  Most likely, this occurred because the course directors have encouraged student participation and feedback during the rotation.  The former course director, Mark Dogoli, was an exceptional educator who made learning fun.  The schedule is flexible, and students are continually involved in the care of their patient.  The course of the disease can be seen through the ER shift.  When procedures are needed, the medical student often has the opportunity to do them if desired. 

Other services, such as Medicine, Surgery, and Pediatrics, received high marks of satisfaction overall, but had some negative comments regarding their house officers.  Most of the frustration seemed directed at “disinterest in teaching” or interns and residents that were not “supportive or encouraging.”  A “toxic” or “malignant” atmosphere is observed by some students.  The perception that each inpatient rotation is “team dependent” likely has much to do with this.  Some residents are more interested in teaching or are simply better teachers than others.  Some residents are more likely to sit down with a student and either teach a skill, such as tying surgical knots, or teach a topic, such as acidosis, than others.  On the other hand, some residents are more interested in accomplishing their work—and will not hesitate to send students on errands while they work on something else.  This may or may not be a bad thing, depending on the student involved.

Overall, students seemed to express dissatisfaction most when they do not feel involved with their patient care.  This is clear in all rotations, especially Ophthalmology, where the greatest criticism came from the lack of patient contact and frustration with the number of lectures.  But this is true of other services:  “Inpatient Pediatrics . . . . the senior residents did not facilitate our integration into the team.  All patient care took place behind our backs, and we spent most of our time scrambling to figure out what happened to our patients . . . my outpatient peds experience was outstanding.”  One person’s comments on medicine:  “We were not members of the team at all.  Our presence was ancillary.  There was not an environment conductive to learning and asking questions.”  There should be faculty development for both residents and faculty to help create a standard of excellence among those members of the house staff and faculty involved in education.

Required Basic Rotations prior to electives?

Student opinion is such that only 18.2% would want required rotations prior to starting electives.  The current system is that students have the opportunity to choose basic rotations and then fill time not slotted with basic rotations with electives.  The advantages of such a system are that students who want to do research, away rotations or sub-internships have the freedom to do so.  Though students do not always get the basic rotations when they want them, the flexibility offered is often seen as a strength of the program.

At the same time, students do not believe that 9 week electives should be shortened to increase elective time.  Additional rotations that students most often suggested as requirements included: Radiology, ICU, anesthesia, and family medicine.

15.9% of students received their evaluations in a timely manner.  Comments for question 13 state that evaluations were received up to 6 months after the end of the rotation.  This was part of the reason that only 34.3% of the student body believed that evaluations commonly reflected their performance.  It was asked how an evaluator would remember the student 6 months after the student was on service.  Suggestions to improve the program were to have evaluators that know the student well—a repeating theme was that an evaluator has little contact with the student.  If more time could be spent with an attending that evaluates one, that would be an improvement.  Likewise, there was a call for more resident feedback; residents typically spend more time with the student.  Rotations that allowed the student to pick the evaluator were praised.  There was call for face-to-face evaluations and feedback during the rotation and then at a session at the end of the rotation as well.  There were mixed reviews on standardizing grades (making them less subjective).  There were criticisms of the Medicine RIME scheme and how it fosters undo competition.  Furthermore, there was comments on the consistency of grading.  Students note the marked difficulty in getting higher level grades in some rotations (esp. Medicine, but Surgery, Peds and Ambulatory were also mentioned) versus others.  Grading should be standardized.  When the fourth years started, it was said that 80% of students received a grade of B in each class.  This is no longer the case, if one equates a B to a HP.  There is a feeling that this hurts Hopkins students now (and esp. last year) during the residency application process.

Physician and Society

19.9% satisfaction.  Students criticized the repetitive nature of the course.  Though some students note “fantastic discussions,” these do not happen all of the time.  There is complaint about the paper. Students say they could learn more about the community and society by going out into it.  The paper requirement is not well received.

Rational Therapeutics

50.7% approved of Rational Therapeutics.  Some said that the class could be started earlier.  Also there was more approval of cases and dosing, rather than lectures regarding internet resources.  Dr. Petty is well liked and appreciated.

Call

94.2% of students would want food vouchers when on call.  Food options in the hospital at night have improved with the addition of Subway.  However, the loss of the Chinese restaurant decreased 8-11pm food options.  48.9% of students commonly worked more than 80 hours a week while on clinical rotations.  This can happen when students take call every 3^rd or 4^th day.  Pediatrics has instituted a night float system, which alleviates this problem.  75.2% believe that student work hours should be restricted like resident work hours and 73% feel as though students should be sent home after overnight call.

Call Rooms

Not one rotation had a higher approval rating than 41.1% (Hopkins Ob)   They ranged from 12.9% to 41.1%.  Rotations that currently require students to have overnight call include Surgery and Ob/Gyn.  Pediatrics has instituted a night float system, but call rooms are still needed as residents do go to sleep when possible.  Medicine does not explicitly ask students to take overnight call.  However, there are students who choose to—and those students who are on call can find themselves there until 2 am.  When this happens, students should be able to sleep at the hospital.  Students commonly sleep in the Doctor’s Lounge.  This should not be the purpose of the Doctor’s Lounge.  It is suggested that unused call rooms should be located and allocated for medical student use.  If there were 12-15 call rooms allocated for medical student use, this would be an ideal situation.  Both basic rotation and subinternships would likely be covered at Hopkins.  Though not specifically asked about in the survey, this is a problem.  These rooms should be coordinated so that students are aware which rooms are available for their service.  This situation needs to be addressed at the other hospitals as well.

Doctor’s Lounge

27.5% approval.  Students like the tv and there is mixed opinion on the furniture donated by the class of 2003.  Students call for more phones, computers, and a printer that works.  One student commented that s/he had to walk to the PCTB to print out articles that s/he would rather print out in the Doctor’s Lounge.  Students would appreciate the addition of 1 or 2 large refrigerators and 1 or 2 microwaves.  A number of students mentioned the hospital staff that use the room for the phone (there is only one house phone in the room) and/or to watch tv.  The bathroom must be renovated.  It is poorly ventilated and commonly dirty.  Often there is the smell of cigarette smoke.  Some suggested a shower.

Computer Access at Other Institutions

At GBMC, 12 of 22 students (54%) had easy access to a computer.  7 of 22 (31.8%) had difficult access.  3 of 22 report no access (13.6%).  At Sinai,  25 of 87 (28.7%) report easy computer access, 40 of 87 (46%) report difficult access, and 12 of 87 (13.8%) report no access.  At St. Agnes, 13 of 19 (68.4%) report easy access, 4 of 21 (21.1%) report difficult access, 2 of 19 (10.5%) report no access.

Parking

94.2% of students were satisfied with their parking options during third and fourth year.  Parking at Bayview had a 49.6% approval rating, likely because of the difference in parking there.  During Medicine at Bayview, students have the opportunity to park in the closer East lot.  During other rotations, they will walk from the farther Northeast Lot.  As the Visitors lot undergoes construction, more students will be forced to park in the Northeast Lot.

Preparation for Internship

One of the stronger points of the clinical education is its ability to prepare students for internship.  65.3% of fourth-year students felt well prepared for their internship.  Overall, students were satisfied with their ability for self directed learning, ability to assess patients, their ability to take a history, perform a physical exam and interpret lab results.  (70.9%-91.9%).  Students were less satisfied with their ability to manage their time as an intern, but not terribly so (58.1% felt well prepared).  Similarly 58.6% were prepared to suture a laceration.  Areas that could use improvement include the ability to interpret imaging studies (51.1%), board preparation (49.2%).  Only 45.9% of students were well prepared to draw blood.  32.6% were prepared to place an IV, and 33.1% were well prepared to take an ABG. 13.6% said they were able to place a central venous catheter.  2.3% were prepared to run a code.  22.7% were prepared to perform CPR.  As CPR and ACLS/ATLS training are important components of internship year, perhaps some resources can be set aside for additional training in these subjects.

Second Year

The Second Year curriculum currently consists of 3 classes (Pathophysiology, Pathology, and Pharmacology) that are organized by organ system.  The curriculum is intense and time spent in class is markedly increased from first year.  Clinical Skills is taught during second year and is generally seen as a highlight of the year.  Physician and Society is again taught, with a series of “selectives.”  Students basically select their discussion group session with this system.

Satisfaction with the particular classes were as follows:

Pathophysiology

Generally well received with no group lower than 50% satisfaction and 5 of 7 above 65% satisfaction.  In particular, Renal and Neurology received excellent reviews.  The quality of teaching in these sections was consistently complemented as outstanding.  Michael Choi and David Newman-Toker were named again and again.  Rheumatology, Cardiology and Lung also had a number of positive reviews.  The faculty were described as energetic and excited about teaching, who took the time to make subjects understandable.  Reviews of ID were mixed, criticism was directed at too much information in too little time and that it could have been presented better.  Students did not necessarily have a grasp on what antibiotics were used for each organism.  Reproduction was criticized for having too many lectures in a short time period with minimal breaks.  Dermatology was also criticized for having too much information in too little time.  The workload for ID was described as too much by a number of students.  This sentiment was echoed for Neuro and Lung.  The Clinical Skills curriculum becomes more work as the year progresses and makes studying for Blocks 4, 5, and 6 more difficult.

Pathology

Pathology also was well received with no group lower than 57% satisfaction.  5 of 7 were above 60%.  Systems that stood out in Pathology were Bone, Neuro, and Renal, though there were positive comments for other topics as well.  Students seemed to enjoy the practical session of ID with plating—although there were a number who felt strongly the opposite way.  Also regarding ID, students felt the workload was too heavy.  Renal was also described as too heavy by a number of students.

Pharmacology

Compared to the other Second Year classes, Pharmacology scored lower on student satisfaction.  3 of 7 classes were below 50% satisfaction with no class scoring higher than 56.2%.  There were a number of comments praising the straightforward nature of the class.  Goals were defined and material covered was for the exam.  Criticism was aimed at the Cardiology section of the class.  Largely, complaint was centered on the organization, which differed from previous sections of Pharmacology (how to treat certain diseases v. basic drug properties and effects).  Some felt that the level of teaching was thus too high—that the course was better suited for residents (comment 61 on Q40).  Course needs to be structured more towards teaching basic concepts first.

Clinical Skills

Very highly regarded section.  Both parts rated above 80% satisfaction.  Students enjoy learning the practical aspects of medicine.  Would prefer that Clinical skills be implemented sooner, perhaps during first year.  This would increase students’ confidence in their physical exam and decrease the time load on second year students.  Advanced clinical skills could be taught as well, including increased exposure to procedures.  Some commented on the differences between preceptors.  Though this can be an advantage, it can also be a disadvantage.  Would recommend further faculty development to ensure that similar skill sets are taught to all students.  One student commented that his/her preceptor had him/her come in on Saturdays; this should be discouraged.  It was seen as an advantage when the Clinical Skills section coincided with the system being taught in the lecture section (e.g. neurology exam during neurology).  Also, fourth years criticize the lack of musculoskeletal education.  At no point was a back or knee exam taught to this class.  It was not taught to the third year class, either. In terms of preparation for the wards, satisfaction was as follows:

Students seem comfortable with taking histories and somewhat less comfortable with physical examination upon leaving second year.  However, there is a gap in their perception of being ready to work on the wards.  Some suggestions included adding order writing and labs.

Physician and Society/AIME

Students enjoy the selective section of Physician and Society.  Again, the paper requirement is criticized.  Students would prefer clinicians to be small group leaders in Physician and Society whenever possible.  AIME is a program started in 2003-4 that teaches interpersonal skills in patient interactions.  Students appreciate the smaller group setting for Standardized Patients in AIME versus the larger student small groups in PAS.  Students do not like the overlap between AIME, Physician and Society, and Clinical skills.  They would prefer a more consolidated class that did not repeat topics between classes. 

First Year

First year curriculum is a block system where students work on one class at a time.  There is a longitudinal Physician and Society class where social, legal and economic issues are taught.  Introduction to Clinical Medicine is a preceptorship where students are matched with a physician and spends an afternoon with him/her once every 1-2 weeks.  A typical day starts in the lecture hall with 1-2 lectures and is followed by small group.  There may or may not be a lecture afterwards.  The typical day ends at 1pm.  On Fridays, there is often a Clinical Correlation, where a patient visits with the class and tells her or his story.

Overall satisfaction with the First Year follows by class. 

Satisfaction with individual classes was as follows:

Immunology

This course introduces students to basic aspects the immune system and immunology.  This is the model for first year classes.  Drs. Silicano and Desiderio do an excellent job.  The course is well organized and planned.  The lecturers are charismatic and keep students interested.  There is an excellent review at the end of the course summarizing everything that is taught, and students are well prepared for the exam.

Developmental Biology

14.1% Satisfaction.   A two week course focusing on the genes and gene products that relate to development.  This course may be among the least liked courses during medical school.  The pertinent clinical information is retaught in Anatomy, but there is very little pertinent clinical information taught at all during these 2 weeks.  Lectures were focused on specific genes.  Many students complained of boredom; some complained of disinterested faculty.  This is seen across all 4 classes.  Some recommend to dismantle the course and integrate it into an Embryology course.  This would maintain the current genetic basis, but add the embryology that students need for their clinical rotations (Ob/Gyn and Peds) and boards. 

Anatomy

Students attend one lecture in the morning and then proceed to dissection.

Overall, the breakdown of anatomy was as follows:

This is a very well-liked class with a number of very positive comments.  The faculty are dynamic and charismatic, and the overall experience of the class is excellent for many.  The teaching is excellent and the class is hands-on.  Looking at the class distribution, it is clear that the first and second years love the class—however satisfaction does seem to decrease as the years go by.  Interestingly, there are no negative comments about anatomy until one gets to the third and fourth year comments.  There, students comment about lack of clinical relevance and how having surgeons help teach the class would add much.  Overall, however, this is an excellent class and the faculty are model teachers.

This course is taught in concert with Psychiatry.  Students seem to enjoy small group and lecture, though reviews were mixed.  Praise for the course director. 

Two week block with satisfaction similar to Neuro/Psych. 

Students enjoy the clinical relevance of Friday interview sessions.  For many, it is the first time actually conducting a patient interview.

Molecules and Cells

Generally well received, however students would appreciate more clinically oriented lectures and communication between faculty members to decrease repetitiveness.  Some small group leaders were less willing to answer questions about lectures, though it is felt that they should.  There was a request for more faculty at small group and less TA’s, though this may not be a problem in general.

Organ Systems

Another liked subject and block.  Strong section directors who explain their subjects well, esp. Dr. Art Shoukas.

54.6% satisfaction.  Interesting that the percent satisfaction was so low.  This class arranges for a student and preceptor to spend time in a clinical setting.  The student generally shadows the preceptor once every 1-2 weeks.  The actual amount of clinical experience varies between preceptors, and this seems to be the criticism regarding the class.  It is a “hit or miss” class depending on your preceptor.  Some will let you interview patients and go to the OR with them.  Others will just have the student shadow.  Many students shadowed physicians prior to medical school.  It is recommended that students be taught clinical skills during this course.  Faculty development could be useful to standardize the experience for each medical student.

Physician and Society

21% satisfaction.  Students had difficulty having discussion type sessions while in large lecture settings.  Comment was made that it is hard to have ethical, case type discussions when students have little or no medical knowledge. 

Grading system for Pre-Clinical Years

Overall, students seem to want a Pass/Fail system for their preclinical education.  Part of the reason for this is that the impression exists that 1^st and 2^nd year grades do not have the same effect on one’s residency application as do the Clinical Years.  Students want an atmosphere more conducive to learning for the sake of learning rather than a competitive one.

• Lectures should be coordinated to minimize repeating topics.
• Increase clinical relevance.  25.7% were satisfied with the amount of clinical exposure
• Computer software and support generally well received.  61.9% satisfaction with Overlayer as a learning tool. 75.2% satisfaction with support programs—Blackboard.  Blackboard is very well received. It allows communication, provides lecture notes, old exams, and streaming lectures.
• Number of computers is considered low.  43.6% are satisfied with the # of computers.  Computer access is rated higher at 65%, however it is repeatedly mentioned there are times of the day when it is very difficult to get access.
  • Would increase # of computers with internet access to have one computer for every 2-3 students.  This would also help alleviate the burden of sharing computers with the graduate students.
  • Small groups were seen positively:  62%.  Some would like to see an increasing number of clinicians participate in small group.  Would expand input on a topic, as PhD’s sometimes do not have the clinical knowledge regarding that topic.
  • More faculty and less TA’s when possible.
• Clinical Correlations are seen positively.
• In general, faculty were seen as accessible, though some students commented on problems   53.1% satisfaction.  Would continue to encourage office hours for faculty and openness to questions.

General Questions

In the summer of 2004, Dean Herlong stepped down from his position.  He was replaced by Associate Dean Tom Koenig and Assistant Deans Michael Barone and Redonda Miller.  In general, the transition went smoothly and they have been well received.  One student describes them as “fantastic.”  Students were satisfied with their access to the administration (68.7%) and the administration’s responsiveness to their issues(61.1%).  Student satisfaction regarding the Dean’s role in a student’s education is lower at 47.1%.  Comments on this seem to revolve around students wanting to know their Dean better.  A number of Second Years commented that they have never met or seen the Associate Deans since their appointment—that the Associate deans did not introduce themselves to that class.  The increase of Deans from 1 to 3 has generally been hailed as a good change, especially in terms of accessibility.  Student satisfaction with the change was 71.7%

11.9% satisfaction

Unfortunately, the system is more noted for the lack of pre-clinical advising than any thing else.  In previous years, students have been assigned to the faculty member who interviewed them for admission.  This has not been the best system as many students do not form a relationship with this person.  The advisor also may not know anything about the field that the student is going into and likely has no connection that would help the student.  One student comments that Hopkins is a great place for a self-motivated, active learner who will seek out help when needed—but this does not change the fact that there is room for improvement.  Perceptions are more positive for the pre clinical classes, but it is still not high.  This may be a result of the 1^st years not knowing exactly what is expected once they go through the residency match process.  Guidance through the first 2 years is especially important for those going into competitive specialties.  In addition, students would want a centralized resource for helping them get summer research positions and to let them be aware of international opportunities.  Tom Koenig is developing a new advising/peer mentoring system that will hopefully eliminate this.  The Medical Student Society has been involved with this.

Response to the Financial Aid office has been mixed.  46.1% were satisfied with the amount of aid package in regards to it covering needs.  49% found it fair and 50% found it satisfactory when compared with other schools.  Criticism was directed at the difficulty in getting questions answered, and the decrease in aid award during the fourth year.  Though students are students for less of the year according to the financial aid calendar, for many, the costs of interviewing and the new USMLE 2 Requirement were simply too much during the fourth year. 

Student satisfaction with the cost of health insurance is at 17.3%  Satisfaction declines from the 4^th year class (29%) to the first year class (12%).  This is not acceptable given the services offered.  Particular concerns regard coverage for families and dental plans for families.  In addition, there is concern regarding the coverage of mental health counseling and treatment.  Students do not get enough visits covered by insurances, especially when one factors in the cost of health insurance.

11% of students were satisfied with ease of appointments.  41.9% answered Very Dissatisfied.  28.6% answered with 2 (lower than indifferent).  For students to get appointments at UHS is very difficult.  The wait is often a week or more, even for sick visits.  Billing is generally difficult to understand.  When referrals are needed, or when students need to go to an outside facility, it gets more confusing.  Students note that it is confusing and a hassle to take bills to the Billing office for reimbursements.  This becomes more of a problem during the clinical years when students are tied to a service.  Because only 30.6% of the students are satisfied with the accuracy of the billing, it means that extra time must be spent in the Billing office or on the phone.

Safety on campus

47.9% of students were satisfied with safety on campus.  Complaints focused on the parking garage and the areas around campus more than on the campus itself.  This is an issue especially for students who choose to park close to campus rather than pay the exorbitant fees for garage parking first and second year.  However, given the number of guard stations and security on campus, the campus itself is a safe place to be.

The library offers a number of computerized and non-computer resources.  In general, its collection and access to journals is expansive.  However, some problems exist. Computer availability at the Library is a problem.  Considering that many of the journals offered are online, this should be addressed.  While 57.4% of the student body was satisfied with the book and journal collection, only 25.2% of the student body was satisfied with the hours.  This is likely related to the issue of study space on campus; however, for students on certain clinical rotations, getting to the library during its hours can also be a problem.

Study space for students on campus is a real issue.  15.1% of the student body was satisfied with the amount of study space.  Only 8.7% of first year students were satisfied.  Most students question why the School of Medicine does not have a facility like the School of Public Health or School of Nursing.  They have a greater number of well-lighted study spaces with comfortable seating, food options, and computer access—all components of a good study space.  One student commented on the lack of dinner options available—this made him or her go elsewhere to study.  Furthermore, they even have a modern extension of the Cooley Center on their top floor.  They have wireless internet that medical students either cannot access or do not know how.  Some students do not study there for the reason that it is the Public Health school.  One comment remarks that it is “not a welcome environment” for medical students.  Students believe that the SOM should have equivalent facilities.  Many students use the facilities at the University of Maryland to study.  The administration has contacted the Medical Student Society as to how to address this issue prior to construction of a new building.  The Pre-Clinical Teaching Building is criticized for being outdated and an uncomfortable place to study.  It does offer 24-hour student access, but there is very little study space.  Computers in the IRC are difficult to access during the day.  43.6% of students are satisfied with the number of computers, however, only 28.3% of first years are satisfied.  This is likely because the fourth years (57% satisfaction) saw the old IRC before it was renovated.  With the new computers and the integrated Blackboard system has come higher demand.  Students appreciate the Blackboard System with its old exams, lecture notes, etc. and especially appreciate the recorded lectures.  Students can review and study at their leisure.  Especially for this reason, if additional computers were added that have internet access, it would be beneficial.  One computer for every 2-3 students would be ideal, given that the medical school shares facilities with the graduate school.  Students would like wireless capability in the building and wireless printing.  Response to CD-ROM lecture based learning was mixed, with some students not having access to software on the weekend.

Students have a number of options including parking on campus, a Monument St. lot, Fallsway, or parking on surrounding streets.  Campus parking is over $100 a month; many students are unwilling to pay this.  Obtaining a pass to the Fallsway lot is often difficult to obtain in general; when handed down from upperclassmen, they are sometimes inactivated.  The Monument lot, though cheaper than campus parking, is not equivalent to Fallsway.  Students describe a much longer wait and hence commute when parking at Monument.  Some students attempt to park in the neighborhoods surrounding Hopkins to avoid paying this price.  However, this is unsafe.  A number of vehicles have been broken into.  Only 10.3% of students are satisfied with options for first and second year students.

The Cooley Center provides free gym access for Medical Students.  It has undergone renovation over the last 1-2 years and is much improved from 4 years ago.  34.7% of students were satisfied with the equipment.  42.5% were satisfied with the hours of operation.  Students want longer hours on the weekends, especially.  Students would also like longer hours in the Public Health School Cooley Center.  It appears as though a greater number of students are going there because of the better facilities.

6.4% were satisfied with availability of food during off hours on campus.  During the day, there are numerous options available in the hospital, PCTB, street vendors, and the Northeast Market.  The Market is cheap, but unsafe after dark.  14.2% were satisfied with the price of food on campus.  This affects both students on call and those studying for their preclinical exams.

Though a good deal of work went into the development of this study, a number of limitations are noted. 

One of the difficulties with surveying medical students is their lack of free time.  To maximize participation, the number of questions asked was balanced against likely student response rate.  With the advice of Steve Arenberg, it was determined that by decreasing question number (and time needed to complete the survey) we would get a higher response rate.  It was felt that a response rate of 67% was very successful.

That being said, the breakdown of classes during the Second Year could have been broken down further to further isolate each specific section.  For instance, Neurology could be asked about rather than Neuro/Repro/Eye.  This likely influenced the ratings for each second-year teaching block.  We asked about teaching blocks rather than specific subjects to decrease the number of questions.

The subjective answers provided a good deal of information regarding a number of courses, but it is questioned whether if students’ strong opinions about one course limited the input that could have been obtained about other courses.  For instance, while students were very willing to write comments regarding the Cardiology section of Pharmacology—what other issues were not addressed?

In the future, would also attempt to address student services in better depth:  for example, ease of getting assistance from financial aid office or billing.

However, it is felt that this study was a useful instrument and should be considered strongly in the evaluation of this institution.