Erika Schillinger

All Publications

• Rethinking empathy decline: results from an OSCE. The clinical teacher Teng, V. C., Nguyen, C., Hall, K. T., Rydel, T., Sattler, A., Schillinger, E., Weinlander, E., Lin, S. 2017

  Abstract

  The phenomenon of empathy decline among medical students during training is widely accepted, with evidence based largely on studies using self-administered instruments. Recently, researchers have called into question this phenomenon, in light of new findings that suggest a discrepancy between self-administered empathy scores and observed empathic behaviours: for example, during objective structured clinical examinations (OSCEs). Our objective was to compare observed empathy among medical students in different clerkship years using an OSCE.Participants were medical students in their first or second year of clinical clerkships, enrolled in a required family medicine clerkship at Stanford University. Participants completed an OSCE that was directly observed by trained faculty staff, who used the Measure of Patient-Centered Communication (MPCC) instrument to measure empathic behaviours. Statistics were used to determine correlations between observed empathy and the students' year of clerkship, gender, and specialty preference.A total of 129 medical students, evenly divided by gender and clerkship year, participated. There was a possible trend towards higher MPCC scores among students in their second clerkship year compared with students in their first year (p = 0.09), which became more significant when adjusted for outlier effects (p = 0.05). There was no difference in performance by gender. Students interested in a 'people-oriented' specialty scored higher in 'handling the patient's frustration' compared with those who are interested in a 'technology-oriented' specialty.In our study, observed empathic behaviours were not lower in the second compared with the first year of clerkship training. More research is warranted to investigate the apparent discrepancy between self-administered empathy scores and observed empathic behaviours. New findings suggest a discrepancy between self-administered empathy scores and observed empathic behaviours.

  View details for DOI 10.1111/tct.12608

  View details for PubMedID 28164429

• Patient-Centered Care Challenges and Surprises: Through the Clerkship Students' Eyes. Family medicine Boggiano, V. L., Wu, Y., Bruce, J. S., Merrell, S. B., Schillinger, E. 2017; 49 (1): 57-61

  Abstract

  The patient-centered care model for health care delivery encourages medical providers to respect patients' preferences and give patients more autonomy over their health care decisions. This approach has gained importance within US medical school curricula. Yet, little is known about student perspectives on both patient-centered care and the benefits and challenges that lie therein. This manuscript explores the greatest impediments to, as well as the benefits from, student engagement in patient-centered care from the perspectives of students participating in their family medicine outpatient clerkship.Clerkship students on their core family medicine clerkship at Stanford University School of Medicine were provided the following open-ended prompt: "Describe a patient-centered care challenge or surprise in the family medicine core clerkship." Free-text responses were collected and analyzed using content and thematic analysis.A total of 326 responses from 216 students were analyzed for frequency and patient-centered themes. Nine final themes emerged and were grouped into three domains: student definitions of patient-centered care, patient-centered care impact on patients, and patient-centered care impact on medical professionals.Our study suggests that students find the patient-centered care model for health care delivery to be challenging but worthwhile. We highlight that students find communication with patients in a patient-centered manner challenging and discuss the need for improved medical education about patient-centered care in order to better prepare students to implement the model in a variety of psychosocial and medical contexts.

  View details for PubMedID 28166582

• Creating the medical school of the future through incremental curricular transformation: the Stanford Healthcare Innovations and Experiential Learning Directive (SHIELD). Education for primary care : an official publication of the Association of Course Organisers, National Association of GP Tutors, World Organisation of Family Doctors Lin, S., Osborn, K., Sattler, A., Nelligan, I., Svec, D., Aaronson, A., Schillinger, E. 2016: 1-5

  View details for PubMedID 27892817

• Finding the Words: Medical Students' Reflections on Communication Challenges in Clinic FAMILY MEDICINE Braverman, G., Merrell, S. B., Bruce, J. S., Makoul, G., Schillinger, E. 2016; 48 (10): 775-783

  Abstract

  Interpersonal communication is essential to providing excellent patient care and requires ongoing development. Although aspects of medical student interpersonal communication may degrade throughout career progression, it is unknown what specific elements pose challenges. We aimed to characterize clerkship students' perspectives on communication challenges in the outpatient setting to help inform curricular development.Third-year medical students in a required family medicine clerkship were asked to describe a communication challenge they encountered. Open-ended written responses were collected through a mandatory post-clerkship survey. Responses were qualitatively coded using an a priori framework for teaching and assessing communication skills (The SEGUE Framework for Teaching and Assessing Communication Skills) with data-derived additions to the framework, followed by a team-based thematic analysis.We collected 799 reflections written by 518 students from 2007-2014. Three dominant themes emerged from the analysis: challenges with (1) effectively exchanging information with patients, (2) managing emotional aspects of the patient encounter, and (3) negotiating terms of the encounter.Communication curricula focus on content and process of the medical interview, but insufficient time and energy are devoted to psychosocial factors, including aspects of the encounter that are emotionally charged or conflicting. While gaps in students' communication skillsets may be anticipated or observed by educators, this study offers an analysis of students' own perceptions of the challenges they face.

  View details for Web of Science ID 000387121300004

  View details for PubMedID 27875600

• Qualities of Resident Teachers Valued by Medical Students FAMILY MEDICINE Montacute, T., Teng, V. C., Yu, G. C., Schillinger, E., Lin, S. 2016; 48 (5): 381-384

  Abstract

  Medical students often see residents as the most important teachers on the wards. However, there is a relative lack of data on the qualities that medical students value in their resident teachers. We conducted a qualitative study to determine the teaching behaviors that medical students value in their resident teachers.Over a 1-year period, 28 medical students completed 115 open-ended written reflections about their educational experiences with residents at a single, university-affiliated, community-based family medicine residency program in San Jose, CA. Qualitative data were analyzed using the constant comparative method associated with grounded theory. Ten recurring themes were identified after triangulation with published literature.When given the opportunity to make open-ended written reflections about the teaching abilities of their resident teachers, medical students most often commented on topics relevant to a "safe learning environment." More than one in four reflections were associated with this theme, and all were characterized as positive, suggesting that the ability to set a safe learning environment is a quality that medical students value in their resident teachers. In contrast, the least frequently occurring theme was "knowledge," suggesting that residents' fund of knowledge may not be as important as other qualities in the eyes of medical students.Our study adds to a growing body of literature suggesting that, from the medical students' perspective, a resident's fund of medical knowledge may not be as important as his/her ability to establish a supportive, safe, and nonthreatening environment to learn and practice medicine.

  View details for Web of Science ID 000376224100009

  View details for PubMedID 27159098

• Training Future Clinician-Educators: A Track for Family Medicine Residents. Family medicine Lin, S., Sattler, A., Chen Yu, G., Basaviah, P., Schillinger, E. 2016; 48 (3): 212-216

  Abstract

  Despite a growing demand for skilled clinician-educators, residents today rarely receive formal training in clinical teaching, curriculum development, administration, leadership, or educational scholarship. The authors describe the development, implementation, and preliminary evaluation of the O'Connor Stanford Leaders in Education Residency (OSLER) track, a novel clinician-educator track within the family medicine residency program affiliated with Stanford University School of Medicine.In 2010, the OSLER track was introduced at O'Connor Hospital, a community hospital that houses an 8-8-8 family medicine residency program. Residents who are in good standing can apply to the track at the midpoint of their first postgraduate year. Residents are immersed in a flexible, experience-based, 2.5-year-long curriculum with hands-on teaching activities at its core. To foster skills in educational scholarship, track residents are required to design and complete a scholarly project.A comprehensive evaluation plan is currently in progress. Preliminary data indicates high levels of satisfaction with the track's overall value, impact on core teaching skills, and effect on career trajectory. Residents gained more confidence in core teaching skills as they progressed through the track. Scholarly work output by residents has increased significantly since the track was implemented. The residency program has seen an increased interest from applicants since the track was started, with data suggesting that applicant quality has increased from the pre-track to post-track years.More research is needed to assess the effectiveness and reproducibility of this clinician-educator track. If proven, this model may be replicated at other academic medical centers.

  View details for PubMedID 26950910

• Training Future Clinician-Educators: A Track for Family Medicine Residents. Family medicine Lin, S., Sattler, A., Chen Yu, G., Basaviah, P., Schillinger, E. 2016; 48 (3): 212-216

  View details for PubMedID 26950910

• Value-added medical education: engaging future doctors to transform health care delivery today. Journal of general internal medicine Lin, S. Y., Schillinger, E., Irby, D. M. 2015; 30 (2): 150-151

  View details for DOI 10.1007/s11606-014-3018-3

  View details for PubMedID 25217209

• Beyond Knowledge, Toward Linguistic Competency: An Experiential Curriculum JOURNAL OF GENERAL INTERNAL MEDICINE Bereknyei, S., Nevins, A., Schillinger, E., Garcia, R. D., Stuart, A. E., Braddock, C. H. 2010; 25: S155-S159

  Abstract

  Training is essential for future health care providers to effectively communicate with limited English proficient (LEP) patients during interpreted encounters. Our aim is to describe an innovative skill-based medical school linguistic competency curriculum and its impact on knowledge and skills.At Stanford University School of Medicine, we incorporated a linguistic competency curriculum into a 2-year Practice of Medicine preclinical doctoring course and pediatrics clerkship over three cohorts.First year students participated in extensive interpreter-related training including: a knowledge-based online module, interactive role-play exercises, and didactic skill-building sessions. Students in the pediatrics clerkship participated in interpreted training exercises with facilitated feedback.Knowledge and skills were evaluated in the first and fourth years. First year students' knowledge scores increased (pre-test = 0.62, post-test = 0.89, P < 0.001), and they demonstrated good skill attainment during an end-year performance assessment. One cohort of students participated in the entire curriculum and maintained performance into the fourth year.Our curriculum increased knowledge and led to skill attainment, each of which showed good durability for a cohort of students evaluated 3 years later. With a growing LEP population, these skills are essential to foster in future health care providers to effectively communicate with LEP patients and reduce health disparities.

  View details for DOI 10.1007/s11606-010-1271-7

  View details for Web of Science ID 000277270300016

  View details for PubMedID 20352511

• Teaching clinical students to teach FAMILY MEDICINE LeBaron, S., SCHILLINGER, E. 2004; 36 (2): 87-88

  View details for Web of Science ID 000220020600008

  View details for PubMedID 14872351

• Teaching family medicine medical students about sleep disorders FAMILY MEDICINE Schillinger, E., Kushida, C., Fahrenbach, R., Dement, W., LeBaron, S. 2003; 35 (8): 547-549

  Abstract

  A 3.5-hour workshop was developed to teach family medicine medical students about sleep disorders.This family medicine clerkship requirement engages students in role-plays and provides them with didactic information about common sleep problems.Fifty-one students completed questionnaires assessing their knowledge prior to the workshop, 2 weeks and 6 months after the workshop, and their clinical behavior after the workshop.A role-play-based workshop is an effective, fun way to improve students' sleep knowledge and skills. Students retain that information over a 6-month period and are able to apply it during their clinical clerkships.

  View details for Web of Science ID 000185309100009

  View details for PubMedID 12947515

• Do required preclinical courses with family physicians encourage interest in family medicine? FAMILY MEDICINE Hill-Sakurai, L. E., SCHILLINGER, E., Rittenhouse, D. R., Fahrenbach, R., Hudes, E. S., LeBaron, S., Shore, W. B., Hearst, N. 2003; 35 (8): 579-584

  Abstract

  Many medical schools, including the University of California, San Francisco (UCSF), added required preclinical course work with family physicians in the 1990s. We examined whether current UCSF students interested in family medicine noted more contact with family physicians and more faculty support of their interest than current Stanford students and 1993 UCSF students, neither of whom had required preclinical course work with family physicians.A questionnaire was administered to students interested in family medicine at UCSF and Stanford in February 2001, with response rates of 84% and 90%, respectively. Previously published 1993 data from UCSF were also used for comparison. Data were analyzed using chi-square and t statistics as appropriate.UCSF students in 2001, despite exposure to required preclinical course work with family physicians, did not perceive greater contact with family physicians than Stanford students. Stanford students perceived greater encouragement from their family medicine faculty but less from faculty overall, compared with 2001 UCSF students. UCSF students in 2001 perceived no more overall faculty encouragement than did UCSF students in 1993.Required preclinical course work with family physicians was not consistently associated with greater student perception of faculty support for students' interest in family medicine, nor was it demonstrated to increase the amount or quality of interested students' interaction with family medicine faculty.

  View details for Web of Science ID 000185309100015

  View details for PubMedID 12947521

• The multiple mini-SOAP format for student presentations of complex patients FAMILY MEDICINE SCHILLINGER, E., LeBaron, S. 2003; 35 (1): 13-14

  View details for Web of Science ID 000180366900006

  View details for PubMedID 12564856

• Including the patient in student presentations FAMILY MEDICINE LeBaron, S., SCHILLINGER, E. 2000; 32 (2): 87-88

  View details for Web of Science ID 000086669100008

  View details for PubMedID 10697765

• Acupuncture: its use in medicine WESTERN JOURNAL OF MEDICINE Pearl, D., SCHILLINGER, E. 1999; 171 (3): 176-180

  View details for Web of Science ID 000083289400017

  View details for PubMedID 10560293