The Performance and Trajectory of Medical Students With Disabilities: Results From a Multisite, Multicohort Study.

PURPOSE: To conduct a post-Americans with Disabilities Act Amendments Act of 2008 multisite, multicohort study called the Pathways Project to assess the performance and trajectory of medical students with disabilities (SWDs). METHOD: From June to December 2020, the authors conducted a matched cohort study of SWDs and nondisabled controls from 2 graduating cohorts (2018 and 2019) across 11 U.S. MD-granting medical schools. Each SWD was matched with 2 controls, one from their institution and, whenever possible, one from their cohort for Medical College Admission Test score and self-reported gender. Outcome measures included final attempt Step 1 and Step 2 Clinical Knowledge scores, time to graduation, leave of absence, matching on first attempt, and matching to primary care. RESULTS: A total of 171 SWDs and 341 controls were included; the majority of SWDs had cognitive/learning disabilities (118/171, 69.0%). Compared with controls, SWDs with physical/sensory disabilities had similar times to graduation (88.6%, 95% confidence interval [CI]: 77.0, 100.0 vs 95.1%, 95% CI: 90.3, 99.8; P = .20), Step 1 scores (229.6 vs 233.4; P = .118), and match on first attempt (93.9%, 95% CI: 86.9, 100.0 vs 94.6%, 95% CI: 91.8, 97.4; P = .842), while SWDs with cognitive/learning disabilities had lower Step 1 scores (219.4; P < .001) and were less likely to graduate on time (81.2%, 95% CI: 69.2, 93.2; P = .003) and match on first attempt (85.3%, 95% CI: 78.0, 92.7; P = .009). Accommodated SWDs had Step 1 scores that were 5.9 points higher than nonaccommodated SWDs (95% CI: -0.7, 12.5; P = .08). CONCLUSIONS: Structural barriers remain for SWDs with cognitive/learning disabilities, which could be partially mitigated by accommodations on high-stakes exams.

Tips for Building a Community for Incoming Medical Students Virtually in the COVID-19 Era.

A sense of community benefits medical trainees by preserving mental well-being, nurturing collegiality and mentorship, and grounding ties with partnering organizations and services. Within medical school, building these support relationships often begins shortly after matriculation. In the current pandemic and the accompanying shift to a virtual class format, we believe that a dedicated effort to foster this sense of community is crucial for students who otherwise may feel untethered to their new learning environment. Here, we detail tips for building a medical school community virtually in the COVID-19 era between peers, within the school institution, and within the surrounding environment. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01447-z.

Readiness for Medical School: a Radical Proposal.

Readiness for medical school, like readiness for reading, includes physiological, psychological, educational, and sociological aspects of growth. Full cognitive and neurodevelopment including higher levels of adult thought order occur generally towards the ends of the third decade. Earlier patient care experiences and an understanding of the social and structural determinants of health demand some experiences in the world. We believe a requirement to prove medical school readiness should be to hold a job for a year that interfaces with the public and proves responsibility, reliability, and accountability as documented by a supervisor.

Burnout Among Beginning First-Year Students from Three Health Professional Training Programs.

The study objective was to learn about burnout prevalence among beginning first-year students from three health professional programs-Advance Practice Registered Nursing (APRN), Medicine, and Physician Associate (PA) training. All first-year students were invited to anonymously complete a survey measuring burnout. Subscales for exhaustion and disengagement together accounted for burnout. Means and frequencies were derived for categorical variables (gender, program, and direct entry from college). Subscales were summarized with means and standard deviations. Analysis of variance and post hoc t-tests compared unadjusted differences in means. Based on results, multivariable linear regressions for total burnout and exhaustion examined associations for the independent variables. With a 97% response rate, 70% were female (the APRN program is predominantly female), and 32% began training directly after college. Female students had significantly higher average total burnout and exhaustion than males. APRN and PA students had significantly higher total burnout and exhaustion than MD students. There were no other significant associations. In multivariable linear regressions, APRN students had significantly higher, and PA students had not quite significantly higher, burnout and exhaustion compared with medical students, with no moderation by any other variables. Burnout among first-year students in all three programs was more prevalent than anticipated. Consistent with previous literature, the programs with students who experienced higher burnout used more competitive, multi-tiered grading systems and introduced clinical expectations earlier in training. The implication is that educational leaders should consider effects of competitive grading and early clinical exposure on burnout among beginning health professional students.

Renal stone composed of ritonavir.

Nephrolithiasis is a well-known side effect of many HIV protease inhibitors. However, there have not been reports of stones associated with ritonavir use. Here, we report the case of a 33-year-old woman with HIV on antiretroviral therapy who presented with sharp left flank pain and passed a stone that was later found to contain only ritonavir. Of note, the patient's treatment regimen had not included ritonavir for 2 years prior to this incidence. This case is notable both for the novel finding of a renal calculus composed entirely of ritonavir and the development of nephrolithiasis years after cessation of the aggravating drug. This finding suggests that patients on ritonavir should be more closely monitored and for longer periods of time for potential lithiasis formation.

When patients hurt us.

In this thoughtful article, medical educators in various stages of their careers (resident, mid-career clinician-educators, medical school deans) reflect upon increasing reports of harassment and mistreatment of trainees by patients. In addition to providing a general overview of the limited literature on this topic, the authors describe their own experience collecting information on trainee mistreatment by patients at their institution. They explore the universal difficulty that educators face regarding how to best address this mistreatment and support both faculty and trainees. Given the current sociopolitical climate, there has never been a more urgent need to critically examine this issue. The authors call on the greater medical education community to join them in these important conversations.

Gender Disparities in Medical Student Research Awards: A 13-Year Study From the Yale School of Medicine.

PURPOSE: The Liaison Committee on Medical Education mandates instruction in research conduct, and many U.S. medical schools require students to complete a research project. All Yale School of Medicine (YSM) graduating students submit a research thesis, and ~5% are awarded highest honors. Gender disparities exist in areas related to physician research productivity, including academic rank, research funding, and publications. The authors asked whether gender disparities exist for medical student research. METHOD: The authors conducted a retrospective review of 1,120 theses submitted by graduating medical students from 2003 to 2015 at YSM and collected data on gender, mentoring, research type, sponsoring department, and other characteristics. Multivariate logistic regression modeling examined gender differences in medical student research awards. RESULTS: Women authored 50.9% of theses, but earned only 30.9% of highest honors awards (OR 0.41; 95% CI: 0.23, 0.74). Among factors associated with increased receipt of highest honors that differed by gender, men were more likely than women to work with a mentor with a history of three or more thesis honorees, take a fifth year of study, secure competitive research funding, undertake an MD-master of health science degree, and conduct laboratory research (all P < .001). After adjustment for these factors, and for underrepresented in medicine status and sponsoring department, women remained less likely to receive highest honors (OR 0.51; 95% CI: 0.27, 0.98). CONCLUSIONS: Women YSM students were less likely to receive highest honors for medical research. Gender disparities in postgraduate biomedical research success may start during undergraduate medical education.

Power Day: Addressing the Use and Abuse of Power in Medical Training.

PROBLEM: Medical student mistreatment, as well as patient and staff mistreatment by all levels of medical trainees and faculty, is still prevalent in U.S. clinical training. Largely missing in interventions to reduce mistreatment is acknowledgement of the abuse of power produced by the hierarchical structure in which medicine is practiced. APPROACH: Beginning in 2001, Yale School of Medicine has held annual "Power Day" workshops for third year medical students and advanced practice nursing students, to define and analyse power dynamics within the medical hierarchy and hidden curriculum using literature, guest speakers, and small groups. During rotations, medical students write narratives about the use of power witnessed in the wards. In response to student and small group leader feedback, workshop organizers have developed additional activities related to examining and changing the use of power in clinical teams. OUTCOME: Emerging narrative themes included the potential impact of small acts and students feeling "mute" and "complicit" in morally distressing situations. Small groups provided safe spaces for advice, support, and professional identity formation. By 2005, students recognized residents that used power positively with Power Day awards and alumni served as keynote speakers on the use of power in medicine. By 2010, departments including OB/GYN, surgery, psychiatry, and paediatrics, had added weekly team Power Hour discussions. NEXT STEPS: The authors highlight barriers, benefits, and lessons learned. Barriers include the notion of clinical irrelevance and resistance to the word "power" due to perceived accusation of abuse. Benefits include promoting open dialogue about power, fostering inter-professional collaboration, rewarding positive role modelling by residents and faculty, and creating a network of trainee empowerment and leadership. Furthermore, faculty have started to ask that issues of power be addressed in a more transparent way at their level of the hierarchy as well.

Passing the torch: a proposed amendment to "A Physician Charter".

A Physician Charter has received widespread attention throughout the medical community since its publication in 2002. The Charter, which lays out three principles and 10 commitments that "reaffirm the fundamental and universal principles and values of medical professionalism …" omits an essential principle and its corollary commitment. That fourth principle, essential to the successful perpetuation of the aims of the Charter, we call the Principle of Generativity: Physicians must contribute to the education and development of the next generation of practitioners in order to ensure that the profession lives on and thrives, grounded in its fundamental professional values. Only by emphasizing our obligation to teach professional values to the next generation of physicians, can we expect to "pass the torch" of the profession.

An intervention with third-year medical students to encourage the reporting and management of occupational exposures.

PURPOSE: Medical students are particularly vulnerable to occupational exposures to blood-borne pathogens because of their inexperience. Although exposure rates for medical students remain high, they often do not report such incidents or seek the proper medical care. The authors describe and evaluate an intervention at the Yale University School of Medicine to prevent and manage occupational exposures among medical students. METHOD: Since 2001, students have met with key faculty during orientation and again before clinical clerkships to discuss the circumstances under which most exposures occur, examine the equipment used to draw blood and start IVs, and review instructions about postexposure management. They are also given a laminated card summarizing this information. In 2010 and 2011, the authors surveyed graduating students about their experiences. RESULTS: Two hundred twenty-five of 245 (92%) students responded to the survey, and 82 (36%) had experienced 103 exposures. Forty-seven of those 82 (57%) students reported their exposure, 52 (56%) had the laminated card on them at the time of the incident, and 15 (18%) started postexposure prophylaxis. The most common reasons students cited for not reporting an incident were a low-risk exposure, a sense of embarrassment, or perceived difficulties in getting care. CONCLUSIONS: The authors recommend continuing to educate medical students about the importance of reporting exposures and seeking the proper care. They also recommend educating physicians and residents in an attempt to change the environment around exposures so that medical students no longer feel discouraged from reporting incidents.