The Influence of the STORM Program and Other Elective Experiences During the Summer Between the First and Second Year on Medical Students' Career Interests.

Introduction: The purpose of this study was to investigate the influence of the Summer Training Option in Rural Medicine (STORM) program and other elective experiences during the summer between the first and second pre-clerkship years of medical school on medical students' career intentions. Methods: A retrospective voluntary and anonymous cohort study was conducted by distributing an email survey to the 211 second-year medical students at the University of Kansas School of Medicine (KUSM). The survey consisted of a variety of questions regarding their recent summer break elective experiences. Results: Eighty-nine students (42.2% response rate) completed the survey; 21 respondents participated in the STORM program. Important factors influencing the choice of an elective included, working one-on-one with an educator, hands-on experiences, and receiving academic credit. Sixty-seven respondents (75.3%) concluded that their experience met their expectations, 50 (56.2%) concluded that their experience helped solidify their career goals, while 20 (22.5%) concluded that their experience made them question their career goals. Eleven respondents (12.4%) wished they had participated in a different summer experience, and 16 respondents (18.0%) changed their career plans after their summer experience. Conclusions: A break between first and second years of medical school allowed students to explore career options; such experiences may ignite a particular passion, solidify an already determined specialty choice, or dissuade a student from pursuing a particular career pathway. Medical school affirmation of the importance of significant, sustained, and student-chosen opportunities to work one-on-one with a mentor and engage in hands-on learning during the pre-clerkship years is crucial. The STORM program was one elective option that delivered on students' expectations.

Causes of Anemia in Patients Seen in a Rural Community Hematology Clinic.

Introduction: Anemia is a common medical disorder seen in consultation by hematologists. This study was performed to determine the incidence of the etiologies causing anemia in patients referred to the hematologists at Tammy Walker Cancer Center (TWCC) in the rural Kansas community of Salina. An additional goal of the study was to compare the frequencies of different etiologies for anemia in this cohort of patients with those previously reported by four academic medical centers. Methods: A retrospective review of the medical records of 152 patients seen at TWCC between August 2015 and May 2019 was performed. The patient's history and physical exam, complete blood count, and various additional hematologic studies ordered at the discretion of the TWCC hematologist were used to determine the etiology of each patient's anemia. Results: The most common causes of anemia found in the chart review were iron deficiency (48.7%), hematologic malignancy (14.5%), chronic inflammation (13.8%), renal insufficiency (11.2%), and unexplained anemia (9.9%). While the incidences of anemia due to hematologic malignancy, chronic inflammation, and renal insufficiency were like that reported previously by four academic medical centers, significantly more iron deficiency and less unexplained anemia were found in the patients referred to TWCC. Conclusions: The causes of anemia in patients seen at TWCC were similar to those reported by academic medical centers; however, the incidences were different. The differences in findings may reflect dissimilarities in the demographics of referral populations, the duration, and extent of the evaluation at TWCC, or referral patterns.

Evaluator Agreement in Medical Student Assessment Across a Multi-Campus Medical School During a Standardized Patient Encounter.

PURPOSE: Class rank and clerkship grades impact a medical student's residency application. The variability and inter-rater reliability in assessment across multiple clinical sites within a single university system is unknown. We aimed to determine if medical student assessment across medical school campuses is consistent when using a standardized scoring rubric. DESIGN/METHODS: Attending physicians who participate in assignment of clerkship grades for neurology from three separate clinical campuses of the same medical school observed 10 identical standardized patient encounters completed by third year medical students during the 2017-2018 academic year. Scoring was completed using a standardized rubric. Descriptive analysis and intra-rater comparisons were completed. Evaluations as a part of this study were completed in 2018. RESULTS: Of 50 possible points for the patient encounter, the median score among all medical students and all evaluators was 43 (IQR 40, 45.5). Evaluator number 1 provided a statistically significant lower overall score as compared to evaluators 2 and 3 (p = 0.0001 and p = 0.0006, respectively), who were consistently similar in their overall medical student assessment (p = 0.46). Overall agreement between evaluators was good (ICC = 0.805, 95% CI 0.36-0.95) and consistency was excellent (ICC = 0.91, 95% CI 0.75-0.97). CONCLUSIONS: Medical student evaluation across multiple clinical campus sites via observation of identical standardized patient encounters and use of a standardized scoring rubric generally demonstrated good inter-rater agreement and consistency, but the small variation seen may affect overall clerkship scores.

Physician Burnout in a Rural Kansas Community.

INTRODUCTION: Physician wellness and burnout are topics of intense discussion and study, however, less is known about rural physician burnout. The aim of this study was to assess levels of physician burnout in the rural Kansas community of Salina. METHODS: An electronic, confidential survey was conducted among 145 physicians with active privileges at the local health center and/or surgical center. The survey included demographic features, practice characteristics, and the abbreviated Maslach Burnout Inventory™ (aMBI). In addition, survey participants were invited to provide free-text responses to questions concerning specific causes of burnout and mechanisms to combat feelings of burnout. RESULTS: Of 145 invited, 76 physicians completed the survey. Thirty-six respondents self-identified as primary care physicians, 22 as subspecialists, and 18 as surgeons. aMBI scores for emotional exhaustion (EE), depersonalization (D) and personal accomplishment (PA) ranged from 0 to 18. The mean EE score was 8.4 (SD = 4.9), mean D score was 4.8 (SD = 3.9), and mean PA score was 15.2 (SD = 2.8). Using tertiles, physician burnout (i.e., those in the first tertile) for EE was 39% (30/76), D was 34% (26/76), and PA was 41% (31/75); 22% of physicians surveyed scored high on both EE and D as measured by tertiles, suggestive of more serious burnout. No significant differences in aMBI scores were observed for demographic features or practice characteristics; physicians who worked with medical students had higher PA scores. Contributing to burnout were demands of documentation and difficult patient encounters, while true time away might ameliorate rural physician burnout. CONCLUSIONS: As measured by aMBI constructs, burnout is prevalent among the responding rural physicians practicing in the Salina community.

Rural Kansas Family Physician Satisfaction with Caring for Spanish-Speaking Only Patients.

BACKGROUND: Patient satisfaction with the care they receive can be influenced negatively by a language barrier between the physician and patient. However, there is a paucity of information regarding the consequences of a language barrier on physician satisfaction, although this barrier has the potential to decrease physician wellness. This study sought to determine if a language barrier is a source of professional dissatisfaction in family medicine physicians in rural Kansas. METHODS: In a cross-sectional study, members of the Kansas Academy of Family Physicians who practiced in the rural Kansas counties with the highest percentage of Hispanic residents were surveyed. A questionnaire was developed to determine the demographics of the physician, details regarding his or her practice, and percentage of Hispanic and Spanish-speaking only (SSO) patients in their practice. Physicians also were queried as to their level of Spanish-speaking ability, availability of certified interpreters, and their satisfaction with caring for their SSO patients. RESULTS: Fifty-two physicians were identified and sent questionnaires by mail. Eighteen questionnaires were completed and returned, resulting in a 34% response rate. Respondents remained anonymous. In the practices surveyed, 61% of practice settings had a Hispanic-patient population greater than 25%. Only one of the eighteen respondents had greater than 25% of SSO patients in his or her practice. A certified interpreter was used less than 25% of the time in over 75% of the clinical encounters with SSO patients. Seventy-five percent of physicians reported no difficulty establishing trust and rapport with their SSO patients. Eighty-nine percent of respondents rated their relationship with SSO patients as good to excellent, and 83% were satisfied with the care they were able to provide this group. Seventy-eight percent of respondents reported that their ability to care for SSO patients decreased or had no effect on their professional satisfaction. Seventy-eight percent of physicians also rated their overall professional satisfaction in regards to their physician/patient relationship as good to excellent. However, language barriers affected physician-patient relationships, physician satisfaction with care, and professional satisfaction. CONCLUSION: Language barrier affected physician's relationships with SSO patients, led to decreased physician satisfaction with the care they provided and to decreased professional satisfaction.

From Infancy to Adolescence: The Kansas University School of Medicine-Salina: A Rural Medical Campus Story.

The University of Kansas School of Medicine established a rural regional campus in Salina, Kansas, in 2011. The creation of a four-year medical campus of only 32 total students in a town of less than 50,000 inhabitants appeared to contradict all previous practices where medical schools have been situated in large metropolitan cities with student bodies frequently in the hundreds. The rationale to open the Salina campus was to attract medical students with a desire to train in a rural environment, hoping that many would eventually elect to practice primary care in rural Kansas. The authors evaluated the admission demographics, academic performance, campus satisfaction, and graduate medical education choices of students at Kansas University School of Medicine-Salina (KUSM-S) during its first four years of existence. To date, the Salina campus has succeeded in its mission to train students from rural communities in a rural environment to eventually become rural-based physicians. KUSM-S students have adjusted well to the rigors of medical school, have shown steady improvement in academic performance as measured by United States Medical Licensing Examination scores, and have been overwhelmingly positive about the Salina medical education program. The initial cohort of students has now successfully graduated and secured residency training positions, and most KUSM-S graduates are either continuing their training in primary care in Kansas or intend to return to Kansas to practice following residency training.