Leadership for Medical Students: Lessons Learned From a Relationship-Centered Leadership Curriculum.

Despite the need for and relevance of leadership skills to the success of medical trainees and healthcare professionals, few medical schools offer formal leadership training during the preclinical years. Where such curricula exist, we have found few schools that intentionally incorporate key principles of lifestyle medicine critical to short- and long-term career development. We describe a novel relationship-centered leadership curriculum, grounded in a conceptual framework of emotional intelligence and incorporating key principles of lifestyle medicine, first piloted in 2019 and now in its fourth year of existence. In comparing pre- and post-course self-evaluations on a 5-point Likert scale, students (n = 19) reported increased competencies in Self (3.12 vs 4.20, P < .001), Teams (3.06 vs 4.00, P < .001), and System (2.55 vs 3.55, P < .001) domains. Qualitative responses demonstrated that a vital strength of the course was its direct relevance and immediate applicability to students' personal and professional roles and goals. Results provide encouraging support for using a relationship-centered leadership framework that incorporates core elements of lifestyle medicine and emotional intelligence to facilitate medical students' leadership development, as related to leading oneself and in dynamic relationships with others (e.g., with leaders, colleagues, patients, and within communities, teams, and systems).

Impact and feasibility of a pharmacist-delivered pharmacotherapy rotation on pediatric resident education.

Pharmacotherapy training for pediatric residents is an important part of their overall education. Limited data exist describing formal engagement of clinical pharmacists in residency training. The objective of this study was to evaluate a novel pharmacotherapy rotation for learner gains and program feasibility. We designed a novel pharmacotherapy rotation (PTR) involving a pharmacist preceptor, pediatric resident, and final-year pharmacy students in the pediatric intensive care unit (PICU). Rotation objectives and content were based on learning gaps identified in a review of the resident curriculum. Data from PTRs completed 2014-2020 were used to evaluate PTR impact on residents' knowledge and confidence in pharmacotherapy decision-making, and interprofessional valuing. We also addressed PTR feasibility for long-term and for adoption by others. Measures for demographic, knowledge, and confidence measures were administered to intervention and control groups. Measures for interprofessional valuing and post-PTR feedback were administered only to the intervention group. Pre-post gains were greater for intervention residents (n = 7) than for control (n = 10), (knowledge: p = 0.02, confidence: p < 0.0001). Interprofessional valuing gain for the intervention group was significant (p = 0.004). Few PTR changes have been necessary since initial implementation. Residents provided high ratings of PTR experiences and specific value-added benefits. Designing an inter-professional PTR within the existing PICU and pharmacy rotation enhanced feasibility, curriculum consistency, and flexibility to optimize inter-professional learning.Participation in the PTR enhanced resident pharmacotherapy knowledge and decision-making, and engagement in interprofessional practice. Next steps include expanding the PTR to other settings and specialties with further evaluation study.

A Review of the Quality Indicators of Rigor in Qualitative Research.

Attributes of rigor and quality and suggested best practices for qualitative research design as they relate to the steps of designing, conducting, and reporting qualitative research in health professions educational scholarship are presented. A research question must be clear and focused and supported by a strong conceptual framework, both of which contribute to the selection of appropriate research methods that enhance trustworthiness and minimize researcher bias inherent in qualitative methodologies. Qualitative data collection and analyses are often modified through an iterative approach to answering the research question. Researcher reflexivity, essentially a researcher's insight into their own biases and rationale for decision-making as the study progresses, is critical to rigor. This article reviews common standards of rigor, quality scholarship criteria, and best practices for qualitative research from design through dissemination.

Neonatal Intensive Care Unit Boot Camp: A Preparatory Curriculum for Pediatric Residents.

Introduction: Resident training has changed significantly in recent years, resulting in reduced experiences and practice. Because pediatric residents have fewer required intensive care unit (ICU) rotations, we introduced a neonatal ICU (NICU) boot camp (2014-2015) that continues today to prepare residents immediately prior to beginning an NICU rotation. Methods: The NICU boot camp consists of three 1-hour sessions: two interactive lectures with case-based application and one hands-on, integrative learning using simulation. The sessions are designed to cover basic information to assist in daily rounding and decision making while in the NICU. After their NICU rotation, residents complete a 12-item questionnaire. Program evaluation includes direct observation during sessions, faculty debriefing, and a postprogram resident survey. Results: Fifty-seven residents participated; questionnaire responses were available from 46 (80.70%). Combined percentages of very useful and extremely useful responses for the three sessions were 82.61%, 78.26%, and 82.60%, with 86.95% for the overall program; 80.40% agreed that repeating boot camp prior to each NICU rotation would be useful. Analysis of narrative responses revealed that participation in boot camp enhanced residents' readiness and confidence for patient care in the NICU and as stated for each educational objective. Discussion: Program evaluation results support highly effective and sustainable implementation and achievement of educational objectives. Minor refinements continue for enhancing active learning and content materials and for increasing rigor of program evaluation. Results also suggest that our boot camp may benefit other pediatric programs and serve as a model for use in other resident specialty programs.

Training for Leadership Roles in Academic Medicine: Opportunities for Psychologists in the AAMC LEAD Program.

Psychologists' roles within academic medicine have expanded well beyond research and scholarship. They are active as providers of patient care, medical education, and clinical supervision. Although the number of psychologists in academic health centers continues to grow, they represent a small portion of total medical school faculties. However, with the movement toward collaborative care models, emphasis on interprofessional teams, and increased emphasis on psychological science topics in medical curricula, psychologists are well-positioned to make further contributions. Another path through which psychologists can further increase their contributions and value within academic health centers is to aspire to leadership roles. This article describes the first author's reflections on her experiences in a two-year, cohort-based, educational leadership development certificate program in academic medicine. The cohort was comprised largely of physicians and basic scientists, and a small number of non-physician participants of which the first author was the only clinical psychologist. The insights gained from this experience provide recommendations for psychologists interested in leadership opportunities in academic medicine.

Professional Identity Formation in an Advanced Pharmacy Practice Experience Emphasizing Self-Authorship.

Objective. To examine the extent to which reflective essays written by graduating pharmacy students revealed professional identity formation and self-authorship development. Design. Following a six-week advanced pharmacy practice experience (APPE) grounded in Baxter-Magolda's Learning Partnerships Model of self-authorship development, students completed a culminating reflective essay on their rotation experiences and professional identity formation. Assessment. Thematic and categorical analysis of 41 de-identified essays revealed nine themes and evidence of all Baxter-Magolda's domains and phases of self-authorship. Analysis also suggested relationships between self-authorship and pharmacist professional identity formation. Conclusion. Results suggest that purposeful structuring of learning experiences can facilitate professional identity formation. Further, Baxter-Magolda's framework for self-authorship and use of the Learning Partnership Model seem to align well with pharmacist professional identify formation. Results of this study could be used by pharmacy faculty members when considering how to fill gaps in professional identity formation in future course and curriculum development.

Core Competencies in Integrative Pain Care for Entry-Level Primary Care Physicians.

OBJECTIVE: The objective was to develop a set of core competencies for graduating primary care physicians in integrative pain care (IPC), using the Accreditation Council for Graduate Medical Education (ACGME) domains. These competencies build on previous work in competencies for integrative medicine, interprofessional education, and pain medicine and are proposed for inclusion in residency training. METHODS: A task force was formed to include representation from various professionals who are involved in education, research, and the practice of IPC and who represent broad areas of expertise. The task force convened during a 1.5-day face-to-face meeting, followed by a series of surveys and other vetting processes involving diverse interprofessional groups, which led to the consensus of a final set of competencies. RESULTS: The proposed competencies focus on interprofessional knowledge, skills, and attitudes (KSAs) and are in line with recommendations by the Institute of Medicine, military medicine, and professional pain societies advocating the need for coordination and integration of services for effective pain care with reduced risk and cost and improved outcomes. These ACGME domain compatible competencies for physicians reflect the contributions of several disciplines that will need to be included in evolving interprofessional settings and underscore the need for collaborative care. CONCLUSION: These core competencies can guide the incorporation of KSAs within curricula. The learning experiences should enable medical educators and graduating primary care physicians to focus more on integrative approaches, interprofessional team-based, patient-centered care that use evidence-based, traditional and complementary disciplines and therapeutics to provide safe and effective treatments for people in pain.

Applying Educational Theory to Simulation-Based Training and Assessment in Surgery.

Considerable progress has been made regarding the range of simulator technologies and simulation formats. Similarly, results from research in human learning and behavior have facilitated the development of best practices in simulation-based training (SBT) and surgical education. Today, SBT is a common curriculum component in surgical education that can significantly complement clinical learning, performance, and patient care experiences. Beginning with important considerations for selecting appropriate forms of simulation, several relevant educational theories of learning are described.

A Regional Public Health Field Placement Program: making an IMPACT.

Beginning in 2010, the U.S. Department of Health and Human Services, Health Resources and Services Administration, made provisions in its Public Health Training Center cooperative agreements for field placements. This article describes best practices and lessons learned establishing and managing the South Central Public Health Partnership's Interns and Mentors Program for ACTion (IMPACT) Field Placement Program, which was initially funded through the Centers for Disease Control and Prevention's Centers for Public Health Preparedness Cooperative agreement in 2002. The IMPACT program is based on a six-step process that has been developed and refined over its 10-year history: (a) identifying field placement opportunities, (b) marketing field experience opportunities to students, (c) selecting students seeking field experience opportunities, (d) placing students with practice partners, students with practice partners, (e) evaluating student progress toward field experience objectives, and (f) evaluating the program. This article describes the program's structure and processes, delineates the roles of its academic and practice partners, discusses evidence of its effectiveness, and describes lessons learned from its decade-long history. Hopefully, this information will facilitate the establishment, management and evaluation of internship and field placement programs in other Public Health Training Centers and academic public health programs.

Rasch analysis for the evaluation of rank of student response time in multiple choice examinations.

The availability of computerized testing has broadened the scope of person assessment beyond the usual accuracy-ability domain to include response time analyses. Because there are contexts in which speed is important, e.g. medical practice, it is important to develop tools by which individuals can be evaluated for speed. In this paper, the ability of Rasch measurement to convert ordinal nonparametric rankings of speed to measures is examined and compared to similar measures derived from parametric analysis of response times (pace) and semi-parametric logarithmic time-scaling procedures. Assuming that similar spans of the measures were used, non-parametric methods of raw ranking or percentile-ranking of persons by questions gave statistically acceptable person estimates of speed virtually identical to the parametric or semi-parametric methods. Because no assumptions were made about the underlying time distributions with ranking, generality of conclusions was enhanced. The main drawbacks of the non-parametric ranking procedures were the lack of information on question duration and the overall assignment by the model of variance to the person by question interaction.

New faculty orientation in North American medical schools.

BACKGROUND: Little is known about common elements or "best practices" of new faculty orientation (NFO) programs in medical schools. PURPOSE: The objective was to examine school-wide NFO programs in North American medical schools. METHODS: We reviewed the literature and conducted a web-based survey. Analyses included descriptive statistics and content analysis. RESULTS: We found little evidence of "best practices." Of the 106 responding schools (106/148=71.62%), 72 (67.9%) reported some type of school-wide NFO program. The typical program was organized by an Office of Faculty Affairs or Faculty Development, targeted broad goals, 4 to 8 hour long, offered early in the academic year, and used 2 or more presentation formats (e.g., oral, print). CONCLUSIONS: Based on the literature, this study appears to be the first comprehensive description of NFO programs in medical schools. Multiple types of NFO are needed to accommodate the diversity of faculty and faculty responsibilities. School-wide programs may serve best to develop institutional affiliation and collegiality.

Enhancing residents' neonatal resuscitation competency through unannounced simulation-based training.

BACKGROUND: Almost half of pediatric third-year residents surveyed in 2000 had never led a resuscitation event. With increasing restrictions on residency work hours and a decline in patient volume in some hospitals, there is potential for fewer opportunities. PURPOSE: Our primary purpose was to test the hypothesis that an unannounced mock resuscitation in a high-fidelity in-situ simulation training program would improve both residents' self-confidence and observed performance of adopted best practices in neonatal resuscitation. METHODS: Each pediatric and medicine-pediatric resident in one pediatric residency program responded to an unannounced scenario that required resuscitation of the high fidelity infant simulator. Structured debriefing followed in the same setting, and a second cycle of scenario response and debriefing occurred before ending the 1-hour training experience. Measures included pre- and post-program confidence questionnaires and trained observer assessments of live and videotaped performances. RESULTS: Statistically significant pre-post gains for self-confidence were observed for 8 of the 14 NRP critical behaviors (p=0.00-0.03) reflecting knowledge, technical, and non-technical (teamwork) skills. The pre-post gain in overall confidence score was statistically significant (p=0.00). With a maximum possible assessment score of 41, the average pre-post gain was 8.28 and statistically significant (p<0.001). Results of the video-based assessments revealed statistically significant performance gains (p<0.0001). Correlation between live and video-based assessments were strong for pre-post training scenario performances (pre: r=0.64, p<0.0001; post: r=0.75, p<0.0001). CONCLUSIONS: Results revealed high receptivity to in-situ, simulation-based training and significant positive gains in confidence and observed competency-related abilities. Results support the potential for other applications in residency and continuing education.

The design and utility of institutional teaching awards: a literature review.

BACKGROUND: Institutional teaching awards have been used widely in higher education since the 1970s. Nevertheless, a comprehensive review of the literature on such awards has not been published since 1997. AIM: We conducted a literature review to learn as much as possible about the design (e.g., formats, selection processes) and utility (e.g., impact on individuals and institutions) of teaching awards in order to provide information for use in designing, implementing, or evaluating award programs. METHODS: We searched electronic databases for English-language publications on awards for exemplary teaching. Targeted publications included descriptions and/or investigations of award programs, their impact, and theoretical or conceptual models for awards programs. Screening was conducted by dual review; a third reviewer was assigned for disagreements. Data were analyzed qualitatively. Results were summarized descriptively. RESULTS: We identified 1302 publications for initial relevancy screening by title and abstract. We identified an additional 23 publications in a follow-up search. The full text of 126 publications was reviewed for further relevance. A total of 62 publications were identified as relevant, and of these 43 met our criteria for inclusion. Of the 43, 19 described the design features of 24 awards; 20 reports discussed award utility. Nomination and selection processes and benefits (e.g., plaques) varied as did perceived impact on individuals and institutions. CONCLUSION: Limited evidence exists regarding design and utility of teaching awards. Awards are perceived as having potential for positive impact, including promotions, but may also have unintended negative consequences. Future research should investigate the impact of awards on personal and professional development, and how promotion and tenure committees perceive awards.

Evaluation of a faculty development program aimed at increasing residents' active learning in lectures.

BACKGROUND: Active engagement in the learning process is important to enhance learners' knowledge acquisition and retention and the development of their thinking skills. This study evaluated whether a 1-hour faculty development workshop increased the use of active teaching strategies and enhanced residents' active learning and thinking. METHODS: Faculty teaching in a pediatrics residency participated in a 1-hour workshop (intervention) approximately 1 month before a scheduled lecture. Participants' responses to a preworkshop/postworkshop questionnaire targeted self-efficacy (confidence) for facilitating active learning and thinking and providing feedback about workshop quality. Trained observers assessed each lecture (3-month baseline phase and 3-month intervention phase) using an 8-item scale for use of active learning strategies and a 7-item scale for residents' engagement in active learning. Observers also assessed lecturer-resident interactions and the extent to which residents were asked to justify their answers. RESULTS: Responses to the workshop questionnaire (n  =  32/34; 94%) demonstrated effectiveness and increased confidence. Faculty in the intervention phase demonstrated increased use of interactive teaching strategies for 6 items, with 5 reaching statistical significance (P ≤ .01). Residents' active learning behaviors in lectures were higher in the intervention arm for all 7 items, with 5 reaching statistical significance. Faculty in the intervention group demonstrated increased use of higher-order questioning (P  =  .02) and solicited justifications for answers (P  =  .01). CONCLUSION: A 1-hour faculty development program increased faculty use of active learning strategies and residents' engagement in active learning during resident core curriculum lectures.

Design and effectiveness of a required pre-clinical simulation-based curriculum for fundamental clinical skills and procedures.

BACKGROUND: For more than 20 years, medical literature has increasingly documented the need for students to learn, practice and demonstrate competence in basic clinical knowledge and skills. In 2001, the Louisiana State University Health Science Centers (LSUHSC) School of Medicine - New Orleans replaced its traditional Introduction in to Clinical Medicine (ICM) course with the Science and Practice of Medicine (SPM) course. The main component within the SPM course is the Clinical Skills Lab (CSL). The CSL teaches 30 plus skills to all pre-clinical medical students (Years 1 and 2). METHODS: Since 2002, an annual longitudinal evaluation questionnaire was distributed to all medical students targeting the skills taught in the CSL. Students were asked to rate their self- confidence (Dreyfus and Likert-type) and estimate the number of times each clinical skill was performed (clinically/non-clinically). Of the 30 plus skills taught, 8 were selected for further evaluation. RESULTS: An analysis was performed on the eight skills selected to determine the effectiveness of the CSL. All students that participated in the CSL reported a significant improvement in self-confidence and in number performed in the clinically/non-clinically setting when compared to students that did not experience the CSL. For example, without CSL training, the percentage of students reported at the end of their second year self-perceived expertise as "novice" ranged from 21.4% (CPR) to 84.7% (GU catheterization). Students who completed the two-years CSL, only 7.8% rated their self-perceived expertise at the end of the second year as "novice" and 18.8% for GU catheterization. CONCLUSION: The CSL design is not to replace real clinical patient experiences. It's to provide early exposure, medial knowledge, professionalism and opportunity to practice skills in a patient free environment.

Role of instruction method in novices' acquisition of minimally invasive surgical basic skills.

INTRODUCTION: We investigated the impact of instruction method on novices' acquisition of minimally invasive surgical (MIS) basic skills. MATERIALS AND METHODS: One hundred five novice medical students underwent text-based (TB), video-based (VB), or faculty-tutored (FT) single-session instruction in three basic MIS skill tasks on a box trainer. Pre- and postsession, participants completed a 12-item, 5-point Likert-type scale (1=Not confident at all, 5=Completely confident) of self-efficacy for performing basic MIS skills and had performances on each task recorded. Four raters evaluated every video performance of one task, a two-handed peg transfer, using a 16-cm visual analog measurement (VAM). Inter-rater reliability was good (intra-class correlation coefficient=0.82). The relationship between instruction method, self-efficacy mean score change, and mean VAM change was examined using ANOVA analysis. RESULTS: Eighty-five participants (TB=32, VB=24, FT=29) had valid matched data. Mean scores in self-efficacy and task performance increased from pre- to postsession for every instruction method: (1) Δ self-efficacy=1.04±0.64 (TB), 1.36±0.69 (VB), and 1.41±0.82 (FT); (2) Δ VAM=3.77±2.87 (TB), 3.82±2.35 (VB), and 2.57±2.60 (FT). Analysis of variance revealed no relationship between instruction method and self-efficacy (P=.10) or VAM mean score change (P=.14). CONCLUSIONS: Self-directed instruction methods (e.g., TB and VB) for novices' acquisition of MIS basic skills offer flexible, learner-centered, and cost-effective alternatives to the more expensive FT method.

Hand-eye dominance and depth perception effects in performance on a basic laparoscopic skills set.

OBJECTIVES: Our study determined whether depth perception defects and hand-eye dominance affect an individual's ability to perform laparoscopic skills. METHODS: The study cohort comprised 104 third-year medical students from LSU School of Medicine who completed a questionnaire including information on handedness and were tested for eye dominance and depth perception by using standardized methods. Training sessions involved an initial recorded performance, a 20-minute practice session, followed by a final recorded performance. Recorded sessions were randomized and rated by using a visual analog scale (maximal possible score = 16) based on overall performance (OPS) and depth perception (DPS). A general linear model was used to correlate depth perception defects and hand-eye dominance with assessment scores for OPS and DPS. RESULTS: Students with depth perception defects scored significantly lower on their initial performance than did those with normal depth perception (OPS, 4.80 vs. 7.16, P=0.0008; DPS, 5.25 vs. 6.93, P=0.0195). After training, the depth perception defect group continued to have lower scores compared with the normal depth perception group. However, the 2 groups showed similar increases in pre- to posttraining performance scores (OPS, 3.84 vs. 3.18, P=0.0732). Hand-eye dominance did not significantly affect scores. CONCLUSIONS: Depth perception defects appear to compromise an individual's ability to perform basic laparoscopic skills. Individuals with defects can improve their skills by a proportion comparable to that of people with uncompromised depth perception. Differences in hand-eye dominance do not correlate with performance differences in basic laparoscopic skills. Although further research is necessary, the findings indicate that training can be tailored for individuals with depth perception defects to improve laparoscopic performance.

Flexner revisited: the role and value of the basic sciences in medical education.

A central tenet of Flexner's report was the fundamental role of science in medical education. Today, there is tension between the time needed to teach an ever-expanding knowledge base in science and the time needed for increased instruction in clinical application and in the behavioral, ethical, and managerial knowledge and skills needed to prepare for clinical experiences. One result has been at least a perceived reduction in time and focus on the foundational sciences. In this context, the International Association of Medical Science Educators initiated a study to address the role and value of the basic sciences in medical education by seeking perspectives from various groups of medical educators to five questions: (1) What are the sciences that constitute the foundation for medical practice? (2) What is the value and role of the foundational sciences in medical education? (3) When and how should these foundational sciences be incorporated into the medical education curriculum? (4) What sciences should be prerequisite to entering the undergraduate medical curriculum? (5) What are examples of the best practices for incorporating the foundational sciences into the medical education curriculum? The results suggest a broad group of experts believes that an understanding of basic science content remains essential to clinical practice and that teaching should be accomplished across the entire undergraduate medical education experience and integrated with clinical applications. Learning the sciences also plays a foundational role in developing discipline and rigor in learners' thinking skills, including logical reasoning, critical appraisal, problem solving, decision making, and creativity.

Assessment of matriculating medical students' knowledge and attitudes towards professionalism.

BACKGROUND: Students' perceptions of traditional attributes of professionalism are important for understanding their professional development needs, and determining appropriate curricular initiatives and assessment methods. AIM: This study assessed the knowledge and attitudes towards professionalism of three classes of matriculating students at two institutions. METHODS: Subjects completed four instruments: a multiple-choice test and a clinical scenario instrument assessed knowledge; and a semantic differential scale and Likert-format statement instrument assessed attitudes. Items reflected traditional professionalism attributes. Factor analysis identified scales and descriptive statistics were computed for each scale. RESULTS: Six hundred and forty six students (82%) completed the instruments. Correlations among scales were low to moderate. Knowledge scores were highest for the attributes 'humanism' and 'professional responsibility' and lowest for the attribute 'professional commitment'. Attitude scores were highest for 'humanistic values' and lowest for 'subordinating self-interests'. CONCLUSIONS: Results indicate students' attitudes are positive about several of the attributes associated with traditional professionalism definitions; however, there were cases where students' knowledge and attitudes towards professionalism appear incongruent with traditional definitions. Further development of self-assessments of knowledge and attitudes towards professionalism are suggested.