Medical Student Mock Interviews to Improve Residency Interviewing and Match Success.

PURPOSE: Using a quasi-experimental approach, we examined student and faculty satisfaction with a mock residency interview program. We also examined whether self-selected participants had match rates that differed from nonparticipants. METHODS: Interviews were arranged on a specified evening between students and a physician in the specialty to which the student wished to apply. Interviews were structured as similarly to residency interviews as possible, but included 10 minutes of verbal feedback and subsequent written feedback to all students. Students completed surveys indicating their satisfaction with the mock interview immediately following the interview and 5 months later (after their actual resident interviews). Faculty feedback to students and their satisfaction with the program also was collected. Out of 189 (55%) students in the senior class, 104 volunteered to participate. RESULTS: Immediately following the mock interview, over 90% of students who participated either strongly agreed or agreed that the interview feedback was helpful, seemed realistic, and helped them identify strengths and weaknesses. Responses collected 5 months later were still favorable, but less positive. Faculty identified 7 students who they believed had poor interview techniques and an additional 13 who interviewers believed would be unlikely to match in their specialty. Final match results for the group participating in the mock interview showed a primary match rate of 99%, which was higher than students who did not participate (94%, P < .001). CONCLUSION: In a self-selected group of students who chose to participate, mock interviews were useful in improving student match success compared to students who did not participate in the mock interview program. Because all students were not required to participate, it is unclear whether this tactic would be successful for all students.

Cost and Utilization: Hospitalized Patients on a Family Medicine Service.

OBJECTIVES: The cost of hospitalizations contributes to the rising expense of medical care in the United States. Providing health insurance to uninsured Americans is a strategy to reduce these costs, but only if costs for uninsured patients are disproportionately high. This study examined hospitalization use patterns for uninsured patients compared with those with Medicaid and commercial insurance. METHODS: We performed a retrospective chart review to analyze inpatient admissions to a family medicine teaching service in a 290-bed, for-profit community hospital during a 2-year period based on insurance status of the patient. Outcome variables investigated were length of stay, emergency department visits, and readmission rates to the hospital and/or emergency department. Secondary outcome variables were mean charges. RESULTS: A total of 1102 admissions to a family medicine teaching service were evaluated. Length of stay, readmission rates to the hospital and the emergency department after hospital discharge, and average length of stay compared with diagnosis-related groups were significantly higher in the Medicaid population than for insured and uninsured individuals. Variable costs also were significantly higher. CONCLUSIONS: Insurance status was found to be a significant factor in hospital charges and utilization data, with Medicaid patients having the highest costs. This suggests that moving uninsured patients to Medicaid may not significantly reduce hospitalization costs.

Trends in hospitalizations with antibiotic-resistant infections: U.S., 1997-2006.

OBJECTIVES: Antibiotic resistance is a significant global problem, but the trends in prevalence and impact of antibiotic resistance in hospitalizations in the United States are unclear. We evaluated the trends in hospitalizations associated with antibiotic-resistant infections in U.S. hospitals from 1997 to 2006. METHODS: We analyzed the National Hospital Discharge Survey (NHDS) during 1997-2006 (unweighted n = 3.3 million hospitalizations; weighted n = 370.3 million hospitalizations) and examined trends in prevalence of hospitalizations with antibiotic-resistant infections, length of stay, and discharge status. RESULTS: The number of infection-related hospitalizations with antibiotic resistance increased 359% during the 10-year period, from 37,005 in 1997 to 169,985 in 2006. The steepest rise was seen among individuals < 18 years of age. The mean age of individuals with infection-related hospitalizations that had antibiotic-resistant infections decreased substantially, from 65.7 years (standard error [SE] = 2.01) in 1997 to 44.2 years (SE = 1.47) in 2006. As the proportion of patients with antibiotic-resistant infections who did not have insurance increased, the length of stay for those hospitalizations had a corresponding decrease (r = 0.91, p < 0.01). CONCLUSIONS: Antibiotic-resistant infections are becoming increasingly commonplace in hospitalizations in the U.S., with a steady upward trend between 1997 and 2006. Antibiotic-resistant infections are increasingly being seen in younger patients and those without health insurance.

Medical Student Burnout as Impacted by Trait Emotional Intelligence - Moderated by Three-Year and Four-Year Medical Degree Programs and Gender.

INTRODUCTION: Medical student burnout has received increasing attention in recent years due to greater acceptance of psychological and emotional vulnerability in the health care profession. Given the significant investment of personal and financial resources in this demanding profession, continued evaluation of factors contributing to burnout in medical training is necessary. A midwestern medical college with a longstanding 4-year medical degree program created 2 regional campuses that utilize a calendar-efficient 3-year medical degree program. The objective in this study is to examine if medical student burnout scores are higher for students on the 3-year campuses and how that is affected by emotional intelligence. METHODS: First- and second-year medical students voluntarily completed the Maslach Burnout Inventory for Students (scale: 1 = never, 7 = every day) and the Trait Emotional Intelligence Questionnaire (scale: 1 = completely disagree, 7 = completely agree). Multifactor analysis of variance assessed mean differences in burnout between campus and gender. Multivariate linear regressions were used for predicting burnout from emotional intelligence. RESULTS: Three-year campus students reported significantly (P<0.010) higher mean [SD] scores (8.3 [2.0]) than the 4-year campus students (7.4 [2.4]), and female students reported significantly (P<0.049) higher scores (8.2 [2.0]) than male students (7.6 [2.4]). Five emotional intelligence facets were independently associated with increased burnout scores (R² = 0.26, P<0.001) but significantly varied with campus and gender. CONCLUSIONS: There were higher burnout scores in students studying on the two 3-year campuses compared to students on the traditional 4-year campus and higher scores for female students than male students. Different facets of emotional intelligence mitigated student burnout by campus and gender.

Student Leadership Development Initiative: Benefits of a Unique Medical Student Organization.

BACKGROUND: The Student Leadership Development Initiative was founded at the Medical College of Wisconsin to unite local physician leaders with Medical College of Wisconsin students to develop leadership skills and prepare for careers expanding beyond clinical practice. METHODS: An anonymous survey was distributed to 246 current and past Student Leadership Development Initiative participants, probing confidence in leadership skills, professional goals, and the perceived importance of leadership training. Feedback interviews were also conducted. RESULTS: Respondents reported improvement in areas such as compassion, leadership, and development of career goals. The perceived benefit for developing professional goals and compassion are positively related (P < 0.01) to the number of sessions attended. DISCUSSION: Survey results highlight the importance of leadership training in medical education and suggest an integration strategy for a successful leadership training platform.

Vitamin D and methicillin-resistant Staphylococcus aureus nasal carriage.

Studies have found that vitamin D plays an important role in mediating immune function via a number of pathways, including enhancing the release of antimicrobial peptides in the skin. Given these findings, we hypothesize that low serum vitamin D levels may increase the risk of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). A secondary data analysis of the National Health and Nutrition Examination Survey 2001-2004 was performed to investigate the association between serum vitamin D levels and MRSA nasal carriage for the non-institutionalized population of the USA. An estimated 2.7 million persons (1.2% of the population) are MRSA nasal carriers. An estimated 63.3 million persons (28.4% of the population) are vitamin D deficient (serum vitamin D <20 ng/ml). In an adjusted logistic regression analysis controlling for age, race, gender, poverty income ratio, current health status, hospitalization in the past 12 months, and antibiotic use in the past month, individuals with vitamin D deficiency had a statistically significant increased risk of MRSA carriage of 2.04 (95% CI 1.09-3.84). Vitamin D deficiency is associated with an increased risk of MRSA nasal carriage. Further trials may be warranted to determine whether vitamin D supplementation decreases the risk of MRSA colonization.

Post-traumatic stress disorder screening test performance in civilian primary care.

PURPOSE: we determined the test performance characteristics of four brief post-traumatic stress disorder (PTSD) screening tests in a civilian primary care setting. METHODS: this was a cross-sectional cohort study of adults attending a family medicine residency training clinic in the southeastern USA. Four hundred and eleven participants completed a structured telephone interview that followed an index clinic visit. Screening tests included: PTSD Symptom Checklist-Civilian Version (17 items), SPAN (four items), Breslau's scale (seven items) and Primary Care PTSD screen (PC-PTSD) (four items). A modified Clinician-Administered PTSD Scale was used to determine past month PTSD for comparison. Receiver operating characteristic analysis based on area under the curve (AUC) was used to assess diagnostic efficiency (>0.80 desired). Cut-off scores were selected to yield optimal sensitivity and specificity (>80%). RESULTS: past month PTSD was substantial (women = 35.8% and men = 20.0%; P < 0.01). AUC values were PTSD Symptom Checklist (PCL) (0.897), SPAN (0.806), Breslau's scale (0.886) and PC-PTSD (0.885). Optimal cut-scores yielded the following sensitivities and specificities: PCL (80.0% and 80.7%; cut-off = 43), SPAN (75.9% and 71.6%; cut-off = 3), Breslau's scale (84.5% and 76.4%; cut-off = 4) and PC-PTSD (85.1% and 82.0%; cut-off = 3). Overall and gender-specific screening test performances were explored. CONCLUSIONS: results confirm: (i) PTSD was common, especially among women; (ii) all four PTSD screening tests were diagnostically adequate; (iii) Two of four PTSD screening tests showed adequate sensitivity and specificity (>80%) and (iv) The PC-PTSD screening test (four items) appeared to be the best single screening test. There are few studies to establish the utility of PTSD screening tests within civilian primary care.

Medical Education with 3-Year Regional Campuses: Do They Attract a Different Type of Applicant?

BACKGROUND: In response to calls to increase class sizes, the Medical College of Wisconsin (MCW) opened two new 3-year community-based regional campuses in 2016 and 2017. The goal of this study was to analyze whether the applicants and accepted student pools differed for the school's 3-year and 4-year campuses. METHODS: Deidentified data from Wisconsin applicants to MCW for the class enrolling in 2017 were categorized based on their preference for the Milwaukee or a regional campus. Applicants and admitted student data were compared on Medical College Admissions Test (MCAT) score, undergraduate school grade point average (GPA), sex, age, research intensity of their undergraduate school (Carnegie 1 classification vs all others) and Wisconsin county of residency. RESULTS: Regional campus applicants were significantly older (24.6 vs 23.7, P = 0.023), more likely to reside in nonurban counties (33% vs 13%, < 0.001), attend nonresearch-intense undergraduate schools (65% vs 44%, P < 0.001) and had lower mean MCAT scores (d=0.77, P < .001) than applicants to the Milwaukee campus. Regression models indicated 4 applicant qualities were associated with a preference for 4-year (values > 1.0) or 3-year (values < 1.0) campus: graduation from a Carnegie 1 undergraduate school (OR = 1.626; 95% CI, 1.01 - 2.62), a higher age at the time of application (OR = 1.092; 95% CI, 1.01 - 1.18), total MCAT score (OR = 0.916; 95% CI, 0.89 - 0.95), and permanent residence in a rural Wisconsin county (OR = 0.349; 95% CI, 0.21 - 0.59). When we examined students who were accepted and matriculated as opposed to just applicants, regression models showed that students with higher ages were more likely to attend the 4-year campus (OR = 1.42; 95% CI, 1.15 - 1.76), while a higher total MCAT score (OR = 0.83; 95% CI, 0.76 - 0.91) and rural county residency (OR = 0.27; 95% CI, .1 - 0.73) were associated with atriculation to the 3-year regional campuses. CONCLUSIONS: These results indicate that the regional 3-year campus model is attracting and selecting students with some differences from those at MCW's 4-year campus. After adjusting for other characteristics, students matriculating to the regional 3-year campuses are nearly 4 times more likely to come from a rural county and have slightly higher MCAT scores.

Availability of antibiotics for purchase without a prescription on the internet.

PURPOSE: Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. METHODS: We conducted an Internet search using 2 major search engines (Google and Yahoo) with the key words "purchase antibiotics without a prescription" and "online (English only)." Vendors were compared according to the classes of antibiotics available, quantity, shipping locations, and shipping time. RESULTS: We found 138 unique vendors selling antibiotics without a prescription. Of those vendors, 36.2% sold antibiotics without a prescription, and 63.8% provided an online prescription. Penicillins were available on 94.2% of the sites, macrolides on 96.4%, fluoroquinolones on 61.6%, and cephalosporins on 56.5%. Nearly all, 98.6%, ship to the United States. The mean delivery time was 8 days, with 46.1% expecting delivery in more than 7 days. Among those selling macrolides (n = 133), 93.3% would sell azithromycin in quantities consistent with more than a single course of medication. Compared with vendors that require a medical interview, vendors who sell antibiotics without a prescription were more likely to sell quantities in excess of a single course, and the antibiotics were more likely to take more than 7 days to reach the customer. CONCLUSIONS: Antibiotics are freely available for purchase on the Internet without a prescription, a phenomenon that encourages self-medication and low quality of care.

Student Leadership Development Initiative: A Pilot for a Sustainable, Replicable Model for Incorporating Leadership into Medical Education.

INTRODUCTION: Today's medical students are tomorrow's leaders. As leadership training becomes incorporated into undergraduate medical education, there is a need for validated educational models that are both effective and replicable. METHODS: Between April 2017 and October 2017, groups of 15 to 20 medical students participated in sessions with an exemplary physician leader incorporating a guided interview format and discussion about her or his career. Prepared questions ensured leadership domains were covered. The program was evaluated using a post-session survey. RESULTS: One hundred percent of survey respondents (N = 58) reported that the session was a good use of time. Seventy-eight percent felt more prepared to lead a team; 93% learned specific ways to improve their leadership skills. DISCUSSION: This leadership program is a unique model to provide leadership education to medical students that is both effective and replicable.

Recruiting faculty to perform deliveries in family medicine residencies: results of a residency program survey.

BACKGROUND AND OBJECTIVES: One factor cited for the decline of family physicians delivering babies is a lack of faculty role models during residency training. This study's purpose was to determine how many residency programs experience difficulty recruiting faculty who perform deliveries and whether financial or not financial compensation are associated with recruiting difficulties. METHODS: Using an electronic questionnaire, we surveyed program directors of nonmilitary family medicine residencies in the United States, with a response rate of 60.7%. RESULTS: Among residency programs who tried to recruit faculty with delivery skills, 58% stated that they have difficulties. Two program characteristics were associated with recruitment difficulties: the number of delivery providers among faculty and whether the residency program directors included delivery in their own practices. There were no statistically significant associations between recruiting difficulties and any type of financial reimbursement methods, but nonfinancial incentives were offered more often by programs that had no difficulty recruiting. CONCLUSIONS: More than half of all family medicine residency programs have difficulty recruiting faculty members to provide delivery training. Changing the type of financial compensation for faculty providing maternity care is not likely to assist in recruiting. However, we did find that programs without recruiting difficulties were more likely to offer nonfinancial incentives to faculty members who perform deliveries.

Nasal carriage of Staphylococcus aureus and methicillin-resistant S aureus in the United States, 2001-2002.

PURPOSE: Staphylococcus aureus is a common cause of invasive infections, yet most assessments of prevalence are based on health care-based samples. We computed population-based estimates of nasal carriage of S aureus and risk factors for carriage, as well as population-based estimates of nasal carriage of methicillin-resistant S aureus (MRSA). METHODS: We used the National Health and Nutrition Examination Survey (NHANES) 2001-2002 to estimate carriage of S aureus and MRSA for the non-institutionalized US population including children and adults. RESULTS: An estimated 86.9 million persons (32.40% of the population) were colonized with S aureus. The prevalence of MRSA among S aureus isolates was 2.58%, for an estimated population carriage of MRSA of 0.84% or 2.2 million persons. Among individuals with S aureus isolates, individuals aged 65 years or older had the highest MRSA prevalence (8.28%). Among all the racial/ethnic groups studied, Hispanics had the highest prevalence of colonization with S aureus but, when colonized, were less likely to have MRSA. CONCLUSIONS: This first nationally representative assessment of carriage of S aureus indicates that nearly one third of the population is currently colonized by this organism. Although the prevalence of MRSA remains low, more than 2.2 million people carry this resistant organism; thus, vigilance in promoting appropriate microbial transmission protocols should remain a priority.

Protecting participants in family medicine research: a consensus statement on improving research integrity and participants' safety in educational research, community-based participatory research, and practice network research.

Recent events that include the deaths of research subjects and the falsification of data have drawn greater scrutiny on assuring research data integrity and protecting participants. Several organizations have created guidelines to help guide researchers working in the area of clinical trials and ensure that their research is safe and valid. However, family medicine researchers often engage in research that differs from a typical clinical trial. Investigators working in the areas of educational research, community-based participatory research, and practice-based network research would benefit from similar recommendations to guide their own research. With funding from the US Office of Research Integrity and the Association of American Medical Colleges, we convened a panel to review issues of data integrity and participant protection in educational research, community-based participatory research, and research conducted by practice-based networks. The panel generated 11 recommendations for researchers working in these areas. Three key recommendations include the need for (1) all educational research to undergo review and approval by an institutional review board (IRB), (2) community-based participatory research to be approved not just by an IRB but also by appropriate community representatives, and (3) practice-based researchers to undertake only valid and meaningful studies that can be reviewed by a central IRB, rather than separate IRBs for each participating practice.

Ambulatory antibiotic prescribing for acute bronchitis and cough and hospital admissions for respiratory infections: time trends analysis.

OBJECTIVES: To examine the relationship between ambulatory antibiotic prescribing for acute bronchitis and cough with hospital admissions for respiratory infections in the USA between 1996 and 2003. DESIGN: Analysis of data on antibiotic prescribing for episodes of acute bronchitis/cough illness in ambulatory care and hospitalization for respiratory infections for adults between 1996 and 2003 in the USA. SETTING: USA: ambulatory prescribing behaviour was derived from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey while hospitalizations in acute care hospitals were assessed in the National Hospital Discharge Survey. PARTICIPANTS: Adults 18-64 years old. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Proportion of visits for acute bronchitis/cough receiving a prescription for antibiotics and hospitalization for respiratory infections. RESULTS: Ambulatory antibiotic prescribing practices for acute bronchitis/cough and hospitalizations for respiratory infections exhibited non-linear patterns over the 8 year period. However, antibiotic prescribing practices for acute bronchitis/cough and hospitalizations for respiratory infections had a weak/moderate negative association. For three of the seven yearly changes in prescribing and hospitalizations as one increased the other decreased (P<0.01). CONCLUSIONS: Ambulatory antibiotic prescribing for respiratory tract infections was inversely associated with hospital admissions for respiratory tract infections.

The Merits and Challenges of Three-Year Medical School Curricula: Time for an Evidence-Based Discussion.

The debate about three-year medical school curricula has resurfaced recently, driven by rising education debt burden and a predicted physician shortage. In this Perspective, the authors call for an evidence-based discussion of the merits and challenges of three-year curricula. They examine published evidence that suggests that three-year curricula are viable, including studies on three-year curricula in (1) U.S. medical schools in the 1970s and 1980s, (2) two Canadian medical schools with more than four decades of experience with such curricula, and (3) accelerated family medicine and internal medicine programs. They also briefly describe the new three-year programs that are being implemented at eight U.S. medical schools, including their own. Finally, they offer suggestions regarding how to enhance the discussion between the proponents of and those with concerns about three-year curricula.

Ranking departments of family medicine: the eye of the beholder?

BACKGROUND AND OBJECTIVES: During each of the past several years, a nationally circulated periodical (US News & World Report) has provided a ranking of medical schools and their respective specialty departments. In contrast to the method used to rank medical schools, medical specialties, including family medicine, are ranked based solely on ratings by deans and senior faculty at peer schools. This study's purpose was to explore how closely this expert opinion-based process matches actual objective and quantifiable data about departmental performance. METHODS: Available quantifiable data in the following categories were obtained: administration, academic productivity, and medical student and resident education. Based on their ranking in a category, each department was awarded one to five stars depending on the quintile they achieved (except for the dichotomous variable pertaining to the presence of a postresidency fellowship). Five stars indicate a ranking in the highest quintile. RESULTS: In regards to success in administration, research, and residency education and production of family physicians, the departments, on average, were rated 3.4, 4.2, and 3.6 stars, respectively. Overall, half of the departments consistently ranked in the top quartile, as indicated by an average score of 4.0 to 5.0 stars. CONCLUSIONS: Many of the departments rated highly in the US News & World Report rankings of the departments of family medicine rated very high in the areas of administration, research, and education as determined by quantifiable information. In contrast, several highly ranked departments were not rated favorably in areas usually associated with excellence in academics.

Family physicians delivering babies: what do obstetricians think?

OBJECTIVE: This study assesses the attitudes of obstetricians about family physicians delivering babies. METHODS: We performed a two-stage mail survey of physicians who self-reported their specialty as obstetrics- gynecology in the 2001 South Carolina Directory of Licensed Physicians. After excluding physicians who retired or moved, a response rate of 65% was obtained. RESULTS: Fewer than half of the respondents (45%) supported family physicians providing pregnancy care. Obstetricians in favor of family physicians providing pregnancy care were more likely to work near a family physician who delivered babies, less likely to have been sued in the last 5 years, and more likely to be over age 60. Practice location (rural versus urban) did not predict support for family physicians participating in pregnancy care. Those obstetricians who supported family physicians participating in pregnancy care were comfortable with family physicians managing a wide range of common complications. CONCLUSIONS: Since fewer than half of obstetricians believe that family physicians should offer pregnancy care, family physicians may experience difficulty finding appropriate backup. Because older obstetricians were most likely to support family physicians, the retirement of these individuals from practice may create a problem for family physicians seeking obstetrical backup.

A suggested fourth-year curriculum for medical students planning on entering family medicine.

BACKGROUND: Students interested in a family medicine residency often seek advice about what electives to take in their final year of medical school. This study sought to develop a consensus about what rotations to recommend and what essential skills students should possess before starting their family medicine residency. METHODS: We conducted Delphi studies with panels of experienced community- and university-based family medicine residency directors and predoctoral educators in departments of family medicine at US medical schools. Each group participated in a three-phase Delphi process that asked each member to identify potential rotations and skills and then narrowed the list to those of the highest priority. RESULTS: Both the residency directors and predoctoral educators recommended that students participate in an ambulatory family medicine month in their fourth year of medical school, along with electives in emergency medicine, dermatology, obstetrics, and an acting internship (subinternship) in internal medicine. While there was some divergence in the panel's opinions, both panels felt that superior interviewing skills, the ability to manage undifferentiated problems, and the interpretation of common imaging studies were essential skills that students should have before entering a family medicine residency. CONCLUSIONS: Experienced family medicine educators appear to agree that students benefit most from a few specific rotations during the final year of medical school. This information may be useful to faculty members who advise students during medical school.