The Impact of Tele-Education on Family Medicine Clerkship Students' Learning Outcomes.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic necessitated rapid changes to medical education for student and patient protection. A dearth of published US studies examine resulting clinical education outcomes due to pandemic-induced curricula changes. We describe adaptations made to a family medicine clerkship to move it from traditional in-person delivery to virtual only, and then from virtual to hybrid; and compare educational outcomes of students across delivery types. METHODS: We stratified 386 medical students in their third year completing their 8-week family medicine clerkship by type of content delivery, including in person, virtual only, and hybrid instruction. We examined the impact of these changes on three clerkship learning outcomes: the midblock assessment score, the National Board of Medical Examiners (NBME) exam score, and the final numeric score (FNS). RESULTS: In our sample, 164 (42.5%) received content in person, 36 (9.3%) received virtual only, and 186 (48.2%) received hybrid content. Students receiving virtual only (M=76.4, SD=9.1) had significantly higher midblock assessment scores (F=8.06, df=2, P=.0004) than students receiving hybrid (M=71.7, SD=8.8) and in-person training (M=74.5, SD=7.2). No significant differences existed in students' NBME exam scores or FNSs across delivery types. CONCLUSIONS: Students receiving virtual-only or hybrid content performed at least as well on three clerkship-related educational outcomes as their pre-COVID peers participating in person. Further research is needed to understand how changes to medical education affected student learning and skill development.

A Structural Model of Adverse Childhood Experiences as Antecedents of Rumination Leading to Lower Hope.

Hope is well established within the positive psychology literature as a construct associated with psychological well-being. Recent research has also linked experiences of childhood trauma with lower hope into adulthood. Snyder's hope theory explains this link by suggesting that rumination, as a byproduct of trauma, limits survivors' ability to focus on present day goals, thereby lowering hope. To test this proposed link between childhood trauma and lower hope, we conducted two studies using independent samples of adults living in the United States (Study 1: N' = 258; Study 2: N' = 374). Per Snyder, the studies modeled childhood trauma as a driver of rumination leading to lower hope. The results of Study 1 indicated that a "full mediation" model, directly representing Snyder's theory, produced good fit (χ2 = 254.02, p > .001; df = 131); root mean square error approximation (RMSEA) = .06 (90% confidence interval [CI]: .049, .072); standardized root mean square residual (SRMR) = .055; comparative fit index (CFI): .927. A subsequent bootstrapping analysis (N = 5,000) validated the full mediation model. Study 2 provided identical results, indicating again that a full mediation model of the variables produced good fit. The data from both studies was consistent with Snyder's understanding of the link between trauma and lower hope. The article concludes with a discussion of the studies' implications, particularly how the data supports interventions, such as meditation, that may work to help buffer the ruminating impacts of childhood trauma.

An evaluation of a simulation and video-based training program to address adverse childhood experiences.

Adverse Childhood Experiences (ACEs) are multiple sources of maltreatment and household dysfunction with tremendous impact on health. A trauma-informed (TI) approach is preferred when working with patients with ACEs. The Professional ACEs-Informed Training for Health© (PATH©) educational program and simulation experience using standardized patients (SP) was developed to help healthcare professionals address ACEs with adults. PATH© is a 3-4 hour curriculum comprised of lecture and discussion, video-based demonstration, simulation experience, and debriefing. It was first developed for primary care (PC) residents in family medicine and internal medicine, and subsequently modified for occupational therapy (OT) and physical therapy (PT) students. This study evaluates a preliminary dataset focusing on PATH© skills of PC residents and OT and PT students during simulation. Recordings of 53 learner-SP encounters from 15 OT and PT students and 38 PC residents were coded using standardized behavioral codes. A subset of ten recordings of PC residents who participated in simulations in the first and fourth year of the training program allowed for evaluation of training outcomes over time. Results showed that medical residents and OT and PT students demonstrated skills during SP encounters congruent with TI training on addressing ACEs with adults, particularly in explaining ACEs, demonstrating empathy, collaborative treatment planning, and stigma reduction. PC residents showed both positive and negative changes in PATH©-specific skills from year 1 to 4 of the training program. This study supports the PATH© model and simulation-based training in preparing clinicians to address ACEs with adults and provides insight into further curriculum improvement.

A Comparison of Rural and Academic Training Environments for Third-Year Medical Students on a Family Medicine Rotation.

BACKGROUND AND OBJECTIVES: Medical students have been training in rural environments for many years. However, there is sparse research demonstrating that training in a rural environment provides an equivalent learning experience to training in an academic medical setting. This study addresses that gap by comparing student performance after training in rural or community environment versus an academic setting while completing the family medicine clerkship. METHODS: Participants in this retrospective cohort study were students who completed an 8-week family medicine third-year clerkship between 2013 and 2016. Half spent the first 4 weeks in a rural or community setting while the other half were in an academic setting. These placements were reversed after midterm exams. Data were collected from both student academic files and from rural rotation tracking systems at two time points: midterm and following the 8-week rotation. RESULTS: Results from our sample of 159 medical students (89 [56.0%] male and 70 [44.0%] female) revealed no statistically significant differences in students' midterm (P=.63) and final scores (P=.74) based on training locations. CONCLUSIONS: Study findings suggest that rural and academic clerkships provide equivalent levels of knowledge for family medicine students. This finding has particular relevance for students whose intent is to practice in a rural location. Additional research is needed to identify if these findings are generalizable to other medical schools and locations.

Adverse Childhood Experiences and Trust in the Medical Profession among Young Adults.

Attachment theory suggests that adverse childhood experiences (ACEs) should predict lower trust in the medical profession. To test this theory, a cross-sectional survey was administered to young adults self-identifying as homeless. The purpose of the survey was to examine the relationship of ACEs, attachment style, and trust in the medical profession. Hierarchical linear regression was used to determine if ACEs predict variance in trust in the medical profession after controlling for participants' attachment style and demographics. Results indicated ACEs were a robust predictor of lower trust in the medical profession over the controls. Since lower trust in the medical profession is associated with less willingness to seek care and follow provider recommendations, the established link between poorer health and ACEs may partially result from lower trust in the medical profession. The paper concludes with a discussion of the results' implications for future research and practice with ACE survivors.

Risk factors for fatal crashes in rural Australia.

This paper presents findings from the rural and remote road safety study, conducted in Queensland, Australia, from March 2004 till June 2007, and compares fatal crashes and non-fatal but serious crashes in respect of their environmental, vehicle and operator factors. During the study period there were 613 non-fatal crashes resulting in 684 hospitalised casualties and 119 fatal crashes resulting in 130 fatalities. Additional information from police sources was available on 103 fatal and 309 non-fatal serious crashes. Over three quarters of both fatal and hospitalised casualties were male and the median age in both groups was 34 years. Fatal crashes were more likely to involve speed, alcohol and violations of road rules and fatal crash victims were 2½ times more likely to be unrestrained inside the vehicle than non-fatal casualties, consistent with current international evidence. After controlling for human factors, vehicle and road conditions made a minimal contribution to the seriousness of the crash outcome. Targeted interventions to prevent fatalities on rural and remote roads should focus on reducing speed and drink driving and promoting seatbelt wearing.

All-terrain vehicle crashes and associated injuries in north Queensland: findings from the Rural and Remote Road Safety Study.

OBJECTIVE: To define characteristics of all-terrain vehicle (ATV) crashes occurring in north Queensland from March 2004 till June 2007 with the exploration of associated risk factors. DESIGN: Descriptive analysis of ATV crash data collected by the Rural and Remote Road Safety Study. SETTING: Rural and remote north Queensland. PARTICIPANTS: Forty-two ATV drivers and passengers aged 16 years or over hospitalised at Atherton, Cairns, Mount Isa or Townsville for at least 24 hours as a result of a vehicle crash. MAIN OUTCOME MEASURES: Demographics of participants, reason for travel, nature of crash, injuries sustained and risk factors associated with ATV crash. RESULTS: The majority of casualties were men aged 16-64. Forty-one per cent of accidents occurred while performing agricultural tasks. Furthermore, 39% of casualties had less than one year's experience riding ATVs. Over half the casualties were not wearing a helmet at the time of the crash. Common injuries were head and neck and upper limb injuries. Rollovers tended to occur while performing agricultural tasks and most commonly resulted in multiple injuries. CONCLUSIONS: Considerable trauma results from ATV crashes in rural and remote north Queensland. These crashes are not included in most general vehicle crash data sets, as they are usually limited to events occurring on public roads. Minimal legislation and regulation currently applies to ATV use in agricultural, recreational and commercial settings. Legislation on safer design of ATVs and mandatory courses for riders is an essential part of addressing the burden of ATV crashes on rural and remote communities.

The medical and retrieval costs of road crashes in rural and remote northern Queensland, 2004-2007: findings from the Rural and Remote Road Safety Study.

OBJECTIVE: To estimate costs of retrieval, transport and acute medical services associated with road crashes in northern Queensland from March 2004 to June 2007. DESIGN, SETTING AND PARTICIPANTS: Case study of 696 people aged 16 years or older who had been involved in a road crash in the study area (all areas north and west of Bowen, excluding the urban areas of Townsville and Cairns) and had been admitted to hospital for a minimum of 24 hours after the crash. Data on mode of retrieval, acute care provided and total costs were obtained for each patient. MAIN OUTCOME MEASURES: Method of retrieval or transport; length of stay in intensive care unit (ICU) and/or hospital for each patient; costs of retrieval, transport and inhospital care. RESULTS: Retrieval data were collected for 614 of the 696 study participants (88%). Most primary retrievals (446; 73%) occurred by road. More than half of interhospital transfers were undertaken by fixed or rotary wing services. Casualties in the study occupied a total of 6360 bed-days, of which 734 were ICU bed-days. The total retrieval, transport and acute hospital care costs of road crash victims in northern Queensland over the study period were calculated to be approximately $10.4 million. CONCLUSION: The costs associated with rural and remote road crashes in northern Queensland represent a considerable economic burden.

A rural/urban comparison of the roles of the general practitioner in colorectal cancer management.

OBJECTIVE: To identify and compare the roles of urban, rural and remote general practitioners (GPs) in colorectal cancer (CRC) management. DESIGN: Semistructured interviews exploring GP views of their role in CRC management. SETTING: Urban, rural and remote general practices in north Queensland. PARTICIPANTS: Fifteen GPs in urban, rural and remote practice. MAIN OUTCOME MEASURES: Self-reported roles in the management of CRC patients and factors influencing these roles. RESULTS: All GPs, regardless of location of practice, played a role in diagnosis, referral, postoperative care, psychosocial counselling, follow up and palliative care. Involvement in treatment of CRC patients was only performed by remote GPs. In general, rural and remote GPs played greater roles in care coordination, clinical and psychosocial care. Rural and remote GPs were more heavily involved throughout the entire illness progression when compared with their urban counterparts. CONCLUSIONS: The results of this study indicate that rural and remote GPs in north Queensland play a greater role than urban GPs in the management of CRC. In order to maintain and enhance the roles of rural and remote GPs in CRC care, appropriate guidelines and remuneration should be provided. Palliative care support might also be useful to rural and remote GPs.

Colorectal cancer management - the role of the GP.

BACKGROUND: Colorectal cancer (CRC) contributes significantly to the morbidity and mortality of Australians. The introduction of the National Bowel Cancer Screening Program has focussed attention on the role of the general practitioner in CRC screening. However, their increasing role across the management spectrum of CRC remains poorly researched. OBJECTIVE: This article examines the published literature on the existing and potential roles of the GP in the detection and management of CRC. Evidence about the existing and potential role of the GP was found through a literature search on Medline, PubMed, epidemiological evidence and recent guidelines. DISCUSSION: The role of the GP in CRC management varies. Some GPs play many roles such as advocate, facilitator, supporter, educator and counsellor. The role of the GP is influenced by GP-specialist communication, practice location, and patient and GP factors. There is a potential to increase this role, especially in providing psychosocial support and counselling for both the patient and their family.