Near-peer role modeling: Can fourth-year medical students, recognized for their humanism, enhance reflection among second-year students in a physical diagnosis course?

INTRODUCTION: Humanism is cultivated through reflection and self-awareness. We aimed to employ fourth-year medical students, recognized for their humanism, to facilitate reflective sessions for second-year medical students with the intention of positively influencing reflective process toward humanistic development. METHODS/ANALYSIS: A total of 186 students were randomly assigned to one of three comparison arms: eight groups of eight students (64 students) were facilitated by a fourth-year student who was a Gold Humanism Honor Society member (GHHS); eight groups (64 students) by a volunteer non-GHHS student; and seven groups (58 students) were non-facilitated. Before sessions, second-year students set learning goals concerning interactions with patients; fourth-year students received training materials on facilitation. Groups met twice during their 10 clinical site visits. At the last session, students completed a reflective assignment on their goal progress. Comparative mixed method analyses were conducted among the three comparison arms on reflection (reflective score on in-session assignment) and session satisfaction (survey) in addition to a thematic analysis of responses on the in-session assignment. RESULTS: We found significant differences among all three comparison arms on students' reflective scores (p=0.0003) and satisfaction (p=0.0001). T-tests comparing GHHS- and non-GHHS-facilitated groups showed significantly higher mean reflective scores for GHHS-facilitated groups (p=0.033); there were no differences on session satisfaction. Thematic analysis of students' reflections showed attempts at self-examination, but lacked depth in addressing emotions. There was a common focus on achieving comfort and confidence in clinical skills performance. DISCUSSION/CONCLUSIONS: Near peers, recognized for their humanism, demonstrated significant influence in deepening medical students' reflections surrounding patient interactions or humanistic development. Overall, students preferred facilitated to non-facilitated peer feedback forums. This model holds promise for enhancing self-reflection in medical education, but needs further exploration to determine behavioral effects.

Who's misbehaving? Perceptions of unprofessional social media use by medical students and faculty.

BACKGROUND: Social media use by physicians offers potential benefits but may also be associated with professionalism problems. The objectives of this study were: 1) to examine and compare characteristics of social media use by medical students and faculty; 2) to explore the scope of self- and peer-posting of unprofessional online content; and 3) to determine what actions were taken when unprofessional content was viewed. METHODS: An anonymous, web-based survey was sent to medical students and faculty in October, 2013 at the Albert Einstein College of Medicine in Bronx, New York. RESULTS: Three-quarters of medical students reported using social media "very frequently" (several times a day), whereas less than one-third of faculty did so (p < .001). Medical students reported using privacy settings more often than faculty (96.5 % v. 78.1 %, p < .001). Most medical students (94.2 %) and faculty (94.1 %) reported "never" or "occasionally" monitoring their online presence (p = 0.94). Medical students reported self-posting of profanity, depiction of intoxication, and sexually suggestive material more often than faculty (p < .001). Medical students and faculty both reported peer-posting of unprofessional content significantly more often than self-posting. There was no association between year of medical school and posting of unprofessional content. CONCLUSION: Medical students reported spending more time using social media and posting unprofessional content more often than did faculty.

Spiritual versus religious identity: a necessary distinction in understanding clinicians' behavior and attitudes toward clinical practice and medical student teaching in this realm.

Social sciences view spirituality and religion separately; medicine views them together. We identified distinctions regarding clinical practice and teaching among clinician educators based on their self-identified spirituality versus religiosity. We emailed a 24-item survey on spiritual/religious (S/R) issues to clinician educators (n = 1067) at our institution. Three summary scales were created. Responses to statements, 'I consider myself to be spiritual' and 'I consider myself to be religious' generated four comparison groups: 'spiritual only,' 'religious only,' 'both spiritual and religious' and 'neither.' Analyses employed ANOVA and T tests. A total of 633 (59%) surveys were completed. Four percentage self-identified as 'religious only'; remaining respondents divided evenly, about 30% into each of the other categories. Groups differed from one another on all summary scales (p < .0001). Using T tests, the 'spiritual only' group differed from the 'religious only' group regarding teaching. The 'spiritual and religious' group had the highest mean ratings for all summary scales. The 'neither' and 'religious only' group had the lowest mean ratings. Clinicians' spiritual versus religious identity is associated with differences in behavior/attitudes regarding S/R toward clinical practice and medical student teaching. These findings elucidate opportunities for faculty development to explore effects of beliefs on behavior and attitudes within this realm.

Assessing third-year medical students' ability to address a patient's spiritual distress using an OSCE case.

PURPOSE: To inform curricular development by assessing the ability of third-year medical students to address a patient's spiritual distress during an acute medical crisis in the context of an objective structured clinical examination (OSCE) case. METHOD: During March and April 2010, 170 third-year medical students completed an eight-station videotaped OSCE at Albert Einstein College of Medicine of Yeshiva University. One of the standardized patients (SPs) was a 65-year-old man with acute chest pain who mentioned his religious affiliation and fear of dying. If prompted, he revealed his desire to speak with a chaplain. The SP assessed students' history taking, physical examination, and communication skills. In a postencounter written exercise, students reported their responses to the patient's distress via four open-ended questions. Analysis of the postencounter notes was conducted by three coders for emergent themes. Clinical skills performance was compared between students who reported making chaplain referral and those who did not. RESULTS: A total of 108 students (64%) reported making a chaplain referral; 4 (2%) directly addressed the patient's religious/spiritual beliefs. Students' clinical performance scores showed no significant association with whether they made a chaplain referral. CONCLUSIONS: Findings suggest that the majority of medical students without robust training in addressing patients' spiritual needs can make a chaplain referral when faced with a patient in spiritual crisis. Yet, few students explicitly engaged the patient in a discussion of his beliefs. Thus, future studies are needed to develop more precise assessment measures that can inform development in spirituality and medicine curricula.

Exploring the spiritual/religious dimension of patients: a timely opportunity for personal and professional reflection for graduating medical students.

Teaching about spirituality in medical school training is lacking. Spirituality is a dimension of humanity that can put experiences of health and illness into a meaningful context. Medical students might benefit from understanding how spirituality is an important element in learning to care for patients. Spirituality also provides a context for medical students to explore their own motivations for doctoring. This article describes a longitudinal senior elective course at the end of their medical school training to delve into matters of religion/spirituality surrounding patient care. The authors pose their own perspectives on what both students and faculty gained from the experience.

Teaching medical students how to use interpreters: a three year experience.

Disparities in health exist among ethnic/racial groups, especially among members with limited English proficiency (LEP). The session described in this paper aimed to teach medical students the skills needed to communicate with patients with LEP. Description - We created a required session titled "Cross-Cultural Communication-Using an Interpreter" for third-year medical students with learning objectives and teaching strategies. The session plans evolved over three years. Program Evaluation - Students' perceived efficacy using retrospective pre/post test analysis (n = 110, 86% response rate) administered 7 weeks post-session revealed that 77.3% of students felt "more prepared to communicate with a patient with LEP", 77.3% to "give proper instructions to an untrained interpreter" and 76.4% to "access a hospital language line". Conclusion - Our curricular intervention was effective in increasing students' perceived efficacy in communicating with a patient with LEP, using untrained interpreters and accessing a hospital language line. Skills practice and discussion of using interpreters should be a part of medical education.

Are there universal parenting concepts among culturally diverse families in an inner-city pediatric clinic?

INTRODUCTION: Cultural competence is necessary in providing care to culturally diverse families. Numerous studies have emphasized similarities and differences between predetermined cultural groups, yet few have studied groups across cultures. This project aimed to investigate parenting concepts, which in this context pertains to philosophy of parenting and child care practices across cultures. METHOD: Using a grounded theory approach, ethnographic interviews of 46 families representing 27 countries were taped, transcribed, and analyzed. RESULTS: Similarities in parenting concepts were found among families. Teaching values and respect and the need for strict discipline were important. A sense of community, family, and spirituality/religion was strong. Television was viewed as educational and parents anticipated opportunities for jobs and higher education for their children. Parents were more inclined to use medical treatments than home remedies for acute illnesses, which may have been linked to the finding that their providers had a strong influence. Parents feared children playing alone outdoors; distrusted nonfamily babysitters; and felt conflicted between a desire for cultural preservation versus assimilation. DISCUSSION: Universal concepts in parenting philosophies and practices exist among culturally diverse families. Providers may approach anticipatory guidance by addressing global parental concerns that transcend culture in order to relieve time constraints and the overwhelming task of being knowledgeable about all cultures.

Common menstrual disorders in adolescence: nursing interventions.

Menstrual disorders such as amenorrhea, excessive uterine bleeding, dysmenorrhea, and premenstrual syndrome are common reasons for visits to healthcare providers by adolescent girls. Although menstrual irregularity can be normal during the first few years after menarche, other menstrual signs and symptoms may indicate a pathological condition that requires prompt attention and referral. This article discusses four common menstrual disorders seen in adolescent girls and focuses on specific nursing interventions aimed at eliciting an accurate menstrual history, providing confidentiality and communicating therapeutically, administering culturally sensitive care, and promoting independence and self-care.

Culture & spirituality as an integrated concept in pediatric care.

The purpose of this article is to propose an integrated approach to culture and spirituality in pediatric care. In the spirit of sensitive and respectful communication with patients, pediatric nurses have become increasingly concerned with the child's and family's culture, spirituality, and religion. As a result, various approaches and models have been created to help nurses initiate discussions surrounding these topics. These models have given rise to categorizations of culture, spirituality, and religion. It is important for pediatric nurses to understand that while delineations can be made, there are also many intersecting factors that make separation of these issues difficult and perhaps unnecessary for the purpose of culturally sensitive communication. Pediatric nurses should, perhaps, focus instead on understanding the individual child's or family's traditions, values, and beliefs and how these dimensions impact the health of the child. This article suggests three areas that can be used as an organizing framework for pediatric nurses to broach culturally sensitive issues within the context of pediatric primary healthcare: (1) Family beliefs/values, (2) Family daily practices, and (3) Community involvement.

Sexually transmitted infection. A challenge for nurses working with adolescents.

Sexually active adolescents have high rates of STIs and many barriers to prevention and treatment because of developmental immaturity, difficulty with access to health care, and need for confidential care. Serious health consequences of STIs may occur many years after infection, further compounding adolescents' ability to link cause and effect. Nurses who are committed to the challenge of providing services for adolescents to prevent STIs can help by providing access to confidential care and promoting sexual health. High-risk youth require intensive preventive efforts. Nurses are in an ideal position to meet this challenge in their roles as providers, counselors, and sexuality educators in individual health care encounters and in prevention programs in clinics, schools, and community centers. Effective STI prevention programs should apply theories of behavior change, incorporate adolescents' attitudes and beliefs, and solicit input from the adolescents themselves.