Expectations of and for Clerkship Directors 2.0: A Collaborative Statement from the Alliance for Clinical Education.

This article presents an update of the collaborative statement on clerkship directors (CDs), first published in 2003, from the national undergraduate medical education organizations that comprise the Alliance for Clinical Education (ACE). The clerkship director remains an essential leader in the education of medical students on core clinical rotations, and the role of the CD has and continues to evolve. The selection of a CD should be an explicit contract between the CD, their department, and the medical school, with each party fulfilling their obligations to ensure the success of the students, the clerkship and of the CD. Educational innovations and accreditation requirements have evolved in the last two decades and therefore this article updates the 2003 standards for what is expected of a CD and provides guidelines for the resources and support to be provided.In their roles as CDs, medical student educators engage in several critical activities: administration, education/teaching, coaching, advising, and mentoring, faculty development, compliance with accreditation standards, and scholarly activity. This article describes (a) the work products that are the primary responsibility of the CD; (b) the qualifications for the CD; (c) the support structure, resources, and personnel that are necessary for the CD to accomplish their responsibilities; (d) incentives and career development for the CD; and (e) the dedicated time that should be provided for the clerkship and the CD to succeed. Given all that should rightfully be expected of a CD, a minimum of 50% of a full-time equivalent is recognized as appropriate. The complexity and needs of the clerkship now require that at least one full-time clerkship administrator (CA) be a part of the CD's team.To better reflect the current circumstances, ACE has updated its recommendations for institutions and departments to have clear standards for what is expected of the director of a clinical clerkship and have correspondingly clear guidelines as to what should be expected for CDs in the support they are provided. This work has been endorsed by each of the eight ACE member organizations.

The lecture-free curriculum: Setting the stage for life-long learning: AMEE Guide No. 135.

In this AMEE Guide we propose that instruction in health sciences education transform to 'lecture-free.' We present rationale for this proposal, guidance on approaches and strategies to achieve the goal, likely challenges, and what we consider the value-added outcomes. We are supported by a confluence of factors: advances in the science of learning and the learning of science and clinical reasoning, incontrovertible evidence that active and engaged learning strategies have better outcomes, current and emerging technology infrastructure in and out of the classroom, and best-practice instructional design.

High-Stakes Collaborative Testing: Why Not?

Phenomenon: Studies of high-stakes collaborative testing remain sparse, especially in medical education. We explored high-stakes collaborative testing in medical education, looking specifically at the experiences of students in established and newly formed teams. APPROACH: Third-year psychiatry students at 5 medical schools across 6 sites participated, with 4 participating as established team sites and 2 as comparison team sites. For the collaborative test, we used the National Board of Medical Examiners Psychiatry subject test, administering it via a 2-stage process. Students at all sites were randomly selected to participate in a focus group, with 8-10 students per site (N = 49). We also examined quantitative data for additional triangulation. FINDINGS: Students described a range of heightened emotions around the collaborative test yet perceived it as valuable regardless if they were in established or newly formed teams. Students described learning about the subject matter, themselves, others, and interpersonal dynamics during collaborative testing. Triangulation of these results via quantitative data supported these themes. Insights: Despite student concerns, high-stakes collaborative tests may be both valuable and feasible. The data suggest that high-stakes tests (tests of learning or summative evaluation) could also become tests for learning or formative evaluation. The paucity of research into this methodology in medical education suggests more research is needed.

The ADMSEP Milestones Project.

OBJECTIVE: Credentialing bodies mandate that a medical school's curriculum be based upon recognized guidelines. Within the field of psychiatry, the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) has previously published recommended guidelines for the pre-clinical and clerkship curriculum. Ongoing changes within the Liaison Committee on Medical Education's requirements for medical school curricula, and the publication of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, necessitated review of these guidelines. METHODS: ADMSEP convened a task force of psychiatric educators to develop a consensus report outlining new guidelines. The ADMSEP membership reviewed and approved this final document. RESULTS: The guidelines outline six core learning objectives with corresponding competencies. Each of these competencies specifies accompanying milestones to be achieved through the course of medical school. CONCLUSIONS: ADMSEP believes these guidelines will aid educators in crafting a school's psychiatric curriculum. Clearly articulated milestones may foster the further development of validated educational and assessment tools by ADMSEP and other organizations.

Team cohesiveness, team size and team performance in team-based learning teams.

OBJECTIVES: The purpose of this study was to explore the relationships among variables associated with teams in team-based learning (TBL) settings and team outcomes. METHODS: We administered the National Board of Medical Examiners (NBME) Psychiatry Subject Test first to individuals and then to teams of Year three students at four medical schools that used TBL in their psychiatry core clerkships. Team cohesion was analysed using the Team Performance Scale (TPS). Bivariate correlation and linear regression analysis were used to analyse the relationships among team-level variables (mean individual TPS scores for each team, mean individual NBME scores of teams, team size, rotation and gender make-up) and team NBME test scores. A hierarchical linear model was used to test the effects of individual TPS and individual NBME test scores within each team, as well as the effects of the team-level variables of team size, team rotation and gender on team NBME test scores. Individual NBME test and TPS scores were nested within teams and treated as subsampling units. RESULTS: Individual NBME test scores and individual TPS scores were positively and statistically significantly (p < 0.01) associated with team NBME test scores, when team rotation, team size and gender make-up were controlled for. Higher team NBME test scores were associated with teams rotating later in the year and larger teams (p < 0.01). Gender make-up was not significantly associated. CONCLUSIONS: The results of an NBME Psychiatry Subject Test administered to TBL teams at four medical schools suggest that larger teams on later rotations score higher on a team NBME test. Individual NBME test scores and team cohesion were positively and significantly associated with team NBME test scores. These results suggest the need for additional studies focusing on team outcomes, team cohesion, team size, rotation and other factors as they relate to the effective and efficient performance of TBL teams in health science education.

Well-being in first year medical students.

OBJECTIVE: This study explored the well-being, attitudes toward counseling, willingness to seek counseling, and coping strategies of first year medical students. Gender differences in attitudes toward and willingness to seek counseling were also explored. METHODS: One hundred five first year medical students (98 % response rate) were administered a 59-item questionnaire about well-being, attitudes toward counseling, willingness to seek counseling, and coping strategies during the first week of medical school. The data were analyzed with hierarchical regression and multivariate analysis of covariance (MANCOVA). RESULTS: Female medical students were less willing to seek counseling and had more negative attitudes toward counseling compared to male medical students. Most students indicated that they chose not to seek counseling because they did not feel a need for it. Three students reported that stigma prevented them from seeking counseling. Unhealthy coping strategies (denial, self-blame, and substance use) were negatively associated with well-being while healthy coping strategies (active coping, emotional support, and instrumental support) did not correlate with well-being. CONCLUSIONS: Medical schools should continue efforts to make counseling accessible. Conversations about counseling may help address the more negative attitudes of female students toward counseling, a finding which merits further investigation given that women typically have more positive attitudes toward counseling than men. Use of unhealthy coping strategies can be addressed in classes, clubs, and by advisors and mentors. Limitations of this study include that only first year medical students were surveyed and that it was a cross sectional study.

Team Emotional Intelligence, Team Interactions, and Gender in Medical Students During a Psychiatry Clerkship.

OBJECTIVE: This study examined the relationship between team emotional intelligence, quality of team interactions, and gender. METHODS: Psychiatry clerkship students participating in Team-Based Learning (TBL, n = 484) or no TBL (control, n = 265) completed the Workgroup Emotional Intelligence Profile (WEIP-S) and the Team Performance Scale (TPS). RESULTS: Significant correlations (p < 0.01) existed between quality of team interactions (i.e., TPS) and team emotional intelligence (i.e., WEIP-S) subscales, but not gender. Control and TBL groups experienced significant increases in WEIP-S subscales pre to post (p < 0.01, η (2) = .08), with the TBL group experiencing significantly higher gains in three of four subscales. Control group scored higher on TPS. CONCLUSIONS: A significant relationship exists between team emotional intelligence and quality of team interactions. Gender was unrelated to TPS or WEIP-S subscales. TBL group experienced higher gains in WEIP-S subscales while the control group experienced slightly higher TPS scores. Results suggest implications for medical educators who use TBL.

Alliance for clinical education perspective paper: recommendations for redesigning the "final year" of medical school.

BACKGROUND: Although medical school typically lasts 4 years, little attention has been devoted to the structure of the educational experience that takes place during the final year of medical school. SUMMARY: In this perspectives paper, we outline goals for the 4th year of medical school to facilitate a transition from undergraduate to graduate medical education. We provide recommendations for capstone courses, subinternship rotations, and specialty-specific schedules, and we conclude with recommendations to medical students and medical schools for how to use the recommendations contained in this document. CONCLUSIONS: We provide an overview of general competencies and specialty specific recommendations to serve as a foundation for medical schools to develop robust 4th-year curricula and for medical students to plan their 4th-year schedules.

Medical student psychiatric educators' perceptions of supports, resources, and rewards.

OBJECTIVE: The primary purpose of this study was to determine the adequacy of resources for medical student education in psychiatry in US medical schools. METHODS: An e-questionnaire was deployed to psychiatric educators in the Association of the Directors of Medical Student Education in Psychiatry (ADMSEP) regarding resources for fulfilling their educational mission. RESULTS: Medical student educators in psychiatry were neutral as to whether they had adequate mentoring, yet did report support from their chair. Participants' roles in medical student education and membership in ADMSEP enhanced their work satisfaction, career satisfaction, and career development. Many participants reflected a lack of adequate resources to achieve student education goals. CONCLUSIONS: There are opportunities for improvement in provision of teaching resources, mentoring for medical student educators, greater protected time for teaching and administration, and rewards (salary and non-monetary) for educators. If actualized, these improvements would promote optimization of medical student education in psychiatry.

Faculty bridging individual and organizational resilience: results of a qualitative analysis.

BACKGROUND: Medical student burnout and anxiety has received growing attention in the past decade. The culture of competition and assessment has resulted in increasing stress levels amongst medical students, causing a decline in their academic performance and overall mental health. The objective of this qualitative analysis was to characterize recommendations from educational experts to aid students' academic progress. METHODS: At an international meeting in 2019, worksheets were completed by medical educators during a panel discussion. Participants responded to four scenarios representing common challenges medical students face in school (eg. Postponing Step 1, failing clerkships, etc.). For each case, participants addressed what students, faculty and medical schools could do to mitigate the challenge. Inductive thematic analysis was conducted by two authors followed by deductive categorization using an individual-organizational resilience model. RESULTS: Across the four cases, common suggestions made for students, faculty and medical schools were aligned to a resilience model representing the complex interplay between individuals and organizations and the impact on student wellbeing. DISCUSSION: Using suggestions from medical educators from across the US, we were able to identify recommendations for students, faculty, and medical schools to help students succeed in medical school. By applying a model of resilience, faculty serve as a critical bridge to connect students to the medical school administration. Our findings also support a pass/fail curriculum to ease the competition and burden students place on themselves.

Psychiatry and emergency medicine: medical student and physician attitudes toward homeless persons.

OBJECTIVE: The purpose of the study was to explore changes in medical students' attitudes toward homeless persons during the Psychiatry and Emergency Medicine clerkships. Simultaneously, this study explored attitudes toward homeless persons held by Psychiatry and Emergency Medicine residents and faculty in an attempt to uncover the "hidden curriculum" in medical education, in which values are communicated from teacher to student outside of the formal instruction. METHOD: A group of 79 students on Psychiatry and 66 on Emergency Medicine clerkships were surveyed at the beginning and end of their rotation regarding their attitudes toward homeless persons by use of the Health Professionals' Attitudes Toward the Homeless Inventory (HPATHI). The HPATHI was also administered to 31 Psychiatry residents and faculty and 41 Emergency Medicine residents and faculty one time during the course of this study. RESULTS: For Psychiatry clerks, t-tests showed significant differences pre- and post-clerkship experiences on 2 of the 23 items on the HPATHI. No statistically significant differences were noted for the Emergency Medicine students. An analysis of variance revealed statistically significant differences on 7 out of the 23 survey questions for residents and faculty in Psychiatry, as compared with those in Emergency Medicine. CONCLUSION: Results suggest that medical students showed small differences in their attitudes toward homeless people following clerkships in Psychiatry but not in Emergency Medicine. Regarding resident and faculty results, significant differences between specialties were noted, with Psychiatry residents and faculty exhibiting more favorable attitudes toward homeless persons than residents and faculty in Emergency Medicine. Given that medical student competencies should be addressing the broader social issues of homelessness, medical schools need to first understand the attitudes of medical students to such issues, and then develop curricula to overcome inaccurate or stigmatizing beliefs.

Labeling of Genetically Modified (GM) Foods in Peru: Current Dogma and Insights of the Regulatory and Legal Statutes.

The COVID-19 pandemic has affected and afflicted human lives and been a transformative catalyst leading to closure of many companies, disrupting mental health, and reducing access to food and exacerbating food insecurity. This presents an opportunity to reflect on and examine genetically modified (GM) foods and their effective legislative regulation for the benefit of consumers. This review presents a detailed analysis of GM foods' regulation in Peru and the analysis of certain specific cases that show the need for greater regulation of the industry.

Teaching motivational interviewing skills to third-year psychiatry clerkship students.

BACKGROUND: despite a large percentage of health care costs being related to smoking, obesity, and substance abuse, most physicians are not confident in motivating patients to change health behaviors. Motivational interviewing (MI) is a directive, patient-centered approach for eliciting behavior change. The purpose of this study was to teach students MI skills and assess their confidence and knowledge during the psychiatry clerkship using smoking cessation as the target behavior. METHODS: using a pretest/posttest design, 98 students were given a 10-item questionnaire during the psychiatry clerkship to assess their knowledge and confidence in health behavior change. Students received a 3-hour presentation on the principles of MI and practiced skills through role play. Students were encouraged to utilize these skills with patients. RESULTS: paired t tests results showed significant differences pre- and postclerkship for nine of the 10 items, including the student's confidence in working with patients in the area of smoking cessation. CONCLUSION: students can gain basic knowledge and increased confidence in working with patients for promoting behavioral change, even with a brief session, taught by nonexperts in motivational interviewing theory.

The Education Chief Resident in Medical Student Education: indicators of success.

OBJECTIVE: Although residents are actively involved in teaching medical students, some students do not feel that they get adequate teaching from residents. The position of Education Chief Resident in Medical Student Education was developed to enhance the educational experience for the students, cultivate the academic skills of the education chief, and liaise between students and residents. METHODS: The education chiefs spend 10-12 hours a week teaching medical students, assisting primarily with clerkships. To determine student satisfaction with the position of education chief, 85 students were surveyed in the 2007-2008 academic year. The education chiefs were also surveyed regarding their perceptions of how this position benefited their academic development. RESULTS: Seventy-six medical students completed the survey for a response rate of 89%. Students rated highly having education chiefs as part of the psychiatry clerkship. The education chief residents felt that their teaching skills and educational development were enhanced and that the position helped prepare them for careers in academic psychiatry. CONCLUSION: The position of education chief was viewed as valuable to the medical student experience in the psychiatry clerkship, and the education chiefs felt that the position enhanced their professional and educational development.

A Longitudinal Assessment of Professional Identity, Wellness, Imposter Phenomenon, and Calling to Medicine Among Medical Students.

OBJECTIVE: This study assessed changes in professional identity, wellness, imposter phenomenon, and calling to medicine over time in medical school. METHODS: Medical students from the first through third years anonymously completed four validated measures: Perceived Wellness Survey (PWS), Brief Calling Scale (BCS), Physician In-group Identification Scale (PID), and Clance's Imposter Phenomenon Scale (CIP). Survey completion implied informed consent. The study was exempted by the university IRB. RESULTS: All class of 2018 students (n = 110) returned surveys at the beginning of year 1; 58 completed surveys at the end of the preclinical years (post year 2, n = 44) and/or end of the third-year clerkship (post year 3, n = 35) and were analyzed. From pre to post preclinical years, there was a significant decrease in the PID. There were no statistically significant changes in the PWS, BCS, and CIP. From pre year 1 to post third-year clerkships, the PWS and PID decreased, the CIP increased, and the BCS did not change. Only 19% of students participated in all three survey administrations and this group was excluded from the analysis due to the low response rate. CONCLUSION: Student wellness and sense of professional identity (in-group identity) dropped over 3 years of medical education, while imposter phenomenon increased. The BCS did not change over time. The decrease in identity as part of the physician community is concerning; future curriculum initiatives should focus on integration of professional identity into students' individual identities and on initiatives to improve student well-being.