Raising Awareness of Mistreatment Policies and Reporting Procedures Using a Novel Medical Student Mobile Application.

BACKGROUND: Reports of mistreatment are an important first step to improving medical students' learning environment. Students may not report mistreatment due to a lack of awareness of institutional policies, reporting procedures, or for fear of reprisal. AIM: We sought to determine if a medical school cross-platform mobile application (app) could be used to improve students' awareness of mistreatment policies and procedures. SETTING AND PARTICIPANTS: Participants in this intervention included Drexel University College of Medicine (DUCOM) medical students, faculty, and Student Affairs Deans. PROGRAM DESCRIPTION: We created the DUCOMpass© app to make mistreatment policies and procedures more readily available and to ease mistreatment reporting for medical students. PROGRAM EVALUATION: To determine the efficacy of the app at raising mistreatment awareness, we analyzed our institutional Graduation Questionnaire data before and after the introduction of the app (from 2016 to 2023) as compared with the national average. We verified our students' self-reported data with app usage data. DISCUSSION: To our knowledge, this is the first instance of a medical school mobile app being implemented to successfully address medical student mistreatment awareness and reporting. We found that reaching students in a familiar and easily accessible mode(s) of communication is a catalyst for lasting change. NIH TRIAL REGISTRY: Not applicable.

A Review on Mode of Delivery during COVID-19 between December 2019 and April 2020.

OBJECTIVE: This study aims to review the published literature to determine mode of delivery in pregnant women with coronavirus disease 2019 (COVID-19) and the indications reported for cesarean section early in the pandemic to add information to the current narrative and raise awareness of trends discovered. STUDY DESIGN: A systematic review was conducted by searching PubMed, Scopus, and ScienceDirect databases for articles published between December 2019 and April 29, 2020 using a combination of the keywords such as COVID-19, coronavirus 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pregnancy, vaginal delivery, cesarean section, vertical transmission, management, and guidelines. Peer-reviewed case studies with confirmed SARS-CoV-2 women who delivered were included to determine mode of delivery, indications for cesarean section, and maternal and neonatal characteristics. RESULTS: A review of 36 total articles revealed deliveries in 203 SARS-CoV-2 positive pregnant women. A comparable severity of disease in pregnant versus nonpregnant women was noted, as previously determined. Overall, 68.9% of women delivered via cesarean section, with COVID-19 status alone being a common indication. Maternal COVID-19 may also be associated with increased risk of preterm labor, although neonatal outcomes were generally favorable. Despite eight of 206 newborns testing positive for SARS-CoV-2, there remains no definitive evidence of vertical transmission. CONCLUSION: COVID-19 status alone became a common indication for cesarean delivery early in the pandemic, despite lack of evidence for vertical transmission. The increase in cesarean rate in this data may reflect obstetricians attempting to serve their patients in the best way possible given the current climate of constantly evolving guidelines on safest mode of delivery for the mother, infant, and provider. Upholding current recommendations from trusted organizations as new data are published, while also providing individualized support to expecting mothers on most appropriate mode of delivery, will reduce the amount of unnecessary, unplanned cesarean sections and could lessen the psychological impact of delivering during the COVID-19 pandemic. KEY POINTS: · COVID-19 may result in an increased rate of cesarean delivery for SARS-CoV-2 positive pregnant women.. · COVID-19 is a commonly reported indication for cesarean section, despite management guidelines urging against this.. · Although eight neonates tested positive for SARS-CoV-2, all additional fluid and tissue samples tested negative..

Beyond the surface: unveiling gaps in medical education through eyes of diverse learners.

Inadequate education regarding disease manifestations in diverse skin colors hinders diagnosis and exacerbates health disparities. All levels of medical trainees report low confidence in accurately identifying disease in skin of color (SOC). To help further elucidate these concerns, our research aims to assess medical student confidence in recognizing cutaneous diseases in SOC and their viewpoints regarding SOC education within their institution. An eight-question, open-ended survey was provided to medical students before and after a SOC presentation. The survey assessed participants' confidence in their diagnostic ability and perspectives on educational material. Among the 70 attendees, 58 (82.8%) and 64 (91.4%) completed the pre- and post-seminar surveys, respectively. There was a significant discrepancy in confidence levels when assessing cutaneous manifestations of internal pathology in light (Monk Skin Colors 1-5) versus dark (Monk Skin Colors 6-10) skin (p < 0.009). Notably, 78.7% (37/47) perceived the institutional learning materials as insufficient for SOC. Post-seminar reflections indicated that 87.2% (40/46) of students lacked confidence in diagnosing SOC, with 78.7% (32/46) citing inadequate curriculum coverage as the cause. An additional 8.5% (6/46) identified the predominance of white-centric medical descriptions as a hindrance. Students collectively called for improved educational approaches, including better visual representation of diseases in darker skin. Medical education must continue to strive for increased SOC representation to train competent physicians in treating a diverse patient population and reduce disparities in SOC patients.

The mortality inflection point for age and acute cervical spinal cord injury.

BACKGROUND: Acute cervical spinal cord injury (cSCI) is associated with significant morbidity and mortality. Vertebral level and American Spinal Injury Association (ASIA) score influence both hospital course and ultimate outcome. While controlling for these variables, we describe the effect of age on cSCI-related pneumonia and mortality. METHODS: All patients treated at our regional spinal cord injury center with an acute cSCI during a 5-year period (2005-2009) were reviewed retrospectively. Patient demographics, injury level, ASIA score, length of stay (LOS), radiologic, laboratory, and microbiology data were reviewed. Pneumonia was defined as an infiltrate on chest X-ray along with two of the following: leukocytosis, fever greater than 101°F, or positive bronchial alveolar lavage cultures; all occurring within the same 24-hour period. RESULTS: There were 244 cSCI during the study period. In-hospital mortality was significantly higher for those older than 75 years (40.5% vs. 4.0%, p < 0.0001). Pneumonia rates were not significantly different between age groups. In all age groups, high ASIA scores (A and B) were associated with increased pneumonia (61.9% vs. 17.4%, p < 0.0001) and mortality (16.7% vs. 3.5%, p = 0.002). Similarly, patients with higher cervical injury levels (C4 and above) had a higher incidence of pneumonia (39.5% vs. 25.9%, p < 0.05) and a trend toward higher mortality. CONCLUSIONS: Age was associated with an increase in mortality among patients with an acute cSCI. Injury level and ASIA score contributed significantly to overall pneumonia rate and mortality at all ages; however, pneumonia did not correlate directly with mortality in this population. Other factors play a role in the mortality associated with geriatric spinal cord-injured patients, including end-of-life decision making; these need to be investigated further in future studies.

Convergence between cluster analysis and the Angoff method for setting minimum passing scores on credentialing examinations.

Cluster analysis can be a useful statistical technique for setting minimum passing scores on high-stakes examinations by grouping examinees into homogenous clusters based on their responses to test items. It has been most useful for supplementing data or validating minimum passing scores determined from expert judgment approaches, such as the Ebel and Nedelsky methods. However, there is no evidence supporting how well cluster analysis converges with the modified Angoff method, which is frequently used in medical credentialing. Therefore, the purpose of this study is to investigate the efficacy of cluster analysis for validating Angoff-derived minimum passing scores. Data are from 652 examinees who took a national credentialing examination based on a content-by-process test blueprint. Results indicate a high degree of consistency in minimum passing score estimates derived from the modified Angoff and cluster analysis methods. However, the stability of the estimates from cluster analysis across different samples was modest.

An evaluation of the opportunities for collaborative practice occurring in and the impact of interprofessional education on advanced pharmacy practice experiences.

BACKGROUND: To evaluate the impact of interprofessional (IP) education (IPE) programs during the first three years of a four-year doctor of pharmacy program on student preparedness and ability to function as a collaborative team member and to garner student feedback on collaboration experienced during the Advanced Pharmacy Practice Experiences (APPEs). INTERPROFESSIONAL EDUCATION ACTIVITY: Likert scale based statements and open-ended questions were added to the student course evaluations for the APPEs for two graduating classes of students. Quantitative data were analyzed using SPSS (repeated measures ANOVA and MANOVA). Thematic analysis by three reviewers reaching consensus was used to evaluate the qualitative data. Students reported being well prepared for IP collaboration (average ratings ranged from a mean of 3.37-3.46 on a scale of 1-4; 1=not at all prepared and 4=very well prepared). On average, students spent 26-50% of their time working with colleagues from other healthcare professions. In describing their preparedness for IP collaboration, the IP core competency of teams/teamwork was addressed in 50% of the submitted responses. The competencies of values/ethics, roles/responsibilities and IP communication were addressed by 2%, 20% and 28% of the written responses, respectively. DISCUSSION: Required longitudinal IP programs in the first three years of the pharmacy curriculum contribute to the students' perceived preparedness for collaborative practice during their APPEs. Developing practice sites to increase the opportunities for students to practice collaboratively is key. Further education of and emphasis by preceptors relative to the IPE competencies is desired.

Health Professions Students' Perceptions of Their IPE Program: Potential Barriers to Student Engagement with IPE Goals.

BACKGROUND: Extensive evaluative efforts are underway to explore nuances of interprofessional education (IPE). Few studies, however, have utilized methodology that includes multiple interviews with students of various health disciplines, thereby potentially concealing factors that may be impacting students' attitudes and perceptions of IPE. By focusing on the students' perspectives, this case study explores potential barriers and facilitators to students' engagement with their IPE program. METHODS: In-depth, semi-structured interviews were conducted with 20 students from six health disciplines at the ends of years 1 and 2 of their IPE program. Data were analyzed utilizing multi-step coding processes to identify patterns of students' perceptions and attitudes. FINDINGS: Elements that were internal and external to the IPE program (e.g., assignments, time constraints, lack of accountability, anticipatory socialization, and insufficient professional identity formation) were found to impact students' perceptions of the program and possibly their engagement with IPE goals. CONCLUSIONS: This case study sheds new light on how factors related to an IPE program's structure and implementation, as well as factors outside the program, may affect students' perceptions of IPE and perhaps even their willingness and ability to engage in interprofessionalism.

Health Mentor-Reported Outcomes and Perceptions of Student Team Performance in a Longitudinal Interprofessional Education Program.

The need to evaluate the impact of interprofessional education (IPE) on learner outcomes is clear, but assessment of IPE's impact on patient health and well-being is lacking. This mixed-methods study evaluated perspectives of community volunteers, health mentors (HMs) who have at least one chronic condition, who participated in an IPE curriculum. In May 2014, 93 HMs concluding the Health Mentors Program completed a survey evaluating their student teams according to the Interprofessional Education Collaborative core competencies' four domains and program impact on health/wellbeing using a 4-point Likert scale (1=strongly disagree; 4=strongly agree). The average response to statements regarding the four domains of values/ethics, roles/responsibilities, communication, and teamwork statements were all >3.0. HMs rated program satisfaction on a 10-point scale (1=least satisfied, 10=most satisfied) and answered open-ended outcome questions. The average program satisfaction score was 9.13±1.43; increased motivation to make and maintain healthy behaviors was reported. In a follow-up focus group with 10 mentors, high satisfaction levels from working with interprofessional student teams were reported, and substantial improvements in managing health conditions and improving overall health status were relayed. Further studies will determine if the patient-reported outcomes of the mentors correlate with objective health measures.

Jefferson Teamwork Observation Guide (JTOG): An Instrument to Observe Teamwork Behaviors.

Interprofessional education (IPE) is becoming an integral part of the education of health professions students. However, teaching students to become successful members of interprofessional teams is complex, and it is important for students to learn the combinations of skills necessary for teams to function effectively. There are many instruments available to measure many features related to IPE. However, these instruments are often too cumbersome to use in an observational situation since they tend to be lengthy and contain many abstract characteristics that are difficult to identify. The Jefferson Teamwork Observation Guide (JTOG) is a short tool that was created for students early in their educational program to observe teams in action with a set of guidelines to help them focus their observation on behaviors indicative of good teamwork. The JTOG was developed over a 2-year period based on student and clinician feedback and the input of experts in IPE. While initially developed as a purely educational tool for prelicensure students, it is becoming clear that it is an easy-to-use instrument that assesses the behavior of clinicians in practice.

Brain Metastases in Patients with Gynecologic Cancers: A Single Institution Experience and Review of the Literature.

OBJECTIVE: Brain Metastasis (BM) from primary gynecologic cancers is a rare entity. The advances and successes in the treatment of primary gynecologic malignancies, have led to prolonged survival and, a higher incidence of BM. This study aims to report the experience at our institution in managing these patients, and provide possible data points that may be essential to note as prognostic factors, and see if our findings are consistent with the literature in this subject. We also aim to provide a brief literature review of patients with gynecologic cancers and BM. METHODS: This is a small single institution retrospective study of 23 patients with a gynecologic malignancy and BM, identified between the years 2007-2015. Data were collected on variables including patient demographics, disease and treatment. RESULTS: The median overall survival from the primary diagnosis was 28 months. Median time from diagnosis of BM to death was 9 months. CONCLUSION: The outcomes in our study are similar to what is stated in the current literature with regard to BM from gynecologic malignancies. Our literature search also revealed that the molecular analysis and treatment of the primary tumor remain important to prevent BMs. The tendency of tumors to metastasize varies for one tumor type to another for the same type of tumor. The tendency to develop BM may not only depend on risk factors such as stage, grade, and histology, but also on the genetic profile of the primary tumor. The study suggests that multimodal treatment of BM has better outcomes in managing BM from gynecologic cancers.

Peer assessment among first year medical students in anatomy.

Peer assessment has been shown to be an effective tool to promote professionalism in medical students. Peer assessment may be particularly useful in anatomy dissection laboratory as the required close collaboration and long hours of anatomy laboratory provide students insights into their peers' work habits and interpersonal skills. The objective of this study was to quantitatively and qualitatively analyze the use of a validated peer assessment tool in Gross Anatomy. Students in a first year medical school class evaluated three members of their dissection group using an online survey tool. The mid-course and end-of-course evaluation included open-ended comments, as well as a five-point scale that measured three work habits, two interpersonal attributes and one overall score. All 267 students completed the assignment. The overall score and four of the five other assessed categories showed significant improvement from the mid- to end-of-course evaluations. Quantitative and qualitative data also revealed significant improvement among the students who received the lowest mid-course assessments. Seventy-six percent of the class agreed with the statement: "Based on the feedback I received, I made a change in how I worked with or taught my peers." The use of this peer assessment tool used by students in anatomy was associated with improvements in work habits and interpersonal attributes, particularly by the cohort of students who received the lowest mid-course feedback. Peer assessment offers students an opportunity to improve their interpersonal skills and work habits.

Dissecting first-year students' perceptions of health profession groups: potential barriers to interprofessional education.

BACKGROUND: Previous research has shown that health profession students enter interprofessional education (IPE) programs with negative perceptions of health disciplines other than their own, which could serve as possible barriers to engagement with interprofessional principles. Yet, past studies have not fully dissected these perceptions, nor have they examined how these perceptions may contrast with how students view their own future profession. METHODS/FINDINGS: A total of 638 students from six different health profession training programs completed surveys assessing their perceptions/stereotypes of their own and other health professions. ANOVA and MANCOVA analyses showed a high degree of variability in how each profession is perceived by the students, but that the students, regardless of discipline (except medical students), rated their own profession the highest on almost every attribute listed. CONCLUSIONS: The data provide evidence for the tenets of Social Identity Theory raised in the relevant literature. The authors also suggest that the lack of adequately formulated "professional-in-training" identity, as well as the formidability of anticipatory socialization, help to foster and perpetuate these stereotypes and that IPE programs have the potential to exacerbate these negative perceptions.

Jefferson interprofessional clinical rounding project: an innovative approach to patient care.

BACKGROUND: Bedside rounding is an historical clinical model that brings together care providers and the patient to discuss the plan of care. Interprofessional clinical rounding is an approach that uses this historical model to involve multiple health professions. This study was conducted to determine if a model of interprofessional clinical rounding could be implemented successfully in an acute care setting. METHODS: Teams consisting of medical, nursing, and pharmacy students were assigned to work with the attending physician (AP) in the colorectal surgery service. Prior to the rounding experience, students met to review and discuss patients' data from their discipline-specific perspective and then made a presentation of the case to the AP, who used these presentations as an educational opportunity, asking probing questions. A structured observation form was used to assess the team members' interaction during this process, and a debriefing was held at the conclusion of each experience. FINDINGS: Results of the observations suggested that most students were very engaged in the process, while summaries of the debriefing revealed a high level of satisfaction among participants. All groups suggested that they had a better understanding of the roles of other professions as a result of the increased communication and claimed that the process resulted in a more patient-centered approach. They also claimed that the additional information provided through the team approach resulted in a more integrated plan of care because input is provided from these different perspectives. CONCLUSION: Interprofessional bedside rounding can be implemented successfully, resulting in a more effective experience for health professions students.

Effect of the health mentors program on student attitudes toward team care.

Based on a growing body of literature documenting improved cost and quality outcomes related to good team care, interprofessional education (IPE) has been widely endorsed as critical to preparing the future healthcare workforce. This study evaluated the effect of a longitudinal team-based 2-year IPE curriculum on attitudes toward health care teams. Analyses included comparison of baseline measures to the end of the 2-year curriculum of each of the six participating disciplines (medicine, nursing, occupational therapy, pharmacy, physical therapy, and couple and family therapy). Differences between the disciplines were also analyzed. A significant improvement on a 14-item quality of care and teamwork of health professionals subscale of the Attitudes Toward Health Care Teams scale was found. Students surveyed in each of the six disciplines demonstrated significant improvements in attitudes toward quality of care and teamwork from the baseline measure at the beginning of the IPE program to the end of the 2-year program. There were no significant differences noted between disciplines. Assessment of attitudes toward health care teams assisted in evaluation and ongoing quality improvement of the IPE program and could potentially be used in other interprofessional programs that focus on health care teamwork. Next steps include longitudinal assessment of students throughout their programs and into practice to explore the sustainability of attitudes and behaviors, as well as impact on patient outcomes.

Attitudes of faculty and students in medicine and the health professions toward interprofessional education.

BACKGROUND: This study evaluated the important relationship between faculty and student attitudes toward interprofessional education using the Interdisciplinary Education Perception Scale (IEPS). METHODS: Medicine, nursing, occupational therapy, pharmacy, and physical therapy faculty (n = 177) completed the IEPS. Students from these disciplines participate in a 2-year, interdisciplinary curriculum in which they were assigned to a team to work with a patient volunteer. Students (n = 496) completed the IEPS at the end of program year one. The IEPS measures four factors: professional competence/autonomy; perceived need for professional cooperation; perception of actual cooperation/resource sharing within and across professions; and understanding the value of other professions. FINDINGS: Overall attitude scores for faculty and students were high, ranging from 3.93 to 4.40 on a 5-point scale. Attitudes on each factor were also high, with the exception of factor 4, "understanding the value of other professions," having the lowest scores, 3.26 to 3.92. CONCLUSION: The positive attitudes among faculty and students and across professions suggest an acceptance of the principles of interprofessional education and a readiness to engage in interprofessional practice. The lower scores on factor 4 indicate the need for additional educational programs focusing on understanding the roles of each profession.

Health professions students' use of social media.

The internet is increasingly a part of everyday life by facilitating networking opportunities and offering ways to associate with others who have similar interests, values, or goals. An online survey was administered to 644 first-year students and 413 graduating students via Surveymonkey to investigate their media preferences, to gauge if they are active on social media sites, and to evaluate how they responded to advertisements. Students were in the following health professions: biotechnology, couple and family therapy, medicine, nursing, occupational therapy, physical therapy, public health, radiologic and imaging sciences, and pharmacy. Results indicate that students prefer online media as their primary source of information. The majority of students were using Facebook, and very few were using Twitter or LinkedIn or other social networking sites. Understanding social media usage has several implications for educating, connecting with, and researching health professions students from all stages of their academic career.

Special issue on interprofessional education and care.

It's been 12 years since the Journal published its last special themed issue (see Winter 1998, volume 27, no. 1), focused on the World Congress held in Telford, UK, in July 1997. Since that time, there have been a number of subjects that probably warranted special attention, but were not addressed. For that, you can blame one of the Editors of this special issue, who served as Journal Editor during that 10-year period. The topic of interprofessional education (IPE) and care (IPC) is one such theme that warrants our attention at this time. Interprofessional approaches by now have received not only increased attention in the United States, but attention from across the globe. This makes the task of putting together this issue both easy but, at the same time, a bit daunting. Easy in the sense that there is no lack of reports, programs, and efforts at implementing both IPE and IPC from which to choose. Daunting for the same reason: Which are the ones that deserve special attention? What major initiative have we missed?