Building Interest in the Primary Care Specialty Through Enhanced Global Health Experience.

Background An overwhelming majority of matriculating medical students in the USA are keen to deliver quality health care to all people, including the socioeconomically disadvantaged populations in remote, resource-scarce regions nationally and worldwide. Here, we describe a protocol developed to evaluate the interest of our medical students in global health activities. We also examined the relationship between students' interest in global health and readiness to pursue a future career in the primary care specialty. Materials and methods We designed a survey in Qualtrics online software and reached all first-year and third-year medical students between 2019 and 2022 enrolled at the Alabama College of Osteopathic Medicine (ACOM). The survey utilized ordinal scale items to explore the medical students' interest in primary care residency programs, their interest in global health and international travel, and their perceptions of how a range of factors might motivate their desire to participate in global health activities. The study was approved by ACOM's Institutional Review Board (IRB). In order to compare findings from this study with data from other medical schools, we developed constructs using the national aggregate data, in percentages, from matriculants and graduates of Doctor of Osteopathic Medicine (DO) degree-granting medical schools according to gender, published by the American Association of Colleges of Osteopathic Medicine (AACOM). Statistical analysis of national aggregate data was performed using the unpaired t-test. Results Both female and male participants had lived or traveled abroad before starting medical school. Female (98%, n=249) and male (95%, n=140) participants in the first-year cohorts considered helping the underserved population as important or very important as it is related to a career in medicine. Females in the third-year cohorts (97%, n=71) also ranked this statement as important or very important compared to male cohorts (89%, n=31). A higher proportion of females (43%, n=108) compared to males (35%, n=52) in first-year cohorts agreed or strongly agreed that they would likely pursue a residency in primary care. More females (59%, n=43) than males (46%, n=16) in the third-year cohorts agreed or strongly agreed with the same statement. Analysis of the aggregate national data (2009-2022) revealed that the percentage (actual count not available) of female students who planned to practice in underserved/shortage area was higher both at the time of matriculation (M=51%, SD=4%) and before graduation (M=40%, SD=4%) compared to males (matriculation: M=40%, SD=5%; graduation: M=33%, SD=4%) presenting a significant difference (matriculation t(24)=6.7, p<0.0001; graduation t(24)=5.4, p<0.0001). Furthermore, a higher percentage of females at the time of matriculation (M=25%, SD=5%) and graduation (M=40%, SD=6%) planned to practice in the primary care specialties compared to males (matriculation: M=17%, SD=4%; graduation: M=29%, SD=6%) presenting a significant difference (matriculation: t(24)=4.6, p = 0.0001; graduation: t(24)=4.8, p<0.0001). Conclusions Interest in global health activities may be associated with interest in pursuing a future career in the primary care specialty. In this study, more female medical students expressed interest in participating in global health experiences, serving the underserved population domestically and abroad, and expressing interest in primary care than males.

Health Indicators as Measures of Individual Health Status and Their Public Perspectives: Cross-sectional Survey Study.

BACKGROUND: Disease status (eg, cancer stage) has been used in routine clinical practice to determine more accurate treatment plans. Health-related indicators, such as mortality, morbidity, and population group life expectancy, have also been used. However, few studies have specifically focused on the comprehensive and objective measures of individual health status. OBJECTIVE: The aim of this study was to analyze the perspectives of the public toward 29 health indicators obtained from a literature review to provide evidence for further prioritization of the indicators. The difference between health status and disease status should be considered. METHODS: This study used a cross-sectional design. Online surveys were administered through Ohio University, ResearchMatch, and Clemson University, resulting in three samples. Participants aged 18 years or older rated the importance of the 29 health indicators. The rating results were aggregated and analyzed as follows (in each case, the dependent variables were the individual survey responses): (1) to determine the agreement among the three samples regarding the importance of each indicator, where the independent variables (IVs) were the three samples; (2) to examine the mean differences between the retained indicators with agreement across the three samples, where the IVs were the identified indicators; and (3) to rank the groups of indicators into various levels after grouping the indicators with no mean differences, where the IVs were the groups of indicators. RESULTS: In total, 1153 valid responses were analyzed. Descriptive statistics revealed that the top five-rated indicators were drug or substance abuse, smoking or tobacco use, alcohol abuse, major depression, and diet and nutrition. Among the 29 health indicators, the three samples agreed upon the importance of 13 indicators. Inferential statistical analysis indicated that some of the 13 indicators held equal importance. Therefore, the 13 indicators were categorized by rank into seven levels: level 1 included blood sugar level and immunization and vaccination; level 2 included LDL cholesterol; level 3 included HDL cholesterol, blood triglycerides, cancer screening detection, and total cholesterol; level 4 included health literacy rate; level 5 included personal care needs and air quality index greater than 100; level 6 included self-rated health status and HIV testing; and level 7 included the supply of dentists. Levels 1 to 3 were rated significantly higher than levels 4 to 7. CONCLUSIONS: This study provides a baseline for prioritizing 29 health indicators, which can be used by electronic health record or personal health record system designers or developers to determine what can be included in the systems to capture an individual's health status. Currently, self-rated health status is the predominantly used health indicator. Additionally, this study provides a foundation for tracking and measuring preventive health care services more accurately and for developing an individual health status index.

A "U-shaped" Curve: Appreciating How Primary Care Residency Intention Relates to the Cost of Board Preparation and Examination.

INTRODUCTION: The shortage of primary care physicians in the United States has warranted an investigation into how medical education debt and other factors influence medical students' interests in primary care (PC) residencies. However, sparse research has studied how the cost of board preparation and examination relates to career choice. The objective of this study was to determine if there is an association between the cost of preparing and sitting for board examinations and the intention to enter a PC residency for osteopathic medical students. METHODS: We postulated that students who incurred higher financial costs from preparing and sitting for board examinations would be more likely to be interested in non-primary care (NPC) residencies. Using a non-experimental survey design, this study asked respondents to evaluate the following: "I plan to enter a Primary Care Residency (Family Medicine OR General Internal Medicine OR Pediatrics)" using a Likert scale. Respondents were also asked to select which board examination(s) and pertinent resource(s) they had purchased. Total costs were calculated per student. RESULTS: A total of 25,852 osteopathic medical students received the survey, of which 1,280 students responded to and completed it, yielding a 4.95% response rate. The distribution of respondents' intentions to pursue a primary care residency and costs spent yielded a "U" shaped curve. Respondents who Strongly Agreed and Strongly Disagreed to the statement "I plan to enter a Primary Care Residency" spent $5,744 and $5,070 on board-preparation and examination, respectively. No statistically significant differences were found between the cost of preparing and sitting for board examinations and the intention to enter primary care residencies when individuals were grouped by year in school and gender. CONCLUSIONS: Because competitive NPC specialties have relatively higher salaries, we suspected that students who intended to pursue these specialties would have had higher financial costs from board examination and preparation compared to students who intended to pursue PC residencies such as family medicine. Our findings further illustrate these specific educational costs do not correlate with students' stated intentions to enter primary care residencies. As efforts continue to determine a solution for the primary care physician shortage, it becomes clearer that the focus must also encompass non-financial influences that shape career choice.

The Cost of Board Examination and Preparation: An Overlooked Factor in Medical Student Debt.

Objective Board examinations in undergraduate medical education are imperative for competency assessment and a standard licensure process. While the cost of attendance and mean indebtedness of medical students have been quantified, the financial burden experienced by medical students from board preparation and examination has never been quantified. Materials and methods A total of 290 fourth-year osteopathic medical students from 38 osteopathic medical schools completed an anonymous survey that asked them to select the resources they had purchased for board preparation. Along with demographic information, respondents were asked which board examinations they had taken during their medical school education. The price for each resource was located by going to the resource website and finding the "list price" of a brand-new copy/version of that resource. If a price was not found, a current Amazon.com "list price" was utilized. These prices best approximate the maximum a student would spend per resource. Response and statistical analysis such as analysis of variance, post hoc comparison (Scheffé and Bonferronis test), and chi-square tests were conducted using the Statistical Package for Social Sciences (SPSS) Statistics, version 25.0 (IBM SPSS Statistics, Armonk, NY). Results This study found that osteopathic medical students spent, on average, $7,499 (s.d.=$2,506) for board preparation and examination. This cost when isolated is $3,370 for the cost of taking board examinations and $4,129 for the cost of board preparation. Respondents from the West were found to spend most at $9,432, while students from the Northeast spent the least, $7.090. Additionally, non-traditional medical students, those who matriculated after the age of 30 were found to spend more than individuals who began when they were under the age of 25 or between the ages of 25-30. The two most commonly used resources for both Level 1/Step 1 and Level 2/Step 2 examinations were COMBANK and UWorld.  Conclusions/relevance This study is the first of its kind to quantify the mean cost of board preparation and examination in undergraduate medical education at $7,499. When considering the mean indebtedness of the osteopathic graduating class of 2017-2018, 2.94% of medical education debt can be attributed to the cost of board preparation and assessments. As competitiveness for graduate medical education increases, individuals will spend more money to ensure a competitive board exam performance, a key selection factor. Stakeholders in undergraduate medical education are encouraged to further understand the interplay between medical student debt and the cost of board examinations and preparation.

Instrumento de evaluación para el desarrollo en edades tempranas de Frugone y Miño / Assessment instrument for early development of Frugone & Miño

OBJETIVO: Proponer una batería para evaluar el desarrollo motor para estudiantes de primer ciclo básico. METODOLOGÍA: se evaluó una muestra de 190 estudiantes, pertenecientes a tres establecimientos educacionales de la ciudad de Talca, Chile. El rango de edad oscila entre los 5 y 9 años de edad. RESULTADOS: El instrumento evidenció valores aceptables confiabilidad y consistencia interna (Alpha de Cronbach 0,829) Los puntos de corte adoptados son: p<33 Inicial, ≥p33 a p66 Elemental y ≥p66 maduro. Los resultados demuestran que no existen diferencias entre ambos géneros en relación a las habilidades motrices básicas de locomoción, manipulación y equilibrio. CONCLUSIÓN: test de Frugone y Miño es un instrumento fiable para contribuir de forma segura y confiada en la evaluación de los niveles del desarrollo motor en estudiantes escolarizados de primer ciclo básico, lo que sugiere su uso y aplicación en el colegio para monitorizar el progreso del desempeño motor de los alumnos de ambos sexos.

OBJECTIVE: Propose a cognitive assessment (battery) to evaluate the motor development of students during the first basic cycle. METHODOLOGY: A sample of 190 students was evaluated, belonging to three educational establishments in the city of Talca, Chile. The age range varied between 5 and 9 years of age. RESULTS: The instrument showed acceptable values, reliability and internal consistency (Cronbach's Alpha 0.829). The cutting points adopted are: p <33 Initial, ≥p33 to p66 Elemental and ≥p66 mature. CONCLUSION: Frugone & Miño test is a reliable instrument to safely and confidently contribute to the evaluation of the motor development levels in students enrolled in the first basic cycle, which suggests its use and application in school to monitor the progress of the motor performance of students from both sexes. The results show that there are no differences between both genders in relation to the basic motor skills of locomotion, manipulation and balance.

The Importance of Improving Youths' Attitudes Toward Science (ATS): A Validation of a Short Form Assessment of Attitudes in Science Constructs for Fourth Grade (AASC-4).

If children have opportunities to develop positive attitudes toward learning science, the pipeline to science careers can be maintained and enhanced. This article describes the development and validation of a short form, 24-item, ssessment of Attitudes in Science Constructs for Fourth Grade (AASC-4) for utilization in future research aimed at improving youths' Attitudes Toward Science (ATS). A researcher developed long form, 50-item AASC-4 was administered in an intervention and comparison, pre- and post-implementation science education study (n=1,117). Exploratory factor analysis was conducted to reduce the original 50-item AASC-4 to the current 24-item form. The current AASC-4 included 24 questions, and eight constructs. Reliability measures of the short-form AASC-4 improved reliability for Fear of Failure on Course from 0.200 to 0.694, Value of Science from 0.478 to 0.779, Attitudes of Family (Parents) toward Science from 0.706 to 0.754, and Perception of the Science Teacher from 0.700 to 0.791. Utilization of the validated constructs within the short-form AASC-4 may help researchers and educators identify science education intervention features that have positive impact on youths' ATS.

Exploring the Associations Among Nutrition, Science, and Mathematics Knowledge for an Integrative, Food-Based Curriculum.

BACKGROUND: Explore associations between nutrition, science, and mathematics knowledge to provide evidence that integrating food/nutrition education in the fourth-grade curriculum may support gains in academic knowledge. METHODS: Secondary analysis of a quasi-experimental study. Sample included 438 students in 34 fourth-grade classrooms across North Carolina and Ohio; mean age 10 years old; gender (I = 53.2% female; C = 51.6% female). Dependent variable = post-test-nutrition knowledge; independent variables = baseline-nutrition knowledge, and post-test science and mathematics knowledge. Analyses included descriptive statistics and multiple linear regression. RESULTS: The hypothesized model predicted post-nutrition knowledge (F(437) = 149.4, p < .001; Adjusted R = .51). All independent variables were significant predictors with positive association. CONCLUSIONS: Science and mathematics knowledge were predictive of nutrition knowledge indicating use of an integrative science and mathematics curriculum to improve academic knowledge may also simultaneously improve nutrition knowledge among fourth-grade students. Teachers can benefit from integration by meeting multiple academic standards, efficiently using limited classroom time, and increasing nutrition education provided in the classroom.

Healthcare employees' progression through disability benefits.

Progression of Disability Benefits (PODB) refers to the migration of workers with work-limiting disabilities through a system of economic disability benefits that result in their ultimate placement into the Social Security Disability Insurance (SSDI) system [16]. Specifically, this migration involves a "progression" from short-term disability (STD) to long-term disability (LTD) to SSDI income. This project uses Chi-squared Automatic Interaction (CHAID) Technique to study the Healthcare industry, the largest industry in the United States, and its PODB experience. The first part of the study analyzes if claimant demographic (age, gender, disability type) and PODB data (movement from STD to LTD to SSDI) can be used to predict employer industry (dependent variable). Gender was the most significant predictor, while men working outside of Healthcare had the greatest amount of progression to advanced disability levels. The second part of the study assesses if the PODB experience could be predicted through claimant demographics and the sub-set industry within Healthcare in which claimants' were employed. The resulting dendogram reveals that disability type was the strongest predictor of claimant movement through disability benefits levels. Age was the second strongest predictor for all but 1 category of disability type, in which the Healthcare sector was the strongest predictor.

Assessing Medical Student Professionalism: An Analysis of a Peer Assessment.

PURPOSE: Students' professional development is an essential aim of medical school. The purpose of this paper is to report how an assessment of first-year medical students' professional behavior was designed and to investigate its measurement characteristics. METHODS: The assessment was implemented as a peer assessment of professional skills, which were delineated according to a formal professional code developed by our curriculum committee. During the last week of the Fall 2005 semester, the professionalism assessment was administered online to students in a problem-based learning course. RESULTS: The internal consistency of the assessment is adequate. The generalizability study found that raters nested within persons accounted for the majority of variance. While the inter-rater reliability is relatively low, using multiple raters may yield an acceptable estimate of the relative reliability. CONCLUSIONS: The results suggest that this peer assessment is a practical assessment, evidenced by the 91% compliance rate. However, future research and modifications will be needed to address the variance of responses, helping to discriminate between "poor" and "good" observations of professionalism. In addition, multiple raters are required to supply reliable estimates of students' professional behavior. Coupling this evaluation with other professionalism evaluations may help reveal a more complete picture of students' professional behavior.