Identifying potential engaging leaders within medical education: The role of positive influence on peers.

BACKGROUND: Previous research has paid little to no attention towards exploring methods of identifying existing medical student leaders. AIM: Focusing on the role of influence and employing the tenets of the engaging leadership model, this study examines demographic and academic performance-related differences of positive influencers and if students who have been peer-identified as positive influencers also demonstrate high levels of genuine concern for others. METHODS: Three separate fourth-year classes were asked to designate classmates that had significant positive influences on their professional and personal development. The top 10% of those students receiving positive influence nominations were compared with the other students on demographics, academic performance, and genuine concern for others. RESULTS: Besides age, no demographic differences were found between positive influencers and other students. High positive influencers were not found to have higher standardized exam scores but did receive significantly higher clinical clerkship ratings. High positive influencers were found to possess a higher degree of genuine concern for others. CONCLUSION: The findings lend support to (a) utilizing the engaging model to explore leaders and leadership within medical education, (b) this particular method of identifying existing medical student leaders, and

Preparing for the MD: How Long, at What Cost, and With What Outcomes?

PURPOSE: To assess educational and professional outcomes of an accelerated combined bachelor of science-doctor of medicine (BS-MD) program using data collected from 1968 through 2018. METHOD: Participants of this longitudinal study included 2,235 students who entered medical school between 1968 and 2014: 1,134 in the accelerated program and 1,101 in the regular curriculum (control group)-matched by year of entrance to medical school, gender, and Medical College Admission Test (MCAT) scores. Outcome measures included performance on medical licensing examinations, academic progress, satisfaction with medical school, educational debt, first-year residency program directors' ratings on clinical competence, specialty choice, board certification, and faculty appointments. RESULTS: The authors found no practically important differences between students in the accelerated program and those in the control group on licensing examination performance, academic progress, specialty choice, board certification, and faculty appointments. Accelerated students had lower mean educational debt (P < .01, effect sizes = 0.81 and 0.45 for, respectively, their baccalaureate debt and medical school debt), lower satisfaction with their second year of medical school (P < .01, effect size = 0.21), and lower global satisfaction with their medical school education (P < .01, effect size = 0.35). Residency program directors' ratings in 6 postgraduate competency areas showed no practically important differences between the students in the accelerated program and those in the control group. The proportion of Asian students was higher among program participants (P < .01, effect size = 0.43). CONCLUSIONS: Students in the accelerated program earned BS and MD degrees at a faster pace and pursued careers that were comparable to students in a matched control who were in a regular MD program. Findings indicate that shortening the length of medical education does not compromise educational and professional outcomes.

Disciplinary action by medical boards and prior behavior in medical school.

BACKGROUND: Evidence supporting professionalism as a critical measure of competence in medical education is limited. In this case-control study, we investigated the association of disciplinary action against practicing physicians with prior unprofessional behavior in medical school. We also examined the specific types of behavior that are most predictive of disciplinary action against practicing physicians with unprofessional behavior in medical school. METHODS: The study included 235 graduates of three medical schools who were disciplined by one of 40 state medical boards between 1990 and 2003 (case physicians). The 469 control physicians were matched with the case physicians according to medical school and graduation year. Predictor variables from medical school included the presence or absence of narratives describing unprofessional behavior, grades, standardized-test scores, and demographic characteristics. Narratives were assigned an overall rating for unprofessional behavior. Those that met the threshold for unprofessional behavior were further classified among eight types of behavior and assigned a severity rating (moderate to severe). RESULTS: Disciplinary action by a medical board was strongly associated with prior unprofessional behavior in medical school (odds ratio, 3.0; 95 percent confidence interval, 1.9 to 4.8), for a population attributable risk of disciplinary action of 26 percent. The types of unprofessional behavior most strongly linked with disciplinary action were severe irresponsibility (odds ratio, 8.5; 95 percent confidence interval, 1.8 to 40.1) and severely diminished capacity for self-improvement (odds ratio, 3.1; 95 percent confidence interval, 1.2 to 8.2). Disciplinary action by a medical board was also associated with low scores on the Medical College Admission Test and poor grades in the first two years of medical school (1 percent and 7 percent population attributable risk, respectively), but the association with these variables was less strong than that with unprofessional behavior. CONCLUSIONS: In this case-control study, disciplinary action among practicing physicians by medical boards was strongly associated with unprofessional behavior in medical school. Students with the strongest association were those who were described as irresponsible or as having diminished ability to improve their behavior. Professionalism should have a central role in medical academics and throughout one's medical career.

Validating an Ataxia Functional Composite Scale in spinocerebellar ataxia.

The Ataxia Functional Composite Scale (AFCS) may provide a sensitive and reproducible assessment of treatment responses in studies of the spinocerebellar ataxias (SCA). We previously assessed the effects of buspirone in a cohort of patients with SCA via the International Cooperative Ataxia Rating Scale (ICARS). At each assessment period, AFCS scores were also obtained. A strong correlation of AFCS with ICARS scores was demonstrated at all assessment periods. This study supports the validity of the AFCS as a useful assessment of ataxia in this population.

Does physician attire influence patient satisfaction in an outpatient obstetrics and gynecology setting?

OBJECTIVE: The purpose of our study was to determine whether physician attire played a role in patient satisfaction after a new obstetrician/gynecologist encounter. STUDY DESIGN: Over a 3-month period, 20 physicians were randomly assigned to dress in business attire, casual clothing, or scrub suit each week. One thousand one hundred sixteen patients who had an office visit with a new obstetrician/gynecologist for at least 10 minutes completed a satisfaction survey, which assessed patient comfort as well as perception of the competency and professionalism of the physician. Patients were blinded to the physician attire manipulation. RESULTS: There was no difference in the mean overall satisfaction score among the 3 physician attire groups. No differences existed in satisfaction scores when analyzed by individual survey item or by demographic factors, after controlling for attire. CONCLUSION: Patients are equally satisfied with physicians who dress in business attire, casual clothing, or scrub suit.

Treatment of spinocerebellar ataxia with buspirone.

Preliminary data suggest potential benefit of 5-HT receptor agonists in the treatment of ataxias. We studied the effects of buspirone in a cohort of twenty patients with spinocerebellar ataxia (SCA). Twenty patients were treated in this double-blind, placebo controlled, cross-over trial with either buspirone HCl 30 mg twice daily or placebo for 3 months. Buspirone was not shown to be superior to placebo in the treatment of patients with SCA.

Development and evaluation of a 1-day interclerkship program for medical students on medical errors and patient safety.

Medical students need to be well informed about medical errors and patient safety. Pursuant to a needs assessment and pilot program, 229 third-year students participated in a 1-day program on patient safety including a plenary session and workshops. Attitudes and beliefs were measured by a survey at the beginning and end of the program. Completed surveys were returned by 124 (54%) students. Their level of agreement with 14 of 21 rating scale items changed in the expected direction. There were 7 items in which the students' baseline responses were already positive and did not change significantly. A 1-day program on patient safety in the third year of medical school can change students' attitudes and beliefs. There may be a subset of students needing closer attention. The findings provide evidence for the validity of the attitude survey and reinforce the effectiveness of interclerkship programs in medical schools.

Effects of a Brief Curricular Intervention on Medical Students' Attitudes Toward People with Disabilities in Healthcare Settings.

This study sought to evaluate the effects of a brief curricular intervention on medical students' attitudes toward physical disability in healthcare settings. Students participated in a focused curriculum about people with disabilities (PWDs), which included 2.5 hours of lectures, panel discussions, and video presentations. After the curricular sessions, students were surveyed (n = 237), and their attitudes toward PWDs in healthcare settings were compared with those of students who did not undergo the intervention (n = 251) using the Disability Attitudes in Health Care (DAHC) scale. Thematic analysis of the students' comments regarding the session was performed to supplement the DAHC scale. The intervention group responded with significantly more positive attitudes on 6 of the 17 items on the DAHC scale, and multiple linear regression analysis confirmed the independent effect of the curriculum on higher DAHC scale scores. Female students had more positive attitudes on the survey than did male students, although the effect of the curriculum was independent of gender. Previous experiences with PWDs did not correlate to higher attitude scores. These results suggest that a brief curricular intervention on disability can engender more positive attitudes in medical students toward PWDs.

Predicting Peer Nominations Among Medical Students: A Social Network Approach.

PURPOSE: Minimal attention has been paid to what factors may predict peer nomination or how peer nominations might exhibit a clustering effect. Focusing on the homophily principle that "birds of a feather flock together," and using a social network analysis approach, the authors investigated how certain student- and/or school-based factors might predict the likelihood of peer nomination, and the clusters, if any, that occur among those nominations. METHOD: In 2013, the Jefferson Longitudinal Study of Medical Education included a special instrument to evaluate peer nominations. A total of 211 (81%) of 260 graduating medical students from the Sidney Kimmel Medical College responded to the peer nomination question. Data were analyzed using a relational contingency table and an ANOVA density model. RESULTS: Although peer nominations did not cluster around gender, age, or class rank, those students within an accelerated program, as well as those entering certain specialties, were more likely to nominate each other. The authors suggest that clerkships in certain specialties, as well as the accelerated program, may provide structured opportunities for students to connect and integrate, and that these opportunities may have an impact on peer nomination. The findings suggest that social network analysis is a useful approach to examine various aspects of peer nomination processes. CONCLUSIONS: The authors discuss implications regarding harnessing social cohesion within clinical clerkships, the possible development of siloed departmental identity and in-group favoritism, and future research possibilities.

Medical School Anatomy and Pathology Workshops for High School Students Enhance Learning and Provide Inspiration for Careers in Medicine.

"Anatomy and Pathology Workshop" is a cadaver-based outreach program that models medical education to large groups of high school students. This study was designed to evaluate the impact of this program on students' knowledge of anatomy and interest in biomedical science. A total of 144 high school students participated in the workshop in 2015. Preworkshop and postworkshop assessments were administered to assess students' learning. A postworkshop survey was conducted to solicit students' reflections and feedback. It was found that student performance in the postworkshop examination (mean 78%) had significantly improved when compared to the performance in the preexamination (mean 54%), indicating that this program enhances learning. Students were also inspired to consider opportunities in medicine and allied health professions-97% indicated that they had a better understanding of medical education; 95% agreed that they had better understanding of the human body; 84% thought anatomy was interesting and exciting; and 62% of the students indicated that they looked forward to studying medicine or another health profession. Students rated the instructors highly-95% agreed that the instructors were professional and served as role models. Medical/graduate student instructors were also highly regarded by the high school students-96% thought it was valuable to have student instructors and 94% thought that student instructors were caring and enthusiastic about teaching. In summary, this study demonstrates that outreach programs provided by medical schools help young adults during their formative years by modeling professionalism, providing role models, enhancing learning, and encouraging many to consider opportunities in the health professions.

Measuring professionalism: a review of studies with instruments reported in the literature between 1982 and 2002.

PURPOSE: To describe the measurement properties of instruments reported in the literature that faculty might use to measure professionalism in medical students and residents. METHOD: The authors reviewed studies published between 1982 and 2002 that had been located using Medline and four other databases. A national panel of 12 experts in measurement and research in medical education extracted data from research reports using a structured critique form. RESULTS: A total of 134 empirical studies related to the concept of professionalism were identified. The content of 114 involved specific elements of professionalism, such as ethics, humanism, and multiculturalism, or associated phenomena in the educational environment such as abuse and cheating. Few studies addressed professionalism as a comprehensive construct (11 studies) or as a distinct facet of clinical competence (nine studies). The purpose of 109 studies was research or program evaluation, rather than summative or formative assessment. Sixty five used self-administered instruments with no independent observation of the participants' professional behavior. Evidence of reliability was reported in 62 studies. Although content validity was reported in 86 studies, only 34 provided strong evidence. Evidence of concurrent or predictive validity was provided in 43 and 16 studies, respectively. CONCLUSIONS: There are few well-documented studies of instruments that can be used to measure professionalism in formative or summative evaluation. When evaluating the tools described in published research it is essential for faculty to look critically for evidence related to the three fundamental measurement properties of content validity, reliability, and practicality.

Can empathy, other personality attributes, and level of positive social influence in medical school identify potential leaders in medicine?

PURPOSE: To test the hypotheses that medical students recognized by peers as the most positive social influencers would score (1) high on measures of engaging personality attributes that are conducive to relationship building (empathy, sociability, activity, self-esteem), and (2) low on disengaging personality attributes that are detrimental to interpersonal relationships (loneliness, neuroticism, aggression-hostility, impulsive sensation seeking). METHOD: The study included 666 Jefferson Medical College students who graduated in 2011-2013. Students used a peer nomination instrument to identify classmates who had a positive influence on their professional and personal development. At matriculation, these students had completed a survey that included the Jefferson Scale of Empathy and Zuckerman-Kuhlman Personality Questionnaire short form and abridged versions of the Rosenberg Self-Esteem Scale and UCLA Loneliness Scale. In multivariate analyses of variance, the method of contrasted groups was used to compare the personality attributes of students nominated most frequently by their peers as positive influencers (top influencers [top 25% in their class distribution], n = 176) with those of students nominated least frequently (bottom influencers [bottom 25%], n = 171). RESULTS: The top influencers scored significantly higher on empathy, sociability, and activity and significantly lower on loneliness compared with the bottom influencers. However, the effect size estimates of the differences were moderate at best. CONCLUSIONS: The research hypotheses were partially confirmed. Positive social influencers appear to possess personality attributes conducive to relationship building, which is an important feature of effective leadership. The findings have implications for identifying and training potential leaders in medicine.

Increased rates of pregnancy complications in women with celiac disease.

BACKGROUND: Celiac disease is an immune-mediated small bowel disorder that develops in genetically susceptible individuals upon exposure to dietary gluten. Celiac disease could have extra-intestinal manifestations that affect women's reproductive health. The aim of this study was to investigate fertility and outcomes of pregnancy among women with celiac disease. METHODS: In a retrospective cohort study, we analyzed information collected from patients at a tertiary care celiac center and from members of 2 national celiac disease awareness organizations. Women without celiac disease were used as controls. Women completed an anonymous online survey, answering 43 questions about menstrual history, fertility, and outcomes of pregnancy (329 with small bowel biopsy-confirmed celiac disease and 641 controls). RESULTS: Of the 970 women included in the study, 733 (75.6%) reported that they had been pregnant at some point; there was no significant difference between women with celiac disease (n=245/329, 74.5%) and controls (488/641, 76.1%; P=0.57). However, fewer women with celiac disease than controls (79.6% vs. 84.8%) gave birth following 1 or more pregnancies (P=0.03). Women with celiac disease had higher percentages of spontaneous abortion than controls (50.6% vs. 40.6%; P=0.01), and of premature delivery (23.6% vs. 15.9% among controls; P=0.02). The mean age at menarche was higher in the celiac disease group (12.7 years) than controls (12.4 years; P=0.01). CONCLUSIONS: In a retrospective cohort analysis examining reproductive features of women with celiac disease, we associated celiac disease with significant increases in spontaneous abortion, premature delivery, and later age of menarche.

Do global rating forms enable program directors to assess the ACGME competencies?

PURPOSE: In 1999 the Accreditation Council for Graduate Medical Education (ACGME) mandated that GME programs require their residents to be proficient in six general competencies. The purpose of this study was to ascertain whether an existing global rating form could be modified to assess these competencies. METHOD: A rating form covering 23 skills described in the ACGME competencies was developed. The directors of 92 specialty and subspecialty programs at Thomas Jefferson University Hospital and the Albert Einstein Medical Center in Philadelphia were asked to rate residents at the end of the 2001-02 and 2002-03 academic years. RESULTS: Ratings for 1,295 of 1,367 (95%) residents were available. Residents were awarded the highest mean ratings on items tied to professionalism, compassion, and empathy. The lowest mean ratings were assigned for items related to consideration of costs in care and management of resources. Factor analysis indicated that the program directors viewed overall competence in two dimensions of medical knowledge and interpersonal skills. This factor structure was stable for groups of specialties, and residents' gender and training level. Mean ratings in each dimension were progressively higher for residents at advanced levels of training. CONCLUSION: Global rating forms, the tool that program directors use most frequently to document residents' competence, may not be adequate to assess the six general competencies. The results are consistent with earlier published research indicating that physicians view competence in just two broad dimensions, which questions the premise of the six ACGME competencies. Further research is needed to validate and measure six distinct dimensions of clinical competence.

Evaluation of the UME-21 initiative at 18 medical schools between 1999 and 2001.

BACKGROUND: This study evaluated the processes of curricular change and the initial outcomes of the Undergraduate Medical Education for the 21st Century (UME-21) project at 18 schools. METHODS: Site visits were conducted at eight partner schools in 1999 and 2001. Written proposals, progress reports, and final reports of 18 schools were reviewed. Senior medical students' responses to questionnaires, including the annual Association of American Medical Colleges Graduation Questionnaire and a UME-21 supplemental graduation questionnaire, were analyzed. RESULTS: There was variation among the schools in the curriculum at baseline, in the structure of the UME-21 innovation that was introduced, and in the process of implementation. There was an increase in seniors' ratings of instruction in the newer areas of evidencebased medicine, quality assurance, and cost-effectiveness in relation to national norms between 1999 and 2001. There was less impact on the more traditional content areas of ethics, patient communications, prevention, and leadership skills. CONCLUSIONS: The circumstances of the national evaluation introduced many methodological complexities, some of which could have been avoided if planning for evaluation had started earlier. However, the evaluation revealed that even modest funding directed toward specific curricular goals can produce measurable change and can have effects that extend beyond the initial scope of the project.

Equivalence of students' scores on timed and untimed anatomy practical examinations.

Untimed examinations are popular with students because there is a perception that first impressions may be incorrect, and that difficult questions require more time for reflection. In this report, we tested the hypothesis that timed anatomy practical examinations are inherently more difficult than untimed examinations. Students in the Doctor of Physical Therapy program at Thomas Jefferson University were assessed on their understanding of anatomic relationships using multiple-choice questions. For the class of 2012 (n = 46), students were allowed to circulate freely among 40 testing stations during the 40-minute testing session. For the class of 2013 (n = 46), students were required to move sequentially through the 40 testing stations (one minute per item). Students in both years were given three practical examinations covering the back/upper limb, lower limb, and trunk. An identical set of questions was used for both groups of students (untimed and timed examinations). Our results indicate that there is no significant difference between student performance on untimed and timed examinations (final percent scores of 87.3 and 88.9, respectively). This result also held true for students in the top and bottom 20th percentiles of the class. Moreover, time limits did not lead to errors on even the most difficult, higher-order questions (i.e., items with P-values < 0.70). Thus, limiting time at testing stations during an anatomy practical examination does not adversely affect student performance.

Development and evaluation of a program to strengthen first year residents' proficiency in leading end-of-life discussions.

PURPOSE: Multiple interventions have been developed to teach and improve internal medicine residents' end-of-life communication skills, but have not been easily adaptable to other institutions. The purpose of this study was to develop and evaluate a program to enhance physicians' end-of-life communication with families of dying patients using a format that could be incorporated into an existing curriculum for first-year internal medicine residents. METHODS: An end-of-life educational program was developed and evaluated in the context of educating first-year residents at an urban academic medical center during the 2008-2009 academic year. The program consisted of three sessions including an interactive workshop flanked by pre- and post-workshop evaluations in simulated encounter and clinical vignette formats. Simulated encounters were recorded on video and residents' performances were rated by two independent observers using a 23 point checklist. RESULTS: Complete data were available for 24 (73%) of 33 residents who participated in the program. The residents' checklist scores increased significantly from a mean of 48.1 at baseline to 73.9 at follow-up. The increase in the scores on the clinical vignettes was also statistically significant, but of lesser magnitude. CONCLUSIONS: A short, focused intervention can have significant impact on residents' communication skills in the setting of an end-of-life objective structured clinical examination (OSCE).

Evaluation of the use of patient-focused simulation for student assessment in a surgery clerkship.

BACKGROUND: The purpose of this study was to evaluate the use of simulated patients in conjunction with anatomic and tissue task-training models to assess skills. METHODS: Faculty reviewed the objectives of the clerkship to identify skills to be acquired. Three cases were developed related to rectal examination, suturing, and inserting intravenous lines and nasogastric tubes. Student scores were based on their ability to gather data from simulated patients and perform procedures on simulation models. RESULTS: A total of 670 students were assessed between 2006 and 2009. Alpha reliability coefficients were .97 for Communication/Interpersonal Skills, .71 for Procedures, and .58 for Data Gathering. Students receiving low ratings from faculty in the clerkship had significantly (P < .001) lower simulation scores. There were significant (P < .001) relationships between scores and grades in other clerkships. CONCLUSIONS: The combination of simulated patients and simulation models yielded reliable scores for procedural and interpersonal skills, and evidence of validity related to clinical ratings.

Resident scores on a patient satisfaction survey: evidence for maintenance of communication skills throughout residency.

OBJECTIVE: To examine whether resident communication skills evaluated through patient satisfaction surveys demonstrate evidence of decline through the 3 years of internal medicine residency. METHODS: Data for this study were collected retrospectively from a database of patient satisfaction surveys completed for internal medicine residents at different levels of training. Patient satisfaction was measured with the Aggregated EVGFP (excellent, very good, good, fair, or poor) questionnaire recommended by the American Board of Internal Medicine. RESULTS: Over a span of 5 years (2005-2009), a total of 768 patient rating forms were completed for 67 residents during their 3 years of residency training. In postgraduate year (PGY)-1, the residents had a mean satisfaction rating of 4.33 ± 0.48 compared to a mean rating of 4.37 ± 0.45 in their PGY-3 year. Analysis of variance indicated no significant difference by PGY level. CONCLUSION: Our findings demonstrate that resident communication skills and patient satisfaction do not decline during the 3 years of residency. This is contrary to our hypothesis that patient satisfaction would worsen as residents progressed through training.