Leveraging Mindfulness to Reduce Stress and Improve Quality of Life Among Pharmacy Students.

OBJECTIVE: Methods to improve stress and well-being for health profession trainees are limited. Mindfulness, elevating awareness to the present moment experience with compassion, has been shown to demonstrate effectiveness to enhance well-being. This research leverages techniques from mindfulness to develop and evaluate a credit-bearing longitudinal mindfulness elective, designed to teach mindfulness to improve stress and quality of life (QoL). METHODS: A mindfulness elective was created for pharmacy students. A longitudinal, case-control, survey-based design was used to compare stress and QoL between mindfulness participants and nonparticipant controls. Stress was assessed by the Perceived Stress Scale (PSS) and QoL by the SF-12 v2 Health-Related QoL Scale (SF-12 v2 QoL). RESULTS: Four weeks after course completion, the average PSS score was lower among participants compared to controls (18.58 SD 5.85 vs 20.79 SD 6.31, Cohen's d = 0.36). The Mental Health Component score of SF-12 v2 QoL was higher among participants versus controls (41.94 SD 8.58 vs 36.93 SD 9.59, Cohen's d = 0.55). The Physical Health Component score of SF-12 v2 QoL was lower among participants than the control group (46.13 SD 5.48 vs 48.62 SD 6.53, Cohen's d = 0.41). CONCLUSION: The results indicate small to moderate effect sizes associated with participation in a mindfulness elective, reducing stress and improving mental QoL among pharmacy students. The structure and potential benefits of the course can be extrapolated to other institutions. By offering course credit for mindfulness practice, health profession schools can support student wellness.

Implementation of the AAMC's Holistic Review Model for Psychiatry Resident Recruitment.

Introduction: In psychiatry, several converging factors are impacting the recruitment of residents: the increased competitiveness of the specialty, the national trend to take active steps to improve diversity and inclusion, and the decision from USMLE to change Step 1 to a pass/fail result. Methods: We developed a workshop for psychiatry residency program directors to meet these challenges and transition into using a holistic review model during recruitment. The workshop included (1) a didactic session providing background on the AAMC holistic review model; (2) a small-group exercise to determine and prioritize experiences, attributes, competencies, and metrics (EACMs) aligned with the program's mission and aims; (3) a review of the rankings from the previous exercise, selection of two "very important" criteria for each of the four domains of the EACM model, and operationalization of these criteria based on the recruitment process; and (4) a discussion focused on application of program criteria with example applicants. Results: The holistic review workshop was conducted at the American Association of Psychiatry Residency Directors conference in 2021 with 48 self-selected attendees. Following the workshop, 74% of attendees reported a likelihood of implementing holistic applications during their next application cycle, 78% were able to leave with at least one actionable item, 100% thought that the session was interactive, and 78% felt that the session met their expectations. Discussion: Implementing a holistic review for psychiatry residency recruitment can assist programs in responding to the rapidly changing landscape and achieve aims for improving diversity and inclusion.

Patient involvement in assessment of postgraduate medical learners: A scoping review.

CONTEXT: Competency-based assessment of learners may benefit from a more holistic, inclusive, approach for determining readiness for unsupervised practice. However, despite movements towards greater patient partnership in health care generally, inclusion of patients in postgraduate medical learners' assessment is largely absent. METHODS: We conducted a scoping review to map the nature, extent and range of literature examining the inclusion (or exclusion) of patients within the assessment of postgraduate medical learners. Guided by Arskey and O'Malley's framework and informed by Levac et al. and Thomas et al., we searched two databases (MEDLINE® and Embase®) from inception until February 2021 using subheadings related to assessment, patients and postgraduate learners. Data analysis examined characteristics regarding the nature and factor influencing patient involvement in assessment. RESULTS: We identified 41 papers spanning four decades. Some literature suggests patients are willing to be engaged in assessment, however choose not to engage when, for example, language barriers may exist. When stratified by specialty or clinical setting, the influence of factors such as gender, race, ethnicity or medical condition seems to remain consistent. Patients may participate in assessment as a stand-alone group or part of a multi-source feedback process. Patients generally provided high ratings but commented on the observed professional behaviours and communication skills in comparison with physicians who focused on medical expertise. CONCLUSION: Factors that influence patient involvement in assessment are multifactorial including patients' willingness themselves, language and reading-comprehension challenges and available resources for training programmes to facilitate the integration of patient assessments. These barriers however are not insurmountable. While understudied, research examining patient involvement in assessment is increasing; however, our review suggests that the extent which the unique insights will be taken up in postgraduate medical education may be dependent on assessment systems readiness and, in particular, physician readiness to partner with patients in this way.

Can Nonclinician Raters Be Trained to Assess Clinical Reasoning in Postencounter Patient Notes?

PURPOSE: Clinical reasoning is often assessed through patient notes (PNs) following standardized patient (SP) encounters. While nonclinicians can score PNs using analytic tools such as checklists, these do not sufficiently encompass the holistic judgments of clinician faculty. To better model faculty judgments, the authors developed checklists with faculty-specified scoring formulas embedded in spreadsheets and studied the resulting interrater reliability (IRR) of nonclinician raters (SPs and medics) and student pass/fail status. METHOD: In Study 1, nonclinician and faculty raters rescored PNs of 55 third-year medical students across 5 cases of the 2017 Graduation Competency Examination (GCE) to determine IRR. In Study 2, nonclinician raters scored all notes of the 5-case 2018 GCE (178 students). Faculty rescored all notes of failing students and could modify formula-derived scores if faculty felt appropriate. Faculty also rescored and corrected scores of additional notes for a total of 90 notes (3 cases, including failing notes). RESULTS: Mean overall percent exact agreement between nonclinician and faculty ratings was 87% (weighted kappa, 0.86) and 83% (weighted kappa, 0.88) for Study 1 and Study 2, respectively. SP and medic IRRs did not differ significantly. Four students failed the note section in 2018; 3 passed after faculty corrections. Few corrections were made to nonfailing students' notes. CONCLUSIONS: Nonclinician PN raters using checklists and scoring rules may provide a feasible alternative to faculty raters for low-stakes assessments and for the bulk of well-performing students. Faculty effort can be targeted strategically at rescoring notes of low-performing students and providing more detailed feedback.

Prospective Observational Study of the Clinical Prognoses of Patients with Bloodstream Infections Caused by Ampicillin-Susceptible but Penicillin-Resistant Enterococcus faecalis.

The purpose of this study was to evaluate the clinical impacts of ampicillin-susceptible but penicillin-resistant (ASPR) phenotypes of Enterococcus faecalis on clinical outcomes in patients with bloodstream infection (BSI). A total of 295 patients with an E. faecalis BSI from six sentinel hospitals during a 2-year period (from May 2016 to April 2018) were enrolled in this study. Putative risk factors, including host-, treatment-, and pathogen-related variables, were assessed to determine the associations with the 30-day mortality rate of patients with an E. faecalis BSI. The proportion of ASPR E. faecalis isolates was 22.7% (67/295). ASPR isolates (adjusted odds ratio, 2.27; 95% confidence interval, 1.01 to 5.02) exhibited a significant association with an increased 30-day mortality rate, and a significant difference in survival was identified in a group of patients treated with ampicillin- and/or piperacillin-based regimens who were stratified according to the penicillin susceptibility of the causative pathogen (P = 0.011 by a log rank test). ASPR E. faecalis BSIs resulted in a >2-fold-higher 30-day mortality rate (26.9%; 18/67) than for the BSIs caused by penicillin-susceptible strains (12.3%; 28/228). The differences in mortality rates of patients stratified by penicillin susceptibility were likely due to the treatment failures of ampicillin and/or piperacillin in patients with an ASPR E. faecalis BSI.

Impact of host-pathogen-treatment tripartite components on early mortality of patients with Escherichia coli bloodstream infection: Prospective observational study.

BACKGROUND: Risk factors affecting early morality of patients with Escherichia coli bloodstream infection (BSI) were investigated including the host-pathogen-treatment tripartite components. METHODS: Six general hospitals in South Korea participated in this multicentre prospective observational study from May 2016 to April 2017 and a total of 1492 laboratory-confirmed E. coli BSI cases were studied. Cox regression was used to estimate risks of the primary endpoint, i.e., all-cause mortality within 30 days from the initial blood culture. Six multivariate analysis models were constructed in accordance to the clinical importance and intra- and inter-component multicollinearity. FINDINGS: Among the 1492 E. coli BSI cases, 9.5% (n = 141) patients expired within 30 days. Six models of multivariate analysis indicated risk factors of critical illness, primary infection of peritoneum, and chronic liver disease including cirrhosis for host variables; of phylogenetic group B2, ST131-sublineage H30Rx, multidrug resistance, group 1 CTX-M extended-spectrum beta-lactamase production, and having either of fyuA, afa, and sfa/foc virulence genes for causative E. coli pathogen variables; and of delayed definitive therapy for antimicrobial treatment variables. In addition, as a protective factor, primary urinary tract infection was identified. INTERPRETATION: Despite decades' effort searching for the risk factors for E. coli BSI, systemic understanding covering the entire tripartite component is still lacking. This study detailed the organic impact of host-pathogen-treatment tripartite components for early mortality in patients with E. coli BSI.

Changes in Antimicrobial Usage Patterns in Korea: 12-Year Analysis Based on Database of the National Health Insurance Service-National Sample Cohort.

National antimicrobial usage and prescription patterns during the 12 years from 2002 to 2013 were analyzed using the National Health Insurance Service-National Sample Cohort. Antimicrobial usage was analyzed by major illness, sex, age, area of residence, income rank, diagnosis, and type of medical institution for each year. Total antimicrobial prescriptions increased from 15.943 daily defined dose (DDD)/1,000 inhabitants/day in 2002 to 24.219 in 2013. In 2013, 72% of total prescriptions were administered in clinics. Antimicrobials were most frequently prescribed to children younger than 10 years, followed by adults aged 70 years or older and those aged 60-69 years. Penicillins and cephems were the most popular classes of antimicrobial used. In 2013, 48% of total antibiotic usage (11.683 DDD/1,000 inhabitants/day) was due to respiratory diseases. After the Korean government has implemented a series of healthcare policies, antibiotic prescription decreased for the treatment of upper respiratory infection, the causative agents are mostly viruses.

Beyond cognitive measures: Empirical evidence supporting holistic medical school admissions practices and professional identity formation.

This article was migrated. The article was marked as recommended. Background: Medical schools seek admissions methods that identify applicants who hold promise to become physicians who will navigate and shape the future medical landscape. The focus on traditional cognitive measures for admission has prompted calls for holistic admissions review during the past five years. Yet, empirical evidence linking selection measures to holistic admissions practices has not been fully established, including their relationship with professional identity formation over time. A non-cognitive admissions situational judgment screening test (CASPer) measuring personal and professional characteristics was added to the University of Illinois College of Medicine admissions process two years ago, as we implemented a new curriculum that emphasizes professional identity development. Purpose: This study examined associations among admissions measures (Medical College Admission Test [MCAT], grade point average [GPA], interview, and CASPer), and their predictive relationships with curricular measures of professional identity formation (Professional Identity Essay [PIE]) and moral reasoning (Defining Issues Test [DIT2]). Methods: Data were taken from two entering cohorts ( n = 596; entering class of 2017 and 2018 across 3 regional sites). Correlations and regression analyses were used to examine associations between admissions and professional identity measures. Results: CASPer and in-person admissions interview ratings had significant positive correlations, suggesting that CASPer can contribute to effective screening processes. In addition, CASPer demonstrated statistically significant positive relationships with professional identity (CASPer and PIE, r=.10, p<.05) and a measure of moral reasoning (CASPer and DIT2 type indicator, r=.09, p<.05). Association between CASPer and PIE remained consistent, even after controlling for MCAT, interview, and GPA. Conclusion: Our institutional focus on professional identity formation has provided new ways to conceptualize students' readiness for medical school - demonstrated academic rigor as well as signs of professionalism, ethics, and motivation. Non-academic factors measured in situational judgment tests may promote better alignment of admissions practices and desired educational outcomes.