Student well-being during dedicated preparation for USMLE Step 1 and COMLEX Level 1 exams.

BACKGROUND: Nearly all U.S. medical students engage in a 4-8 week period of intense preparation for their first-level licensure exams, termed a "dedicated preparation period" (DPP). It is widely assumed that student well-being is harmed during DPPs, but evidence is limited. This study characterized students' physical, intellectual, emotional, and social well-being during DPPs. METHODS: This was a cross-sectional survey sent electronically to all second-year students at four U.S. medical schools after each school's respective DPP for USMLE Step 1 or COMLEX Level 1 in 2019. Survey items assessed DPP characteristics, cost of resources, and perceived financial strain as predictors for 18 outcomes measured by items with Likert-type response options. Open-ended responses on DPPs' influence underwent thematic analysis. RESULTS: A total of 314/750 (42%) students completed surveys. DPPs lasted a median of 7 weeks (IQR 6-8 weeks), and students spent 70 h/week (IQR 56-80 h/week) studying. A total of 62 (20%) reported experiencing a significant life event that impacted their ability to study during their DPPs. Most reported 2 outcomes improved: medical knowledge base (95%) and confidence in ability to care for patients (56%). Most reported 9 outcomes worsened, including overall quality of life (72%), feeling burned out (77%), and personal anxiety (81%). A total of 25% reported paying for preparation materials strained their finances. Greater perceived financial strain was associated with worsening 11 outcomes, with reported amount spent associated with worsening 2 outcomes. Themes from student descriptions of how DPPs for first-level exams influenced them included (1) opportunity for synthesis of medical knowledge, (2) exercise of endurance and self-discipline required for professional practice, (3) dissonance among exam preparation resource content, formal curriculum, and professional values, (4) isolation, deprivation, and anguish from competing for the highest possible score, and (5) effects on well-being after DPPs. CONCLUSIONS: DPPs are currently experienced by many students as a period of personal and social deprivation, which may be worsened by perceived financial stress more than the amount of money they spend on preparation materials. DPPs should be considered as a target for reform as medical educators attempt to prevent student suffering and enhance their well-being.

Breaking Bad News: A Small-Group Learning Module and Simulated Patient Case for Preclerkship Students.

INTRODUCTION: Breaking bad news is a difficult skill that can elicit significant distress among learners. As such, it is important for learners to practice this skill in a controlled environment, which affords time to address any distress that arises and the opportunity to receive supportive feedback on performance. This breaking bad news module was designed for preclerkship students with previous training in basic communication skills and served as capstone to the preclerkship portion of the communication skills curriculum. METHODS: The small-group session was delivered to groups of 10-12 students and facilitated by a faculty member with expertise in communication skills. The small-group session included approximately 60 minutes of didactics and discussion, followed by a 30-minute faculty demonstration with simulated patients (SPs). Learners then had 30 minutes to practice with the SPs and received constructive feedback from the SPs and the faculty facilitator. Approximately 1 week following the small-group module, learners participated in an individual encounter with an SP and were assessed on physical examination skills and communication skills. Learners received detailed evaluations and feedback on breaking bad news skills from the SPs. Finally, learners had individual feedback meetings with their faculty facilitator, who reviewed the videotaped encounters, focusing on performance and experience of breaking bad news to the SP. RESULTS: In the 2015-2016 academic year, 217 medical students participated in this module. Learners demonstrated proficiency in the physical exam skills with 90% of learners asking about 5/8 components of the presenting complaint and 85% performing 5/8 physical exam maneuvers correctly. Similarly learners demonstrated expected levels of competence in interpersonal and communication skills. DISCUSSION: This learning exercise provided training in a critical communication skill but also supplied a framework for assessing and responding to personal and patient distress.

Patterns of Sensitivity to Emotion in Children with Williams Syndrome and Autism: Relations Between Autonomic Nervous System Reactivity and Social Functioning.

Williams syndrome (WS) and autism spectrum disorder (ASD) are associated with atypical social-emotional functioning. Affective visual stimuli were used to assess autonomic reactivity and emotion identification, and the social responsiveness scale was used to determine the level social functioning in children with WS and ASD contrasted with typical development (TD), to examine syndrome-specific and syndrome-general features. Children with ASD exhibited the highest arousal in response to faces, with a lack of difference in autonomic sensitivity across different emotional expressions, unlike in WS and TD. The WS group demonstrated unique deficits in identifying neutral stimuli. While autonomic responsivity to neutral faces was associated with social functioning in all children, converging profiles characterized children with WS contrasted with TD and ASD.

FLS skill acquisition: a comparison of blocked vs interleaved practice.

INTRODUCTION: Fundamentals of Laparoscopic Surgery (FLS) certification is required for general surgery. The recommended practice for learning FLS is to practice tasks one at a time until proficient (blocked practice). Learning theory suggests that interleaved practice, a method in which tasks are rotated rather than learned one at a time, may result in superior learning. METHOD: Residents were randomized into 1 of 2 groups: blocked practice or interleaved practice. We compared the performance of residents across groups over 20 trials of each of 4 FLS tasks (peg transfer, pattern cut, extracorporeal suture, and intracorporeal suture). Four weeks later, participants returned to the laboratory and completed 2 additional trials of each of the 4 tasks. RESULTS: Performance on each of the tasks improved with increased practice. The interleaved group showed significantly better performance on the peg transfer task; trends favoring the interleaved group resulted for the other tasks. Standardized mean differences in favor of the interleaved group were substantial both at the end of practice and at follow-up (with the exception of the pattern cut). CONCLUSION: Interleaved practice appears to have advantages over blocked practice in developing and retaining FLS skills. We encourage others to experiment with the method to confirm our findings.

EEG sensorimotor correlates of translating sounds into actions.

Understanding the actions of others is a necessary foundational cornerstone for effective and affective social interactions. Such understanding may result from a mapping of observed actions as well as heard sounds onto one's own motor representations of those events. To examine the electrophysiological basis of action-related sounds, EEG data were collected in two studies from adults who were exposed to auditory events in one of three categories: action (either hand- or mouth-based sounds), non-action (environmental sounds), and control sounds (scrambled versions of action sounds). In both studies, triplets of sounds of the same category were typically presented, although occasionally, to ensure an attentive state, trials containing a sound from a different category were presented within the triplet and participants were asked to respond to this oddball event either covertly in one study or overtly in another. Additionally, participants in both studies were asked to mimic hand- and mouth-based motor actions associated with the sounds (motor task). Action sounds elicited larger EEG mu rhythm (8-13 Hz) suppression, relative to control sounds, primarily over left hemisphere, while non-action sounds showed larger mu suppression primarily over right hemisphere. Furthermore, hand-based sounds elicited greater mu suppression over the hand area in sensorimotor cortex compared to mouth-based sounds. These patterns of mu suppression across cortical regions to different categories of sounds and to effector-specific sounds suggest differential engagement of a mirroring system in the human brain when processing sounds.

Sensitivity of the autonomic nervous system to visual and auditory affect across social and non-social domains in williams syndrome.

Although individuals with Williams syndrome (WS) typically demonstrate an increased appetitive social drive, their social profile is characterized by dissociations, including socially fearless behavior coupled with anxiousness, and distinct patterns of "peaks and valleys" of ability. The aim of this study was to compare the processing of social and non-social visually and aurally presented affective stimuli, at the levels of behavior and autonomic nervous system (ANS) responsivity, in individuals with WS contrasted with a typically developing (TD) group, with the view of elucidating the highly sociable and emotionally sensitive predisposition noted in WS. Behavioral findings supported previous studies of enhanced competence in processing social over non-social stimuli by individuals with WS; however, the patterns of ANS functioning underlying the behavioral performance revealed a surprising profile previously undocumented in WS. Specifically, increased heart rate (HR) reactivity, and a failure for electrodermal activity to habituate were found in individuals with WS contrasted with the TD group, predominantly in response to visual social affective stimuli. Within the auditory domain, greater arousal linked to variation in heart beat period was observed in relation to music stimuli in individuals with WS. Taken together, the findings suggest that the pattern of ANS response in WS is more complex than previously noted, with increased arousal to face and music stimuli potentially underpinning the heightened behavioral emotionality to such stimuli. The lack of habituation may underlie the increased affiliation and attraction to faces characterizing individuals with WS. Future research directions are suggested.

Cross-modal influences of affect across social and non-social domains in individuals with Williams syndrome.

The Williams syndrome (WS) cognitive profile is characterized by relative strengths in face processing, an attentional bias towards social stimuli, and an increased affinity and emotional reactivity to music. An audio-visual integration study examined the effects of auditory emotion on visual (social/non-social) affect identification in individuals with WS and typically developing (TD) and developmentally delayed (DD) controls. The social bias in WS was hypothesized to manifest as an increased ability to process social than non-social affect, and a reduced auditory influence in social contexts. The control groups were hypothesized to perform similarly across conditions. The results showed that while participants with WS exhibited indistinguishable performance to TD controls in identifying facial affect, DD controls performed significantly more poorly. The TD group outperformed the WS and DD groups in identifying non-social affect. The results suggest that emotionally evocative music facilitated the ability of participants with WS to process emotional facial expressions. These surprisingly strong facial-processing skills in individuals with WS may have been due to the effects of combining social and music stimuli and to a reduction in anxiety due to the music in particular. Several directions for future research are suggested.

Affiliative behavior in Williams syndrome: social perception and real-life social behavior.

A frequently noted but largely anecdotal behavioral observation in Williams syndrome (WS) is an increased tendency to approach strangers, yet the basis for this behavior remains unknown. We examined the relationship between affect identification ability and affiliative behavior in participants with WS relative to a neurotypical comparison group. We quantified social behavior from self-judgments of approachability for faces, and from parent/other evaluations of real life. Relative to typical individuals, participants with WS were perceived as more sociable by others, exhibited perceptual deficits in affect identification, and judged faces of strangers as more approachable. In WS, high self-rated willingness to approach strangers was correlated with poor affect identification ability, suggesting that these two findings may be causally related. We suggest that the real-life hypersociability in WS may arise at least in part from abnormal perceptual processing of other people's faces, rather than from an overall bias at the level of behavior. While this did not achieve statistical significance, it provides preliminary evidence to suggest that impaired social-perceptual ability may play a role in increased approachability in WS.

Atypical hemispheric asymmetry in the perception of negative human vocalizations in individuals with Williams syndrome.

Williams syndrome is a neurological condition associated with high levels of auditory reactivity and emotional expression combined with impaired perception of prosody. Yet, little is currently known about the neural organization of affective auditory processing in individuals with this disorder. The current study examines auditory emotion processing in individuals with Williams syndrome. Hemispheric organization for positive and negative human non-linguistic sound processing was compared in participants with and without the disorder using a dichotic listening paradigm. While controls exhibited an expected right cerebral hemisphere advantage for processing negative sounds, those with Williams syndrome showed the opposite pattern. No differences between the groups emerged for the positive stimuli. The results suggest aberrant processing of negative auditory information in Williams syndrome.