Status of portfolios in undergraduate medical education in the LCME accredited US medical school.

AIM: We sought to investigate the number of US medical schools utilizing portfolios, the format of portfolios, information technology (IT) innovations, purpose of portfolios and their ability to engage faculty and students. METHODS: A 21-question survey regarding portfolios was sent to the 141 LCME-accredited, US medical schools. The response rate was 50% (71/141); 47% of respondents (33/71) reported that their medical school used portfolios in some form. Of those, 7% reported the use of paper-based portfolios and 76% use electronic portfolios. Forty-five percent reported portfolio use for formative evaluation only; 48% for both formative and summative evaluation, and 3% for summative evaluation alone. RESULTS: Seventy-two percent developed a longitudinal, competency-based portfolio. The most common feature of portfolios was reflective writing (79%). Seventy-three percent allow access to the portfolio off-campus, 58% allow usage of tablets and mobile devices, and 9% involve social media within the portfolio. Eighty percent and 69% agreed that the portfolio engaged students and faculty, respectively. Ninety-seven percent reported that the portfolios used at their institution have room for improvement. CONCLUSION: While there is significant variation in the purpose and structure of portfolios in the medical schools surveyed, most schools using portfolios reported a high level of engagement with students and faculty.

An exploratory study on microaggressions in medical school: What are they and why should we care?

INTRODUCTION: Microaggressions and their impact have been documented in minority college students; however, little is known about the experience of medical students. This study reports the prevalence and understanding of microaggressions among medical students at the University of Florida College of Medicine (UFCOM), while gaining insights into experiences of medical students dealing with microaggressions. METHOD: A nine-question survey was sent out to all medical students at the UFCOM in the spring of 2017 to understand their experiences with microaggressions. The authors used simple statistics and chi-test to analyze the demographic data and an inductive thematic qualitative analysis was performed on the open-ended responses to study medical students' understanding of the term, experiences, and impact of microaggressions. RESULTS: The response rate was 64% (n = 351/545). Fifty-four percent reported experiencing microaggressions, of those the majority were female students (73% compared with 51% among male students, p = 0.0003); for female students from minority backgrounds this was 68% and for white female students 76% (p = 0.2606). Microaggressions are more common in the second year of medical school (30%), followed by the third year (23%). Most students were able to recognize and identify microaggressions, but some denied the concept existed, attributing concerns about microaggressions to a culture promoting oversensitivity and political correctness. Students described microaggressions related to sexism; religion; skin colour; and ethnicity. Students described indifference, emotional reactions and denial of the event as coping mechanisms. CONCLUSION: Microaggressions are prevalent on a day-to-day basis among medical students with female students from a minority background as well as white female students experiencing more microaggressions. Further research is needed to explore interventions to counter microaggressions in order to ensure a healthy learning environment.

Online Faculty Development for Implementation and Use of Student Portfolios.

INTRODUCTION: Over the past decade, portfolios have gained popularity in medical education as tools to evaluate and provide feedback about learning and completion of professionally authentic tasks. Though faculty development has been noted to be key for successful portfolios, there are few available resources. As part of an interinstitutional collaborative project, we have developed online faculty development modules that provide pedagogical information about portfolios, practical advice, and resources from the available literature. METHODS: The materials associated with this publication include downloadable modules, which take approximately 45 minutes to complete and can be paused at any time, and sample questions to facilitate small-group discussion with faculty either in the planning stage of portfolios or as part of program evaluation of an institution's portfolios. RESULTS: A survey taken by faculty from four medical schools after completion of the modules showed that they were well received, with 41% of participants stating that they were very knowledgeable after undertaking the modules compared to 11% before undertaking the modules. Faculty reported increased interest in the topic and increased confidence in their ability to undertake planning for development of portfolios at their institution and considered using the modules as a mandatory curriculum for portfolio coaches at their institutions. DISCUSSION: We suggest that these modules be used for individual self-development, as part of faculty development sessions for portfolio coaches and mentors, or to provide faculty with background information about portfolios during the planning phase of portfolios at an institution.

Family-centered rounds and medical student education: a qualitative examination of students' perceptions.

BACKGROUND: Although current literature supports the benefits of family-centered rounds on medical education, few studies have explored students' perceptions of family-centered rounds. PURPOSE: The aim of this study was to provide a better and broader understanding of the effect of family-centered rounds on medical student education. METHODS: During the inpatient portion of the third-year pediatric clerkship at a southeastern United States 4-year medical school, students were exposed to family-centered and conference room work rounds and completed a post-hoc reflective open-ended questionnaire. The study was conducted from July to December 2007 and the inpatient experience was at one of two large academic medical centers. Using a constant comparative approach, the qualitative content of 45 of the 63 potential students' responses was analyzed. RESULTS: Family-centered rounds served as an opportunity for medical students to build their practice-based knowledge through direct and simultaneous interaction with the medical team, patients, and families. Family member communication, medical team communication, and increased exposure to patients allowed for unique learning opportunities such as augmentation of communication skills, practice with use of lay terms, legitimate peripheral participation, and humanizing cognitive understanding of diseases. Areas of concern noted by the students included space limitations, length of rounds, potential anxiety provoked in the patient, and faculty and resident comfort with teaching certain topics. CONCLUSIONS: Our qualitative analysis of medical student perceptions on family-centered rounds suggests that pediatric medical student education may benefit by improving knowledge and practice with communication and humanizing disease processes. However, perceived barriers, such as concerns about space or instructor comfort with teaching certain topics, existed. Further studies are warranted to gain a better understanding of the educational impact of conducting this type of rounds.

Pediatric residents' learning styles and temperaments and their relationships to standardized test scores.

BACKGROUND: Board certification is an important professional qualification and a prerequisite for credentialing, and the Accreditation Council for Graduate Medical Education (ACGME) assesses board certification rates as a component of residency program effectiveness. To date, research has shown that preresidency measures, including National Board of Medical Examiners scores, Alpha Omega Alpha Honor Medical Society membership, or medical school grades poorly predict postresidency board examination scores. However, learning styles and temperament have been identified as factors that 5 affect test-taking performance. The purpose of this study is to characterize the learning styles and temperaments of pediatric residents and to evaluate their relationships to yearly in-service and postresidency board examination scores. METHODS: This cross-sectional study analyzed the learning styles and temperaments of current and past pediatric residents by administration of 3 validated tools: the Kolb Learning Style Inventory, the Keirsey Temperament Sorter, and the Felder-Silverman Learning Style test. These results were compared with known, normative, general and medical population data and evaluated for correlation to in-service examination and postresidency board examination scores. RESULTS: The predominant learning style for pediatric residents was converging 44% (33 of 75 residents) and the predominant temperament was guardian 61% (34 of 56 residents). The learning style and temperament distribution of the residents was significantly different from published population data (P  =  .002 and .04, respectively). Learning styles, with one exception, were found to be unrelated to standardized test scores. CONCLUSIONS: The predominant learning style and temperament of pediatric residents is significantly different than that of the populations of general and medical trainees. However, learning styles and temperament do not predict outcomes on standardized in-service and board examinations in pediatric residents.

Risk and promotive factors in families, schools, and communities: a contextual model of positive youth development in adolescence.

OBJECTIVE: Emerging evidence about optimal youth development highlights the importance of both reducing negative behavior and promoting positive behavior. In our study we tested a contextual model derived from positive youth-development theory by examining the association of family, school, and community risk and promotive factors, with several outcome indices of both positive and negative adolescent development. METHODS: A sample of 42305 adolescents aged 11 to 17 (51% girls) was drawn from the 2003 National Survey of Children's Health. Survey item composites were formed representing promotive and risk factors in the family (eg, closeness, aggression) and school and community (eg, community connectedness, school violence). Outcome composites reflected positive (social competence, health-promoting behavior, self-esteem) and negative (externalizing, internalizing, academic problems) developmental outcomes. Ordinary least squares regression was used to test the overall model. RESULTS: Between 0.10 and 0.50 of the variance in each outcome was explained by the contextual model. Multiple positive family characteristics were related to adolescent social competence and self-esteem, as well as lowered levels of internalizing and externalizing behavior and academic problems. Family communication, rules about television, and parents' own healthy behavior were related to adolescent health-promoting behavior. School and community safety were associated with increased social competence and decreased externalizing behavior. School violence was related to adolescent internalizing and externalizing behavior, as well as academic problems and lower self-esteem. CONCLUSIONS: Our results support the proposition that healthy adolescent development has roots in multiple contexts. Youth who were involved in contexts that provided positive resources from important others (ie, parents, schools, and communities) not only were less likely to exhibit negative outcomes, but also were more likely to show evidence of positive development. These findings provide important implications for intervention and prevention efforts and, more generally, for the promotion of positive, competent, and healthy youth development.

The impact of community risks and resources on adolescent risky behavior and health care expenditures.

PURPOSE: To examine a nested model that predicts adolescent risky behavior, health care use, and health care expenditures from individual characteristics, such as age and gender, and community characteristics such as social capital and community-level risky behavior rates. METHODS: Claims and encounter data were used to classify adolescents enrolled in Florida's Healthy Kids Program into two groups: those who engaged in risky behavior (ARB) and those who did not (NRB). Hierarchical linear modeling techniques were used to predict the odds of risky behavior, the odds of health care use, and health care expenditures based on individual and community characteristics. RESULTS: ARB consumed significantly more health care services than NRB, and their higher use and charges were attributable not only to individual level factors (i.e., age, gender, presence of special health care need, metropolitan residence status), but also to community level factors (i.e., social capital, risky behavior rates, violence, and ethnic/racial composition) as well. In particular, community investment in social capital predicted lower levels of risky behavior as well as lower health care expenditures. CONCLUSIONS: This information is important in terms of policy efforts at providing health care for this vulnerable group of individuals, as well as in developing prevention and intervention programs that can be delivered through the health care system and via links to community supports.

Training school nurses: screening and brief intervention for tobacco use.

This field project focused on training school nurses to do screening and brief interventions for tobacco use. Needed resources were organized in a kit.