Evidence for validity of a survey to measure the learning environment for professionalism.

BACKGROUND: With the emphasis on professionalism in academic health settings, including recently added accreditation requirements for US medical schools, there is a need for a valid and feasible method to assess the learning environment for professionalism. AIM: This article describes the development and investigation of the validity of a brief measure, the learning environment for professionalism (LEP) survey, designed to assess medical student perceptions of professionalism among residents and faculty during clinical rotations. METHOD: Two successive cohorts of third-year medical students completed the 22-item LEP survey at the conclusion of clerkship rotations, providing a total of 902 responses for scale reliability and principal components factor analysis, as well as assessment of changes in scores over time and correlations with a related clerkship evaluation item. RESULTS: The internal structure of the LEP survey was consistent with intended goals to assess both positive and negative professionalism behaviors. Acceptable internal consistency, sensitivity to change over time, and positive relationships between LEP scores and a concurrent measure of professionalism were observed. CONCLUSIONS: Use of the instrument could help identify clinical learning environments for professionalism that represent either best practices or areas in need of improvement, assess the impact of professionalism initiatives, and help satisfy accreditation requirements.

A randomized controlled trial of behavior change counseling education for medical students.

BACKGROUND: Educating medical students about how to effectively counsel patients with negative health behaviors (i.e., lack of exercise, smoking) is vitally important. Behavior change counseling is a promising method that can be used by physicians to encourage positive changes in health behaviors. PURPOSE: To examine the effectiveness of a 2 h workshop in behavior change counseling for medical students. METHODS: This study used a pre-post control group design with 35 second-year medical students who were randomly assigned to participate in a behavior change counseling intervention or wait-list control group. Student knowledge and attitudes were assessed using multiple choice items and open-ended question prompts. Student skills were assessed via performance in a standardized patient encounter rated using the Behavior Change Counseling Index (BECCI). RESULTS: Student attitudes toward behavior change counseling were positive at both pre- and post-test assessment in both groups. Knowledge scores and BECCI total scores showed significantly greater improvement in the intervention group compared to the wait-list control group. CONCLUSIONS: This study found that a brief educational intervention had a positive impact on medical students' knowledge and skills in behavior change counseling, and that student attitudes about the counseling method were very positive.

Maternal-Fetal Physiology, Intrapartum Care, Postpartum Care: A Team-Based Learning Module for Normal Obstetrics.

Introduction: Team-based learning (TBL) is an active learning strategy used at the University of Arkansas for Medical Sciences in both the preclinical and clinical years of medical school. The Department of Obstetrics and Gynecology (OB/GYN) uses TBLs during a 6-week clinical clerkship. This TBL is the first in a series of six and was designed to teach the topic of normal obstetrics to third-year medical students. Methods: Prior to the TBL, students were provided with learning objectives and a list of advance preparation resources. These resources included a reading assignment from the student textbook, as well as optional online videos and optional online interactive quizzes. The students then came to class and completed an individual readiness assurance test (iRAT) and a group readiness assurance test (gRAT). The majority of in-class time was spent working through complex application exercises in the form of case vignettes. The TBLs were facilitated by a faculty member in the OB/GYN department. Results: Since its initiation in June 2018, 93 students have participated in this TBL activity. The mean score on the iRAT was 88.9%, and the mean score on the gRAT was 98.8%. Ninety-eight percent of students reported that they were satisfied with this learning activity. Discussion: This TBL was well received by students and unique in that it utilized a variety of types of advance preparation resources. With few other published OB/GYN TBLs available, we believe that this module could be a valuable resource for OB/GYN clerkships.

Optimal learning environments from the perspective of resident physicians and associations with accreditation length.

BACKGROUND: Indicators of program quality in graduate medical education have not been thoroughly well developed or studied. This study explores resident physicians' perceptions of program quality and associations with an external quality indicator. METHOD: Responses to two open-ended questions about program strengths and areas in need of improvement were analyzed for 392 residents from 14 specialty programs that were reaccredited between 1999 and 2005. Computerized text analysis facilitated reliable categorization of 1,502 comments. Mann-Whitney U tests and nonparametric analyses for correlated data were used to examine associations between resident perceptions and accreditation length. RESULTS: The most frequently mentioned program strengths were related to the quality of faculty, exposure to patients, education, and the social environment. Of these core strengths, residents in programs with longer cycle lengths had significantly more comments about the quality of faculty in their program. CONCLUSIONS: Resident feedback can provide beneficial information about dimensions of program quality and the learning environment.

Crystal clear or tin ear: how do medical students interpret derogatory comments about patients and other professionals?

PURPOSE: To assess the learning environment at our medical school, third-year medical students complete an 11-item survey called the Learning Environment for Professionalism (LEP) at the end of each clerkship. The LEP survey asks about the frequency of faculty and resident professional and unprofessional behaviors that students observed; two of the items specifically address derogatory comments. This study used focus group methodology to explore how medical students interpret the derogatory comments they reported on the LEP survey. METHODS: Seven focus groups were conducted with 82 medical students after they completed the LEP survey. Analysis of focus group transcripts was performed to better understand the nature and meaning that students ascribe to derogatory comments. RESULTS: The study results provide insights into the types of derogatory comments that medical students heard during their clerkship rotations, why the comments were made and how they were interpreted. Emergent themes, labeled by the authors as 1) 'onstage-offstage', 2) 'one bad apple', and 3) 'pressure cooker environment', highlight the contextual aspects and understandings ascribed by students to the derogatory comments. Incidentally, students felt that the comments were not associated with fatigue, but were associated with cumulative stress and burn-out. CONCLUSIONS: The results suggest students have a clear understanding of the nature of unprofessional comments made by role models during clerkships and point to important systems-related issues that could be leveraged to improve clinical learning environments.