Pilot study exploring the presence of leadership curricula in undergraduate medical education.

INTRODUCTION: The physician's role in the healthcare delivery system extends beyond patient care to include numerous critical leadership roles in healthcare. In addition to treating patients, physicians manage multidisciplinary teams and influence policies to optimise public health. Yet, leadership education is not currently emphasised as part of undergraduate medical education. The purpose of this pilot study was to survey US allopathic medical schools about their current leadership curricula for medical students, including aspects that promote or inhibit effective curricular implementation. METHODS: A survey was developed and administered to representatives at US allopathic medical schools regarding the presence and nature of leadership curricula for medical students currently in place, as well as barriers to effective implementation. RESULTS: A total of 41 of 144 medical schools (28%) responded to the survey. Of the schools that responded, 25 schools reported the presence of a leadership curriculum. Primary competencies and goals were similar among these institutions, but the structure of the curriculum and how it is being implemented varied. The study did not identify consistent methods of assessing student leadership competencies. Themes of improved communication and integration within the curriculum emerged as actions promoting successful implementation. Financial restraints and buy-in among stakeholder groups (eg, faculty, staff and students) were mentioned most frequently as barriers to the effective implementation of leadership curricula. CONCLUSIONS: Although leadership education within undergraduate medical education is emphasised by a variety of groups, including the Association of American Medical Colleges, medical schools do not appear to universally address this topic. The Liaison Committee on Medical Education, the primary accrediting body for medical schools, does not currently require leadership education as a core topic for accreditation. To provide effective education on leadership to medical students, administrative bodies could improve their support for this topic by considering the factors identified that both hinder and promote implementation.

Studying moral distress (MD) and moral injury (MI) among inpatient and outpatient healthcare professionals during the COVID-19 pandemic.

BACKGROUND: COVID-19 increased moral distress (MD) and moral injury (MI) among healthcare professionals (HCPs). MD and MI were studied among inpatient and outpatient HCPs during March 2022. OBJECTIVES: We sought to examine (1) the relationship between MD and MI; (2) the relationship between MD/MI and pandemic-related burnout and resilience; and (3) the degree to which HCPs experienced pandemic-related MD and MI based on their background. METHODS: A survey was conducted to measure MD, MI, burnout, resilience, and intent to leave healthcare at 2 academic medical centers during a 4-week period. A convenience sample of 184 participants (physicians, nurses, residents, respiratory therapists, advanced practice providers) completed the survey. In this mixed-methods approach, researchers analyzed both quantitative and qualitative survey data and triangulated the findings. RESULTS: There was a moderate association between MD and MI (r = .47, P < .001). Regression results indicated that burnout was significantly associated with both MD and MI (P = .02 and P < .001, respectively), while intent to leave was associated only with MD (P < .001). Qualitative results yielded 8 sources of MD and MI: workload, distrust, lack of teamwork/collaboration, loss of connection, lack of leadership, futile care, outside stressors, and vulnerability. CONCLUSIONS: While interrelated conceptually, MD and MI should be viewed as distinct constructs. HCPs were significantly impacted by the COVID-19 pandemic, with MD and MI being experienced by all HCP categories. Understanding the sources of MD and MI among HCPs could help to improve well-being and work satisfaction.

A Pilot Study Assessment of Medical Student Knowledge and System Citizenship Attitudes Pertaining to Health Systems Science.

Background and Purpose: Health system science (HSS) has been described as the third pillar of medical education. We introduced a new health system science and interprofessional practice (HSSIP) curriculum, and measured students' HSS knowledge and attitudes concerning health system citizenship. Methods: This pilot study involved first-year (M1) and fourth-year (M4) medical students in two cohorts across 2 years. Only M1 students in the second cohort participated in the new HSSIP curriculum. We compared student performance on a new National Board of Medical Examiners (NBME) HSS subject exam, and student attitudes toward system citizenship via a new attitudinal survey. Results: Fifty-six eligible fourth-year students (68%) and 70 (76%) study eligible first-year students participated in the study. NBME HSS exam performance by M4 students was statistically significantly higher than M1 students for both cohorts, with moderate to large effect sizes. Exam performance for M1 students not experiencing the HSS curriculum was higher than for M1 students who received HSS curricular content. Attitudes toward HSS by M4 versus M1 students were statistically significantly different on several survey items with moderate effect sizes. Scale internal consistency for the HSS attitude survey was strong (0.83 or higher). Discussion: There were differences among M4 and M1 medical students concerning knowledge of and attitudes toward HSS, with performance on the NBME subject exam similar to a national sample. Exam performance by M1 students was likely impacted by class size and other factors. Our results support the need for increased attention to HSS during medical education. Our health system citizenship survey has potential for further development and cross-institutional collaboration.

Utilization of a New Customizable Scoring Tool to Recruit and Select Pulmonary/Critical Care Fellows.

BACKGROUND: Finding the ideal candidate for a residency/fellowship program has always been difficult. Finding the "perfect" match has always been the ultimate goal. However, many factors affect obtaining that "perfect" match. In the past, we would have each attending physician review around 20 to 50 Electronic Residency Application Service (ERAS) applications and rank them into three categories: high, middle, or low. Depending on their ranking, the applicant would be invited for an interview. After the interview, the applicants' files (ERAS and interview) would be reviewed and ranked by the faculty as a group. This was time-consuming and fraught with too much subjectivity and minimal objectivity. We, therefore, sought to find a way to assess and rank applicants in a more objective and less time-consuming manner. By creating a customizable scoring tool, we were able to screen applicants to our pulmonary/critical care fellowship program in an efficient and a more objective manner. OBJECTIVES: A customizable scoring tool was developed weighting components in the ERAS and interview process, allowing residency/fellowship programs to create a final rank list consistent with the programs' desired applicants. METHODS: Two hundred and sixty pulmonary/critical care fellowship applications were reviewed from 2013 to 2018. In 2018, we used our new scoring rubric to create a rank list and rescore previous applicants. The traditional and new lists were compared to the final rank list submitted to the National Residency Matching Program (NRMP) for 2018. We wanted to ascertain which scoring method correlated best with the final rank list submitted to the NRMP. We obtained feedback from eight faculty members who had reviewed applicants with both scoring tools. RESULTS: The novel customizable scoring tool positively correlated with the final rank list submitted to the NRMP (r= 0.86). The novel tool showed a better correlation to the final rank list than the traditional method. Faculties (6/6, 100%) responded positively to the new tool. CONCLUSIONS:  Our new customizable tool has allowed us to create a final rank list that is efficient and more focused on our faculty's desired applicants. We hope to assess and compare the quality of applicants matched through this scoring system and the traditional method by using faculty evaluations, milestones, and test scores.

Evaluation of an Interprofessional Learning Experience for Telephone Consultations.

BACKGROUND AND PURPOSE: There is limited training for healthcare students in the performance of telephone consultations. To facilitate communication between healthcare professionals when face-to-face interactions are not possible, a telephone consultation simulation was developed. The simulation involved students in a doctor of physical therapy program and senior medical students. This study aimed to explore the development and suitability of a simulated case with a focus on interprofessional telephone consultation. METHODS: A convenience sample of 28 physical therapy students and 38 medical students from two institutions in southwest Virginia participated in the simulation experience. To assess the outcomes of the simulation on interprofessional communication, the IPASS verbal handoff assessment was performed by the participants and focus group interviews occurred immediately following the experience. In addition, an assessment of key information provided during the conversation was performed for each of the seven interprofessional groups. RESULTS: Students demonstrated near perfect agreement on the IPASS assessment. Five of the seven interprofessional groups perceived that they were able to communicate key information and collectively agree upon a recommendation for the continuation of the patient assessment. The two groups that demonstrated more difficulty with communication appeared to struggle with communicating the patient's past medical history relevant to the current situation, despite the majority of students feeling confident in their communications. In addition, two themes were presented during the interprofessional focus group interviews: 1) clear communication to maintain patient safety and 2) efficiently conveying the patient's background. DISCUSSION: The health professions students participating in the scenario were able to consistently note the communication skills observed and reflect upon the need for clear communication between providers during a patient consultation. Key components of an efficient telephone consultation were identified, along with opportunities to improve this type of interaction between health professionals.

Building Health Systems Science Education from the Core Domain of Interprofessional Education at Virginia Tech Carilion School of Medicine.

The Virginia Tech Carilion School of Medicine (VTCSOM) is a 4-year allopathic medical school in Roanoke, VA. The curriculum is organized into four learning domains: basic science, clinical science, research, and interprofessionalism (IPE). A recent curriculum renewal effort allowed the school to embark upon a redesign of the IPE learning domain to incorporate new core content from health systems science (HSS). We describe how our unique approach to IPE is being preserved as we innovate to produce graduates who are future thought leaders and "systems citizens," prepared to deliver patient care with an expanded knowledge of the health systems in which they will eventually practice.

Piloting a patient safety and quality improvement co-curriculum.

Background: Despite the push for resident and faculty involvement in patient safety (PS) and quality improvement (QI), there is limited literature describing programs that train them to conduct PS/QI projects. Objective: To determine the effectiveness of a co-learning PS/QI curriculum. Method: The authors implemented a co-learning (residents and faculty together) PS/QI curriculum within our general Internal Medicine program over 1 year. The curriculum consisted of two workshops, between-session guidance, and final presentation. The authors evaluated effectiveness by self-assessment of attitude, knowledge, and behavior change and PS/QI project completion. Results: Thirty-eight of 32 (95%) resident and 8 faculty member participants attended the workshops and 27 of 40 (67%) completed the evaluation. Participants (87-96%) responded favorably regarding workshop effectiveness. The authors found significant improvement in 78% of items pertaining to PS/QI knowledge/skills, but no difference for attitudinal items. The final project evaluation participants rated project content as relevant to learning needs (75%); training as well-organized (75%); faculty mentorship for the project as supportive (75%); and the overall project as excellent or very good (71%). Conclusion: The authors successfully demonstrated a framework for co-teaching faculty and residents to conduct PS/QI projects. Participants acquired necessary tools to practice in an ever-evolving clinical setting emphasizing a patient-centered and quality-focused environment.

Always on call: thoughts from a neophyte physician.

This commentary describes a new physician who encountered a patient in crisis in a nonmedical environment. It discusses professional obligations, ethical principles, errors committed, and reasoning behind such errors. Unusual circumstances, uncertainty about how to properly identify oneself as a physician, self-doubt, and discomfort with practicing outside one's scope of training are recognized as reasons behind these errors. Medical students should be reminded of their ethical obligation to offer emergency care within their limitations, instructed how to identify themselves, and guided to become competent team leaders. Resident doctors should continue to receive instruction as they internalize ethical principles and identify their scopes of practice. Practicing physicians should be competent in offering basic emergency care if needed.

Reliability of the physical medicine and rehabilitation resident observation and competency assessment tool: a multi-institution study.

OBJECTIVES: To assess the psychometric qualities of a method of resident physician evaluation by faculty. DESIGN: Multicenter study by seven Physical Medicine and Rehabilitation training programs. Faculty physicians observed residents in brief patient encounters or teaching sessions, rated specific competencies, and provided residents with immediate feedback. The resident observation and competency assessment form included competencies in patient care, professionalism, interpersonal and communication skills, systems-based practice, and practice-based learning and improvement. Residents and faculty rated satisfaction with the process. RESULTS: Three hundred sixty-two ratings were completed on 88 different residents. Each resident received an average of 3.8 ratings across two academic years. Overall internal consistency reliability was high (0.98); reliability of the individual competencies ranged from 0.74 to 0.76. Item means were correlated with year of training for two skill sets, with higher means for more experienced residents. The majority of participants gave high ratings of satisfaction; correlation between satisfaction ratings of attending and resident physicians was 0.63 (P < 0.01). CONCLUSIONS: The resident observation and competency assessment is a reliable method to assess resident skills in five of six general competencies. Construct validity of the tool is supported by the fact that faculty rated two skill sets higher for senior residents.

The development of physician confidence during surgical and medical internship.

BACKGROUND: While much research has addressed physician competency, the development of confidence has not been studied. We sought to identify which elements of internship residents feel most contributed to building their confidence. METHODS: By anonymous survey, University of Pennsylvania residents rated 104 internship elements for contribution to building physician confidence and reported their subjective confidence during and since internship. RESULTS: Two hundred ten residents in 18 specialties participated. Detailed ratings for all 104 elements are provided. Generally, independent decision-making items and good back-up support were equally highly valued, as was developing work efficiency. Poorly valued items included high patient loads, long hours, and abusive interactions. Surgical and medical residents agreed. Mean confidence increased during internship from 12 to 32 (1-100 scale) but remained in the 50s during residency for most specialties. CONCLUSIONS: Faculty should make informed, deliberate attempts to provide those elements identified as most fostering the development of physician confidence.

A conceptual model for program evaluation in graduate medical education.

The author provides (1) a brief overview of the literature concerning program evaluation as applied to medical education, (2) a task-oriented conceptual model for use by residency directors in planning for program evaluation of graduate medical education training programs, (3) an explanation of the term "outcomes evaluation" including distinguishing between types of educational outcomes, and (4) a description of a five-step process of implementing the conceptual model.Recent accreditation standards for graduate medical education programs require a shift from a process-oriented to an outcomes-oriented model of evaluation. Accordingly, residency program directors must ensure compliance by undertaking comprehensive program evaluation procedures that demonstrate educational outcomes. Such procedures include attention to the need and focus of the evaluation; the evaluation methods to be used; and the documentation and presentation of evaluation results to key constituents. Involving teaching faculty and residents in developing a comprehensive evaluation program is vital to success. Regardless of philosophic debates pertaining to the appropriateness of the outcomes model for medical education, this approach appears likely to predominate in the foreseeable future particularly as related to the six general competencies of the physician. A practical, task-oriented approach will assist program directors in ensuring compliance with program evaluation standards.

Service learning in the medical curriculum: developing and evaluating an elective experience.

BACKGROUND: Medical educators are seeking ways to nurture the service commitments of their medical students while promoting interactions with the communities they serve. Service learning is a pedagogy that links community service with academic experience. DESCRIPTION: The University of Kentucky College of Medicine has developed and implemented an experiential service learning elective. The elective is based in local community agencies where small groups of students perform an asset-needs assessment and design a service project based on their findings. The elective is linked to a behavioral science course that provides accompanying biopsychosocial instruction. EVALUATION: Over the 2-year project period, we used multiple methods (i.e., surveys, interviews, reflection questionnaires, evaluations of student performance, and course evaluations) to gather information on the motivations, observations, and assessments of students, faculty preceptors, and community agency partners. CONCLUSION: Linking a service learning elective to a pre-existing course worked well, achieved its objectives, and will be continued

Spirituality in medicine: a comparison of medical students' attitudes and clinical performance.

OBJECTIVE: The authors sought to examine attitudes about spirituality in medicine among medical students in psychiatric clerkships and determine whether instruction on concepts of spirituality in medicine had an effect on students' clinical performance in related tasks. METHODS: A total of 192 students entering psychiatric clerkships were randomly assigned to one of two groups; both groups received identical didactic instruction on spirituality in medicine. One group worked on a problem-based learning case that featured spirituality as a prominent theme, whereas the other group worked on problem-based learning cases that made no mention of it. Students completed pre- and posttest questionnaires, and their examination at the end of rotation included a standardized patient encounter requiring them to elicit a spiritual history. RESULTS: Among the 131 students who completed and returned both questionnaires, a significant difference (p=0.001) was noted between groups on students' self-reported knowledge of taking a spiritual history. However, students in the two groups received identical scores on the component of the examination requiring them to write a spiritual history. CONCLUSIONS: Although students who were exposed to material on spirituality in medicine reported greater understanding of the issue, no difference in clinical performance was observed.

Pilot study of a 360-degree assessment instrument for physical medicine & rehabilitation residency programs.

OBJECTIVE: To perform a pilot test on a new format for multidisciplinary assessment of resident physicians' professionalism and clinical performance in acute inpatient rehabilitation settings. DESIGN: In this pilot study, a 26-item ratings instrument was developed for use by therapists, nurses, social workers, case managers, and psychologists to rate inpatient residents. RESULTS: A total of 421 ratings forms were returned over four academic years. Alpha reliability coefficient for instrumentation sample was 0.99. chi2 and analysis of variance procedures examined item mean differences. Significant differences (P

How we implemented a service-learning elective.

This paper describes the process used to introduce a service-learning course into the medical curriculum at the University of Kentucky College of Medicine. The rationale for taking the initiative to begin such a project is outlined and curriculum planning considerations are reviewed, including how to identify project team members, choose community agency partners, develop the instructional plan, and define roles and responsibilities of the participants. The importance of understanding the philosophy of service learning and taking time for reflection are underscored. Also discussed are program evaluation issues and strategies are suggested for evaluating service learning, obtaining information relevant to the continuation of the project, and disseminating information about the service learning outcomes.