Evaluating the DR-ED Listserv as a Medical Education Networking and Support Tool.

The listserv, although considered old technology by some, continues to show benefit for and growth in subscribers. We investigated the roles the DR-ED listserv plays within the medical education community. We asked, Who subscribes? Why do they subscribe? and How do they use the listserv? We conducted a mixed-methods evaluation of the DR-ED listserv based on message content analysis and user surveys. We found the DR-ED listserv fulfills medical educators' need to network collegially; keep current with issues and ideas in the field; share solutions to problems; share resources; and advertise development opportunities. We found two types of listserv engagement: a) one-way engagement by using it as a resource, or two-way engagement by using and sharing resources. Our findings also highlight the value users attribute to virtual resources and the role listservs can play as economical professional development in a time of constrained costs, and our analysis methods can be used to guide future listserv evaluations. We conclude the relatively easy access to a global medical education listserv is one strategy to create a community of practice for medical education practitioners.

Learning by doing and creation of the shared discovery curriculum.

BACKGROUND: The Michigan State College of Human Medicine began as an experiment to teach medical students in community-based settings and to create a primary care workforce for the state. Decades later, CHM faced internal and external challenges that spurred creation of a new curriculum - the Share Discovery Curriculum - founded on learning by doing and other learning theories. METHODS: A curricular design group (CDG) developed guiding principles for reform. Based on this, pedagogies and structures were selected to achieve this vision and developed into a curricular structure. Components of the first-year curriculum were piloted with a group of students and faculty members. RESULTS: Six guiding principles were endorsed, grounded in learning theories such as Dewey's Learning by Doing. Based upon these, several key features of the new curriculum emerged: learning communities; one-on-one coaches for students; symptom-based presentations for content; simulation, authentic clinical tasks, flipped classrooms, and modified practice-based learning as primary teaching modalities; early, integrated clinical and scientific learning; milestones as course learning objectives; and a multidimensional, competency-based assessment system. DISCUSSION: The process and outcomes described here are intended as an exemplar for schools undertaking curricular change. Early stakeholder engagement, faculty development, sustainable administrative systems, and managing complexity are core to the success of such endeavors.

An Exemplar Milestone Framework for Scaffolding a Competency-Based Medical School Curriculum.

A strong competency and milestone framework is imperative for medical schools adopting competency-based education and assessment. Milestones can be used to align what is taught and what students are asked to demonstrate from matriculation to graduation. We describe the creation and implementation of our milestone framework as an exemplar. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01558-1.

Emotional intelligence in undergraduate medical students: a scoping review.

PURPOSE: To perform a scoping review to determine what is known about emotional intelligence (EI) in undergraduate medical education (UME). Two main questions were asked: A. What medical student characteristics are associated with EI? Are there correlations with demographic or other factors? B. What research studies have been done on EI in UME? For example, is there evidence EI changes over time as a result of personal experiences? Should EI be used as an admission criterion? Can EI improve as a result of experiences or deliberate interventions? METHOD: The authors searched four databases (PubMed, PsycInfo, Education Resources Information Center, and Web of Science) for all papers published up to and including December 2020. Two reviewers independently screened articles to determine if they met inclusion criteria. All authors extracted and analyzed data. RESULTS: A set of 1520 papers on the topic of emotional intelligence was identified, with 119 papers meeting inclusion criteria. Most studies were done at international locations with only 17 done at US medical schools. Seventy-five were cohort or cross-sectional studies. Study populations were mixed among the studies, with year of medical study, inclusion of other healthcare students, and participation rates among the inter-study differences noted. CONCLUSIONS: Numerous gaps in the literature on EI exist with several points being clear: (1) there is disagreement on the definition of EI, (2) it is undetermined whether EI is a trait or an ability, and (3) there is marked variability among the instruments used to measure EI. It is also becoming apparent that using EI determination may be helpful as a component of the admission process, higher EI is likely related to improved clinical reasoning, and higher EI contributes to more effective stress management.

Utilizing learning communities to deliver an integrated undergraduate medical education curriculum.

AIM: Learning communities (LCs) have been identified as a structure to support student wellness as well as create a positive learning environment and have been increasingly adopted in undergraduate medical education (UGME). In 2016, Michigan State University College of Human Medicine made curricular changes which integrated basic, social, and clinical sciences. One of the major strategies adopted to deliver this integrated curriculum was to create LCs that served as a central scaffold for students' academic development. Our primary aim is to describe how the school utilized LC faculty to deliver this core integrated curriculum. METHODS: Students were surveyed about their perceptions of the effectiveness of the LCs in delivering an integrated science curriculum. Student academic performance in the new curriculum was compared to that of students from the legacy curriculum as a measure of the effectiveness of the curricular changes. RESULTS: The percentage of students in each class who responded to surveys ranged between 78.7% and 95.8%. Mean Likert responses (1 = strongly disagree; 5 = strongly agree) for statements 'the Faculty Fellow is effective in helping me learn the scholar group content', 'the Faculty Fellow is an effective teacher in our scholar group', and 'the Faculty Fellow is well prepared for our scholar group' ranged from 4.37 to 4.78, 4.72 to 4.76, and 4.81 to 4.86, respectively. In addition, a comparison of summative exam scores of the new curriculum's students to the legacy curriculum's students demonstrated comparable or better performances in the new curriculum. CONCLUSIONS: Utilizing LCs to deliver an integrated science curriculum is an underutilized strategy in UGME. Surveys on student satisfaction and academic performance are encouraging. Additional outcome measures are planned to continually evaluate this innovative multifaceted integration.

Fundamentals of Scholarly Peer Review: A Workshop for Health Professions Educators on Practicing Scholarly Citizenship.

Introduction: Education scholarship requires peer reviewers. For novice scholars, reviewing is an important developmental activity that cultivates deeper participation in the scholarship community. Yet getting started with reviewing is challenging for those not involved with the educational scholarship community. Beyond scientific expertise, reviewers must have a mentoring mindset, skills in providing constructive feedback, and knowledge of common ethical challenges associated with producing and evaluating scholarship. Methods: Our workshop introduced novice health professions educators to peer reviewing. It included four stimulus presentations about the peer reviewer's mindset and skills, followed by reinforcement activities. The workshop could be adapted to variously sized groups. An 8:1 ratio of participants to facilitators was ideal for activities. Topics covered included considerations before accepting an invitation, the review process, the good citizen approach to reviewing, and reviewer ethics. The session concluded with suggestions for continued development of peer reviewer competencies. The workshop was evaluated using a custom survey. Results: Throughout 2019 and early 2020, 58 health professions educators and trainees participated in the workshop across varied venues. Evaluations were obtained from 33 participants (57%). Nearly all rated the workshop as high quality and valuable to peer reviewer preparation. Most (26 of 33; 75%) gained confidence about their qualifications to serve as reviewers. Eighty percent (28 of 33) believed they could recognize ethical dilemmas. Discussion: This workshop provided a springboard for peer reviewing health professions education scholarship. Participants generally praised the experience for introducing them to the world of peer review and preparing them for it.

Medical Student Progress Examination Performance and Its Relationship With Metacognition, Critical Thinking, and Self-Regulated Learning Strategies.

PURPOSE: Metacognition and critical thinking are essential for academic success. The relationship between these components and medical student learning, as assessed with progress examinations, informs curriculum development and efforts to ensure learning progression of all students. This study assessed learning mechanisms by modeling medical students' progress test performance longitudinally at Michigan State University College of Human Medicine. METHOD: Medical students' (n = 184) medical knowledge was assessed 5 times from fall 2017 through spring 2019 using the Comprehensive Basic Science Examination (CBSE). Structural equation modeling was conducted to investigate associations between 3 latent structures-metacognitive awareness, critical thinking, and self-regulation-and their relationship with students' initial CBSE scores and growth in such scores. The authors measured metacognitive knowledge and regulation by the Metacognitive Awareness Inventory, critical thinking skills by the Watson-Glaser Critical Thinking Appraisal, and self-regulation by the Learning and Study Strategies Inventory. RESULTS: Students' aggregate performance on 5 CBSE scores grew 31.0% the first semester, 16.5% the second semester, 30.1% the third semester, and 22.4% the last semester. Critical thinking had a significant positive relationship with initial performance (JOURNAL/acmed/04.03/00001888-202102000-00048/inline-graphic1/v/2021-01-22T214722Z/r/image-tiff1.956, P < .001), self-regulation had a significant positive relationship with growth (JOURNAL/acmed/04.03/00001888-202102000-00048/inline-graphic2/v/2021-01-22T214722Z/r/image-tiff3.287, P < .05), and metacognitive awareness had a negative relationship with growth of student performance in the progress test (JOURNAL/acmed/04.03/00001888-202102000-00048/inline-graphic3/v/2021-01-22T214722Z/r/image-tiff-3.426, P < .01). CONCLUSIONS: This structural equation framework is useful for examining the relationships among 3 latent structures-critical thinking, metacognition, and self-regulation-and their relationships with students' progress scores in academic achievement. The initial status of progress examination scores was explained by students' critical thinking ability, but their learning growth on the progress scores was explained by their self-regulation and metacognitive ability. These findings help explain student performance on standardized progress examinations and can aid in interventions to promote student success.

The Family Medicine Attitudes Questionnaire: A Valid Instrument to Assess Student Attitudes Toward Family Medicine.

BACKGROUND AND OBJECTIVES: Medical student attitudes toward family medicine influence student likelihood of choosing family medicine and the US primary care physician workforce. We sought to refine and assess the validity of the Family Medicine Attitudes Questionnaire, an instrument that assesses student attitudes toward family medicine in US medical students. METHODS: A 24-item questionnaire, including items assessing students' attitudes toward family medicine's importance, family physician shortage, family medicine research, family systems, family physicians' expertise, and lifestyle, was offered to fourth-year students at 16 US medical schools. We evaluated the questionnaire's content validity, construct validity, and criterion validity. Content validity was assessed using a qualitative approach to direct observation, construct validity by data reduction and iterative factor analyses, and criterion validity by correlating items with intention to match into family medicine. RESULTS: The questionnaire was completed by 1,188 (44.9%) of 2,644 students invited to complete it; 10 items were removed in the validation process. The final 14-item instrument had a Cronbach α of 0.767. Total score correlated with family medicine specialty choice (P<.001). A questionnaire score of 56 or higher is 78.1% sensitive and 65.3% specific for identifying students who intend to match into family medicine. In regression analysis, questionnaire score was an independent predictor of choosing family medicine (odds ratio 1.289, confidence interval 1.223-1.347). CONCLUSIONS: The Family Medicine Attitudes Questionnaire is a valid instrument for assessing US medical student attitudes toward family medicine. This tool will help educators assess the impact of curricular and policy interventions designed to promote family medicine specialty choice.

Authorship Order in Medical Education Publications: In Search of Practical Guidance for the Community.

Phenomenon: With scholarly collaborations come questions about the order of authorship. Authorship order is an important consideration because it often used as an indicator of seniority, expertise, leadership, and scholarly productivity. As a result, authorship order factors into decisions about hiring, salary, resource allocation, and professional advancement. This study describes principles commonly applied to authorship order decisions within the medical education community and educators' opinions about the significance of authorship order. Approach: A questionnaire was developed to ascertain current practices related to authorship decisions. Sixteen items were rated in terms of frequency of actual use and the desirability of the practice using a 4-point rating scale: 1 (never), 2 (sometimes), 3 (often), and 4 (always). Additional questions addressed the perceived significance of authorship order. The last set of questions provided information about respondents' personal and career characteristics. The survey was delivered via e-mail to a random sample of 391 subscribers from the DR-ED listserv. Findings: Fifty-four e-mail addresses were returned as undeliverable; of the remaining 337 mailed surveys, 109 responses (32.3%) were received. Five of the current practices for determining authorship order were rated as both frequent and desirable; 4 items had low ratings suggesting that these practices were both infrequent and undesirable. For 7 items, there was a significant gap between the ratings of practice frequency and desirability. When asked about preferred authorship order strategies, most respondents (94%) endorsed listing authors by descending order based on contribution but were split in identifying the last author (47%) or second author (46%) as the next best placement after first author. Respondents supported the practice of many journals requiring authors to disclose their contributions, agreeing (69%) that it provides useful information for promotion and tenure committees; however, 43% were uncertain about how disclosed contributions were reflected in authorship order. Insights: Respondents strongly endorsed the importance of listing authors in order of decreasing contribution, although the meaning of second versus last author lacks consensus. This finding, together the other strategies that received strong endorsement and those that were not strongly endorsed, provides a starting point to develop guidance for medical educators about how to determine authorship order. Clear guidance for authors would promote fairness and accountability within the medical education community as well as provide more consistent interpretation for those who consider authorship order for career- and resource-related decisions.

Teaching residents mental health care.

OBJECTIVE: We tested the hypothesis that trained medical faculty can train residents effectively in a mental health care model. METHODS: After the authors trained medical faculty intensively for 15 months in primary care mental health, the newly trained faculty taught medical residents intensively. Residents were evaluated pre- and post-residency and compared to non-equivalent control residents in another city. Using ANOVA, the primary endpoint was residents' use of a mental health care model with simulated patients. Secondary endpoints were residents' skills using models for patient-centered interviewing and for informing and motivating patients. RESULTS: For the mental health care model, there was a significant interaction between study site and time (F = 33.51, p < .001, Eta2 = .34); mean pre-test and post-test control group scores were 8.15 and 8.79, respectively, compared to 7.44 and 15.0 for the intervention group. Findings were similarly positive for models of patient-centered interviewing and informing and motivating. CONCLUSIONS: Training medical faculty to teach residents a mental health care model offers a new educational approach to the widespread problem of poor mental health care. PRACTICE IMPLICATIONS: While the models tested here can provide guidance in conducting mental health care, further evaluation of the train-the-trainer program for preparing residents is needed.

Whose Paper Is It Anyway? Authorship Criteria According to Established Scholars in Health Professions Education.

PURPOSE: The health professions education (HPE) community is a crossroad of scholars from various disciplines with potentially conflicting views on who qualifies as author. Established HPE scholars are expected to model ethical research conduct, but no research has investigated the extent to which authorship criteria are understood and applied by leaders in the field. This study investigated what leading scholars consider appropriate criteria for authorship and how often these criteria are ignored. METHOD: Directors of research and editors of HPE journals completed an anonymous survey between September 2015 and August 2016 with questions about authorship practices they experienced and recommended, common authorship criteria, and how often they had encountered unethical authorship decisions. RESULTS: Out of 82 invited scholars, 46 participated in the survey (response rate = 56.0%). They reported a stark contrast between current and recommended authorship practices. Twenty-two (51.2%) had experienced unethical pressure regarding authorship order, 15 (34.9%) had not been included as author when they qualified, and 25 (58.1%) had seen authors included who did not qualify. A slight majority (n = 25; 58.1%) correctly identified authorship standards widely adopted by biomedical journals. CONCLUSIONS: A surprising proportion of leaders in the HPE field had encountered unethical authorship practices. Despite widely disseminated authorship criteria, the findings suggest that offering authorship to those who do not qualify, or arguably worse, excluding those who should have been included, remains a common practice. The authors offer strategies to scholars, editors, and tenure and promotion committees to combat these practices.

Initial Development and Validation of a Family Medicine Attitudes Questionnaire.

BACKGROUND AND OBJECTIVES: Although many curricular and policy interventions are designed to influence students' attitudes toward family medicine, assessment of these interventions is limited by lack of a comprehensive, validated measure of students' attitudes. We sought to develop and validate a questionnaire that effectively assesses medical student attitudes toward family medicine. METHODS: A 31-item questionnaire was assessed for internal, external, and content validity. The questionnaire was offered to fourth-year students at two Midwestern medical schools. Internal validity was assessed using data reduction and iterative factor analyses. External validity was assessed by correlating scores with intention to match in family medicine. Content validity was assessed by directly observing students as they completed the questionnaire and qualitatively evaluating student comments. RESULTS: Of 858 students invited, 426 (49.7%) provided usable questionnaire data. After removal of questions with lower interitem correlations and simplification of subscales, the modified questionnaire achieved acceptable subscale internal consistency and a Cronbach alpha of 0.798. The overall instrument summative score correlated with family medicine career choice (P<0.001). Most subscales and individual items also correlated with family medicine choice. Ten students were directly observed, using an iterative process, and modifications were made based on student understanding. CONCLUSIONS: Development of a validated questionnaire assessing medical student attitudes toward family medicine is feasible. With further refinement, the Family Medicine Attitudes Questionnaire may be useful in evaluating the impact of curricular interventions on students' perceptions of family medicine, contributing to an evidence-based approach to recruitment of students to the specialty.

The Effect of a Community-Based Medical School on the State and Local Physician Workforce.

PURPOSE: To assess the effect of community-based medical education as implemented by Michigan State University College of Human Medicine (MSU-CHM), which has immersed students in diverse communities across Michigan since its founding, on the physician workforce in the six communities in which clinical campuses were initially established. METHOD: The authors used American Medical Association Masterfile data from 2011 to obtain practice locations and specialty data for all MSU-CHM graduates from 1972 through 2006. They classified physicians as either practicing primary care or practicing in a high-need specialty. Using Geographic Information Systems software, the authors geocoded practice locations to the ZIP Code level, evaluated whether the practice was within a Health Professional Shortage Area, and determined rurality, using 2006 Rural-Urban Commuting Area Code data. They visually compared maps of the footprints of each campus to glean insights. RESULTS: The authors analyzed 3,107 of 3,309 graduates (94%). Of these, 635 (20%) practiced within 50 miles of their medical school campus. Saginaw and Flint graduates were more likely to practice in Detroit and its surrounding suburbs, reflecting these communities' urban character. Grand Rapids, the community with the strongest tertiary medical care focus, had the lowest proportions of rural and high-need specialty graduates. CONCLUSIONS: This case study suggests that distributed medical education campuses can have a significant effect on the long-term regional physician workforce. Students' long-term practice choices may also reflect the patient populations and specialty patterns of the communities where they learn.

Progress on a New Kind of Progress Test: Assessing Medical Students' Clinical Skills.

PROBLEM: Progress testing of medical knowledge has advantages over traditional medical school examination strategies. However, little is known about its use in assessing medical students' clinical skills or their integration of clinical skills with necessary science knowledge. The authors previously reported on the feasibility of the Progress Clinical Skills Examination (PCSE), piloted with a group of early learners. This subsequent pilot test studied the exam's validity to determine whether the PCSE is sensitive to the growth in students' clinical skills across the four years of medical school. APPROACH: In 2014, 38 medical student volunteers (years 1-4) in the traditional 2 + 2 curriculum at Michigan State University College of Human Medicine participated in the eight-station PCSE. Faculty and standardized patients assessed students' clinical skills, and faculty assessed students' responses to postencounter necessary science questions. Students performed pretest self-assessment across multiple measures and completed a posttest evaluation of their PCSE experience. OUTCOMES: Student performance generally increased by year in medical school for communication, history-taking, and physical examination skills. Necessary science knowledge increased substantially from first-year to second-year students, with less change thereafter. Students felt the PCSE was a fair test of their clinical skills and provided an opportunity to demonstrate their understanding of the related necessary science. NEXT STEPS: The authors have been piloting a wider pool of cases. In 2016, they adopted the PCSE as part of the summative assessment strategy for the medical school's new integrated four-year curriculum. Continued assessment of student performance trajectories is planned.

Pediatric Prehospital Medication Dosing Errors: A Mixed-Methods Study.

Prehospital dosing errors affect approximately 56,000 US children yearly. To decrease these errors, barriers, enablers and solutions from the paramedic (EMT-P) and medical director (MD) standpoint need to be understood. We conducted a mixed-methods study of EMT-P and MDs in Michigan utilizing focus groups (FG). FGs were held at EMS agencies and state EMS conferences. Questions focused on the drug dose delivery process, barriers and enablers to correct dosing and possible solutions to decrease errors. Responses were coded by the research team for themes and number of response mentions. Participants completed a pre-FG survey on pediatric experience and agency characteristics. There were 35 EMT-P and 9 MD participants: 43% of EMT-Ps had been practicing > 10 years, 11% had been practicing < 1 year; and 25% reported they had not administered a drug dose to a child in the last 12 months. EMT-Ps who were "very comfortable" with their ability to administer a correct drug dose to infants, toddlers, school-aged, and adolescents were: 5%, 7%, 10%, and 54%, respectively. FGs identified themes of: difficulty obtaining weight, infrequent pediatric encounters, infrequent/inadequate pediatric training, difficulties with drug packaging, drug bags that were not "EMS friendly," difficulty with drug calculations, and lack of dosing aids. Simplification of dose delivery, an improved length based tape for EMS, pediatric checklists, and dose cards in mL were given as solutions. This mixed-methods study identified barriers and potential solutions to reducing prehospital pediatric drug dosing errors. Solutions should be thoroughly tested prior to implementation.