MPRO: A Professionalism Curriculum to Enhance the Professional Identity Formation of University Premedical Students.

Limited opportunities exist for university premedical students to gain exposure to the realities of clinical practice through physician shadowing or through a formal curriculum. Medical Professionalism and Observership utilizes didactics, reflective writing, small- and large- group discussions, and clinical observerships to enhance the process of professional identity formation during a critical developmental window of late- adolescence. The pilot semester included a sample of 135 students, all in their sophomore, junior, or senior years of study at Rice University. Students were selected through an application process and paired with physicians at Houston Methodist Hospital based on specialty preference and availability. Students were required to participate in biweekly lectures and discussions and to submit a weekly reflection on topics discussed in the course and their shadowing experiences. Student evaluations were administered to survey changes in students' knowledge and perceptions of the curriculum. Selected reflections were read for evidence of professional identity formation. Lectures increased students' exposure to core competencies within the medical profession and influenced their desire to become physicians. Reflective writings demonstrated integration of these core competencies into the professional identity of students. Structured reflection and didactics, when coupled with physician shadowing, appear to promote integration of the values, beliefs, and attitudes of medical professionalism. Future studies should seek to demonstrate how such a curriculum affects professional identity formation through established measures, and to assess whether such a curriculum may influence students' preparedness for medical training and practice as they progress along their careers.

The process of attrition in pre-medical studies: A large-scale analysis across 102 schools.

The important but difficult choice of vocational trajectory often takes place in college, beginning with majoring in a subject and taking relevant coursework. Of all possible disciplines, pre-medical studies are often not a formally defined major but pursued by a substantial proportion of the college population. Understanding students' experiences with pre-med coursework is valuable and understudied, as most research on medical education focuses on the later medical school and residency. We examined the pattern and predictors of attrition at various milestones along the pre-med coursework track during college. Using a College Board dataset, we analyzed a sample of 15,442 students spanning 102 institutions who began their post-secondary education in years between 2006 and 2009. We examined whether students fulfilled the required coursework to remain eligible for medical schools at several milestones: 1) one semester of general chemistry, biology, physics, 2) two semesters of general chemistry, biology, physics, 3) one semester of organic chemistry, and 4) either the second semester of organic chemistry or one semester of biochemistry, and predictors of persistence at each milestone. Only 16.5% of students who intended to major in pre-med graduate college with the required coursework for medical schools. Attrition rates are highest initially but drop as students take more advanced courses. Predictors of persistence include academic preparedness before college (e.g., SAT scores, high school GPA) and college performance (e.g., grades in pre-med courses). Students who perform better academically both in high school and in college courses are more likely to remain eligible for medical school.

Premedical Student Exposure to Pharmaceutical Marketing: Too Much, Too Soon?

BACKGROUND AND OBJECTIVES: Direct pharmaceutical marketing to physicians by pharmaceutical representatives is effective in changing behavior of health care providers, resulting in less evidence-based prescribing. Although much has been written about pharmaceutical marketing exposures among medical students, less is known about direct marketing exposures before students matriculate. This study examined the types of pharmaceutical representative direct marketing exposures for premedical students and where they occurred. METHODS: From June to August of 2017, researchers surveyed students who accepted admission to US public medical schools. These prematriculated students completed our survey just prior to matriculation. The survey inquired about whether the students were exposed to pharmaceutical marketing directly from pharmaceutical salespeople, the types of marketing they observed or received, and where these interactions occurred. RESULTS: Survey participants included 911 prematriculated students from 14 of the 188 medical schools invited to participate. Seventy-one percent (646) of the participants received or observed someone receiving pharmaceutical marketing gifts, small meals or snacks, articles, or samples. The two most common contexts for direct pharmaceutical marketing exposures were during shadowing experiences (54%, 346) and during employment (50%, 323). CONCLUSIONS: The findings suggest that it may be common for medical students to have interacted directly with pharmaceutical salespeople or observed other health professionals in these interactions before they matriculate in medical school. Because many of these interactions occur during clinical experiences required by institutions for admission, medical schools and premedical associations should consider delivering conflict-of-interest education early in medical school education or before students matriculate.

Trends in Racial/Ethnic Representation Among US Medical Students.

Importance: With increasing efforts to create a diverse physician workforce that is reflective of the demographic characteristics of the US population, it remains unclear whether progress has been made since 2009, when the Liaison Committee on Medical Education set forth new diversity accreditation guidelines. Objective: To examine demographic trends of medical school applicants and matriculants relative to the overall age-adjusted US population. Design, Setting, and Participants: Repeated cross-sectional study of Association of American Medical Colleges data on self-reported race/ethnicity and sex of medical school applicants and matriculants compared with population distribution of the medical school-aged population (20-34 years). Data from US allopathic medical school applicants and matriculants from 2002 to 2017 were analyzed. Main Outcomes and Measures: Trends were measured using the representation quotient, the ratio of the proportion of a racial/ethnic group in the medical student body to the general age-matched US population. Linear regression estimates were used to evaluate the trend over time for Asian, black, white, Hispanic, American Indian or Alaska Native (AIAN), and Native Hawaiian or Other Pacific Islander medical school matriculants by sex. Results: The number of medical school applicants increased 53%, from 33 625 to 51 658, and the number of matriculants increased 29.3%, from 16 488 to 21 326, between 2002 and 2017. During that time, proportions of black, Hispanic, Asian, and Native Hawaiian or Other Pacific Islander male and female individuals aged 20 to 34 years in the United States increased, while proportions of white male and female individuals decreased and proportions of AIAN male and female individuals were stable. From 2002 to 2017, black, Hispanic, and AIAN applicants and matriculants of both sexes were underrepresented, with a significant trend toward decreased representation for black female applicants from 2002 to 2012 (representation quotient slope, -0.011; 95% CI, -0.015 to -0.007; P < .001). Conclusions and Relevance: Black, Hispanic, and AIAN students remain underrepresented among medical school matriculants compared with the US population. This underrepresentation has not changed significantly since the institution of the Liaison Committee of Medical Education diversity accreditation guidelines in 2009. This study's findings suggest a need for both the development and the evaluation of more robust policies and programs to create a physician workforce that is demographically representative of the US population.

Parting ways: Sex-based differences in premedical attrition.

Despite women's greater propensity to enter college aspiring to careers in medicine, they are less likely than men to persist in these ambitions. Past research suggests that students' experiences in coursework strongly influence their decision to continue along or depart from the premedical track, yet it remains unclear whether women and men have differential experiences in coursework that contribute to sex-based disparities in premedical attrition. To gain insight into whether and how premeds' experiences in coursework contribute to gendered patterns of attrition, this study employs a mixed methods design that combines longitudinal survey data collected from premedical students at a large state university with in-depth interview data collected from a subset of respondents. Survey results (n = 268) demonstrate that while women report more stress from premedical coursework than men, these differences do not help to explain the female-male gap in attrition. Rather, it is women's lower levels of affinity for premedical coursework-specifically, their less positive evaluations of premed coursework, and greater enjoyment of non-premed courses-that contribute most notably to the gender gap in attrition. Qualitative results (n = 39) suggest that women's affinity for premed coursework is diminished by more frequent, negative interactions with faculty, and a tendency to interpret low grades in premedical coursework as a sign that this career track is a 'poor fit' for their strengths and aptitudes. These findings broadly align with scholarship on the role of self-expressive decision-making in curricular sex segregation. Interview data also point to a critical factor for sustaining women's medical career aspirations: clinical experiences. Ranging from shadowing, to volunteer experiences, to jobs in local hospitals, these experiences allow women to 'try on' the role of doctor and inspire resilience in the face of academic adversity. The implications of findings for future research on premedical education are discussed.

Evaluation of critical thinking course for premedical students using literature and film.

PURPOSE: Premedical education is one stage in which various educational approaches are used to promote critical thinking. Given that critical thinking ability could be regarded as one of the intended outcomes of social science and humanities education, this study explored the effectiveness of a course to promote critical thinking in a premedical curriculum using both literature and film. METHODS: Fifty-one 2nd year premedical students enrolled in a 'Critical Thinking for Premeds' course. Students were required to read or watch a selected material, submit group discussion agendas, attend five group discussion sessions, and write critical essays. Five tutors facilitated the group discussions, observed and assessed the students' performance and critical essay. Students' critical thinking disposition and opinion on assigned reading materials were examined before and after the course. A program evaluation survey was conducted to investigate the students' reaction after the course. RESULTS: On average, students appreciated 78.6% of the total assigned materials. The students indicated that group discussions and the narrative comments of facilitators contributed the most to develop critical thinking. After the course, the students' tendency preferring cheaper price books, as well as medicine-related books decreased significantly. Students who had critical essay scores greater than or equal to the median demonstrated a significant improvement in critical thinking disposition scores. CONCLUSION: The course was well-accepted by premedical students and had several positive outcomes. A more effective use of the course could be anticipated with a clearer explanation of the purpose, the consideration of previous reading experience, and use of complementary learning activities.

What's Your Style? Enhanced Interprofessional Communication and Practice Using the Communication Wheel.

Today's health care environment requires collaborative teams to provide safe, effective care. This study assessed the extent to which a face-to-face workshop increased nursing and premedical students' awareness of varying communication styles and their potential impact on interprofessional communication and practice. A self-assessment tool was administered before, immediately after, and 1 month after the workshop. Significant increases in familiarity working on interprofessional teams, identifying different communication styles, and ability to apply communication strategies were found immediately after and 1 month after the workshop.

Informing the uninformed: a multitier approach to uncover students' misconceptions on cardiovascular physiology.

Misconceptions about physiology are a major threat to accurate scientific and clinical reasoning in medical education. Awareness is often mentioned as a prerequisite to achieve conceptual understanding; however, students are frequently unaware of their incorrect understanding. We explored the multitier approach as a tool to obtain insight into students' awareness and misconceptions regarding cardiovascular physiology. Biomedical sciences students ( N = 81) participated in a diagnostic multitier assessment on cardiovascular physiology. Each question consisted of an answer tier and an explanation tier. Both tiers were paired with confidence tiers, i.e., 5-point Likert scales, which were used as an indicator for metacognitive evaluation, i.e., awareness. The average test score was 3.07 (maximum 4.0) for the answer tier only, and reduced to 1.57 when answer and explanation tiers were combined. A weak correlation ( R2 = 0.13, P = 0.001) between students' confidence and their test scores was found for the combined responses. Correct combined answers were associated with an increase in confidence score of 0.27 vs. incorrect answers. Using a Bland-Altman analysis, we showed that students generally overestimated their knowledge. In total, 28.7% of all responses were classified as misconceptions, defined as incorrect answers paired with high confidence. In all, findings indicate that the multitier approach is useful to study students' conceptual understanding and uncover misconceptions on cardiovascular physiology. Furthermore, this study supports the need for metacognitive measures in order to improve teaching and learning in medical education.

Depressive symptoms, burnout, and declining medical career interest among undergraduate pre-medical students.

OBJECTIVES: To investigate the relationship between mental health issues and medical career interest among undergraduate premedical students, and to explore whether this association varies by gender. METHODS: A longitudinal survey of freshman and sophomore premedical students at Indiana University was conducted during the 2015-16 academic year. Survey data were collected from 390 respondents via an online questionnaire (response rate=14%) in September 2015, and 292 of these respondents participated in the follow-up survey in April 2016 (retention rate=75%). Multi-level regression models were used to estimate the associations among depressive symptoms, burnout, and medical career interest. RESULTS: Respondents who experienced more depressive symptoms (ß = -.07, z =-2.49, p =.013) and higher levels of burnout (ß = -.50, z =-3.98, p <.001) reported significant reductions in medical career interest over the study period. These associations remained consistent after controlling for socio-demographic characteristics and prior academic achievement. Depressive symptoms were associated with steeper declines in medical career interest among women compared to men (ß = -.09, z =-2.01, p =.045), though the relationship between burnout and medical career interest did not significantly vary by gender. CONCLUSIONS: Results provide evidence that premeds who experience more depressive symptoms and higher levels of burnout become less interested in entering the medical profession. The negative association between depressive symptoms and medical career interest was even more pronounced among premedical women compared to men. Findings suggest that colleges and universities in the United States should implement programs aimed at safeguarding the mental health of premedical students.

Friend or frenemy? Experiential homophily and educational track attrition among premedical students.

Support from experientially similar others-individuals who have been through the same life transition or faced a similar set of stressful circumstances-has been shown to be effective for coping with issues ranging from chronic illness to bereavement. Less research has examined how networks comprised of experientially similar others may shape academic outcomes. Using longitudinal egocentric network data collected from early career premedical students at a large research university (n = 268), results indicate that greater experiential homophily in premeds' networks are associated with a lower likelihood of departing from the premedical career track at the end of the academic year. Interview data (n = 39) highlight three support functions provided by premedical peers that help to explain this relationship: 1) concrete task assistance with assignments and studying, 2) empathic understanding and emotional support, and 3) advice and reassurance from more advanced peers. Results hint at the potential utility of peer support for the retention of students at-risk of straying from the premedical career track, and have implications for other fields of study.

Interaction Effects of Happiness and Physical Activity on Smoking Initiation.

OBJECTIVE: Our aim was to assess the potential relationships among happiness, physical activity, and smoking initiation among undergraduate medical students in Saudi Arabia. METHODS: We performed a cross-sectional study of randomly selected first- to fifth-year undergraduate medical students. Smoking initiation was defined as "ever trying smoking a cigarette, waterpipe, cigar/cigarillo, or other type of tobacco, even one or 2 puffs." The short scale Oxford Happiness Questionnaire was used to assess each student's happiness. Multivariate logistic regression analysis was performed. RESULTS: Of the 406 students surveyed (208 boys, 198 girls), 86 (21.1%) had initiated smoking. We found an interaction between physical activity (PA) and happiness on smoking initiation (p-interaction = .012). Among boys with low levels of PA, lower levels of happiness were associated with a greater likelihood of smoking initiation (OR = 5.8, 95%CI = 1.9 - 17.5). Also, high levels of PA increased the chance of smoking initiation among male students with high levels of happiness (OR = 5.6, 95%CI = 2.1 - 14.5). CONCLUSION: Our results suggest that young men with low levels of happiness and low levels of PA, as well as high levels of PA and high levels of happiness, may be targeted as a priority population in tobacco control intervention programs.

Premedical Students' Attitudes Toward Primary Care Medicine.

BACKGROUND: Expanded insurance coverage will likely increase the demand for primary care physicians in the United States. Despite this demand, the number of medical students planning to specialize in primary care is decreasing. OBJECTIVE: To explore premedical students' attitudes toward the primary care specialty. METHODS: Students enrolled in premedicine at a large Midwestern university were invited to complete the Primary Care Attitudes Survey (Cronbach α=.76). This 25-item survey measures attitudes about primary care on a 5-point Likert scale, ranging from 1, "strongly disagree" to 5, "strongly agree." Basic sociodemographic characteristics were assessed using descriptive statistics, and frequencies of individual survey responses were calculated using SPSS statistical software version 21.0. RESULTS: A total of 100 premedical students (mean [SD] age, 19.8 [1.5] years; 59 female, 82 white non-Hispanic, and 33 freshman) completed the survey. Of 100 students, 33 planned to pursue primary care; 66 thought that primary care physicians would always have a job; 25 thought that primary care may become obsolete as medicine becomes more specialized; 48 thought that physician assistants and nurse practitioners would take over many primary care duties in the future; 91 thought that primary care physicians make important contributions to medicine; and 84 agreed that primary care focuses on the whole patient. CONCLUSIONS: Premedical students held positive views about the importance of primary care; however, many expressed uncertainty about the stability of primary care careers in the future. Further, a substantial number of students believed common misconceptions about the scope and practice of primary care, such as primary care doctors are gatekeepers and mostly diagnose colds and ear infections.

Academic performance in human anatomy and physiology classes: a 2-yr study of academic motivation and grade expectation.

This project used a nonexperimental design with a convenience sample and studied the relationship between academic motivation, grade expectation, and academic performance in 1,210 students enrolled in undergraduate human anatomy and physiology (HAP) classes over a 2-yr period. A 42-item survey that included 28 items of the adapted academic motivation scale for HAP based on self-determination theory was administered in class during the first 3 wk of each semester. Students with higher grade point averages, who studied for longer hours and reported to be more motivated to succeed, did better academically in these classes. There was a significant relationship between students' scores on the adapted academic motivation scale and performance. Students were more extrinsically motivated to succeed in HAP courses than intrinsically motivated to succeed, and the analyses revealed that the most significant predictor of final grade was within the extrinsic scale (introjected and external types). Students' motivations remained stable throughout the course sequence. The data showed a significant relationship between HAP students' expected grade and their final grade in class. Finally, 65.5% of students overestimated their final grade, with 29% of students overestimating by two to four letter grades.

An innovative programme for premedical students.

BACKGROUND: The worldwide shortage of doctors and the low representation of minorities in medicine outline the need for enrichment programmes that expose a diverse population of youth to health careers. This report describes the innovative Summer Premed Program run at the University of California, Irvine School of Medicine, from the perspective of our diverse group of participating high school students. METHODS: Our unique and highly interactive programme focused on providing youths with a glimpse of life in medical school. Students participated in interactive workshops such as a cadaver lab, robotics, patient interviews and bedside ultrasound. To determine the success of the programme, a feedback survey was distributed to all students at the end of the programme. RESULTS: During the summers of 2012, 2013 and 2014, 418 high-school students participated in the programme and 19.4 per cent were under-represented in medicine. Of the 418 students, 371 (89%) completed evaluations. The average rating of all the workshops ranged from 3.26 to 4.68 (out of maximum of 5) with cadaver lab, suturing workshops and patient interviews each having the highest rating of approximately 4.7. Additionally, resulting from this programme, students gave an average rating of 4.42 for comfort in interviewing patients, and 4.55 for professional development. DISCUSSION: The results reveal that the Summer Premed Program at the University of California, Irvine School of Medicine, was successful towards exposing a diverse range of youths to medical school while motivating them to pursue careers in medicine. The follow-up of participants' career choices is needed to assess the long-term effectiveness of the programme. [There is a] need for enrichment programmes that expose a diverse population of youth to health careers.

Professional identity formation: creating a longitudinal framework through TIME (Transformation in Medical Education).

The University of Texas System established the Transformation in Medical Education (TIME) initiative to reconfigure and shorten medical education from college matriculation through medical school graduation. One of the key changes proposed as part of the TIME initiative was to begin emphasizing professional identity formation (PIF) at the premedical level. The TIME Steering Committee appointed an interdisciplinary task force to explore the fundamentals of PIF and to formulate strategies that would help students develop their professional identity as they transform into physicians. In this article, the authors describe the task force's process for defining PIF and developing a framework, which includes 10 key aspects, 6 domains, and 30 subdomains to characterize the complexity of physician identity. The task force mapped this framework onto three developmental phases of medical education typified by the undergraduate student, the clerkship-level medical student, and the graduating medical student. The task force provided strategies for the promotion and assessment of PIF for each subdomain at each of the three phases, in addition to references and resources. Assessments were suggested for student feedback, curriculum evaluation, and theoretical development. The authors emphasize the importance of longitudinal, formative assessment using a combination of existing assessment methods. Though not unique to the medical profession, PIF is critical to the practice of exemplary medicine and the well-being of patients and physicians.

Is a career in medicine the right choice? The impact of a physician shadowing program on undergraduate premedical students.

PROBLEM: Undergraduate (i.e., baccalaureate) premedical students have limited exposure to clinical practice before applying to medical school-a shortcoming, given the personal and financial resources required to complete medical training. APPROACH: The Stanford Immersion in Medicine Series (SIMS) is a program that streamlines the completion of regulatory requirements for premedical students and allows them to develop one-on-one mentor-mentee relationships with practicing physicians. The program, offered quarterly since 2007, is an elective available for Stanford University sophomores, juniors, and seniors. Participants apply to the program and, if accepted, receive patient rights and professionalism training. Students shadow the physician they are paired with at least four times and submit a reflective essay about their experience.SIMS program coordinators administered surveys before and after shadowing to assess changes in students' perceptions and understanding of medical careers. OUTCOMES: The authors observed, in the 61 Stanford premedical students who participated in SIMS between March and June 2010 and completed both pre- and postprogram questionnaires, significant increases in familiarity with physician responsibilities and in understanding physician-patient interactions. The authors detected no significant changes in student commitment to pursuing medicine. Student perceptions of the value of shadowing-high both pre- and post shadowing-did not change. NEXT STEPS: Physician shadowing by premedical baccalaureate students appears to promote an understanding of physician roles and workplace challenges. Future studies should identify the ideal timing, format, and duration of shadowing to optimize the experience and allow students to make informed decisions about whether to pursue a medical career.

Association of academic performance of premedical students to satisfaction and engagement in a short training program: a cross sectional study presenting gender differences.

BACKGROUND: It is important that students have a high academic engagement and satisfaction in order to have good academic achievement. No study measures association of these elements in a short training program. This study aimed to measure the correlation between academic achievement, satisfaction and engagement dimensions in a short training program among premedical students. METHODS: We carried out a cross sectional study, in August 2013, at Cercle d'Etudiants, Ingénieurs, Médecins et Professeurs de Lycée pour le Triomphe de l'Excellence (CEMPLEX) training center, a center which prepares students for the national common entrance examination into medical schools in Cameroon. We included all students attending this training center during last examination period. They were asked to fill out a questionnaire on paper. Academic engagement was measured using three dimensions: vigor, dedication and absorption. Satisfaction to lessons, for each learning subject was collected. Academic achievement was calculated using mean of the score of all learning subjects affected with their coefficient. Pearson coefficient (r) and multiple regression models were used to measure association. A p value < 0.05 was statistically significant. RESULTS: In total, 180 students were analyzed. In univariate linear analysis, we found correlation with academic achievement for vigor (r = 0.338, p = 0.006) and dedication (r = 0.287, p = 0.021) only in male students. In multiple regression linear analysis, academic engagement and satisfaction were correlated to academic achievement only in male students (R2 = 0.159, p = 0.035). No correlation was found in female students and in all students. The independent variables (vigor, dedication, absorption and satisfaction) explained 6.8-24.3% of the variance of academic achievement. CONCLUSION: It is only in male students that academic engagement and satisfaction to lessons are correlated to academic achievement in this short training program for premedical students and this correlation is weak.