Relationships between medical student wellness, self-efficacy, and academic performance during the "post-COVID" period.

This study was a part of a longitudinal study investigating the relationships between medical student wellness, self-efficacy, and performance. Eighty-two eligible students were asked to complete online surveys during their second (M2) and third (M3) years. Performance outcomes included scores on various summative assessments during the M.D. program. Wellness survey results indicated that the sample of 38 M2 and 28 M3 students were overall well and self-efficacious, and they broadly maintained similar wellness characteristics across their medical education despite COVID-19 disruptions. Twenty-three students completed both surveys, and a paired analysis for this subgroup showed modest increases in stress and burnout in the M3 year. Notable correlations were observed between self-efficacy for academic work and a whole range of wellness variables for M2 students. M2 academic performance was modestly correlated to self-efficacy (rs = 0.38, P = 0.02, n = 38) and student burnout (rs = -0.34, P = 0.04, n = 38). In contrast, for the M3 students there was little correlation between wellness, clinical self-efficacy, and clinical performance, with the only significant relationships observed to be between overall clinical self-efficacy and the strength of social networks (rs = 0.41, P = 0.03, n = 28) and between scores for postencounter notes during Objective Structure Clinical Examinations (OSCEs) and self-efficacy in evidence-based medicine (rs = 0.44, P = 0.02, n = 28). In conclusion, 1) students remained generally well throughout the post-COVID period, and 2) self-efficacy for academic work is a good predictor of student wellness and performance during the preclerkship period but not during clinical training.NEW & NOTEWORTHY This study followed a group of medical students through the "post-COVID" period to assess their wellness as they transitioned from basic sciences to clinical training. We found that their wellness and belief in their ability to succeed (self-efficacy) remained strong, showing their resiliency. We observed correlations between self-efficacy and their level of wellness and academic performance during basic science classes but not during clinical training.

Pulmonary vein capture is a predictor for long-term success of stand-alone pulmonary vein isolation with cryoballoon ablation in patients with persistent atrial fibrillation.

Background: The mechanisms of AF development and progression are still not completely understood. Despite the relative efficacy of ablation, the risk of AF recurrence is substantial, particularly in patients with persistent AF (perAF). At present we do not have any reliable intra-procedural electrophysiologic predictors of long-term success of AF ablation other than pulmonary vein isolation. We evaluated selected intraprocedural pulmonary vein characteristics that may be helpful in future guidance of persistent AF ablation. Methods: 390 consecutive procedures using cryoballoon for initial AF ablation were divided by clinical presentation (paroxysmal or persistent AF), and by pulmonary vein (PV) response to pacing after completion of ablation (discrete electrogram elicited with pacing-"PV capture" or not-"Control"). Patients were followed (median 20 months) for recurrent atrial arrhythmias as the primary end point of the study. Results: PV capture was identified in 20.3% and 17.1% and patients with paroxysmal and persistent AF respectively (ns). In patients with persistent AF presence of PV capture was associated with significantly better outcomes compared to patients without PV capture (p < 0.001). In the group "persistent AF and PV capture", an initial strategy of PV isolation and reisolation of the PVs (without additional lesions) for patients with recurrent atrial arrhythmias resulted in 20/23 (87%) patients in sinus rhythm off antiarrhythmic medications at study completion. In patients with paroxysmal AF, PV capture was not associated with outcome benefits. Specific electrophysiologic characteristics of PV (PV capture cycle length: PVCCL) did not have an impact on AF recurrence, although 25% shortening of PVCCL was observed after 60 s periods of pacing at short cycle lengths. No background demographic patient characteristic differences were identified between patients with vs. without PV capture. Conclusion: The presence of PV capture was associated with better outcomes in patients with persistent AF. PV capture may identify those patients with persistent AF in whom cryoballoon PV isolation alone is sufficient as an initial ablation procedure and as the primary ablation strategy for recurrent AF.

Effects of voluntary attendance patterns on first-year medical students' wellness and academic performance during COVID-19.

There is increasing evidence that attendance is not a reliable predictor of academic performance, which invites the question of whether attendance may have alternative positive effects such as increased student wellness. While conducting an observational cohort study on the relationship of attendance to performance and wellness, the COVID-19 pandemic lockdown changed the ability of students to attend class. Matriculating medical students were recruited to participate at the beginning of their first year in August 2019. In-person attendance was collected prospectively until the lockdown began in March 2020. This was then correlated with performance on course final examinations and responses to two separate incidences of a survey on stress, burnout, social isolation, and loneliness. The first survey was deployed January through February 2020 (pre-COVID) and the second June 2020 (during COVID lockdown). Attendance declined across the year (76.0%-25.0%). There was a small positive correlation of attendance to performance in module 1 (r = 0.235, P = 0.035) with none in the remaining two modules (P = 0.870, P = 0.410). The high attenders at the time of the lockdown had no decline in their performance when attendance was no longer possible. Attendance negatively correlated with stress and loneliness but not with the remainder of the wellness metrics. There was no significant change in any of the wellness metrics between the pre-COVID and during COVID time points. While the data support the conclusion that attendance is not required to maintain performance in this population, these data suggest a small protective effect against stress and loneliness.

Lessons Learned in the Design and Implementation of Virtual Telemedicine Curriculum for Third Year Medical Students Incorporating New AAMC Telehealth Competencies.

This article was migrated. The article was marked as recommended. Background: Telehealth, including Telemedicine, is the use of electronic communications technology to provide healthcare at a distance. There is a growing need to train future physicians to be adept and knowledgeable of telehealth. The Association of American Medical Colleges (AAMC) recently defined six core competency domains for Telehealth for medical residents and attending physicians. Methods: A multidisciplinary team of medical educators, Telemedicine practitioners, instructional technology experts and a senior medical student designed a Telemedicine curriculum centered on five primary educational activities. Training moved progressively from novice Telemedicine experiences to Telemedicine encounters with standardized patients and post-encounter debriefs to promote active learning, engagement, and self-regulation. The Telemedicine curriculum was prioritized and delivered to the entire class of 2022 (114 third-year medical students). Results: Student satisfaction surveys and post formative quiz items were used to assess the impact of the Telemedicine Curriculum. Over 95% of surveyed students agreed or strongly agreed the course was organized and helpful in developing clinical skills in preparation for clerkship. Students particularly valued the opportunity to engage in patient encounters while learning Telemedicine-specific patient safety and communication skills. Conclusion: With careful attention to instructional design, active learning formats that are historically successful in face-to-face settings can be equally successful in virtual settings. Standardized patients and peers can be trained to provide appropriate feedback in the right virtual setting.

Patterns of medical student engagement in a second-year pathophysiology course: relationship to USMLE Step 1 performance.

Historically, attendance has been a marker of academic performance, but the current medical education literature has had mixed results. In addition, attendance is dropping in the preclinical curricula, whereas, at the same time, the focus on United States Medical Licensing Examination Step 1 performance is increasing. This present study is a mixed-method approach correlating student attendance and access to the formal curriculum in a second-year pathophysiology course to performance on Step 1. Additionally, survey and focus group data evaluated the usage and importance of both the formal curriculum and third-party resources. Out of 112 eligible students, 77 participated in the study. There was no correlation between attendance or access to the learning materials and Step 1 performance. There was a strong correlation between the performance on the final examination and that of Step 1 (r = 0.813; P < 0.001) and a moderate correlation between formative quiz (r = 0.321; P = 0.005) and individual readiness assessment test performance (r = 0.351; P = 0.002) and Step 1 performance. Survey and focus group data show that students place high importance on faculty-developed materials that they can use on their own, but not attendance. The third-party resources are highly used as an adjunct to the formal curriculum and to focus on Step 1 study. Attendance and access to the formal curriculum do not predict Step 1 performance, whereas performance on high- and low-stakes internal assessments do. Further study on how the lack of social interaction gained from attendance affects development of other competencies and the learning climate are warranted.

Pre-clerkship medical students' perceptions of medical professionalism.

BACKGROUND: Professionalism instruction and assessment is a core component of medical education, and essential for professional identity formation (PIF). Thus, understanding the socialization of medical students to the values of the profession (i.e., medical professionalism), and how these may evolve, warrants continued understanding. METHODS: The purpose of this study was to examine and compare pre-clerkship (first and second year) medical students' perceptions of professionalism. First and second year medical students participate in this study. This was a two-phase mixed-methods cohort study conducted across two academic years (2014-2015 and 2015-2016). In Phase I, first and second year medical students participated in a nominal group technique (NGT) session. NGT data was analyzed qualitatively to generate a card-sorting exercise of professionalism attributes for Phase II. In Phase II, data from the sorting task was analyzed using Principle Component Analysis (PCA). RESULTS: The PCA for first year students derived a 7-factor solution. Factors (i.e., professionalism domains) identified were: Self-management and patient-centeredness, ethics and professional reputation, dependability, self-awareness and self-improvement, image, proficiency and lifelong learning and integrity. The PCA for second year students derived a 5-factor solution; factors identified were: "Good Doctor" attributes, responsibility, ethics, innovation and self-improvement and unbiased. CONCLUSIONS: Identification and organization of attributes into an overarching professionalism mental model provide a window into the active reconstruction of students' professional identity during the nascent stages of medical education. M1 professionalism domains were more consistent with the conventional professional image of the physician (e.g. Ethics and Professional reputation, Dependability, Integrity), whereas, M2 domains reflected a more global view (e.g., "Good Doctor" attributes, Responsibility, Ethics). This study provides a lens into the dynamic nature of students' PIF and encourages educators to evaluate PIF pedagogy at their own institutions.

Relationship between classroom attendance and examination performance in a second-year medical pathophysiology class.

Studies completed with undergraduate populations have shown that attendance positively correlates with academic performance. A marked decline in classroom attendance within medical school has recently been noticed with the availability of video capture of lectures and other online material. This study compares these in the era of online material. It took place during the second-year Gastrointestinal and Renal Systems module. Attendance was mandatory at team-based learning and case-based learning sessions on new material and voluntary at lectures (29 sessions) and case-based learning on material previously covered (9 sessions). Attendance was recorded prospectively. All lectures were recorded, and all related files were available to students online. Performance was based on a 118 multiple-choice question final examination. Students voluntarily completed the Motivated Strategies for Learning Questionnaire (MSLQ). The study group consisted of 78 students (68% of 114 total) of whom 48 completed the MSLQ. Mean attendance was 24%, with 33% of students attending none of the nonmandatory sessions. The median score on the final exam for participants was 86.0 (range: 28.8). High levels of self-efficacy and the ability to self-regulate effort were predictive of low attendance. Attendance was positively predicted by an orientation toward peer learning and help seeking. There was no correlation between the percentage of classes attended and performance on the final exam. We conclude that different facets of self-regulated learning predict attendance, with highly confident students being the least likely to attend, and that attendance at in-class sessions is no longer a good marker for performance.

A comparison of bleeding complications between warfarin, dabigatran, and rivaroxaban in patients undergoing cryoballoon ablation.

INTRODUCTION: In recent years, several novel anticoagulants have been approved for the prevention of thromboembolic strokes as an alternative to warfarin in patients with atrial arrhythmias. Studies have evaluated these medications in patients undergoing radiofrequency ablation, yet no data exists to evaluate the bleeding risk in patients undergoing cryoballoon ablation procedures. METHODS: Patients that underwent either cryoballoon ablation alone or with additional radiofrequency ablation over the past 3 years were included in the study. Patients were stratified into one of three subsets based on type of anticoagulation (warfarin, dabigatran, or rivaroxaban). Bleeding complications during the first 48 h and first 2 weeks following the ablation were recorded. Major complications were defined as hemorrhage requiring blood products or need for vascular intervention. Minor complications included prolonged bleeding from catheter insertion site, development of ecchymosis, or hematoma formation. Intraprocedural activated clotting times (ACT) were assessed and compared. RESULTS: A total of 217 patients met inclusion criteria of which 87 (40.1 %) patients were on warfarin, 90 (41.5 %) patients on dabigatran, and 40 (18.4 %) patients on rivaroxaban. The overall bleeding complication rate was 12.0 %. All complications occurred within the first 48 h post-ablation. Nine (10.3 %) complications occurred in the warfarin subset, ten (11.1 %) in the rivaroxaban subset, and seven (17.5 %) in the dabigatran subset (p = 0.49). The warfarin and dabigatran subsets had higher average ACT levels (424.9 versus 406.5) compared to the rivaroxaban subset (393.4; p < 0.01). Subanalyses found no difference in bleeding complications based on procedure type. CONCLUSION: Bleeding complications post-ablation were similar for warfarin, dabigatran, and rivaroxaban in patients undergoing cryoballoon ablation. Compared with radiofrequency ablation, cryoablation does not place patients at an increased bleeding risk.

A comparison of bleeding complications post-ablation between warfarin and dabigatran.

INTRODUCTION: Although warfarin has traditionally been used for reducing risk of stroke in patients with atrial fibrillation, over the past year, the direct thrombin inhibitor dabigatran has become an accepted alternative. No study has conclusively investigated bleeding risks of patients treated with dabigatran immediately following radiofrequency catheter ablation (RFCA) procedures. METHODS: We evaluated 156 consecutive patients referred for RFCA of atrial arrhythmias: 31 patients were on dabigatran and 125 patients were on warfarin. The incidence of bleeding complications during the first 48 h and the first week following ablation were recorded and comparisons made using Fisher's exact test. Major complications were defined as hemorrhage requiring blood products or the need for vascular intervention. Minor complications were defined as prolonged bleeding from the catheter insertion site, hematoma formation, or development of ecchymosis. Our study also took into account the intraprocedure activated clotting time (ACT) levels in an effort to describe any differences between both patient groups. RESULTS: There were no differences in age, gender, procedure type, or level of intraprocedural anticoagulation between the warfarin and dabigatran groups. No major bleeding complications were observed in either patient group at either 48 h or 1 week postprocedure. Six of the 31 dabigatran patients and 21 of the 125 warfarin patients had minor bleeding complications. There was no statistically significant difference between the incidence of minor bleeding complications between the two groups (p = 0.7384), although rebleeding was more commonly observed in patients on dabigatran. In regard to the intraprocedure ACT levels, there was more variability in the dabigatran patient group, and it was more difficult to achieve the goal ACT level, yet these results did not affect overall bleeding complications. CONCLUSION: In our cohort, bleeding-related complications 48 h and 1 week post-ablation were similar for warfarin and dabigatran. Dabigatran is associated with more intraprocedural variability in ACT than warfarin.