Preparing for the MD: How Long, at What Cost, and With What Outcomes?

PURPOSE: To assess educational and professional outcomes of an accelerated combined bachelor of science-doctor of medicine (BS-MD) program using data collected from 1968 through 2018. METHOD: Participants of this longitudinal study included 2,235 students who entered medical school between 1968 and 2014: 1,134 in the accelerated program and 1,101 in the regular curriculum (control group)-matched by year of entrance to medical school, gender, and Medical College Admission Test (MCAT) scores. Outcome measures included performance on medical licensing examinations, academic progress, satisfaction with medical school, educational debt, first-year residency program directors' ratings on clinical competence, specialty choice, board certification, and faculty appointments. RESULTS: The authors found no practically important differences between students in the accelerated program and those in the control group on licensing examination performance, academic progress, specialty choice, board certification, and faculty appointments. Accelerated students had lower mean educational debt (P < .01, effect sizes = 0.81 and 0.45 for, respectively, their baccalaureate debt and medical school debt), lower satisfaction with their second year of medical school (P < .01, effect size = 0.21), and lower global satisfaction with their medical school education (P < .01, effect size = 0.35). Residency program directors' ratings in 6 postgraduate competency areas showed no practically important differences between the students in the accelerated program and those in the control group. The proportion of Asian students was higher among program participants (P < .01, effect size = 0.43). CONCLUSIONS: Students in the accelerated program earned BS and MD degrees at a faster pace and pursued careers that were comparable to students in a matched control who were in a regular MD program. Findings indicate that shortening the length of medical education does not compromise educational and professional outcomes.

Effects of a Brief Curricular Intervention on Medical Students' Attitudes Toward People with Disabilities in Healthcare Settings.

This study sought to evaluate the effects of a brief curricular intervention on medical students' attitudes toward physical disability in healthcare settings. Students participated in a focused curriculum about people with disabilities (PWDs), which included 2.5 hours of lectures, panel discussions, and video presentations. After the curricular sessions, students were surveyed (n = 237), and their attitudes toward PWDs in healthcare settings were compared with those of students who did not undergo the intervention (n = 251) using the Disability Attitudes in Health Care (DAHC) scale. Thematic analysis of the students' comments regarding the session was performed to supplement the DAHC scale. The intervention group responded with significantly more positive attitudes on 6 of the 17 items on the DAHC scale, and multiple linear regression analysis confirmed the independent effect of the curriculum on higher DAHC scale scores. Female students had more positive attitudes on the survey than did male students, although the effect of the curriculum was independent of gender. Previous experiences with PWDs did not correlate to higher attitude scores. These results suggest that a brief curricular intervention on disability can engender more positive attitudes in medical students toward PWDs.

Predicting Peer Nominations Among Medical Students: A Social Network Approach.

PURPOSE: Minimal attention has been paid to what factors may predict peer nomination or how peer nominations might exhibit a clustering effect. Focusing on the homophily principle that "birds of a feather flock together," and using a social network analysis approach, the authors investigated how certain student- and/or school-based factors might predict the likelihood of peer nomination, and the clusters, if any, that occur among those nominations. METHOD: In 2013, the Jefferson Longitudinal Study of Medical Education included a special instrument to evaluate peer nominations. A total of 211 (81%) of 260 graduating medical students from the Sidney Kimmel Medical College responded to the peer nomination question. Data were analyzed using a relational contingency table and an ANOVA density model. RESULTS: Although peer nominations did not cluster around gender, age, or class rank, those students within an accelerated program, as well as those entering certain specialties, were more likely to nominate each other. The authors suggest that clerkships in certain specialties, as well as the accelerated program, may provide structured opportunities for students to connect and integrate, and that these opportunities may have an impact on peer nomination. The findings suggest that social network analysis is a useful approach to examine various aspects of peer nomination processes. CONCLUSIONS: The authors discuss implications regarding harnessing social cohesion within clinical clerkships, the possible development of siloed departmental identity and in-group favoritism, and future research possibilities.

Medical School Anatomy and Pathology Workshops for High School Students Enhance Learning and Provide Inspiration for Careers in Medicine.

"Anatomy and Pathology Workshop" is a cadaver-based outreach program that models medical education to large groups of high school students. This study was designed to evaluate the impact of this program on students' knowledge of anatomy and interest in biomedical science. A total of 144 high school students participated in the workshop in 2015. Preworkshop and postworkshop assessments were administered to assess students' learning. A postworkshop survey was conducted to solicit students' reflections and feedback. It was found that student performance in the postworkshop examination (mean 78%) had significantly improved when compared to the performance in the preexamination (mean 54%), indicating that this program enhances learning. Students were also inspired to consider opportunities in medicine and allied health professions-97% indicated that they had a better understanding of medical education; 95% agreed that they had better understanding of the human body; 84% thought anatomy was interesting and exciting; and 62% of the students indicated that they looked forward to studying medicine or another health profession. Students rated the instructors highly-95% agreed that the instructors were professional and served as role models. Medical/graduate student instructors were also highly regarded by the high school students-96% thought it was valuable to have student instructors and 94% thought that student instructors were caring and enthusiastic about teaching. In summary, this study demonstrates that outreach programs provided by medical schools help young adults during their formative years by modeling professionalism, providing role models, enhancing learning, and encouraging many to consider opportunities in the health professions.

Increased rates of pregnancy complications in women with celiac disease.

BACKGROUND: Celiac disease is an immune-mediated small bowel disorder that develops in genetically susceptible individuals upon exposure to dietary gluten. Celiac disease could have extra-intestinal manifestations that affect women's reproductive health. The aim of this study was to investigate fertility and outcomes of pregnancy among women with celiac disease. METHODS: In a retrospective cohort study, we analyzed information collected from patients at a tertiary care celiac center and from members of 2 national celiac disease awareness organizations. Women without celiac disease were used as controls. Women completed an anonymous online survey, answering 43 questions about menstrual history, fertility, and outcomes of pregnancy (329 with small bowel biopsy-confirmed celiac disease and 641 controls). RESULTS: Of the 970 women included in the study, 733 (75.6%) reported that they had been pregnant at some point; there was no significant difference between women with celiac disease (n=245/329, 74.5%) and controls (488/641, 76.1%; P=0.57). However, fewer women with celiac disease than controls (79.6% vs. 84.8%) gave birth following 1 or more pregnancies (P=0.03). Women with celiac disease had higher percentages of spontaneous abortion than controls (50.6% vs. 40.6%; P=0.01), and of premature delivery (23.6% vs. 15.9% among controls; P=0.02). The mean age at menarche was higher in the celiac disease group (12.7 years) than controls (12.4 years; P=0.01). CONCLUSIONS: In a retrospective cohort analysis examining reproductive features of women with celiac disease, we associated celiac disease with significant increases in spontaneous abortion, premature delivery, and later age of menarche.

Can empathy, other personality attributes, and level of positive social influence in medical school identify potential leaders in medicine?

PURPOSE: To test the hypotheses that medical students recognized by peers as the most positive social influencers would score (1) high on measures of engaging personality attributes that are conducive to relationship building (empathy, sociability, activity, self-esteem), and (2) low on disengaging personality attributes that are detrimental to interpersonal relationships (loneliness, neuroticism, aggression-hostility, impulsive sensation seeking). METHOD: The study included 666 Jefferson Medical College students who graduated in 2011-2013. Students used a peer nomination instrument to identify classmates who had a positive influence on their professional and personal development. At matriculation, these students had completed a survey that included the Jefferson Scale of Empathy and Zuckerman-Kuhlman Personality Questionnaire short form and abridged versions of the Rosenberg Self-Esteem Scale and UCLA Loneliness Scale. In multivariate analyses of variance, the method of contrasted groups was used to compare the personality attributes of students nominated most frequently by their peers as positive influencers (top influencers [top 25% in their class distribution], n = 176) with those of students nominated least frequently (bottom influencers [bottom 25%], n = 171). RESULTS: The top influencers scored significantly higher on empathy, sociability, and activity and significantly lower on loneliness compared with the bottom influencers. However, the effect size estimates of the differences were moderate at best. CONCLUSIONS: The research hypotheses were partially confirmed. Positive social influencers appear to possess personality attributes conducive to relationship building, which is an important feature of effective leadership. The findings have implications for identifying and training potential leaders in medicine.

Identifying potential engaging leaders within medical education: The role of positive influence on peers.

BACKGROUND: Previous research has paid little to no attention towards exploring methods of identifying existing medical student leaders. AIM: Focusing on the role of influence and employing the tenets of the engaging leadership model, this study examines demographic and academic performance-related differences of positive influencers and if students who have been peer-identified as positive influencers also demonstrate high levels of genuine concern for others. METHODS: Three separate fourth-year classes were asked to designate classmates that had significant positive influences on their professional and personal development. The top 10% of those students receiving positive influence nominations were compared with the other students on demographics, academic performance, and genuine concern for others. RESULTS: Besides age, no demographic differences were found between positive influencers and other students. High positive influencers were not found to have higher standardized exam scores but did receive significantly higher clinical clerkship ratings. High positive influencers were found to possess a higher degree of genuine concern for others. CONCLUSION: The findings lend support to (a) utilizing the engaging model to explore leaders and leadership within medical education, (b) this particular method of identifying existing medical student leaders, and

Equivalence of students' scores on timed and untimed anatomy practical examinations.

Untimed examinations are popular with students because there is a perception that first impressions may be incorrect, and that difficult questions require more time for reflection. In this report, we tested the hypothesis that timed anatomy practical examinations are inherently more difficult than untimed examinations. Students in the Doctor of Physical Therapy program at Thomas Jefferson University were assessed on their understanding of anatomic relationships using multiple-choice questions. For the class of 2012 (n = 46), students were allowed to circulate freely among 40 testing stations during the 40-minute testing session. For the class of 2013 (n = 46), students were required to move sequentially through the 40 testing stations (one minute per item). Students in both years were given three practical examinations covering the back/upper limb, lower limb, and trunk. An identical set of questions was used for both groups of students (untimed and timed examinations). Our results indicate that there is no significant difference between student performance on untimed and timed examinations (final percent scores of 87.3 and 88.9, respectively). This result also held true for students in the top and bottom 20th percentiles of the class. Moreover, time limits did not lead to errors on even the most difficult, higher-order questions (i.e., items with P-values < 0.70). Thus, limiting time at testing stations during an anatomy practical examination does not adversely affect student performance.

Evaluation of the use of patient-focused simulation for student assessment in a surgery clerkship.

BACKGROUND: The purpose of this study was to evaluate the use of simulated patients in conjunction with anatomic and tissue task-training models to assess skills. METHODS: Faculty reviewed the objectives of the clerkship to identify skills to be acquired. Three cases were developed related to rectal examination, suturing, and inserting intravenous lines and nasogastric tubes. Student scores were based on their ability to gather data from simulated patients and perform procedures on simulation models. RESULTS: A total of 670 students were assessed between 2006 and 2009. Alpha reliability coefficients were .97 for Communication/Interpersonal Skills, .71 for Procedures, and .58 for Data Gathering. Students receiving low ratings from faculty in the clerkship had significantly (P < .001) lower simulation scores. There were significant (P < .001) relationships between scores and grades in other clerkships. CONCLUSIONS: The combination of simulated patients and simulation models yielded reliable scores for procedural and interpersonal skills, and evidence of validity related to clinical ratings.

Development and evaluation of a program to strengthen first year residents' proficiency in leading end-of-life discussions.

PURPOSE: Multiple interventions have been developed to teach and improve internal medicine residents' end-of-life communication skills, but have not been easily adaptable to other institutions. The purpose of this study was to develop and evaluate a program to enhance physicians' end-of-life communication with families of dying patients using a format that could be incorporated into an existing curriculum for first-year internal medicine residents. METHODS: An end-of-life educational program was developed and evaluated in the context of educating first-year residents at an urban academic medical center during the 2008-2009 academic year. The program consisted of three sessions including an interactive workshop flanked by pre- and post-workshop evaluations in simulated encounter and clinical vignette formats. Simulated encounters were recorded on video and residents' performances were rated by two independent observers using a 23 point checklist. RESULTS: Complete data were available for 24 (73%) of 33 residents who participated in the program. The residents' checklist scores increased significantly from a mean of 48.1 at baseline to 73.9 at follow-up. The increase in the scores on the clinical vignettes was also statistically significant, but of lesser magnitude. CONCLUSIONS: A short, focused intervention can have significant impact on residents' communication skills in the setting of an end-of-life objective structured clinical examination (OSCE).

Resident scores on a patient satisfaction survey: evidence for maintenance of communication skills throughout residency.

OBJECTIVE: To examine whether resident communication skills evaluated through patient satisfaction surveys demonstrate evidence of decline through the 3 years of internal medicine residency. METHODS: Data for this study were collected retrospectively from a database of patient satisfaction surveys completed for internal medicine residents at different levels of training. Patient satisfaction was measured with the Aggregated EVGFP (excellent, very good, good, fair, or poor) questionnaire recommended by the American Board of Internal Medicine. RESULTS: Over a span of 5 years (2005-2009), a total of 768 patient rating forms were completed for 67 residents during their 3 years of residency training. In postgraduate year (PGY)-1, the residents had a mean satisfaction rating of 4.33 ± 0.48 compared to a mean rating of 4.37 ± 0.45 in their PGY-3 year. Analysis of variance indicated no significant difference by PGY level. CONCLUSION: Our findings demonstrate that resident communication skills and patient satisfaction do not decline during the 3 years of residency. This is contrary to our hypothesis that patient satisfaction would worsen as residents progressed through training.

Attitudes of students in medicine, nursing, occupational therapy, and physical therapy toward interprofessional education.

With the growing interest in interprofessional education and practice, methods to evaluate the effectiveness of related curricular activities are essential. The purpose of this study was twofold: (1) to assess the attitudes of students in medicine, nursing, occupational therapy, and physical therapy toward interprofessional education using the Interdisciplinary Education Perception Scale and Readiness for Interprofessional Learning Scale and (2) to compare data with normative data previously reported. The two instruments were administered to 474 first-year students in medicine, nursing, occupational therapy, and physical therapy who completed the forms in the context of a workshop at the conclusion of the first year of an interprofessional health mentor program. Differences among professions were reported. Students in medicine and physical therapy rated members of their own professions significantly higher in the areas of competence/autonomy and need for cooperation as compared with those in nursing and occupational therapy. Along with reporting similarities and differences, the results provide additional normative data on these tools that can be used when choosing tools to evaluate interprofessional education attitudes.

Measurement and correlates of physicians' lifelong learning.

PURPOSE: To examine the psychometric properties and correlates of an instrument to measure physicians' orientation toward lifelong learning with attention to differences between full-time and academic clinicians. METHOD: The authors mailed a survey in 2006 to a national sample of 5,349 alumni of Jefferson Medical College who graduated between 1975 and 2000; 3,195 (60%) responded. The respondents were classified as full-time clinicians (n = 1,127) and academic clinicians (n = 1,612). The other 456 respondents were involved in administration or research. The revised Jefferson Scale of Physician Lifelong Learning (JeffSPLL) was included in the survey. Factor analysis, regression analysis, and analysis of variance were used to examine the construct- and criterion-related validities of the scale. RESULTS: Factor analysis of the JeffSPLL items resulted in three factors designated as "learning beliefs and motivation," "attention to learning opportunities," and "skills in seeking information," which supported its construct validity. Alpha reliability coefficients were 0.85 and 0.86, and test-retest reliability coefficients were 0.72 and 0.77 for full-time clinicians and academic clinicians, respectively. For full-time clinicians and academic clinicians, scores on the JeffSPLL were significantly (P < .01) correlated with measures of learning motivation, professional accomplishments, career satisfaction, and commitment to lifelong learning, which supported the criterion-related validity of the scale. CONCLUSIONS: The findings indicate that the JeffSPLL is a psychometrically sound instrument that measures physicians' orientation toward lifelong learning among full-time clinicians and academic clinicians. The instrument can be used to monitor educational programs, assess educational outcomes, and examine group differences.

Effectiveness of "teaching the teachers" initiative for ultrasound training in Africa.

RATIONALE AND OBJECTIVES: To determine the effectiveness of a comprehensive educational program that trained a group of physicians in diagnostic ultrasound (US), so that they would return to their respective countries to train others with the intent of helping to standardize knowledge and improve the quality of US in Africa. Additionally, to compare the effectiveness of this program to that of a similar, but larger, program. MATERIALS AND METHODS: Twelve physicians from sub-Saharan Africa were selected for an intensive 3-month training program sponsored by Radiological Society of North America Research and Education Foundation Grant in all aspects of diagnostic US. A 100-item open-ended test was used to assess learning and retention of knowledge by administration of the same test at three points: at entry into the program, at completion, and 6-month follow-up. Findings were compared with the previously published results of a larger study. RESULTS: Mean test scores increased significantly from a mean of 58.4% at entry to 76.8% at end-of-program. The mean 6-month follow-up test score (79.1%) was slightly higher than posttest and approached significance, similar to the larger group. Nine of the 12 physicians were selected to establish affiliated ultrasound training programs. CONCLUSION: The results of this testing process are both statistically and clinically significant, because they document an increase in knowledge at the end of an intensive 3-month training program, similar to the results reported for a larger group. There was retention and even slight improvement in the physicians' knowledge at 6-month follow-up, a time during which they were teaching others in their home countries in Africa.

The relationship between performance on a medical school's clinical skills assessment and USMLE Step 2 CS.

BACKGROUND: Little is known about the relationship between performance on clinical assessments during medical school and performance on similar licensing tests. METHOD: Correlation coefficients were computed and corrected for measurement error using data for 217 students who completed a school's clinical assessment and took the Step 2 Clinical Skills (CS) examination. RESULTS: Observed (and corrected) correlations between the two tests were 0.18 (0.32) for Data Gathering, 0.35 (0.75) for Documentation, and 0.32 (0.56) for Communication/Interpersonal Skills. The highest correlation within each test was between Documentation and Data Gathering. The lowest was between Documentation and Communication/ Interpersonal Skills. CONCLUSIONS: The pattern of correlations supports each test's construct validity. The low correlations suggest that the tests are not redundant, and do not support using the scores on the school's assessment to predict performance on Step 2 CS. Future studies of these relationships need to address the time between the two assessments and the effect of intervening remedial programs.

Cross-sectional assessment of medical and nursing students' attitudes toward chronic illness at matriculation and graduation.

BACKGROUND: It is important to assess students' attitudes toward chronic illness to enhance curriculum and support interprofessional learning. METHOD: A 40-item questionnaire was administered to 704 medical and nursing students. Qualitative and quantitative analyses examined their attitudes and understanding of chronic illness as well as differences between medical and nursing students. RESULTS: Content analysis and factor analysis indicated that entering students were more positive about chronic illness than graduates. Most underestimated its economic impact. Positive attitudes toward chronic illness were associated with taking a personal interest in patients. The attitudes of nursing students were generally similar to those of medical students, but there were differences related to patient adherence, the role of nurses in patient education, managing comorbidities, and confidentiality of electronic medical records. CONCLUSIONS: Entering students were more positive about chronic illness than graduates. Although medical and nursing students' attitudes were very similar, differences have implications for interprofessional education.

Evaluation of the congruence between students' postencounter notes and standardized patients' checklists in a clinical skills examination.

BACKGROUND AND PURPOSE: Questions remain about the congruence between students' written notes and checklists as summaries of encounters. METHODS: Students examined standardized patients and summarized findings in postencounter notes. The patients completed checklists. A physician read the students' notes and completed parallel checklists to document the history and physical items performed. Rates of under- and overdocumentation were calculated. RESULTS: Students documented findings for 71% of items performed - an underdocumentation rate of 29%. Approximately 94% of their documented findings were consistent with what they had done. Their rate of overdocumentation was 6%, in which they documented findings inconsistent with the checklists. About half the students had no instances of overdocumentation. CONCLUSION: Students' rate of underdocumentation was comparable to experienced clinicians. Although their overdocumentation rate was low overall, it was high for a few students. Evaluation of the congruence between checklists and postencounter notes provides useful information and informs checklist development.

Validating an Ataxia Functional Composite Scale in spinocerebellar ataxia.

The Ataxia Functional Composite Scale (AFCS) may provide a sensitive and reproducible assessment of treatment responses in studies of the spinocerebellar ataxias (SCA). We previously assessed the effects of buspirone in a cohort of patients with SCA via the International Cooperative Ataxia Rating Scale (ICARS). At each assessment period, AFCS scores were also obtained. A strong correlation of AFCS with ICARS scores was demonstrated at all assessment periods. This study supports the validity of the AFCS as a useful assessment of ataxia in this population.

Treatment of spinocerebellar ataxia with buspirone.

Preliminary data suggest potential benefit of 5-HT receptor agonists in the treatment of ataxias. We studied the effects of buspirone in a cohort of twenty patients with spinocerebellar ataxia (SCA). Twenty patients were treated in this double-blind, placebo controlled, cross-over trial with either buspirone HCl 30 mg twice daily or placebo for 3 months. Buspirone was not shown to be superior to placebo in the treatment of patients with SCA.