Impact of Masking Academic Metrics on Enrolling a Broadly Diverse and Mission-Aligned Student Body.

PROBLEM: The June 2023 U.S. Supreme Court decision overturning affirmative action required medical schools to discontinue considering race/ethnicity in admissions decisions. Medical schools must now identify different strategies if they aim to recruit and admit applicants from groups underrepresented in medicine (URiM; race/ethnicity), as enrolling broadly diverse students remains critical for serving the U.S. population. APPROACH: Washington State University Elson S. Floyd College of Medicine (established in 2015) has an admissions process that assesses academic metrics using national threshold combinations of undergraduate grade point averages (UGPAs) and Medical College Admission Test (MCAT) scores (published on school's website), and legal residency in or ties to Washington state, as prescreening criteria for secondary applications. UGPAs and MCAT scores are then masked from further consideration, allowing for decisions to be made with a focus on mission-aligned criteria, such as certain personal attributes and lived experiences and coming from specific environments (i.e., educationally or socioeconomically disadvantaged backgrounds, rural communities, military service, or a member of a federally recognized Tribe). OUTCOMES: In the last 5 admissions cycles (enrollment years 2018-2022), cohort data demonstrates that as the admissions funnel narrows and each subsequent pool is smaller than the preceding one, the representation of mission-aligned applicants increases, despite the masking of academic metrics. The most recently enrolled class (enrollment year 2022) of 80 had 14 (17.5%) URiM students, closely mirroring the state's general population. The overall yield (acceptance:matriculation) has steadily improved with the last 2 cycles to 1.68:1 and 1.65:1, indicating slightly more than 1.5 times the number of offers needed to fill the class are being made. NEXT STEPS: Next steps include further refining the process by considering more granular data on applicants' childhood community characteristics and rural background and examining how admissions data may correlate with residency and practice location and communities served.

Interprofessional collaboration: three best practice models of interprofessional education.

Interprofessional education is a collaborative approach to develop healthcare students as future interprofessional team members and a recommendation suggested by the Institute of Medicine. Complex medical issues can be best addressed by interprofessional teams. Training future healthcare providers to work in such teams will help facilitate this model resulting in improved healthcare outcomes for patients. In this paper, three universities, the Rosalind Franklin University of Medicine and Science, the University of Florida and the University of Washington describe their training curricula models of collaborative and interprofessional education.The models represent a didactic program, a community-based experience and an interprofessional-simulation experience. The didactic program emphasizes interprofessional team building skills, knowledge of professions, patient centered care, service learning, the impact of culture on healthcare delivery and an interprofessional clinical component. The community-based experience demonstrates how interprofessional collaborations provide service to patients and how the environment and availability of resources impact one's health status. The interprofessional-simulation experience describes clinical team skills training in both formative and summative simulations used to develop skills in communication and leadership.One common theme leading to a successful experience among these three interprofessional models included helping students to understand their own professional identity while gaining an understanding of other professional's roles on the health care team. Commitment from departments and colleges, diverse calendar agreements, curricular mapping, mentor and faculty training, a sense of community, adequate physical space, technology, and community relationships were all identified as critical resources for a successful program. Summary recommendations for best practices included the need for administrative support, interprofessional programmatic infrastructure, committed faculty, and the recognition of student participation as key components to success for anyone developing an IPE centered program.

The impact of a diagnostic reminder system on student clinical reasoning during simulated case studies.

INTRODUCTION: Diagnostic reminder systems (DRS) may help students improve their clinical reasoning skill and gain competency in using informatics tools. This study explored the influence of Isabel PRO, a web-based DRS, on student diagnostic reasoning during simulated encounters. METHODS: Diagnostic reasoning was assessed in 20 fourth-year medical students during four simulated case scenarios. After seeing each case, students submitted diagnostic hypotheses before (Pre-Isabel) and after (Post-Isabel) using Isabel PRO. The quality of the Pre- and Post-Isabel diagnostic hypotheses was assessed and compared to determine the impact of a DRS on student diagnostic reasoning. A follow-up survey and focus group identified student perception toward the use of a DRS in educational settings. RESULTS: Paired t testing demonstrated that diagnostic accuracy significantly improved after using Isabel PRO (P < 0.05). Students found the software relatively simple to learn, felt that it helped them reflect on diagnostic options that they had not originally considered, and valued the opportunity to use the software in conjunction with simulated cases. CONCLUSIONS: Despite limited experience, students were able to effectively use a DRS to improve their diagnostic accuracy. Use of a DRS within the context of a patient case represents a distinct clinical skill set requiring appropriate training. Providing learners with gold standard examples of how to best use a specific informatics tool within specific clinical situations is an essential learning component. Simulated case scenarios offer an appropriate platform for introducing diagnostic support tools to learners within a clinical context.

Simulation-based examinations in physician assistant education: A comparison of two standard-setting methods.

PURPOSE: this study explored the reliability of two simple standard-setting methods that are used to set passing standards for a standardized patient (SP) exam in physician assistant (PA) education. METHODS: fifty-four second-year PA students participated in a multistation SP-based clinical skills exam. Cut scores were set using the Angoff and Borderline Group methods. A panel of PA faculty set cut scores using the Angoff method. A modified version of the Borderline Group method set cut scores using SP global ratings verified by faculty review. Inter-rater reliability between judges was evaluated using kappa coefficient (k) for the Angoff method and intraclass correlation coefficient (ICC) for the Borderline Group method. RESULTS: the Borderline Group method set an overall cut score for the exam of 76% (95% CI +/- 5) and the Angoff method set a cut score at 62% (95% CI +/- 9). Both methods demonstrated sufficient inter-rater reliability (k 0.60, ICC > 0.70; both significant at p < 0.05), although one case (preop history and physical) demonstrated poor inter-rater reliability between judges using the Borderline Group method. DISCUSSION: the Borderline Group method offered a slightly more reliable cut score when compared to the standard set by the Angoff method, but was more challenging to implement. In addition, one case demonstrated poor inter-rater reliability with the Borderline Group method. Using SPs to complete global borderline ratings offers one solution to make the Borderline Group method more feasibile, but requires a high degree of initial rater calibration and periodic measures of interrater reliability between faculty and SPs.

Allport's Intergroup Contact Theory as a theoretical base for impacting student attitudes in interprofessional education.

Interprofessional education has been defined as "members or students of two or more professionals associated with health or social care, engaged in learning with, from and about each other". Ideally, students trained using interprofessional education paradigms become interprofessional team members who gain respect and improve their attitudes about each other, and ultimately improve patient outcomes. However, it has been stated that before interprofessional education can claim its importance and successes, its impact must be critically evaluated. What theory can explain the impact that interprofessional education seems to have on changing students' attitudes of other professionals and positively affecting their performance as interprofessional healthcare team members? The authors of this paper suggest conditions identified in Gordon Allport's Contact Theory may be used as a theoretical base in interprofessional education to positively impact attitudinal change of students towards working as an interprofessional team member. For the purpose of this paper, equal status and common goals will be the two conditions highlighted as a theoretical base in interprofessional education. The premise to be explored in this paper is that utilizing a sound theoretical base in interprofessional education may positively impact students' attitudes towards working in interprofessional teams.

Rural physicians' attitudes toward the elderly: evidence of ageism?

Rural elderly patients receive health services primarily in the outpatient setting, with their primary care provider often serving as their only point of contact with the health care system. Little is known however about the attitudes of physicians, and more specifically attitudes of those practicing in rural locations, toward differing age groups of the elderly. The current study was undertaken to examine the perceptions and attitudes of rural Florida physicians who routinely provide care for the elderly. We utilized an existing and validated survey instrument designed to measure the perceptions and attitudes of health professionals toward 3 different cohorts of elderly people: the elderly population in general, the elderly population older than 85 years, and the nursing home population. The study provides evidence that physicians who routinely provide care for the elderly in rural Florida demonstrate ageist perceptions, especially against those older than 85 years and the nursing home population. The trends identified are important because they may directly influence the quality of care that this population receives.

To IRB or not to IRB?

Improving medical practice begins with the improvement of medical education. In this process, most academic medical faculty assume the dual roles of both teacher and researcher, often without intending to or realizing that they are. With the increased tightening of regulation and supervision of biomedical research in the United States, academic medical institutions and their individual faculty face the daunting regulatory compliance problems that are traditionally associated with clinical and bench research projects. In 2000, as part of a new geriatrics curriculum initiative, one medical school (not the authors' present institution) developed a mentor program that was designed to positively influence students' attitudes about aging. Despite the attempts of faculty to design the curriculum and evaluation process to conform to human subjects regulations, formal allegations of research misconduct were brought against the faculty who were in charge of the curriculum. Even though research that shows that 70% of alleged research misconduct charges result in exoneration, an accusation of misconduct can have serious consequences for faculty including suspension of their project, undergoing an intensive investigation, and potentially making it impossible for the faculty member or institution to apply for future federally supported research funds. The authors wrote this article to serve as a wake-up call for medical educators to become intimately familiar with their own institution's institutional review board process and be proactive in educating themselves and their peers regarding research in medical education.

Dynamic health promotion for the geriatric population.

The documents Healthy People 2000 and its update, Healthy People 2010, have helped focus national attention on the neglected areas of disease prevention and health promotion and maintenance. Despite increasing awareness and the proliferation of research that demonstrates the effectiveness of a healthy lifestyle for disease prevention, patients and healthcare professionals continue to struggle with an effective approach to effecting healthy lifestyle strategies. The inclusion of health promotion goals into care plans seldom is enough to create positive behavioral changes in a patient. Understanding what motivates an older individual to adopt healthy habits and what behavioral change process the individual must take to be successful is a key starting point for the rehabilitation nurse dedicated to the promotion of health and wellness. The transtheoretical model of change (TTM) is an approach that can be used to create an atmosphere for the adoption of healthy lifestyle practices, and assist in the behavioral change process necessary to promote older adults' success in this endeavor.