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1.
BMC Med Educ ; 22(1): 16, 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34983481

RESUMO

BACKGROUND: Nearly all U.S. medical students engage in a 4-8 week period of intense preparation for their first-level licensure exams, termed a "dedicated preparation period" (DPP). It is widely assumed that student well-being is harmed during DPPs, but evidence is limited. This study characterized students' physical, intellectual, emotional, and social well-being during DPPs. METHODS: This was a cross-sectional survey sent electronically to all second-year students at four U.S. medical schools after each school's respective DPP for USMLE Step 1 or COMLEX Level 1 in 2019. Survey items assessed DPP characteristics, cost of resources, and perceived financial strain as predictors for 18 outcomes measured by items with Likert-type response options. Open-ended responses on DPPs' influence underwent thematic analysis. RESULTS: A total of 314/750 (42%) students completed surveys. DPPs lasted a median of 7 weeks (IQR 6-8 weeks), and students spent 70 h/week (IQR 56-80 h/week) studying. A total of 62 (20%) reported experiencing a significant life event that impacted their ability to study during their DPPs. Most reported 2 outcomes improved: medical knowledge base (95%) and confidence in ability to care for patients (56%). Most reported 9 outcomes worsened, including overall quality of life (72%), feeling burned out (77%), and personal anxiety (81%). A total of 25% reported paying for preparation materials strained their finances. Greater perceived financial strain was associated with worsening 11 outcomes, with reported amount spent associated with worsening 2 outcomes. Themes from student descriptions of how DPPs for first-level exams influenced them included (1) opportunity for synthesis of medical knowledge, (2) exercise of endurance and self-discipline required for professional practice, (3) dissonance among exam preparation resource content, formal curriculum, and professional values, (4) isolation, deprivation, and anguish from competing for the highest possible score, and (5) effects on well-being after DPPs. CONCLUSIONS: DPPs are currently experienced by many students as a period of personal and social deprivation, which may be worsened by perceived financial stress more than the amount of money they spend on preparation materials. DPPs should be considered as a target for reform as medical educators attempt to prevent student suffering and enhance their well-being.


Assuntos
Educação de Graduação em Medicina , Estudantes de Medicina , Estudos Transversais , Avaliação Educacional , Humanos , Licenciamento em Medicina , Qualidade de Vida
2.
JAAPA ; 35(1): 49-52, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34908559

RESUMO

OBJECTIVE: This study built on a recent publication to explore physician assistant (PA) licensure renewal applications, as well as PA likelihood to seek help for physical or mental health conditions. METHODS: We were able to obtain licensure renewal applications from 47 states. A national survey was then conducted to explore the connection between licensure questions and help-seeking behavior. RESULTS: Only 18 states were consistent with the Americans with Disabilities Act (ADA) in their approach to initial and renewal applications. Thirty-five percent of PAs expressed reluctance to seek help for a mental health issue due to concerns about licensure repercussions. States with applications that were inconsistent with the ADA were significantly more likely to express these concerns. CONCLUSIONS: Considerable stigma exists among PAs regarding seeking help for mental health issues. Problematic licensure questions increase this reluctance. Advocacy is needed to reduce stigma of mental health and substance use, and to modernize licensure applications.


Assuntos
Pessoas com Deficiência , Assistentes Médicos , Humanos , Licenciamento em Medicina , Saúde Mental , Aceitação pelo Paciente de Cuidados de Saúde , Estigma Social , Estados Unidos
3.
J Grad Med Educ ; 13(5): 711-716, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34721801

RESUMO

Background: Pass/fail USMLE Step 1 score reporting may have varying implications for trainees of different demographic and training backgrounds. Objective: To characterize the perspectives of a diverse cohort of trainees on the impact of pass/fail Step 1 score reporting. Methods: In 2020, 197 US and international medical school deans and 822 designated institutional officials were invited to distribute anonymous electronic surveys among their trainees. Separate surveys for medical students and residents/fellows were developed based on the authors' prior work surveying program directors on this topic. Underrepresented in medicine (UiM) was defined in accordance with AAMC definitions. Descriptive and comparative analyses were performed, and results were considered statistically significant with P < .05. Results: A total of 11 633 trainees responded (4379 medical students and 7254 residents/fellows; 3.3% of an estimated 285 000 US trainees). More students favored the score reporting change than residents/fellows (43% vs 31%; P < .001; 95% CI 0-24). Trainees identifying as UiM were more likely to favor the change (50% vs 34%; P < .001; 95% CI 0-32) and to agree it would decrease socioeconomic disparities (44% vs 25%; P < .001; 95% CI 0-38) relative to non-UiM trainees. Nearly twice as many osteopathic and international medical graduate students felt they would be disadvantaged compared to MD students because of pass/fail score reporting (61% vs 31%; P < .001; 95% CI 0-60). Conclusions: Trainee perspectives regarding USMLE Step 1 score reporting are mixed. UiM trainees were more likely to favor the score reporting change, while osteopathic and international medical students were less in favor of the change.


Assuntos
Internato e Residência , Medicina Osteopática , Estudantes de Medicina , Avaliação Educacional , Humanos , Licenciamento em Medicina , Medicina Osteopática/educação
7.
GMS J Med Educ ; 38(5): Doc88, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34286068

RESUMO

Introduction: In Germany, foreign physicians are a fixed component of the medical profession. According to the German Medical Licensure Act, physicians having completed their qualification in another country are required to pass a knowledge examination which falls within the competence of examination offices or the regional governments. Project outline: The preparatory course consists of 10 modules. On Fridays, individual cases are discussed in small groups and specific examination techniques are trained. On Saturdays, illnesses are simulated by simulated patients. After each encounter, faculty experts, psychologists and peer group members provide the participants with 360° feedback. Due to the COVID-19 pandemic, the course which had been established 2 years beforehand has now been switched to an online class within one week. Friday units were visualized in power-point presentations and tutorial videos were discussed. On Saturdays, the cases were simulated by simulated patients and transmitted via a telemedicine platform. Results: The course could be conducted without interruptions (75 hours of in-class tuition and 75 hours of online tuition). In the oral evaluation the participants criticized telemedicine as a medium for imparting of practical skills. 7/22 (32%) of the participants underwent the knowledge examination and 6/7 (86%) of them passed it (versus 18/19 of the participants of in-class tuition (95%)). Discussion: There was a clear preference for in-class tuition. It was noted that the telemedical setting entailed some restrictions. However, the switch to online classes did not affect the pass rate. Conclusion: The switch from in-class to online units was feasible. The gained insights were taken into account when conceiving the online semester at our faculty and especially the tuition with the support of simulated patients.


Assuntos
COVID-19 , Currículo , Educação Médica , Médicos Graduados Estrangeiros , Internet , Licenciamento em Medicina , Pandemias , Competência Clínica , Avaliação Educacional , Alemanha , Guias como Assunto , Humanos , Distanciamento Físico , Faculdades de Medicina , Estações do Ano
10.
Acad Med ; 96(9): 1324-1331, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34133345

RESUMO

PURPOSE: The United States Medical Licensing Examination (USMLE) sequence and the Accreditation Council for Graduate Medical Education (ACGME) milestones represent 2 major components along the continuum of assessment from undergraduate through graduate medical education. This study examines associations between USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores and ACGME emergency medicine (EM) milestone ratings. METHOD: In February 2019, subject matter experts (SMEs) provided judgments of expected associations for each combination of Step examination and EM subcompetency. The resulting sets of subcompetencies with expected strong and weak associations were selected for convergent and discriminant validity analysis, respectively. National-level data for 2013-2018 were provided; the final sample included 6,618 EM residents from 158 training programs. Empirical bivariate correlations between milestone ratings and Step scores were calculated, then those correlations were compared with the SMEs' judgments. Multilevel regression analyses were conducted on the selected subcompetencies, in which milestone ratings were the dependent variable, and Step 1 score, Step 2 CK score, and cohort year were independent variables. RESULTS: Regression results showed small but statistically significant positive relationships between Step 2 CK score and the subcompetencies (regression coefficients ranged from 0.02 [95% confidence interval (CI), 0.01-0.03] to 0.12 [95% CI, 0.11-0.13]; all P < .05), with the degree of association matching the SMEs' judgments for 7 of the 9 selected subcompetencies. For example, a 1 standard deviation increase in Step 2 CK score predicted a 0.12 increase in MK-01 milestone rating, when controlling for Step 1. Step 1 score showed a small statistically significant effect with only the MK-01 subcompetency (regression coefficient = 0.06 [95% CI, 0.05-0.07], P < .05). CONCLUSIONS: These results provide incremental validity evidence in support of Step 1 and Step 2 CK score and EM milestone rating uses.


Assuntos
Competência Clínica/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Avaliação Educacional/estatística & dados numéricos , Medicina de Emergência/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Acreditação , Adulto , Avaliação Educacional/métodos , Medicina de Emergência/educação , Feminino , Humanos , Licenciamento em Medicina , Masculino , Pessoa de Meia-Idade , Análise Multinível , Análise de Regressão , Reprodutibilidade dos Testes , Estados Unidos , Adulto Jovem
11.
Acad Med ; 96(9): 1319-1323, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34133346

RESUMO

PURPOSE: The United States Medical Licensing Examination (USMLE) recently announced 2 policy changes: shifting from numeric score reporting on the Step 1 examination to pass/fail reporting and limiting examinees to 4 attempts for each Step component. In light of these policies, exam measures other than scores, such as the number of examination attempts, are of interest. Attempt limit policies are intended to ensure minimum standards of physician competency, yet little research has explored how Step attempts relate to physician practice outcomes. This study examined the relationship between USMLE attempts and the likelihood of receiving disciplinary actions from state medical boards. METHOD: The sample population was 219,018 graduates from U.S. and Canadian MD-granting medical schools who passed all USMLE Step examinations by 2011 and obtained a medical license in the United States, using data from the NBME and the Federation of State Medical Boards. Logistic regressions estimated how attempts on Steps 1, 2 Clinical Knowledge (CK), and 3 examinations influenced the likelihood of receiving disciplinary actions by 2018, while accounting for physician characteristics. RESULTS: A total of 3,399 physicians (2%) received at least 1 disciplinary action. Additional attempts needed to pass Steps 1, 2 CK, and 3 were associated with an increased likelihood of receiving disciplinary actions (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.01, 1.13; OR: 1.09, 95% CI: 1.03, 1.16; OR: 1.11, 95% CI: 1.04, 1.17, respectively), after accounting for other factors. CONCLUSIONS: Physicians who took multiple attempts to pass Steps 1, 2 CK, and 3 were associated with higher estimated likelihood of receiving disciplinary actions. This study offers support for licensure and practice standards to account for physicians' USMLE attempts. The relatively small effect sizes, however, caution policy makers from placing sole emphasis on this relationship.


Assuntos
Avaliação Educacional/estatística & dados numéricos , Disciplina no Trabalho/estatística & dados numéricos , Licenciamento em Medicina/estatística & dados numéricos , Médicos/estatística & dados numéricos , Má Conduta Profissional/estatística & dados numéricos , Adulto , Canadá , Competência Clínica , Avaliação Educacional/normas , Feminino , Humanos , Licenciamento em Medicina/normas , Modelos Logísticos , Masculino , Razão de Chances , Médicos/normas , Faculdades de Medicina/normas , Estados Unidos
14.
J Osteopath Med ; 121(8): 673-685, 2021 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-34090320

RESUMO

CONTEXT: Many medical schools have a distributed model for clinical clerkship education, challenging our ability to determine student gaps during clinical education. With the graduating class of 2017, A.T. Still University's School of Osteopathic Medicine in Arizona (ATSU-SOMA) began requiring additional online curricula for all clerkship courses. OBJECTIVES: To determine whether third year and fourth year students receiving ATSU-SOMA's online curricula during core clerkships performed better overall on national standardized examinations than students from previous years who had not received the curricula, and whether scores from online coursework correlated with outcomes on standardized examinations as possible early predictors of success. METHODS: This retrospective cohort study analyzed existing data (demographics and assessments) from ATSU-SOMA classes of 2017-2020 (curriculum group) and 2014-2016 (precurriculum group). The effect of the curriculum on national standardized examinations (Comprehensive Osteopathic Medical Achievement Test [COMAT] and Comprehensive Osteopathic Medical Licensing Examination of the United States [COMLEX-USA]) was estimated using augmented inverse probability weighting (AIPW). Correlations between assignment scores and national standardized examinations were estimated using linear regression models. RESULTS: The curriculum group had 405 students with a mean (standard deviation [SD]) age of 25.7 (±3.1) years. Two hundred and fifteen (53.1%) students in the curriculum group were female and 190 (46.9%) were male. The precurriculum group had 308 students (mean ± SD age, 26.4 ± 4.2 years; 157 [51.0%] male; 151 [49.0%] female). The online curriculum group had higher COMAT clinical subject exam scores in obstetrics and gynecology, osteopathic principles and practice (OPP), psychiatry, and surgery (all p≤0.04), as well as higher COMLEX-USA Level 2-Cognitive Evaluation (CE) family medicine and OPP subscores (both p≤0.03). The curriculum group had a 9.4 point increase in mean total COMLEX-USA Level 2-CE score (p=0.08). No effect was found for the curriculum overall on COMAT mean or COMLEX-USA Level 2-Performance Evaluation scores (all p≥0.11). Total coursework scores in each core clerkship, excluding pediatrics, were correlated with COMAT mean score (all adjusted p≤0.03). Mean scores for five of the seven assignment types in core clerkships, excluding evidence based medicine types, were positively correlated with COMAT mean scores (all adjusted p≤0.049). All assignment types correlated with COMLEX-USA Level 2-CE total score (all adjusted p≤0.04), except interprofessional education (IPE). CONCLUSIONS: Results from this study of 713 students from ATSU-SOMA suggested that our online curriculum supplemented clinic based learning during clerkship courses and improved student outcomes on national standardized examinations.


Assuntos
Estudantes de Medicina , Adulto , Criança , Currículo , Avaliação Educacional , Feminino , Humanos , Licenciamento em Medicina , Masculino , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
17.
Plast Reconstr Surg ; 148(1): 219-223, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34076626

RESUMO

SUMMARY: The United States Medical Licensing Examination announced the changing of Step 1 score reporting from a three-digit number to pass/fail beginning on January 1, 2022. Plastic surgery residency programs have traditionally used United States Medical Licensing Examination Step 1 scores to compare plastic surgery residency applicants. Without a numerical score, the plastic surgery residency application review process will likely change. This article discusses advantages, disadvantages, and steps forward for residency programs related to the upcoming change. The authors encourage programs to continue to seek innovative methods of objectively and holistically evaluating applications.


Assuntos
Avaliação Educacional/normas , Internato e Residência/organização & administração , Licenciamento em Medicina/normas , Seleção de Pessoal/organização & administração , Cirurgia Plástica/educação , Humanos , Internato e Residência/normas , Seleção de Pessoal/normas , Cirurgia Plástica/normas , Estados Unidos
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