High-Stakes Collaborative Testing: Why Not?

Phenomenon: Studies of high-stakes collaborative testing remain sparse, especially in medical education. We explored high-stakes collaborative testing in medical education, looking specifically at the experiences of students in established and newly formed teams. APPROACH: Third-year psychiatry students at 5 medical schools across 6 sites participated, with 4 participating as established team sites and 2 as comparison team sites. For the collaborative test, we used the National Board of Medical Examiners Psychiatry subject test, administering it via a 2-stage process. Students at all sites were randomly selected to participate in a focus group, with 8-10 students per site (N = 49). We also examined quantitative data for additional triangulation. FINDINGS: Students described a range of heightened emotions around the collaborative test yet perceived it as valuable regardless if they were in established or newly formed teams. Students described learning about the subject matter, themselves, others, and interpersonal dynamics during collaborative testing. Triangulation of these results via quantitative data supported these themes. Insights: Despite student concerns, high-stakes collaborative tests may be both valuable and feasible. The data suggest that high-stakes tests (tests of learning or summative evaluation) could also become tests for learning or formative evaluation. The paucity of research into this methodology in medical education suggests more research is needed.

A typology of teaching roles and relationships for medical education.

BACKGROUND: Educational programs involve interactions between the instructors and the learners. In these interactions, instructors may play various roles. However, a nomenclature for relationships with learners appropriate to those roles has not been developed for medical education. AIMS: This article presents a typology of instructor's roles to facilitate the connection of outcomes with instructional methods and to inform training sessions for instructors. METHOD: Published articles in general education and medical education were searched for examples of terms used for instructor's roles in developmental interactions. Examples were grouped and classified to develop a two-dimensional typology. RESULTS: The typology has eight categories on two dimensions. One dimension is the purpose for interaction: (1) knowledge transmission, (2) professional identity formation, (3) negotiating the institutional milieu, and (4) relationship building. The other dimension is dichotomous on whether the instructor is a member of the profession to which the learners aspire. Twelve terms were categorized: Advisor, Advocate, Buddy, Coach, Counselor, Facilitator, Guru, Master, Mentor, Role model, Teacher and Tutor. CONCLUSIONS: Faculty instructors in medical education are often pressed for time, so clarifying role expectations is a low-cost scheme to enhance results. Using the typology can align instructor behavior with the desired learner outcomes and enhance efficient use of instructional time.

Team cohesiveness, team size and team performance in team-based learning teams.

OBJECTIVES: The purpose of this study was to explore the relationships among variables associated with teams in team-based learning (TBL) settings and team outcomes. METHODS: We administered the National Board of Medical Examiners (NBME) Psychiatry Subject Test first to individuals and then to teams of Year three students at four medical schools that used TBL in their psychiatry core clerkships. Team cohesion was analysed using the Team Performance Scale (TPS). Bivariate correlation and linear regression analysis were used to analyse the relationships among team-level variables (mean individual TPS scores for each team, mean individual NBME scores of teams, team size, rotation and gender make-up) and team NBME test scores. A hierarchical linear model was used to test the effects of individual TPS and individual NBME test scores within each team, as well as the effects of the team-level variables of team size, team rotation and gender on team NBME test scores. Individual NBME test and TPS scores were nested within teams and treated as subsampling units. RESULTS: Individual NBME test scores and individual TPS scores were positively and statistically significantly (p < 0.01) associated with team NBME test scores, when team rotation, team size and gender make-up were controlled for. Higher team NBME test scores were associated with teams rotating later in the year and larger teams (p < 0.01). Gender make-up was not significantly associated. CONCLUSIONS: The results of an NBME Psychiatry Subject Test administered to TBL teams at four medical schools suggest that larger teams on later rotations score higher on a team NBME test. Individual NBME test scores and team cohesion were positively and significantly associated with team NBME test scores. These results suggest the need for additional studies focusing on team outcomes, team cohesion, team size, rotation and other factors as they relate to the effective and efficient performance of TBL teams in health science education.

Team Emotional Intelligence, Team Interactions, and Gender in Medical Students During a Psychiatry Clerkship.

OBJECTIVE: This study examined the relationship between team emotional intelligence, quality of team interactions, and gender. METHODS: Psychiatry clerkship students participating in Team-Based Learning (TBL, n = 484) or no TBL (control, n = 265) completed the Workgroup Emotional Intelligence Profile (WEIP-S) and the Team Performance Scale (TPS). RESULTS: Significant correlations (p < 0.01) existed between quality of team interactions (i.e., TPS) and team emotional intelligence (i.e., WEIP-S) subscales, but not gender. Control and TBL groups experienced significant increases in WEIP-S subscales pre to post (p < 0.01, η (2) = .08), with the TBL group experiencing significantly higher gains in three of four subscales. Control group scored higher on TPS. CONCLUSIONS: A significant relationship exists between team emotional intelligence and quality of team interactions. Gender was unrelated to TPS or WEIP-S subscales. TBL group experienced higher gains in WEIP-S subscales while the control group experienced slightly higher TPS scores. Results suggest implications for medical educators who use TBL.

Where Do We Go From Here? An Inventory of Publicly Available Data About Educator Academies, Medical Education Departments, and Offices of Medical Education.

ABSTRACT: With the recent widespread growth and interest among medical educators, analysis of how departments of medical education are structured and their intersection with existing structures within the same institution, such as an office of medical education and/or academy of educators, is warranted. Based on a review of the literature, the authors determined there was a need for an inventory of what medical schools have to offer their faculty, whether it be an office, an academy, or a department. This project sought to inventory the current structures of medical education departments, offices, and academies at U.S. medical schools to explore reporting structure, functions, and characteristics of these entities. Data were extracted from the A Snapshot of Medical Student Education in the United States and Canada: Reports From 145 Schools, published in 2020 in the journal Academic Medicine, for each reporting institution. This led to exploration of medical school websites to catalog institutional structures. Data collected in this inventory demonstrate the range of structures used by medical schools to offer faculty support for their work as teachers and educational researchers. The hypothesis was that departments of medical education would be the least prevalent structures identified in U.S. medical schools, which was indeed a finding. Although the search yielded considerable data for the inventory, there is a dearth of published literature describing current models and characteristics of these different entities. Significant difficulties were encountered locating information clearly delineating roles and responsibilities of each entity on many medical schools' public-facing web pages. Findings are significant because they underscore the challenges medical education leaders have in obtaining information to research, compare, select, and design the administrative model(s) best suited to support faculty educators at their institution. Future work should include creating a detailed catalogue with descriptive information supplied by schools.

Development of emotional intelligence in a team-based learning internal medicine clerkship.

BACKGROUND: Although increasing number of articles have been published on team-based learning (TBL), none has explored team emotional intelligence. AIM: We extend the literature by examining changes in team emotional intelligence during a third year clerkship where TBL is a primary instructional strategy. We hypothesized that team emotional intelligence will change in a positive direction (i.e., increase) during the clerkship. METHOD: With IRB approval, during the 2009-2010 academic year third-year students in their internal medicine clerkship (N = 105, 100% response rate) completed the Workgroup Emotional Intelligence Profile - Short Version (WEIP-S) at the beginning and at the end of their 12-week clerkship. TBL is an instructional strategy utilized during the internal medicine clerkship. RESULTS: Paired t-tests showed that team emotional intelligence increased significantly pre to post clerkship for three of the four areas: awareness of own emotions (p = 0.018), recognizing emotions in others (p = 0.031), and ability to manage other's emotions (p = 0.013). There was no change for ability to control own emotions (p = 0.570). CONCLUSION: In an internal medicine clerkship, where TBL is utilized as an instructional strategy, team emotional intelligence increases. This supports TBL as an adjunctive tool to traditional medical education pedagogy.

The ethical and pedagogical effects of modeling "not-so-universal" precautions.

AIM: We sought to understand current medical students' levels of training and knowledge, and their attitudes regarding universal precautions practices and underlying professional and ethical issues. METHOD: A total of 54 US medical students at two schools were interviewed to determine the level of understanding and training students receive about universal precautions, their feelings about the effectiveness (or ineffectiveness) of universal precautions, the frequency and kinds of universal precautions used by healthcare professionals as observed by medical students, and students' perspectives about the lack of or inconsistent use of universal precautions. RESULTS: Pre-clinical students focused on safe-sex practices among students and professionals, as well as simple, important acts to protect oneself against infection and disease, such as hand-washing. Clinical students, on the other hand, had more exposure to observing and practicing universal precautions, thus presented us with more, in-depth responses pertaining to inconsistent and ineffective use of universal precautions among peers and role models. Several themes were noted from students' responses. CONCLUSION: This study confirms previously acquired data that universal precautions are not consistently or appropriately used by healthcare professionals, it is a significant and novel study in that it reveals a hidden, ethical, and clinical problem in medical education.

The ethics of HIV testing and disclosure for healthcare professionals: what do our future doctors think?

AIM: This study examined future medical professionals' attitudes and beliefs regarding mandatory human immunodeficiency virus (HIV) testing and disclosure. METHOD: A total of 54 US medical students were interviewed regarding mandatory testing and disclosure of HIV status for both patient and health care professional populations. Interviews were qualitatively analyzed using thematic analysis by the first author and verified by the second author. RESULTS: Medical students considered a variety of perspectives, even placing themselves in the shoes of their patients or imagining themselves as a healthcare professional with HIV. Mixed opinions were presented regarding the importance of HIV testing for students coupled with a fear about school administration regarding HIV positive test results and the outcome of a student's career. Third- and fourth-year medical students felt that there should be no obligation to disclose one's HIV status to patients, colleagues, or employers. However, most of these students did feel that patients had an obligation to disclose their HIV status to healthcare professionals. CONCLUSION: This study gives medical educators a glimpse into what our future doctors think about HIV testing and disclosure, and how difficult it is for them to recognize that they can be patients too, as they are conflicted by professional and personal values.

A Snapshot of Current US Medical School Off-Ramp Programs-a Way to Leave Medical School with Another Degree.

Although most students finish medical school, those who do not frequently have no obvious programmatic alternatives. In recent years, a growing number of medical schools have been developing "off-ramp" programs to help such learners. We surveyed 12 medical schools with off-ramp programs to understand their characteristics and challenges. Differences existed between programs but most were deemed helpful to the students and institutions they served. Advantages included the opportunity to acknowledge the students' hard work, increase career opportunities, and reduce debt. Understanding and promoting such programs will assist students for whom medical school does not represent the optimal career path.

Differences in motives between Millennial and Generation X medical students.

OBJECTIVES Three domains comprise the field of human assessment: ability, motive and personality. Differences in personality and cognitive abilities between generations have been documented, but differences in motive between generations have not been explored. This study explored generational differences in medical students regarding motives using the Thematic Apperception Test (TAT). METHODS Four hundred and twenty six students (97% response rate) at one medical school (Generation X = 229, Millennials = 197) who matriculated in 1995 & 1996 (Generation X) or in 2003 & 2004 (Millennials) wrote a story after being shown two TAT picture cards. Student stories for each TAT card were scored for different aspects of motives: Achievement, Affiliation, and Power. RESULTS A multiple analysis of variance (p < 0.05) showed significant differences between Millennials' and Generation X-ers' needs for Power on both TAT cards and needs for Achievement and Affiliation on one TAT card. The main effect for gender was significant for both TAT cards regarding Achievement. No main effect for ethnicity was noted. CONCLUSIONS Differences in needs for Achievement, Affiliation and Power exist between Millennial and Generation X medical students. Generation X-ers scored higher on the motive of Power, whereas Millennials scored higher on the motives of Achievement and Affiliation.

Stability of values during medical school.

BACKGROUND: Medical students' values represent an understudied area of research in medical education research. No known studies have investigated how medical students' values change over time from matriculation to graduation. AIM: Values are thought to remain relatively stable over the life course. However, little research supports this claim. Therefore, we examined the extent to which values change or remain the same during medical school. METHOD: Forty-six first-year medical students completed the Physician Values in Practice Scale (PVIPS) during their first and fourth years of medical school. The PVIPS contains 38 statements of values about medical practice and comprises six scales: Prestige, Service, Autonomy, Lifestyle, Management, and Scholarly Pursuits. RESULTS: Matched pair t-tests (p < 0.05) indicated significant differences between students' PVIPS scores pretest (first year of medical school) and posttest (fourth year of medical school) for 2 of the 6 values (Autonomy: t(45) = -4.12, p < 0.001 and Lifestyle: t(45) = -2.62, p = 0.012). CONCLUSIONS: Medical students values appear to change slightly during their 4 years of medical education. In line with literature suggesting that the medical education process is associated with change in certain student qualities and attributes (e.g., empathy), physician values may be another variable so affected.

"Virtual Radiology Workstation": Improving Medical Students' Radiology Rotation.

BACKGROUND: Radiology education in clinical clerkship is increasingly important. There is an acute need for active engagement and self-directed learning by medical students rotating in radiology compared with mainly observational current learning practice involving shadowing in the reading room. ACTIVITY: "Virtual Radiology Workstations" supplemented by PowerPoint presentation of normal radiologic anatomy were introduced for fourth-year medical student radiology electives. RESULTS AND DISCUSSION: All 18 students were satisfied with this new teaching model and agreed their understanding of imaging procedures, and recognition of basic anatomic structures improved. It also resulted in efficient utilization of both the teachers' and the students' time.

A Perfect Match? A Scoping Review of the Influence of Personality Matching on Adult Mentoring Relationships-Implications for Academic Medicine.

INTRODUCTION: Mentoring is a widely regarded faculty development strategy in academic medicine. However, the lack of understanding about mentoring relationship dynamics limits effective recruitment, implementation, and evaluation. Despite decades of publications describing adult mentoring initiatives, few studies examine personality influence in mentoring relationships. This scoping review examined the extent, range, and nature of the research on personality matching in mentoring relationships, and identified research gaps in the literature. METHODS: Scoping review methodology guided a search of six databases representing higher education, health sciences education, and professional contexts where mentoring is used. Consistent with the inclusive approach of a scoping review, authors included academic papers and other article types. RESULTS: The scoping review yielded 39 articles. Literature mostly originated in the United States, publication sources represented multiple disciplines, and the context for the majority of articles was the workplace. The most common publication type was a research report. Although all articles addressed personality or mentoring, only three articles examined personality matching and its contribution to the mentoring relationship. Finally, although the Big Five personality traits were cited in multiple studies, other personality frameworks were used. DISCUSSION: Academic medicine expends resources developing and supporting mentoring programs but there remains limited understanding of how best to identify and match mentors and protégés. Further understanding of the role of joint and unique personality traits in academic medicine mentoring relationships seems necessary, if the field continues to invest, time, money, and resources for mentoring programs.

Emotional intelligence and medical specialty choice: findings from three empirical studies.

CONTEXT: Despite only modest evidence linking personality-type variables to medical specialty choice, stereotypes involving empathy and 'emotional connectedness' persist, especially between primary care providers and surgeons or subspecialists. This paper examines emotional intelligence (EI) and specialty choice among students at three US medical schools. METHODS: Results from three independent studies are presented. Study 1 used the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) administered to a single cohort of 84 Year 4 medical students. Study 2 used the Trait Meta-Mood Scale (TMMS) and Davis' Interpersonal Reactivity Index (IRI) administered to three cohorts (n = 250) of Year 3 medical students. Study 3 used the Bar-On Emotional Quotient Inventory (EQ-I) administered to two cohorts of Year 1 medical students (n = 292). Results were linked to specialty choice data retrieved from the National Residency Match Program (NRMP). Classifications of specialty choice included: (i) primary care (family practice, internal medicine, paediatrics) versus non-primary care (all others), and (ii) primary care, hospital-based specialties (anaesthesiology, emergency medicine, pathology, radiology), and technical and surgical specialties (neurology, obstetrics and gynaecology, ophthalmology, and all surgical fields). CONCLUSIONS: Across all three studies - and using both classifications of specialty choice - no significant differences in EI were found between students entering primary care and non-primary care specialties. Limitations are acknowledged, and future directions for research involving EI are identified.

Influences on specialty choice for students entering person-oriented and technique-oriented specialties.

BACKGROUND: Given changing trends in specialty choices among medical students coupled with continued challenges associated with medical specialty decision-making, it is important for medical educators to understand how students make decisions about their medical career. Medical educators should be aware of how medical school-based experiences and interactions such as faculty, courses, and services impact students' specialty choices and decisions. AIM: The study determined if differences in influences on specialty decision-making exist for students entering person-oriented specialties versus technique-oriented specialties. METHODS: Three hundred and fifty-six fourth-year medical students completed a questionnaire about how the faculty, curriculum, student services, mentoring and professional development programs, lifestyle considerations, family/friends, and other factors influenced their choice of specialty. RESULTS: Chi-square analyses indicated that students pursuing person-oriented specialties compared to technique-oriented specialties were moderately more likely to be influenced by their personal physician, by school faculty, and by medical school activities; slightly more likely to be influenced by medical school offices and services; and slightly less likely to be influenced by income expectations. CONCLUSIONS: Students interested in person-oriented specialties versus technique-oriented specialties indicate differences in what influences their specialty choice. This study may be helpful to medical educators and advisors who work with students on specialty decision-making.

A Longitudinal Assessment of Professional Identity, Wellness, Imposter Phenomenon, and Calling to Medicine Among Medical Students.

OBJECTIVE: This study assessed changes in professional identity, wellness, imposter phenomenon, and calling to medicine over time in medical school. METHODS: Medical students from the first through third years anonymously completed four validated measures: Perceived Wellness Survey (PWS), Brief Calling Scale (BCS), Physician In-group Identification Scale (PID), and Clance's Imposter Phenomenon Scale (CIP). Survey completion implied informed consent. The study was exempted by the university IRB. RESULTS: All class of 2018 students (n = 110) returned surveys at the beginning of year 1; 58 completed surveys at the end of the preclinical years (post year 2, n = 44) and/or end of the third-year clerkship (post year 3, n = 35) and were analyzed. From pre to post preclinical years, there was a significant decrease in the PID. There were no statistically significant changes in the PWS, BCS, and CIP. From pre year 1 to post third-year clerkships, the PWS and PID decreased, the CIP increased, and the BCS did not change. Only 19% of students participated in all three survey administrations and this group was excluded from the analysis due to the low response rate. CONCLUSION: Student wellness and sense of professional identity (in-group identity) dropped over 3 years of medical education, while imposter phenomenon increased. The BCS did not change over time. The decrease in identity as part of the physician community is concerning; future curriculum initiatives should focus on integration of professional identity into students' individual identities and on initiatives to improve student well-being.

The Educational Climate Inventory: Measuring Students' Perceptions of the Preclerkship and Clerkship Settings.

PURPOSE: To develop an instrument to assess educational climate, a critical aspect of the medical school learning environment that previous tools have not explored in depth. METHOD: Fifty items were written, capturing aspects of Dweck's performance-learning distinction, to distinguish students' perceptions of the educational climate as learning/mastery oriented (where the goal is growth and development) versus performance oriented (where the goal is appearance of competence). These items were included in a 2014 survey of first-, second-, and third-year students at six diverse medical schools. Students rated their preclerkship or clerkship experiences and provided demographic and other data. The final Educational Climate Inventory (ECI) was determined via exploratory and confirmatory factor analysis. Relationships between scale scores and other variables were calculated. RESULTS: Responses were received from 1,441/2,590 students (56%). The 20-item ECI resulted, with three factors: centrality of learning and mutual respect; competitiveness and stress; and passive learning and memorization. Clerkship students' ratings of their learning climate were more performance oriented than preclerkship students' ratings (P < .001). Among preclerkship students, ECI scores were more performance oriented in schools with grading versus pass-fail systems (P < .04). Students who viewed their climate as more performance oriented were less satisfied with their medical school (P < .001) and choice of medicine as a career (P < .001). CONCLUSIONS: The ECI allows educators to assess students' perceptions of the learning climate. It has potential as an evaluation instrument to determine the efficacy of attempts to move health professions education toward learning and mastery.

Comparing millennial and generation X medical students at one medical school.

PURPOSE: Two main generational cohorts comprising students enrolled in medical schools today are Generation Xers (born 1965-1980) and Millennial students (born 1981-1999). A subset is Cuspars (born 1975-1980), who share traits with both generations. Population theorists ascribe different personal characteristics, attitudes, and preferences to each group. The authors examined whether selected characteristics describing Generation X and Millennial students were quantifiable using a personality measure. Differences among Generation X, Millennial, and Cuspar medical students were investigated. METHOD: Eight hundred and nine medical students (399 females and 410 males) who matriculated between 1989-94 and 2001-04 at the Northeastern Ohio Universities College of Medicine completed the 16 Personality Factor Questionnaire (16PF). Differences in responses to the 16PF among the three generations were analyzed using multivariate analysis of variance (MANOVA). RESULTS: Analyses showed significant differences for Generation X versus Millennial students on 10 of the 16 personality factors. Millennial students scored significantly higher than Generation X students on factors including Rule-Consciousness, Emotional Stability, and Perfectionism; Generation X students scored higher than Millennials on Self-Reliance. Millennials also were significantly different from Generation Xers on several other factors. Significant differences were noted among Cuspars, Generation Xers, and Millennials. CONCLUSIONS: The 16PF is a useful tool to examine differences among these groups and to help understand the factors that constitute their personalities. Given differences among the generational groups, the authors forecast possible educational implications for medical school academic affairs and student services, and suggest areas for future research.

Personality and clinical skills: any correlation?

BACKGROUND: To determine correlations between personality factors and clinical skills of second-year medical school students. METHOD: Participants were 206 medical students who had completed the Sixteen Personality Factor Questionnaire (16PF) and the Clinical Skills Assessment II (CSA II). RESULTS: of the 16PF and CSA II were analyzed using Pearson R. Results Overall CSA II score correlated positively with Warmth and negatively with Abstractedness and Privateness. Communication skills correlated positively with Warmth, Emotional Stability, and Perfectionism and negatively with Privateness. Data gathering correlated positively with Warmth and negatively with Abstractedness. Physical exam and Case presentation subtests had no correlates. CONCLUSION: The findings of this study suggest that a relationship may exist between personality and clinical skills.