Effect of In-Class vs Online Education on Sexual Health Communication Skills in First-Year Medical Students: a Pilot Study.

OBJECTIVE: Online education is effective for knowledge acquisition, but its effect on clinical skill development is not well characterized. We aimed to compare communication skills of 50 first-year medical students who learned to assess and treat patients through an online learning module vs an in-class lecture. METHODS: Twenty-six students were randomized to learn about antidepressant-induced sexual dysfunction in class and 24 learned the same content through an online module. Students were individually observed conducting an interview with a standardized patient with antidepressant-induced sexual dysfunction. Students were assessed by faculty raters blinded to the student's learning mode. Standardized patients were asked about their willingness to have the student as their physician. RESULTS: More students who learned in class vs online demonstrated appropriate verbal empathy (18 [69%] vs 8 [33%]; P = 0.01), defined as completing each task in the "verbal empathy" assessment domain, as measured by a faculty rater. Other assessed variables were not significantly different. Standardized patients' willingness (vs unwillingness; P = 0.01) to have the student as their physician was associated with the demonstration (by faculty appraisal) of a number of basic skills: using open-ended questions, asking one question at a time, using gender-neutral terminology when asking about the patient's relationship, and using appropriate sexual-health terminology. CONCLUSIONS: This study, although limited by a single-site design and the small number of participants, offers preliminary evidence that, if confirmed, may suggest that in-class learning from a psychiatrist (vs from an online module) is associated with greater verbal empathy in the assessment of SSRI-related sexual dysfunction.

Validation of a Teaching Effectiveness Assessment in Psychiatry Continuing Medical Education.

OBJECTIVE: Little is known about factors associated with effective continuing medical education (CME) in psychiatry. The authors aimed to validate a method to assess psychiatry CME teaching effectiveness and to determine associations between teaching effectiveness scores and characteristics of presentations, presenters, and participants. METHODS: This cross-sectional study was conducted at the Mayo Clinic Psychiatry Clinical Reviews and Psychiatry in Medical Settings. Presentations were evaluated using an eight-item CME teaching effectiveness instrument, its content based on previously published instruments. Factor analysis, internal consistency and interrater reliabilities, and temporal stability reliability were calculated. Associations were determined between teaching effectiveness scores and characteristics of presentations, presenters, and participants. RESULTS: In total, 364 participants returned 246 completed surveys (response rate, 67.6%). Factor analysis revealed a unidimensional model of psychiatry CME teaching effectiveness. Cronbach α for the instrument was excellent at 0.94. Item mean score (SD) ranged from 4.33 (0.92) to 4.71 (0.59) on a 5-point scale. Overall interrater reliability was 0.84 (95% CI, 0.75-0.91), and temporal stability was 0.89 (95% CI, 0.77-0.97). No associations were found between teaching effectiveness scores and characteristics of presentations, presenters, and participants. CONCLUSIONS: This study provides a new, validated measure of CME teaching effectiveness that could be used to improve psychiatry CME. In contrast to prior research in other medical specialties, CME teaching effectiveness scores were not associated with use of case-based or interactive presentations. This outcome suggests the need for distinctive considerations regarding psychiatry CME; a singular approach to CME teaching may not apply to all medical specialties.

Reliability of self-reported nicotine use as determined by serum cotinine levels in patients referred for liver transplantation.

BACKGROUND: Smoking has been associated with a higher incidence of post-hepatic transplantation de novo noncutaneous neoplasms and vascular complications. There are conflicting reports regarding increased posttransplant mortality. OBJECTIVE: The authors sought to determine the reliability of patient-reported nicotine product use (NPU) in candidates for hepatic transplantation. METHOD: The authors performed a retrospective chart review of all patients referred for liver transplantation in a 12-month period. Each patient's report of recent or current nicotine product use through smoking, chewing tobacco, or nicotine replacement products, as obtained in interviews, was compared with the quantitative result of serum cotinine levels. RESULTS: Of 171 patients referred for liver transplant evaluation during a 12-month period, 17% reported ongoing NPU, and 83% denied it. Of the patients who denied recent NPU, 11% had serum cotinine levels reflective of active use. Of the patients reporting active NPU, 97% had positive cotinine levels. CONCLUSION: There was a high degree of reliability of patient self-reported NPU, but detecting deceptive reporting is important in the selection of patients who will have long-term success with liver transplantation.

Denial of hepatic transplantation on the basis of smoking: is it ethical?

PURPOSE OF REVIEW: There is disagreement and inconsistency between liver transplant programs regarding the acceptance or rejection of smokers as candidates for transplantation. This article reviews the outcome data for transplanted smokers, the rate of maintained abstinence from cigarettes by smokers who have quit and the ethics of using tobacco use as a transplant selection criterion. RECENT FINDINGS: Consistent with earlier studies, recently published articles continue to demonstrate an increased risk of noncutaneous malignancies, higher rates of graft arterial thrombosis and a higher mortality rate in liver transplant patients who smoke as compared with nonsmokers. There is a significant rate of relapse to smoking after transplantation, and the rates are higher among patients with alcoholic liver disease. Recent studies have shown that 10-16% of patients with biochemical verification of active smoking deny their tobacco use when interviewed for transplant consideration. Although extensively, if not universally, used to exclude transplant candidates, a recent study of marijuana use showed no difference in mortality outcomes as compared with nonusers. SUMMARY: With the exception of one recent study, there is substantial literature to support increased morbidity and mortality among posthepatic transplant smokers.