In this interesting study, more than 3,000 student – standardized patient (SP) encounters were analyzed by the gender and ethnicity of the participants. Medical students and SPs completed non-identical evaluations of the medical student’s empathy. Female students overall were rated as slightly more empathetic than male students by both self-ratings and SP ratings, regardless of SP demographics. Effects of race were more complex. African-American students as a group were rated as slightly less empathetic than other students by SPs, but overall self-rated with the highest marks for empathy, incongruent with SP ratings. African-American male SPs tended to be the “easiest graders”, i.e. give the highest marks for empathy, to all students except for African-American male students. These results should, this reviewer thinks, be viewed as hypothesis-generating, but cause concern about using these ratings for high-stakes decisions. — Laura Willett, MD
Researchers anonymously surveyed emergency medicine residency interviewees at a single program (73% response rate). Each candidate had undergone two traditional interviews and a 4-station Multiple Mini-Interview (MMI) during their interview day. Only 10% overall had previously experienced the MMI, and 60% preferred the traditional interview format. Potential reasons for the preference were substantial minorities feeling that the MMI required specialized knowledge, and that the MMI gave them less opportunity to present an accurate portrayal of themselves. — Laura Willett, MD
Soares WE 3rd, Sohoni A, Hern HG, Wills CP, Alter HJ, Simon BC Comparison of the Multiple Mini-Interview With the Traditional Interview for U.S. Emergency Medicine Residency Applicants: A Single-Institution Experience. Acad Med. 2014 Oct 14.
Researchers asked faculty and residents in one pediatrics residency to respond to a survey with open-ended comments (response rates 70%+) yielding a quantitative and qualitative look at this important topic. “Both groups agreed that faculty provided too much direction with moderate frequency,” and several causes were mentioned fairly frequently: high patient census and acuity; fragmented resident time; frequent handovers; and differences in expectations. There seems to be potential for a vicious cycle in which “overdirection by faculty may make residents more passive, whereas resident passivity may stimulate faculty to exert more control.” Residents and faculty globally evaluated both their own behavior and the other groups’ behavior on parallel scales. Not surprisingly, both groups judged their own behavior more positively than they did the other group’s. — Laura Willett, MD
Biondi EA, Varade WS, Garfunkel LC, Lynn JF, Craig MS, Cellini MM, Shone LP, Harris JP, Baldwin CD, Discordance Between Resident and Faculty Perceptions of Resident Autonomy: Can Self-Determination Theory Help Interpret Differences and Guide Strategies for Bridging the Divide? Acad Med. 2014 Oct 2.
A three-day patient safety course was added to the curriculum of third year-students just prior to their clinical clerkships. The course content included items such as causes of errors and quality improvement; teamwork and error-reporting; self-regulation and clerkship ethics; and communication with patients and caregivers. Data was collected in the form of surveys, containing vignettes of medical error cases, which students filled out before and after course attendance. After completing the course, students had an increased understanding of patient safety and medical errors. Students’ awareness of the complexity of the medical system and its collective responsibility for errors were increased after the course. –Lee Ann Schein, Ph.D.
Roh H, Park SJ, Kim T., Patient safety education to change medical students’ attitudes and sense of responsibility.Med Teach. 2014 Oct 22:1-7.
This is an interesting qualitative “ethnographic” observational study of intraprofessional relationships between ER and general internal medicine (GIM) physicians in a major Canadian hospital, supplemented by ad hoc and scheduled interviews with faculty, residents, and nurses. An institutional mandate to decrease patient time in the ER before admission or release (publicly reported data) was imposed two years before the study started. After analyzing their data, the researchers felt that this mandate had potentially engendered negative consequences on: trainee education, ER-GIM physician relationships, interprofessional relationships with nursing, and truly patient-centered care. Participants perceived that the pressure to make admissions decisions quickly led to less emphasis on diagnostic thinking with trainees, and a greater tendency to admit frail elderly patients with “failure to cope” (US physicians, read “failure to thrive”) who may not have really needed admission to the hospital in the opinion of the GIM teams. Also, there was resentment of a new nursing leadership role which, in the authors’ words, does not exist “to provide better patient care but, rather … reinforces the hidden curriculum of efficiency.” A weakness of the study is that there is no corresponding data from before the ER time mandate. Certainly, negative ER-GIM relationships and negative views of certain high-need patient populations have existed before our current intensive focus on QI metrics. — Laura Willett, MD
Webster F, Rice K, Dainty KN, Zwarenstein M, Durant S, Kuper A. Failure to Cope: The Hidden Curriculum of Emergency Department Wait Times and the Implications for Clinical Training. Acad Med. 2014 Sep 30.
Promoting professionalism in undergraduate medical education is an important goal of medical schools. It has been noted that burnout and decreased empathy have been observed in third year students. Drexel University College of Medicine instituted a Professional Formation Curriculum to try to combat this trend. This paper investigates a new third year course in this curriculum consisting of peer supported, small groups with specially trained faculty facilitators utilizing Google+ Hangout social networking technology. The year-long groups promote private, peer support where students post meaningful experiences or self reflections centered on professional behavior. Via Blackboard, group participants discuss these narratives in a safe environment. Students’ empathy was assessed using the Jefferson Scale of Empathy and their ability for personal reflection was assessed using the Groningen Reflection Ability Scale. The results showed no decrease in empathy in theses students and an increase in ability for personal reflection at the conclusion of the course.–Lee Ann Schein, Ph.D.
Duke P, Grosseman S, Novack DH, Rosenzweig S., Preserving third year medical students’ empathy and enhancing self-reflection using small group “virtual hangout” technology. Med Teach. 2014 Sep 5:1-6.
Both readers and writers of medical education research should take note of Sullivan’s editorial in this month’s Journal of Graduate Medical Education wherein she outlines common “spin” techniques used in reporting education research results and how to avoid them. We’re all aware of fishing expeditions where investigators look at every possible association, and the all too common practice of attributing lack of difference between study groups to small sample size, but some may not have considered reporting Likert scale means to the 100th decimal point as being similarly problematic. Many of the solutions she proposes are simple, straight forward, and generally involve careful planning with judicious use of a key ingredient often forgotten- common sense. — Sarang Kim, MD
Link To Article (not yet available in PubMed)
Gail M. Sullivan (2014) Is There a Role for Spin Doctors in Med Ed Research?. Journal of Graduate Medical Education: September 2014, Vol. 6, No. 3, pp. 405-407.
Diagnostic mistakes in internal medicine are common, and this study probably underestimates them. Researchers, many of them residents, in Toronto tracked diagnoses made on medicine inpatients by the ER physician, the admitting resident, and the admitting attending. The “real” diagnosis was determined by chart review; the admitting attending’s diagnosis was accepted if no contrary information was found. Attendings were more accurate than residents (79% vs. 66%), but this may reflect the study methodology and the fact that more information may have accumulated between the resident’s and the attending’s evaluations. Attendings were very influenced by the residents’ diagnosis. When the resident was correct, attendings were correct in 96% of cases; but if the resident was incorrect, the attending made the correct diagnosis in only 44% of cases. — Laura Willett, MD
Michael D. Jain, George A. Tomlinson, Danica Lam, Jessica Liu, Deepti Damaraju, Allan S. Detsky, and Luke A. Devine (2014) Workplace-Based Assessment of Internal Medicine Resident Diagnostic Accuracy. Journal of Graduate Medical Education: September 2014, Vol. 6, No. 3, pp. 532-535.
In this lovely qualitative study, entering first-year medical students listened to 2-minute podcast clips of lectures previously given by well-rated (>4 on a 5-point Likert global scale) or poorly-rated (<3 on the same scale) faculty members. During the podcast clip, a photograph of an attractive or unattractive gender-matched person was projected onto a large screen. Students were then given 30 seconds to give a global rating on the same Likert scale and describe their impressions of the teacher. The descriptions were analyzed and broke down into two independent components: knowledge/intellect and “charisma”. “Charisma” included sub-components caring, engaging, entertaining, confident, and organized.
Interestingly, student global ratings based on the 2-minute podcast clip were very highly correlated (r=0.78) to prior students’ end-of-course ratings. Knowledge/intellect scores did not influence the global rating (p=0.5), but both charisma and having an attractive picture projected had a high positive association (p<0.001). Average ratings over 4 were reserved for high-charisma presentations, while average ratings less than 3.5 were associated with low-charisma presentations with an unattractive picture on display. In addition to being humorous, this study brings into question our use of learner global evaluations for high-stakes decisions regarding faculty. — Laura Willett, MD
Rannelli L1, Coderre S, Paget M, Woloschuk W, Wright B, McLaughlin K. How do medical students form impressions of the effectiveness of classroom teachers? Med Educ. 2014 Aug;48(8):831-7. doi: 10.1111/medu.12420.
Poor tolerance of ambiguity in physicians has been associated with higher healthcare costs from excessive test-ordering and higher rates of burnout. In this AAMC survey of all 2013 matriculating allopathic medical students (74% participation rate, n=13,867), students were asked 7 Likert-style questions from a previously derived questionnaire assessing comfort with ambiguous situations. A sample question: “If I am uncertain about the responsibilities involved in a particular task, I get very anxious.” Predictors of a higher tolerance for ambiguity with at least a moderate effect size were: higher age at matriculation (particularly ages 26 and more) and lower scores on a widely-used perceived stress score. — Laura Willett, MD