Double Check That Citation! Misrepresentation Of Publications By Residency Applicants

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Publication   The investigators of this study examined data from the Canadian Resident Match Service (similar to the US Electronic Residency Application Service, or ERAS) to assess misrepresentation of publications reported among applicants to Canadian otolaryngology residency programs over a 3-year period. Citations were verified using PubMed, Google Scholar and electronic journals, with misrepresentation defined as falsely claiming authorship of an existing article, claimed authorship of a non-existing article, or improper order of authorship. Of a total of 427 peer-reviewed publications reported by 124 of 182 applicants, 385 were verified, and 47 (12%) were misrepresented by 29 (23%) of applicants. Age, gender, prior academic degree, and number of citations per applicant were not associated with likelihood of misrepresentation. This study adds to existing single institution-based studies describing publication misrepresentation in residency applicants. — Sarang Kim, MD.

Sater L, Schwartz JS, Coupland S, Young M, Nguyen LH, Nationwide study of publication misrepresentation in applicants to residency. Med Educ. 2015 Jun;49(6):601-11.

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Role Of Preclinical Classroom Attendance Sharply Divides Faculty and Students

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classroom attendance    In several medical schools, attendance in preclinical years is not mandatory for lectures, recordings of which are usually available to the students. Classroom attendance has diminished in some schools. A single-center cohort study was carried out using internet-based surveys to investigate how students and faculty perceive classroom attendance and how nonattendance influences teachers and the overall learning environment. The study showed that medical students (n = 382) and their teachers (n = 248) have significantly different expectations of the classroom experience, which in part contributes to their different outlooks regarding the importance of classroom attendance and its relationship to professionalism. Compared to students, faculty more significantly perceived a negative impact of poor attendance on lecture (74.7% for faculty vs. 41.6% for students). The authors provide suggestions to overcome this discrepancy including mutual understanding and faculty training in active learning approaches. They note that the study is limited by perceptions at the site of study and the conclusions may not apply to curricula which are predominantly based on small-groups or require attendance for lectures.-Sangita Phadtare, Ph.D., Cooper Medical School of Rowan University

Allyson R. Zazulia and Patricia Goldhoff., Faculty and medical student attitudes about preclinical classroom attendance., Teaching and Learning in Medicine: An International Journal  2014, 26:4, 327-334

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How Do Medical Schools Deal With Students’ Professionalism Lapses?

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professionalism  Researchers interviewed education deans (response rate 61%) regarding their schools’ practices regarding lapses in professionalism.  A majority (80%) had written policies and procedures regarding unprofessional behavior on the part of medical students, but practices were quite variable.  Involvement of student affairs deans, course or clerkship directors, medical education deans, and promotions committees was commonly reported.  Several strategies for remediation were reported by more than 50% of interviewed deans:  mandated mental health evaluation; remediation curriculum or assignment (e.g. reflective writing); mandated professionalism mentor; stress management counseling; and repetition of all or part of the involved course or clerkship.  Many dean expressed concerns regarding feed-forward practices, lack of adequate reporting of professionalism lapses, and unclear criteria for successful remediation.  The authors suggest research to establish best practices in this important area. — Laura Willett, MD

Ziring D, Danoff D, Grosseman S, Langer D, Esposito A, Jan MK, Rosenzweig S, Novack D. How Do Medical Schools Identify and Remediate Professionalism Lapses in Medical Students? A Study of U.S. and Canadian Medical Schools. Acad Med. 2015

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The Implicit (“Hidden”) Curriculum Isn’t All Bad

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Hidden_Curriculum   Researchers interviewed third-year pediatric residents from 3 academic institutions on their sources of learning regarding the six Clinical Learning Environment Review (CLER) focus areas:  patient safety, quality, transitions, supervision, fatigue management, and professionalism.  For each area, residents were asked how much of their learning came from the explicit (formal), implicit (hidden), or extra- (friends and family) curriculum.  Comments were analyzed qualitatively.  A small minority of the learning came from the extra-curriculum.  In all areas except health care quality, which was mostly learned explicitly, the majority of CLER area learning came from the implicit curriculum.  Methods included role modeling, hands-on learning, and passive enculturation.  “Learning in the implicit curriculum, for the most part, aligned with the intended learning outcomes,” and was overall reported very positively by the residents.  An example was a culture supporting residents “feeling comfortable enough to seek out guidance.” — Laura Willett, MD

Balmer DF, Quiah S, DiPace J, Paik S, Ward MA, Richards BF. Learning Across the Explicit, Implicit, and Extra-Curricula: An Exploratory Study of the Relative Proportions of Residents’ Perceived Learning in Clinical Areas at Three Pediatric Residency Programs.
Acad Med. 2015

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The Multiple Mini-Interview May Be Subject To Effects From Socio-Economic Status

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multiple-mini-interview In a single-school descriptive study, low socio-economic status had a modest negative effect on the pooled MMI rater score.  The magnitude of this negative effect was similar to the positive effect of female gender and age 24+ years.  Under-represented minority status had no effect on MMI score.  The negative effect of low socio-economic status on the MMI score did not translate into a negative effect on the admission decision.  That decision was made holistically, with the MMI score being a major but not sole determinant.  A  question unanswered by this study is how much traditional interviewers are affected by socio-economic status. — Laura Willett, MD

Jerant A, Fancher T, Fenton JJ, Fiscella K, Sousa F, Franks P, Henderson M. How Medical School Applicant Race, Ethnicity, and Socioeconomic Status Relate to Multiple Mini-Interview-Based Admissions Outcomes: Findings From One Medical School.
Acad Med. 2015

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We Don’t Know Much About Teaching Medical Ethics

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MEDICAL_ETHICS  This Romanell report, an update from a 1985 landmark article, shows that we still know very little about the optimal goals, outcomes, teaching methods, or assessment methods of medical ethics education.  A much longer (compared to 1985) list of proposed objectives and topics is included, which will be of major interest to those involved in curricular planning.  The report also brings up some issues of faculty management:  “Achieving success requires financial support, recognition, and reward for faculty educators….  In some medical school settings, participation in medical education is implicitly devalued by the fact that teaching is a voluntary, nonremunerated activity.” — Laura Willett, MD.

Carrese JA, Malek J, Watson K, Lehmann LS, Green MJ, McCullough LB, Geller G, Braddock CH 3rd, Doukas DJ. The Essential Role of Medical Ethics Education in Achieving Professionalism: The Romanell Report. Acad Med. 2015 Apr

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Attendings Vary In Their Supervisory Role – A Lot

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ATTENDINGS  This will not be news for our trainees.  Twenty-four internal medicine inpatient teaching service attendings were given a sample student presentation and interviewed regarding their supervisory style.  Different styles were characterized by “the relative prioritization of three competing activities – patient care, trainee supervision, and teaching.”  Two styles were at ends of the spectrum: the direct care style and the minimalist style.  In the direct care style, attendings provided direct patient care either in parallel with the trainee efforts (“I just do everything on my own”) or during many hours of rounding together.  In the minimalist style, attendings “relied heavily on the senior medical resident’s ability to run the team and provide teaching” (“I have been burned before”).  More attendings described an empowerment style or a mixed practice style, both of which involved greater trainee teaching and oversight.  Attendings “largely maintained their style affinity regardless of trainee ability and patient load,” and few had discussed their styles with trainees or other attendings — Laura Willett, MD.

Goldszmidt M Faden L, Dornan T, van Merriënboer J, Bordage G, Lingard L. Attending Physician Variability: A Model of Four Supervisory Styles. Acad Med. 2015 Apr.

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Throw Out The Checklists (To Determine OSCE Failure)!  A Global Competent/Not Competent Rating Is Better

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osce  Forty-seven residents were video-taped performing procedures on simulators during an observed structured clinical examination (OSCE).  Trained raters filled out traditional checklists as well global ratings including one for “overall ability to perform procedure”.  Any “not competent” rating generated a written comment.  There was near perfect inter-rater reliability for overall competence decisions.  A high score on the checklist did not rule out incompetence; written comments on “not competent” performances with high checklist scores included notations such as “significant breaches of sterility”, “laceration or damage of important structures”, and “unsuccessful or too many attempts” — Laura Willett, MD.

Walzak A, Bacchus M, Schaefer JP, Zarnke K, Glow J, Brass C, McLaughlin K, Ma IW. Diagnosing Technical Competence in Six Bedside Procedures: Comparing Checklists and a Global Rating Scale in the Assessment of Resident Performance. Acad Med. 2015 Apr 15.

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Are Connectivist Massive Open Online Courses (cMOOCs) The Solution For Faculty Development In Medical Education?

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facultydevelopment Academic Life in Emergency Medicine is an open access medical education web site aimed at emergency medicine practitioners.  The authors describe their experience with their first six monthly on-line scenarios that raise “nonclinical educational dilemmas”.  Each case, before posting, is reviewed by medical education experts for responses citing relevant literature.  After the case is posted on the site, readers post comments which are then analyzed and shaped into a curated community commentary by associate editors.  This commentary, along with the case and expert commentary, forms the final product.  Pageviews in the first week after a scenario was posted ranged from 493 (mentor-mentee relationships) to 1,124 (job negotiations).  Given difficulties with achieving attendance to in-person faculty development sessions by clinically busy faculty, an interactive web-based platform may be part of the solution — Laura Willett, MD.

Chan TM, Thoma B, Lin M. Creating, Curating, and Sharing Online Faculty Development Resources: The Medical Education in Cases Series Experience. Acad Med. 2015

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We Think The Learning Environment Is Important. Can We Measure It?

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learningEnvironment  Johns Hopkins students filled out a survey including Likert-scale learning environment questions with an 81% completion rate. Investigators created a learning environment measure utilizing 28 questions which loaded into 7 general factors.  The score correlated with the students’ overall perception of the learning environment.  Out of a possible maximum score of 140, students who felt the overall learning environment was “exceptional” gave a mean score of 121, while those who felt it was “poor” or “terrible” gave a mean score of 76.  The “community of peers” factor explained by far the highest percentage of variance in the overall score. — Laura Willett, MD.

Shochet RB, Colbert-Getz JM, Wright SM. The Johns Hopkins Learning Environment Scale: Measuring Medical Students’ Perceptions of the Processes Supporting Professional Formation. Acad Med. 2015

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