Beware The Predatory Medical Journal!

Publishing: Anyone wishing to publish in open access medical journals should read this article first. The authors offer a comprehensive “red flag” checklist of bad practices to help avoid falling prey to illegitimate journals.   Things to look out for: Is there an editorial board? How is peer review conducted? Are there article processing charges or article submission charges? Does the publisher communicate via spam? How will the research be archived and indexed?  By clearly outlining the process in both traditional subscription-based and open access publishing models, the authors present a balanced overview of the concerns and benefits of scholarly communication in today’s world and provide an excellent tool to assist when submitting research to a journal that no one’s ever heard of before. — Victoria Wagner, MLS

Baker EF, Iserson KV, Aswegan AL, Larkin GL, Derse AR, Kraus CK; American College of Emergency Physicians Ethics Committee, Open Access Medical Journals: Promise, Perils, and Pitfalls, Acad Med. 2018 Dec

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Maybe You Shouldn’t Be A Doctor

Perspective: This thoughtful perspective is required reading for all educators who deal with struggling learners.  They cite troubling evidence that a vast majority of educators think that many institutions “had graduated students who should not have graduated,” and they speculate on the causes for this “failure to fail”.  Students not suited cognitively or emotionally to medicine may feel trapped into a medical career by the time and money already invested, or by familial or self-expectations.  As educators, we worry about our learners’ ability to cope with debt they have accumulated, we lack expertise in feedback and remediation, and we don’t know enough about alternative career options to give good advice to our students who we think should not be physicians.  The authors end with several practical recommendations for schools and the profession. — Laura Willett, MD

Bellini LM, Kalet A, Englander R. Providing Compassionate Off-Ramps for Medical Students Is a Moral Imperative. Acad Med. 2018 Dec

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Communication During and After Residency Interviews Causes Applicant Distress

Match: The National Resident Matching Program (NRMP), The Institutional, Program, and Applicant Match Participation Agreement (MPA), and the code of conduct (COC) are clear in stressing the importance of avoiding inappropriate and coercive tactics during the interviews and in follow-up communication. But are the training programs complying?

This study, utilizing an anonymous, 31-question survey sent to candidates applying to 8 residency programs at Cleveland Clinic regarding their interview experiences, studied residency applicant perspectives about postinterview communications (31% of the 6693 candidates responded).

The following rates of inappropriate questions were reportedly asked during interviews:

about other interviews: 72% of applicants were asked, occurring at 25% of all interviews
marital status: 38% of applicants were asked, occurring at 14% of all interviews
children or plans to have children: 17% of applicants were asked, occurring at 5% of all interviews, with women asked about childbearing 50% more frequently than men
how highly they would rank a program: 15% of applicants were asked

Overall, 91% of respondents engaged in postinterview communication. A total of 70% of respondents informed their top program that they had ranked it highly; 70% of this subset reported associated distress, and 78% reported doing this to improve match success. A total of 71% would feel relief if postinterview communication was actively discouraged, and 51% would prefer applicants to be prohibited from notifying programs of their rank. — David Cohen, MD

Camille Berriochoa, Chandana A. Reddy, Steven Dorsey, Steven Campbell, Christine Poblete-Lopez, Richard Schlenk, Abby Spencer, John Lee, Matthew Eagleton, and Rahul D. Tendulkar (2018) The Residency Match: Interview Experiences, Postinterview Communication, and Associated Distress. Journal of Graduate Medical Education: August 2018, Vol. 10, No. 4, pp. 403-408.

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How The Experts Visualize Professionalism Remediation

Professionalism: In this qualitative study, the authors interviewed experienced educators about their professionalism remediation processes.  These experts visualized a 3-stage process, with all 3 stages not being necessary in every case.  During the first phase, “explore and understand”, the main object was to obtain the student’s viewpoint regarding the professionalism complaint.  Often, the process could end there if there was a clear miscommunication or “one-off” incident.  The second phase was focused on “remediation”, with the faculty member acting as a coach to try to help the student meet professional expectations.  Some concerns were expressed that some students could “game” the system during this phase by expressing socially appropriate comments without changing attitudes.  The third phase, “gather evidence for dismissal”, was entered for a small minority of students identified by professionalism complaints, only after a decision was reached that remediation was unlikely to be effective.  Evidence was gathered to bring before duly constituted committees of the medical school.  This structure will be useful for educators working with students reported for professionalism concerns. — Laura Willett, MD

Mak-van der Vossen, Marianne C., MD; Croix, Anne de la, MA, MEd, PhD; Teherani, Arianne, Ms Ed, PhD; Mook, Walther N.K.A. van, MD, PhD; Croiset, Gerda, MD, PhD; Kusurkar, Rashmi A., MD, PhDA Roadmap for Attending to Medical Students’ Professionalism Lapses Academic Medicine: November 27, 2018

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Is Going To Medical School Depressing?

Depression: Yes, for many of us.  Researchers surveyed more than 3,000 medical students in year 1 and year 4 with surveys including validated scales for depression, stress, coping methods, and social support.  Predictors of depression in year 4 were found via multivariate analysis and a predictive score was developed.  Overall, 31% of year 4 students reported “depression symptoms”.  Multivariable analysis showed independent predictors as measured in year 1:  depression at year 1 (the strongest predictor), age >24, race/ethnicity non-white and non-Hispanic, high stress, high measure of negative coping, low social support, and mid-range medical school tuition (the only school-related variable that was predictive).  A weighted score was developed which could range from 0 to 10.  Students with a score of 0-1 had a 15% prevalence of depressive symptoms in year 4 and those with scores of 6-10 had a prevalence of 64%.  The authors speculate about the potential uses of this predictor. — Laura Willett, MD

Dyrbye LN, Wittlin NM, Hardeman RR, Yeazel M, Herrin J, Dovidio JF, Burke SE, Cunningham B, Phelan SM, Shanafelt TD, van Ryn M. A Prognostic Index to Identify the Risk of Developing Depression Symptoms Among U.S. Medical Students Derived From A National, Four-Year Longitudinal Study. Acad Med. 2018 Sep

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Money Talks, To Residents Too

Debt: This survey of family medicine residents regarding debt burden and future employment plans had predictable but sobering findings. Firstly, 60% of these residents had a debt burden of more than $150,000, and 45% of residents with a DO degree had a debt burden of more than $250,000. High levels of debt burden were associated to a large and statistically significant degree with lower interest in academic employment, government employment, and geriatrics fellowship. — Laura Willett, MD

Phillips J, Peterson LE, Fang B, Kovar-Gough I, Phillips RL Jr.  Debt and The Emerging Physician Workforce: The Relationship Between Educational Debt and Family Medicine Residents’ Practice and Fellowship Intentions. Acad Med. 2018 Sep.

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How Long Should That Clerkship Be?

Clerkship: It looks like we have no idea.  Researchers looked at a “natural experiment” in clerkship length during a curriculum change at the University of Michigan Medical School.  During this transition, all clerkship lengths were decreased by 25%.  For example the surgery clerkship was shortened from 8 weeks to 6 weeks.  Multiple outcomes were measured pre- and post- change for all 7 clerkships; while a few were of statistical significance, none appeared to be important.  These outcomes included scores on standardized and/or faculty-developed examinations in each clerkship , performance on a multi-station objective clinical skills exam after completion of all clerkships, and survey measures of student satisfaction and well-being.  — Laura Willett, MD

Monrad SU, Bibler Zaidi NL, Gruppen LD, Gelb DJ, Grum C, Morgan HK, Daniel M, Mangrulkar RS, Santen SA. Does Reducing Clerkship Lengths by 25% Affect Medical Student Performance and Perceptions? Acad Med. 2018 Jul

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