Is Attractive As Important As Smart?

Admissions: Unfortunately yes, suggests this study which should be required reading for admissions and recruitment committee members.  Regular faculty reviewers of residency applications rated fictitious applications with variable demographic and academic data and application photos which were pre-adjudicated for obesity and attractiveness.  The raters were asked to generated a rating between 1 and 5 regarding their interest in interviewing the candidate.  Unattractiveness had a negative impact on this rating similar in magnitude to the positive impact of a higher Step 1 examination score, under-represented minority status, class rank, or clerkship grades.  Obesity had a less robust but still significant effect.  This reviewer is sure that this prejudice is not confined to the radiology faculty who were the subjects of this study, but is widespread within society and the medical community. — Laura Willett, MD

Maxfield CM, Thorpe MP, Desser TS, Heitkamp DE, Hull NC, Johnson KS, Koontz NA, Mlady GW, Welch TJ, Grimm LJ. Bias in Radiology Resident Selection: Do We Discriminate Against the Obese and Unattractive? Acad Med. 2019 May

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Entrustable Professional Activities Through Mastery Learning

Entrustable Professional Activities: Assessment of competency-based education is an ongoing challenge as medical schools are tasked with instilling the AAMC’s EPAs in their graduates.  Capstones, bootcamps, and other transition to residency courses have been developed to decrease variability in readiness for residency.  This study by Northwestern University evaluated students on 3 EPAs (getting informed consent, developing a differential diagnosis, and writing prescriptions) during their 2 week long 4^th year capstone course.  Students underwent a baseline skills assessment followed by faculty supervised educational sessions with deliberate practice, actionable feedback, and a post-intervention skills assessment.  Demonstration of mastery was required.  Students received additional deliberate practice and feedback until a minimum passing score on the post-test was achieved.  In this way, the authors concluded that they were able to verify medical student achievement of the 3 core EPAs in a “low-stakes formative assessment” as suggested by the AAMC.  The authors discuss future implementation of capstone and longitudinal EPA-based mastery learning curricula. — Catherine Chen, MD & Beth Goodman, MD

Salzman DH, McGaghie WC, Caprio TW, Hufmeyer KK, Issa N, Cohen ER, Wayne DB,  A mastery learning capstone course to teach and assess components of three entrustable professional activities to graduating medical students.  Teach Learn Med 2019;31:186

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Failure To Thrive: Predicting Interruption In Academic Progress Using A Growth Chart Metaphor

At Risk Students:  Early identification of students who may be at risk for interrupted academic progress (i.e., having to repeat a course, an entire academic year or facing dismissal) is essential for professors, learning specialists, and those in academic affairs. In this innovative article, a visual approach for graphing accumulated exam points (using 11 summative multiple-choice question exams) over the course of the first and second year of medical school is described.  The authors liken plotting student exam scores to the plotting of height and weight on growth charts used in pediatric well visits.  In their metaphor, performing at the class average or gaining points above the class average would be “healthy” growth, while performing below average and increasingly moving away from the class mean would indicate significant risk.  The model allows for easy data analysis using minimal software and has great promise in providing a simplified way to identify at-risk students as early as the fifth summative exam (they were able to predict students at risk with 85% accuracy and are in process of extending the research to other institutions).    Much like a pediatrician would recommend adequate nutrition for a child not meeting growth markers, educators can plot student exam scores and recommend alternate study strategies and retention practices to ensure adequate academic growth. — Kristen M. Coppola, Ph.D.

Cendán J, Joledo O, Soborowicz M, Marchand L, Selim B. Using Assessment Point Accumulation as a Guide to Identify Students at Risk for Interrupted Academic Progress. Academic Medicine. 2018;93(11):1663-1667.

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US News And World Report Rankings Remain Deeply Flawed And Far Too Influential

Rankings: In this thoughtful commentary, the author describes the US News and World Report formula used to rank medical schools and quotes dean Robert Alpen of Yale that “there’s nothing really in (the) formula that is really evaluating the quality of medical education.  That would be so much more valuable to the applicants, to the students.  And it would incentivize us to do a better job in education.”  The author also posits that the student descriptor inputs to the formula may reinforce “a flawed system that values test-taking abilities above all other attributes even before medical school begins.”  The author suggests other, much more meaningful metrics:  preparation for residency; career trajectory; quality of clinical care 10-20 years after graduation; career satisfaction; research impact of the school; community benefit from school, faculty, and graduates. Obviously, these are much more difficult to measure than the metrics currently in the formula. The author ends with an acknowledgement that the pernicious effect of these rankings are not confined to medical schools but extend to many types of educational institutions.  He quotes law professor Jeffrey Evans Stake:

“US News has set up a game.  The players are the schools being ranked and the faculty members at those schools.  Most faculty members and administrators seek to increase their school’s rank by various strategic moves.  These moves are costly, in terms of money and other resources, but do little or nothing to improve legal education for students.  Indeed, it is worse than that.  Many of the strategies run contrary to the interests of students and society.”

It is important to note that the US News and World Report ranking for “primary care” is not discussed in this commentary, but shares similar fatal flaws:  a plurality of the ranking is based on a dean-level reputational survey with an extremely low response rate; the student descriptors are similarly flawed; and there is no measure of long-term entry into primary care by a school’s graduates. — Laura Willet, MD

McGaghie WC, America’s Best Medical Schools: A Renewed Critique of the U.S. News & World Report Rankings. Acad Med. 2019 Apr

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Don’t Know Much About Entrustable Professional Activities Or Learner Handovers For Medical Students

Enstrustable Professional Activities & Learner Handovers: Two scoping reviews reinforce our overall lack of knowledge about how to employ EPAs and learner handovers, the feeding forward of prior learner performance.  The reviewers of articles on EPAs found only 26 empirical studies of EPAs in medical student education which evaluated the EPAs in light of the Ottawa Criteria for evaluations.  They conclude that “reproducibility, equivalence, educational effect, and catalytic effect (ed. note: curricular effect) all require further study.”  The reviewers of learner handovers found 24 applicable studies, almost all coming from outside the healthcare education literature.  The main consistent finding, in 22 of 24 studies, was that the provision of prior performance information tended to influence raters in the direction of the prior rating.  Other important questions about learner handovers were addressed by fewer studies or had less consistent data. — Laura Willett, MD

Meyer EG, Chen HC, Uijtdehaage S, Durning SJ, Maggio LA. Scoping Review of Entrustable Professional Activities in Undergraduate Medical Education, Acad Med. 2019 Apr

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Humphrey-Murto S, LeBlanc A, Touchie C, Pugh D, Wood TJ, Cowley L, Shaw T. The Influence of Prior Performance Information on Ratings of Current Performance and Implications for Learner Handover: A Scoping Review. Acad Med. 2019 Apr

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How Residents And Fellows Navigate The Telephone

Communication: In this qualitative study, researchers interviewed 17 residents and fellows in multiple specialties regarding workplace telephone conversations.  Generally, these trainees felt that they had learned a lot over the years about how to make their telephone interactions more efficient and productive.  Three major “tensions” were identified:  power differentials; pushback ; and trustworthiness/uncertainty.  All of the tensions could have a negative or positive effect on patient care and learning.  For example, trainees learned how to give more succinct and useful presentations, and tried to view the situation from their conversation partner’s point of view in response to these tensions.  The authors discuss whether trainees should be taught these skills in a more formal way and other implications of their findings. — Laura Willett, MD

Eppich WJ, Dornan T, Rethans JJ, Teunissen PW “Learning the Lingo”: A Grounded Theory Study of Telephone Talk in Clinical Education. Acad Med. 2019 Mar

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Multi-Institution Curriculum Collaboration

Collaboration: In the United States undergraduate medical education has been focusing on defining the competencies and goals of the curriculum, almost to the exclusion of deciding what content should be taught. Each institution, therefore, must reinvent the wheel in determining what topics should be covered in their curriculum. An original collaborative effort by five medical schools took the first step in designing necessary core content and curricular resources for an undergraduate microbiology and immunology course curriculum. They designed self-contained modules for each topic area containing an introductory video, a set of factual videos, an in-class interactive learning session with resources, and summative and formative assessments. The key to these modules is their flexibility. They are designed to be used either as a total educational curriculum or added into an existing curriculum; integrated as a resource, a flipped class room or as the basis of a curriculum. These modules were then implemented to varying degrees in the five schools, with positive student satisfaction and assessment data. This is an innovative curricular design that can standardize the undergraduate microbiology and immunology content taught at US medical schools, while being flexible enough to be integrated into any curriculum. Collaborating on curricular content between schools will enable faculty to more attentively focus their efforts on the quality of teaching. – Lee Ann Schein, PhD.

Chen SF, Deitz J, Batten JN, DeCoste-Lopez J, Adam M, Alspaugh JA, Amieva MR, Becker P, Boslett B, Carline J, Chin-Hong P, Engle DL, Hayward KN, Nevins A, Porwal A, Pottinger PS, Schwartz BS, Smith S, Sow M, Teherani A, Prober CG.A Multi-Institution Collaboration to Define Core Content and Design Flexible Curricular Components for a Foundational Medical School Course: Implications for National Curriculum Reform.Acad Med. 2019 Feb

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