Residents Continue To Be (Even More) Depressed

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Residency: In a systematic review of studies published from the 1980s to the 2010s, the prevalence of depression or depressive symptoms among residents was found to be 28.8%. Specialty, post-graduate year, country, median age, and percentage male were not predictors of depression prevalence.  Interestingly, there was a tonic increase in percentage of depressed residents with calendar year, despite increasingly strict duty hours regulations over the years relevant to included studies. — Laura Willett, MD

Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E, Sen S. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis.JAMA. 2015

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Reflective Writing As A Tool Of Academic Success?

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Reflective Writing The correlation is not so clear.  Within undergraduate medical education there is growing interest in using reflective writing, thought to encourage students to improve their critical thinking, enhance patient care and cultivate attitudes and behaviors needed for clinical practice.  This study from the Mayo Clinic investigates whether there is a relationship between academic performance, gender, residency choice, length of essay and quality of written reflections.  Between 2005 and 2011, 319 first-year anatomy students were asked to write a reflective essay on an anatomy case scenario.  To assess the quality of the written reflections the authors developed and validated a tool modified from the 2010 Wald and Reis REFLECT rubric.  Students were also given the NBME Gross Anatomy and Embryology Subject Examination.  This, as well as the students’ anatomy course grades, was used as measures of academic performance. The resulting statistical analysis showed that there was no correlation between the composite reflection score and performance on either the NMBE subject exam or course grades. There was, however, significant statistical correlation between gender and reflection scores.  Female students had a higher mean score than male students and students who opted for a medicine residency had a higher reflective score than did students who chose a surgery residency.  In addition, the longer the reflection essay, the higher the reflection score.  The authors suggest that success in medicine should not be defined solely by academic scores.  Professionalism and interpersonal skills are also necessary for students to develop into successful physicians , but the jury is still out as to whether or not these are competencies can improve with reflective writing. –Lee Ann Schein, Ph.D.

Ottenberg, Abigale L., Pasalic, Dario, Bui, Gloria T., Pawlina, Wojciech, An Analysis of Reflective Writing Early In The Medical Curriculum: The Relationship Between Reflective Capacity And Academic Achievement, Medical Teacher, 2015

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Is It Live Or Is It Podcast?

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Lectures Don’t stop lecturing yet.  Although this study shows that podcasts are as effective a teaching method as live lectures, the majority of students preferred live interaction with faculty.  Medical education has been increasingly incorporating various types of technologies into undergraduate education.  This study, conducted at the University of Ottawa, explored some differences between two modalities of delivering medical school material; live lectures verses recorded podcasts.  Third year students (n=148) had a one week Otolaryngology-Head&Neck Surgery (OTO-HNS) rotation which included three OTO-HNS lectures.  Students were randomly placed into two groups; one had live lectures (n=73) and the other only podcasts of the lectures, consisting of the same lecture material with the same lecturer (n=75).  The authors compared the two groups with respect to three outcomes; performance on a written exam, performance on an OTO-HNS OSCE station, and a student satisfaction survey.  While both cohorts of students preformed similarly on the written exam (78.4 for the live lecture group and 79.2 for the podcast group), the podcast group outperformed the live lecture group in the OSCEs 14.0/19 compared to 12.5/19.  The student satisfaction survey showed an 88% neutral or positive response to the webcasts.  64% of the podcast cohort responded favorably to the fact that the webcasts can be viewed multiple times.  However, 69% of the podcast group noted that there was a need for live interaction between lecturers and students. Podcasts are seen as beneficial tools for reviewing lectures multiple times or for remote learning, as long as time was factored in for live interaction between faculty and students.  –Lee Ann Schein, Ph.D.

Vaccani, Jean-Philippe, Javidnia, Hedyeh , Susan, Humphrey-Murto, The Effectiveness of Webcast Compared to Live Lectures as a Teaching Tool in Medical School, Medical Teacher 2016, 38: 59–63

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About Half Of MSPEs (“Dean’s Letters”) Don’t Meet Minimal Guidelines

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MSPE Researchers analyzed one medical student performance evaluation (MSPE) from 117 out of the 131 accredited North American MD schools.  Current voluntary guidelines suggest that the letter include a summative keyword (e.g. “excellent”) along with distribution data for the school’s various keywords, and distribution data for the required clerkship grades.  Only 51% of the reviewed MSPEs met these fairly minimal guidelines.  This practice can hurt residency program directors who need to “quickly and acutely evaluate hundreds or thousands of applicants” and hurt high-performing students “who may not be recognized for their achievements.”  The authors hypothesize that a lack of comparative data from the MSPE may lead to greater reliance on “other objective data” such as licensing examination scores. — Laura Willett, MD

Hom J, Richman I, Hall P, Ahuja N, Harman S, Harrington R, Witteles R. The State of Medical Student Performance Evaluations: Improved Transparency or Continued Obfuscation? Acad Med. 2015

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How Can We Measure Inter-Professional Teamwork?

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Teamwork In this timely systematic review, 64 different teamwork assessment tools were reviewed for validity, generalizability, outcomes, and feasibility, and compared to the Association of American Medical Colleges (AAMC)’s 4 inter-professional collaboration competencies.  The authors make a practical recommendation of 4 different tools, one for each competency.  Two of the tools test attitudes and have been used mostly in classroom environments.  Only one tool, the Teamwork Mini-Clincal Evaluation Exercise (T-MEX) evaluated behaviors in the clinical setting, and was found to be useful without extensive rater training.  However, “further research is needed to evaluate generalizability and establish additional validity evidence.” — Laura Willett, MD

Havyer RD, Nelson DR, Wingo MT, Comfere NI, Halvorsen AJ, McDonald FS, Reed DA. Addressing the Interprofessional Collaboration Competencies of the Association of American Medical Colleges: A Systematic Review of Assessment Instruments in Undergraduate Medical Education. Acad Med. 2015

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How To Implement An EPA-Based Residency Evaluation System

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EPA In this practical innovation report, Canadian family medicine residency directors describe how they implemented a robust system of direct observation of their residents in support of a competency-based evaluation system charting their residents’ progress in the entrustable professional activities (EPAs) for family medicine.  Impressively, they obtained an average of about 150 direct observations per resident. Faculty development to improve the reliability of clinical ratings, the development of “practical intuitive tools to capture assessment, and time for preceptors to do this work” were key to the implementation.  Benefits have included the marked increase in direct observation of residents, and the earlier identification of learners in trouble. — Laura Willett, MD

Schultz K, Griffiths J.Implementing Competency-Based Medical Education in a Postgraduate Family Medicine Residency Training Program: A Stepwise Approach, Facilitating Factors, and Processes or Steps That Would Have Been Helpful.
Acad Med. 2015

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How May We Meaningfully Engage Community Stakeholders In Research?

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Community Engagement: The claim that engaging community stakeholders in research has numerous benefits (e.g. increasing researchers’ understanding of study populations and their needs, informing recruitment and dissemination strategies, improving quality, etc.) is widely accepted; however, logistical and financial barriers often prevent such engagement. The authors of this study report that a structured, collaborative and cross-disciplinary approach to community engagement (CE) can mollify many of the obstacles. In 2009, the Meharry-Vanderbilt Community Engagement Research Core (CERC) began testing a new approach, leading to the development of the Community Engagement Studio (CE Studio), a mechanism that “provides a structured method for obtaining input from stakeholders to enhance the design, conduct, and dissemination of research.” The research core has implemented 28 CE Studios for 23 researchers, engaging 152 stakeholders. Post-CE Studio evaluations indicate that 79% of researchers believe that the CE Studio “increased their understanding of and sensitivity to the study populations.” Stakeholders gained a “deeper appreciation of the complexity of clinical research and became invested in the project’s success.” Thus far, projects have been focused on clinical research; however, basic science and medical education researchers would also benefit from this holistic approach. Medical Education administrators may also wish to share this with faculty and students conducting research. Interested parties who would like to replicate this model may download a tool kit developed by CERC staff, faculty and community partners at http://www.meharry-vanderbilt.org.ces-toolkit. — Adrian J. De Gifis, Ph.D.

Yvonne A. Joosten, MPH, Tiffany L. Israel, MSSW, Neely A. Williams, MDiv, Leslie R. Boone, MPH, David G. Schlundt, PhD, Charles P. Mouton, MS, MS, Robert S. Dittus, MD, MPH, Gordon R. Bernard, MD, and Consuelo H. Wilkins, MD, MSCI. Community Engagement Studios: A Structured Approach to Obtaining Meaningful Input From Stakeholders to Inform Research Acad Med. 2015 DEC 90:12: 1646-1650.

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CBCL – The Alphabet Soup Of Active-Learning Methodologies Continues To Expand

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Active Learning: Joining PBL (problem-based learning), CBL (case-based learning), and TBL (team-based learning), is CBCL (case-based collaborative learning).  The method seems to be a variant of TBL, with the major changes being individual readiness assurance testing with challenging (rather than foundational) questions prior to classroom time, and the use of open-ended rather than multiple-choice responses to questions based on evolving cases.  The authors randomized 64 volunteer first-year medical and dental students in a physiology course to 8-person traditional PBL classes or to 16-person CBCL classes.  In the PBL classes, there was no readiness assurance testing and students developed their own educational questions. In the CBCL classes, four 4-person teams answered open-ended questions first individually, then in the 4-person teams, and then as an entire group.  Final test performance was the same in the PBL and CBCL groups, but there was borderline significant improvement in the secondary endpoint of test performance among those students previously performing below the class median.  Overall student responses and observer report of active engagement were positive.  There are many variations on the active-learning theme, all seem positive.  Deans and administrators will likely favor those requiring smaller numbers of faculty. — Laura Willett, MD

Krupat E, Richards JB, Sullivan AM, Fleenor TJ Jr, Schwartzstein RM. Assessing the Effectiveness of Case-Based Collaborative Learning via Randomized Controlled Trial. Acad Med. 2015 Nov 24.

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Students Requiring Extra Time On The MCAT Are At Greater Academic Risk

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MCAT:  In this large study by the Association of American Medical Colleges, students who took extra time on the medical school admissions test due to “documented mental disabilities” were accepted to medical school at similar rates as their peers.  However, they had substantially lower pass rates on US licensing examinations:  Step 1: 82% vs. 94%, Step 2 knowledge 86% vs. 95%, and Step 2 clinical skills 92% vs. 97%.  They also had lower medical school graduation rates, even after 8 years, 88% vs. 96%.  These “differences remained after controlling for MCAT scores and undergraduate grade point averages.”  Thus, taking extra time on the MCAT appears to be a robust and long-lasting marker of academic risk. — Laura Willett, MD

Searcy CA, Dowd KW, Hughes MG, Baldwin S, Pigg T. Association of MCAT scores obtained with standard vs extra administration time with medical school admission, medical student performance, and time to graduation. JAMA 2015 Jun 9;313(22):2253-62.

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What Makes A Teacher Influential? Ask The Teacher.

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TEACHER QUALITY: This qualitative study describing characteristics of influential teachers turns not to learners, but to teachers. The authors asked respected teachers selected to participate in a faculty development program to write about their most influential teachers from when they were students or trainees. Of the 20 of 22 faculty members who participated, 13 named clinical teachers (including one who named himself!), and 7 named non-medical teachers (art teacher, college professor, etc). Notably, these teachers tended not to be course directors, department chairs, or have other official roles. In using grounded theory to analyze the narratives, the authors report that all influential teachers shared qualities of excellent teaching and a caring and selfless relationship with their learners. While these findings are not novel, they do give us pause as we consider the fact that much of what defines success for medical school faculty is research or clinical productivity. If medical schools are not investing in developing or rewarding excellent teachers, who have to meet research and/or clinical productivity measures to demonstrate success, their “caring and selfless relationships with learners” may be threatened. — Sarang Kim, MD

Osterberg L, Swigris R, Weil A, Branch WT Jr.  The highly influential teacher: recognising our unsung heroes. Med Educ. 2015 Nov;49(11):1117-23.

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