Depression In Internship

Depression: Following up on their work showing that depression is quite common in medical trainees, the authors present a qualitative analysis of comments contrasting the text of answers to open-ended questions of interns who became depressed compared with those who did not.  This analysis is limited by low (42% of the 63% who completed the survey) rate of written comments, but the question is of major importance to medical educators.  Interns who become depressed much more frequently mentioned exhaustion, anxiety, stress, and negative personality change.  Their most memorable experience was more likely to be the preventable death of a patient and they more frequently expressed regret at their decision to become a physician.  By contrast, interns who did not become depressed much more frequently mentioned increases in competence, confidence, and knowledge.  Their most memorable experience was more likely to be receipt of recognition for their work, often from a patient.  The authors cite work by others suggesting that resilience training programs may help prevent or treat depression in these circumstances. — Laura Willett, MD

Mata DA, Ramos MA, Kim MM, Guille C, Sen S. In Their Own Words: An Analysis of the Experiences of Medical Interns Participating in a Prospective Cohort Study of Depression. Acad Med. 2016 May 10.

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Am I Planning To Be Pregnant During Residency? Potentially Illegal Residency Interview Questions

Residency Interview: Time for some faculty development for faculty interviewing residency candidates.  In this survey of all US “Match” candidates with a 51% response rate, two thirds of residency applicants reported receiving at least one potentially illegal question during residency interviews.  Such questions included marital status, child-rearing plans, and commitments to rank a program highly, all of which are clearly not allowed by general employment law or “Match” rules.  Such questions were common among all respondents, but more common for female applicants and applicants to surgical specialties. — Laura Willett, MD

Hern HG Jr, Trivedi T, Alter HJ, Wills CP. How Prevalent Are Potentially Illegal Questions During Residency Interviews? A Follow-up Study of Applicants to All Specialties in the National Resident Matching Program. Acad Med. 2016

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Creating Doctors For The Underserved

Primary Care: In this systematic review, the authors found that many factors were associated with becoming a primary care physician in an underserved urban or rural area in the US.  The most consistent associations in terms of numbers of positive studies were under-represented minority status, growing up in a rural area, receiving a National Heath Services (NHS) scholarship, and participation in a predoctoral or postdoctoral rural medicine track.  Mixed positive and negative results were seen in studies of international medical graduates, level of educational debt, and specialty.  For schools and program directors with a mission to improve primary care access of the underserved, as well as policy-makers with influence on NHS funding or specialized tracks, this information will be useful.

Goodfellow A, Ulloa JG, Dowling PT, Talamantes E, Chheda S, Bone C, Moreno G. Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review. Acad Med. 2016

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Most Popular Reviews (1)

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Here’s a look back at some the most popular DR MERL reviews.

Gender Bias: How Did They Do That? Interviews Of Female Full Professors

Authors interviewed 87% of the female full professors at the University of Kansas School of Medicine, asking them for their perspective on how they “made it” to their position and what their advice would be for young women entering the profession…more.

Evaluations: If You Can’t Say Something Nice, Don’t Say Nothing At All: Thumper’s Rule And How Faculty Interpret Narrative Comments On Resident Evaluations

In this qualitative study using constructivist grounded theory analysis, investigators describe how faculty interpret narrative comments on residents’ in-training evaluation….more

Reflective Writing: Reflective Writing As A Tool Of Academic Success?

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…more

Active Learning: Techniques For Medical Educators

Traditionally, lectures are the principle mode of delivering core content in an emergency medicine (EM) curriculum. The authors describe a variety of different active learning approaches that can be incorporated in this curriculum to improve knowledge retention and create a deeper understanding of the material…more

Flipped Classroom: Students Need More Than Web Lectures For Flipped-Classroom Prep

The study describes student preparation in a basic science and a clinical course in which students predominantly used the same study materials. The observation that 40% to 50% of the students chose to combine basic materials with scientific papers, books, and formative test questions does not support the idea…more

Residency: Residents Continue To Be (Even More) Depressed

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%…more

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Teaching Millennials Clinical Skills: Video Selfies, Anyone?

Clinical Skills: In this innovation report from the Really Good Stuff series, investigators studied the use of video selfies for students learning to interview patients. In the video-selfie group, students used iPods to record themselves, then reviewed and edited the footage to create 5 minute “highlight” clips to present to a small group of peers and faculty preceptor after giving an oral case presentation. Control group students interviewed patients and gave oral presentations without use of video. Students reported that reviewing and editing their videos allowed self-reflection and that presenting videos to peers facilitated discussions and identified “key incidents” and learning moments missed during oral presentations alone. The use of video selfies may be appealing to both millennial students who are tech savvy and, for the most part, quite comfortable with selfies, as well as to course directors at schools struggling with direct observation of students by faculty. This approach also takes advantage of a feature on mobile devices that many students already carry in their pockets, obviating the need for schools to rely on high cost audio-visual systems. But keep in mind that this study was done in a research setting with patient consent. Whether this approach will be well accepted by patients and students in other settings, and whether the mounting video footage to be viewed will be perceived as increased workload by the faculty remain to be seen. — Sarang Kim, MD

T Sellito, A Ryan and T Judd. “Video selfies” for feedback and reflection. Med Educ 2016;50:564-591.

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Do You Trust That Intern?

Trust: How do residents decide to trust their interns?  Researchers at multiple internal medicine residencies explored this issue, deriving a model using qualitative methods, interviews and focus groups, and validating the resultant model with a quantitative survey.  The factors which carried the most weight were intern-related, e.g. reliability and competence, followed closely by system-related factors such as patient characteristics and system supports. — Laura Willett, MD

Sheu L, O’Sullivan PS, Aagaard EM, Tad-Y D, Harrell HE, Kogan JR, Nixon J, Hollander H, Hauer KE. How Residents Develop Trust in Interns: A Multi-Institutional Mixed-Methods Study. Acad Med. 2016 Mar

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Computers Are The New “Scut”

Time Management: Results of another time and motion study of internal medicine residents will not be surprising to observers of the 21st-century hospital.  Residents spent 50% of their time on the computer, 60% of their time multi-tasking (e.g. on the computer and the phone simultaneously), and less than 10% of their time with their patients.  This was less than the amount of time moving from one location to another or waiting.  The electronic health record has many benefits but also many unintended consequences. — Laura Willett, MD

Mamykina L, Vawdrey DK, Hripcsak G. How Do Residents Spend Their Shift Time? A Time and Motion Study With a Particular Focus on the Use of Computers. Acad Med. 2016 Mar

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