Caridad Hernandez

Validation of a provider self-report inventory for measuring patient-centered cultural sensitivity in health care using a sample of medical students.

The paper describes the construction and initial evaluation of the new Tucker-Culturally Sensitive Health Care Inventory (T-CSHCI) Provider Form, which was developed to address the shortcomings of existing similar measures. Two hundred seventeen (217) 3rd and 4th year medical students completed the T-CSHCI-Provider Form. Factor analysis was used to identify non-overlapping items. The final solution produced five factors: patient-centeredness, interpersonal skills, disrespect/disempowerment, competence, and cultural knowledge/responsiveness. The five T-CSHCI-Provider Form factors/subscales proved to be reliable and were associated with related constructs as hypothesized. This study provides initial evidence that the T-CSHCI-Provider Form measures independent dimensions of patient-centered culturally sensitive health care as perceived by medical students. Recommendations for ways in which the T-CSHCI Provider Form can be used to guide culturally sensitive health care training are provided.

Interprofessional Education in the Internal Medicine Clerkship Post-LCME Standard Issuance: Results of a National Survey

BackgroundSeveral decades of work have detailed the value and goals of interprofessional education (IPE) within the health professions, defining IPE competencies and best practices. In 2013, the Liaison Committee for Medical Education (LCME) elevated IPE to a U.S. medical school accreditation standard.ObjectiveTo examine the status of IPE within internal medicine (IM) clerkships including perspectives, curricular content, barriers, and assessment a year after the LCME standard issuance.DesignAnonymous online survey.ParticipantsIM clerkship directors from each of the Clerkship Directors in Internal Medicine’s 121 U.S. and Canadian member medical schools in 2014.MethodsIn 2014, a section on IPE (18 items) was included in the Clerkship Directors in Internal Medicine annual survey of its 121 U.S. and Canadian member medical schools.Main MeasuresItems (18) assessed clerkship director (CD) perspectives, status of IPE curricula in IM clerkships, and barriers to IPE implementation. Data were analyzed using descriptive statistics and qualitative analysis of free-text responses to one of the survey questions.Key ResultsThe overall survey response rate was 78% (94/121). The majority (88%) agreed that IPE is important to the practice of IM, and 71% believed IPE should be part of the IM clerkship. Most (76%) CDs agreed there is need for faculty development programs in IPE; 27% had such a program at their institution. Lack of curricular time, scheduling conflicts, and lack of faculty trained in IPE were the most frequently cited barriers. Twenty-nine percent had formal IPE activities within their IM clerkships, and 38% were planning to make changes. Of those with formal IPE activities, over a third (37%) did not involve student assessment.ConclusionsSince LCME standard issuance, only a minority of IM clerkships have included formal IPE activities, with lectures as the predominant method. Opportunities exist for enhancing educational methods as well as IPE faculty development.

OSCE standards-setting procedure facilitated by digital technology.

What problems were addressed? There is a need to declare standards for high-stakes objective structured clinical examination (OSCE) assessments. A number of methods have been described, including variations of the Hofstee, borderline regression and Angoff methods. All require preparation of the evaluators (judges) and a discussion process which yields greater defensibility and credibility of pass/ fail cut points. One challenge posed in this process concerns the real-time manipulation of data such that the judges (clinicians and clinical educators) can complete the evaluation and discussion procedure efficiently. Data collection sheets and manual input of data were used in the past; however, mobile technologies are now available to increase efficiency and allow for the real-time review of cases and of agreement on judgements. What was tried? Our medical college has purchased a survey tool called Qualtrics (qualtrics.com) that is used for student and faculty questionnaires and is available on an intuitive iPad platform. Judges are invited by team leaders to join the survey via an e-mail which provides a secure survey link. The interface allows the judges to choose the likelihood that a given ‘borderline’ student will perform the assessment item successfully, using a sliding bar which serves as a visual analogue scale of infinite definition; the scale is supported by a three-digit number (000–100) such that a user sees exactly what score the mobile slider scale represents. Once all items have been addressed, each user submits the survey and the Qualtrics platform allows for the immediate export of a datasheet which can be used to review all of the judgements. We conducted a 2.5-hour standard-setting session with eight faculty members to complete a three-station OSCE Angoff procedure. The session began with a 30-minute orientation to the Angoff process, and a discussion of the definition of ‘borderline’ performance and judgement agreement protocol. Once all faculty staff were ready to progress, we presented the first case summary followed by deployment of the first Qualtrics survey. Survey results were exported into Excel and the whole group reviewed the judgements. In the event that a minimum–maximum range exceeded 20%, the judges discussed the case until they reached agreement; the process was repeated for the three stations. The impact data collected from the judges illustrate the ease of use, thoughtful and visual decision making, and immediacy of results to be obtained by converging iPad’s mobile technology with Qualtrics. What lessons were learned? The process was completed in 2.5 hours despite five of the eight judges being completely na€ıve to the Angoff method. Only one judge had been involved in a similar exercise in the past. The technology allowed for the immediate review of responses from the panel and facilitated what would have otherwise been a significant amount of manual data entry (20–25 items per case per judge). Furthermore, the technology promises to facilitate the performance of initial judgements away from campus, thus allowing the judges to convene only for the discussion of controversies.

Dermatologic Simulation of Neglected Tropical Diseases for Medical Professionals

Introduction While patients with neglected tropical diseases may present for care in the United States, they are encountered so infrequently that medical professionals may have little chance of being exposed to these illnesses during training. This simulation on dermatological presentations of neglected tropical diseases was used as a teaching tool for multifaceted topics including disease management, interdisciplinary collaboration, and sociocultural issues. To achieve this goal, we created four cases with patients demonstrating clinical and dermatological presentations. Methods Through the use of a moulage kit, this simulation portrayed four common neglected tropical diseases that are rarely encountered in the United States: dengue fever, cutaneous leishmaniasis, lepromatous leprosy, and yaws. Following the clinical experience, a debrief session discussing sociocultural and dermatological factors of neglected tropical diseases occurred. Results The feedback obtained regarding the simulation was exceptionally positive. The participants indicated that the simulation improved their medical knowledge of neglected tropical diseases, diagnostic abilities, and interprofessional communication skills. Discussion This simulation can easily be adapted for use in conferences, health professional education, and patient advocacy, making it relevant for training in a wide variety of settings. Through the application of this simulation, greater progress can be made in the education of medical professionals on neglected tropical diseases and dermatology. Not only will the application of realistic workshops increase medical competency regarding these rarely encountered diseases, it will also provide opportunities to engage with these diseases, which can cultivate interest in the future pursuit of global health.

AM last page. Using Visual Radar Graph Representation of Learner Achievement to Complement the RIME Framework.

• The RIME (Reporter, Interpreter, Manager, Educator) evaluation framework developed by Pangaro can be used to yield insight into a trainee’s development. • A previous AM Last Page presented a tabular map of the RIME framework as it relates to the Accreditation Council for Graduate Medical Education (ACGME) competencies. • Keister and colleagues have validated the use of radar graphs as promising tools for feedback and assessment of trainees. • Achievement of milestones and progression along the RIME axes can be visually represented for formative or summative evaluation. • Modification to Pangaro’s developmental markers (Introduced, Repeated practice, Proficiency, Mastery) with a minor mathematical manipulation allows representation as a visual radar graph for the RIME framework. – The mathematical conversion is necessary to give relative value to each step in the progress. – The conversion scale can be developed locally by programs to highlight the relative value given to these constructs at individual training programs. Using Visual Radar Graph Representation of Learner Achievement to Complement the RIME Framework Juan Cendán, MD, associate professor of surgery and assistant dean for simulation, Caridad Hernández, MD, associate professor of medicine, and Analia Castiglioni, MD, associate professor of medicine, University of Central Florida, College of Medicine

Evaluating Student Attitudes: Perceptions of Interprofessional Experiences Following Participation in a Student-Run Free Clinic

It is increasingly evident that patient health outcomes are improved when they are treated by an effective interdisciplinary healthcare team. Many also endorse that learning to function collaboratively in interdisciplinary settings should start at the onset of one’s medical education. Student-run free clinics, such as the University of Central Florida College of Medicine’s (UCF COM) KNIGHTS (Keeping Neighbors In Good Health Through Service) Clinic, provide opportunities for students to work in concert with other healthcare professionals. This study aimed to discern whether volunteering in this setting had a positive impact on medical students’ perception of working within an interdisciplinary team. A single survey was distributed via Qualtrics to all first and second-year medical students (N = 248) at the UCF COM. The items of interest examined in this study were part of a larger study described elsewhere. The mean responses on a 5-point Likert-like scale to these survey items were recorded and compared between two cohorts: KNIGHTS volunteers and non-volunteers. One hundred twenty-three (49.6%) students responded to the survey and most items showed no statistically significant difference between the two groups (p-value > 0.05). However, there were a few items of interest that did show a significant difference. These included KNIGHTS volunteers being much more likely to have worked with other healthcare professionals (p < 0.001) as well as believing themselves to have a better understanding of the role of medicine within an interprofessional team (p = 0.016). Additionally, KNIGHTS volunteers were more likely to feel like they understood the role of patient education (p = 0.031) and pharmacy (p = 0.040) within an interprofessional team. Interestingly, KNIGHTS volunteers were also more likely to believe that problem-solving skills should be learned with students within their own discipline (p = 0.009) as well as that there is little overlap between the roles of medical students and students from other healthcare disciplines (p = 0.044). Still, overall results showed that both volunteers and non-volunteers had an overall positive perception of interdisciplinary teams and working with other healthcare professionals.

The Effect of Medical Student Volunteering in a Student-Run Clinic on Specialty Choice for Residency

Introduction: Student-run free clinics (SRFCs) are a recent popular addition to medical school education, and a subset of studies has looked at the influence of SRFC volunteering on the medical student’s career development. The majority of the research done in this area has focused on understanding if these SRFCs produce physicians who are more likely to practice medicine in underserved communities, caring for the uninsured. The remainder of the research has investigated if volunteering in an SRFC influences the specialty choice of medical school students. The results of these specialty choice studies give no definitive answer as to whether medical students chose primary or specialty care residencies as a result of their SRFC experience. Keeping Neighbors in Good Health through Service (KNIGHTS) is the SRFC of the University of Central Florida College of Medicine (UCF COM). Both primary and specialty care is offered at the clinic. It is the goal of this study to determine if volunteering in the KNIGHTS SRFC influences UCF COM medical students to choose primary care, thereby helping to meet the rising need for primary care physicians in the United States. Methods: A survey was distributed to first, second, and third-year medical students at the UCF COM to collect data on demographics, prior volunteering experience, and specialty choice for residency. Responses were then combined with records of volunteer hours from the KNIGHTS Clinic and analyzed for correlations. We analyzed the frequency and Pearson’s chi-squared values. A p value of less than 0.05 was considered statistically significant. Results: Our survey had a total response rate of 39.8%. We found that neither the act of becoming a KNIGHTS Clinic volunteer nor the hours volunteered at the KNIGHTS Clinic influenced the UCF COM student’s choice to enter a primary care specialty (p = NS). Additionally, prior volunteering/clinical experience or the gender of the medical school student did not influence a student’s choice to volunteer at the KNIGHTS Clinic. Discussion: Volunteering at KNIGHTS Clinic did not increase student choice to enter primary care, with students choosing other specialties at equal rates, probably due to the variety of specialties present at the KNIGHTS Clinic. This suggests that the volunteer attending physicians present at an SRFC may influence the choice of residency for students. It also suggests that SFRCs are not a viable tool to increase the number of primary care doctors in the United States.

The Effect of Volunteering at a Student-Run Free Healthcare Clinic on Medical Students' Self-Efficacy, Comfortableness, Attitude, and Interest in Working with the Underserved Population and Interest in Primary Care

Introduction The number of primary care physicians in the United States continues to lag behind the number of uninsured people. There has been a growing demand for medical students to improve their self-efficacy, comfortableness, attitude, and interest in working with the underserved and in primary care. This study aims to discern whether volunteering at a student-run, free healthcare clinic has a positive impact on these five variables of interest or not. Methods A 95-item survey was distributed through Qualtrics Survey Software (Qualtrics, Provo, UT, USA) to medical students from the Class of 2018 and Class of 2019 at the University of Central Florida College of Medicine. They were recruited via emails, Facebook, and in-classroom announcements. Mean responses on a Likert-like scale to different survey items were collected and compared between two study cohorts: Keeping Neighbors In Good Health Through Service (KNIGHTS) Clinic volunteers and non-volunteers. Results Results from 128 students showed no significant differences in the means between the two cohorts (p-values were not significant). When volunteers were asked the survey item, “KNIGHTS Clinic positively influenced my attitude towards working with underserved patients,” 62% strongly agreed, 26% agreed, 10% were neutral, and 2% disagreed. Discussion Based on the results, volunteering at KNIGHTS Clinic may not have a positive impact on the five variables of interest. However, the lack of significance may also be due to certain limitations of this study addressed elsewhere in this paper. With the majority of KNIGHTS Clinic volunteers agreeing that “KNIGHTS Clinic positively influenced […their] attitude towards working with underserved patients,” there may be a positive impact of volunteering on volunteers’ attitude towards working with the underserved.

Medical Students' Attitudes Toward Non-Adherent Patients Before and After a Simulated Patient-Role Activity and Small-Group Discussion: Revisited.

Introduction This study seeks to explore whether the documented decline in medical student empathy can be prevented or slowed using simulated patient-role activities and small-group discussions about the patient experience of living with a chronic illness. Methods First-year students (M1, n = 118) at the University of Central Florida College of Medicine (UCFCOM) participated in a simulated patient-role activity resembling the experience of a patient with Type 2 diabetes mellitus. The activity included taking daily “medication,” participating in moderate exercise, and maintaining a low carbohydrate diet. At the end of the simulated patient-role activity, students took part in a small-group discussion about their experiences. Students completed the Jefferson Scale of Physician Empathy: Student Version (JSPE:S) before and after the activity. Additionally, fourth-year students (M4) at UCFCOM completed the JSPE:S to serve as the control, as this class completed the curriculum without any simulated patient-role activities. Results A total of 86 responses out of 118 possible M1 participants (73% response rate) were received. Of these, 62 surveys were completed and were therefore used for statistical analysis. A dependent sample t-test revealed no statistically significant increase on pre-activity (M = 111.15, SD = 8.56) and post-activity (M = 111.38, SD = 9.12) empathy scores (p = .78). A positive correlation was revealed to exist between pre- and post-activity empathy scores (r = 0.72, p < 0.001). Empathy comparisons for the full sample M1 post-activity results (n = 62) and the M4 results (n = 16, M = 106.56, SD = 10.61) revealed no statistically significant difference (p = .11). Discussion Although previous authors have shown that patient role-playing activities, such as those performed in this study, should maintain and/or increase empathy in medical students, our findings suggest that on a short-term scale, empathy levels were not affected by the activity.