Charles A. Pohl

Can There Be a Single System for Peer Assessment of Professionalism among Medical Students? A Multi-Institutional Study

Purpose Peer assessment is a valuable source of information about medical students’ professionalism. How best to facilitate peer assessment of students’ professional behavior remains to be answered, however. This report extends previous research through a multi-institutional study of students’ perspectives about system characteristics for peer assessment of professionalism. It examines whether students from different schools and year levels prefer different characteristics of peer assessment to assess each other candidly, or whether a single system can be designed. It then identifies the characteristics of the resulting preferred system(s). Method At the beginning of academic year 2004–2005, students (1,661 of 2,115; 78%) in years one through four at four schools replied to a survey about which peer assessment characteristics—related to, for example, who receives the assessment, its anonymity, and timing—would prevent or encourage their participation. Multivariate analysis of variance was used to detect differences among institutions and students from each year level. Results Students across year levels and schools generally agreed about the characteristics of peer assessment. They prefer a system that is 100% anonymous, provides immediate feedback, focuses on both unprofessional and professional behaviors, and uses peer assessment formatively while rewarding exemplary behavior and addressing serious repetitive professional lapses. The system, they emphasize, must be embedded in a supportive environment. Conclusions Students’ agreement about peer-assessment characteristics suggests that one system can be created to meet the majority of students’ preferences. Once implemented, the system should be monitored for student acceptability to maximize participation and to determine the formative and summative value of the process.

Peer Nominations as Related to Academic Attainment, Empathy, Personality, and Specialty Interest

Purpose To test the hypotheses that peer nomination is associated with measures of (1) academic performance, (2) empathy, (3) personality, and (4) specialty interest. Method In 2007–2008, 255 third-year medical students at Jefferson Medical College were asked to nominate classmates they considered the best in six areas of clinical and humanistic excellence. The authors compared students who received nominations with those who did not, analyzing differences in academic performance, personality factors (empathy as measured by the Jefferson Scale of Empathy and personality qualities as measured by the Zuckerman–Kuhlman Personality Questionnaire), and specialty interests. Results A comparison of the 155 students who received at least one peer nomination with the 100 students who received none found no significant difference in scores on objective examinations; nominated students, however, were rated significantly higher in clinical competence by faculty in six core third-year clerkships. Nominated students were also significantly more empathic and “active.” In addition, a larger proportion of nominated students choose “people-oriented” (rather than “technology- or procedure-oriented”) specialties. Conclusions These results confirmed the hypotheses that peer nomination can predict clinical competence, empathy and other positive personal qualities, and interest in people-oriented specialties. Thus, in the assessment of medical students, peer nomination holds promise as a valid indicator of positive dimensions of professionalism.

USMLE Step 2 performance and test administration date in the fourth year of medical school.

Purpose. To determine whether the time interval between completing the third-year curriculum and test administration affects a students USMLE Step 2 score. Method. Scores for 846 students in the classes of 2000–2004 were grouped in ten time periods depending on test date. A linear regression model to predict performance on Step 2 using gender, Step 1, and grades in medicine, pediatrics and obstetrics–gynecology was developed based on the class of 1999. Analysis of covariance was used to test the effect of time on scores, adjusting for predicted performance. Results. Step 2 scores decreased significantly (p < .001) across time. Students’ mean scores were four points higher than predicted in the early months and five to eight points lower near the end of the senior year. Conclusions. Students who scheduled Step 2 early in the senior year achieved higher scores, on average, than those who waited until later in the year.

Sooner or Later? Usmle Step 1 Performance and Test Administration Date at the End of the Second Year

Young physicians must pass the United States Medical Licensing Examination (USMLE) for state licensure and specialty board certification. During 2000–2001, nearly all U.S. medical schools (115) required that students attempt Step 1 at some point during their MD programs. Students at schools with curricula consisting of two years of basic science education followed by two years of clinical rotations are often required to complete Step 1 of this comprehensive examination immediately after the end of the second year of medical school to document their basic science knowledge before proceeding into the clinical sciences. The consequences of performance on the USMLE extend beyond medical school. Step 1 has become an important factor in screening and selecting residency candidates through the electronic application process. This cumulative examination has become even more of a high-stakes test among those vying for the most competitive residency programs. For example, the Web site for the San Francisco Matching Program (^http://www.sfmatch.org/&) posts in the dean section the mean Step 1 scores for students applying to graduate medical education programs in otolaryngology, ophthalmology, and neurological surgery. The mean scores for these competitive specialties are significantly higher than the national mean scores. Before the examination became available on computer in 1999, Step 1 was administered twice annually as a paper-and-pencil test. Previously, the majority of examinees chose to take the test in May, but now the computer-based version can be scheduled throughout the year. Students can schedule the examination at their own personal convenience; however, they are subject to the confines of their medical schools’ curricula and the faculty’s policies for promotion and graduation. Little is known about how this change to flexible test scheduling affects student performances. This information can have an impact on the advice that advisors must provide to medical students. In this study, we analyzed the relationships between students’ Step 1 scores and the time intervals that had passed after they had completed the second-year medical school curriculum.

Automatic Border Detection for Assessment of Left Ventricular Diastolic Function Among Normal Neonates: Comparison with Doppler Echocardiography.

Doppler echocardiography is the standard noninvasive method to assess left ventricular (LV) diastolic function. Recently, automatic border detection (ABD), a method based on analysis of integrated ultrasonic backscatter, has been introduced permitting real‐time, on‐line assessment of LV diastolic function. A comparison of these methods in normal, full‐term neonates has not been performed. Therefore, the objectives of this study were to evaluate the usefulness of ABD in the assessment of LV diastolic function among normal neonates, to compare parameters obtained with the ABD method with standard Doppler‐derived indexes of diastolic function, and to assess the reproducibility of ABD measurements. We studied 17 consecutive normal neonates during natural sleep with both methods shortly after birth (mean 17.4 ± 3.9 h) and approximately 2 weeks later (mean 14.8 ± 2.2 days). An average of five consecutive cardiac cycles were performed. Similar to Doppler indexes, no significant change in any ABD parameter of diastolic function occurred between the early and later studies. A complete ABD study could be performed within 5 minutes. Mean interobserver variation for individual ABD measurements ranged from 0% to 11%. Compared with Doppler, rapid filling fraction was greater and atrial filling fraction was less with ABD. Regression analysis showed poor correlation of these parameters between methods, but their ratio by each method remained constant between studies. A similar poor correlation existed between peak E wave velocity by Doppler and peak rapid filling rate by ABD and between peak A wave velocity by Doppler and peak atrial filling rate by ABD. These differences may be explained by technical factors and different aspects of diastolic filling assessed by each method. This study indicated that ABD was a feasible and reproducible method compared with Doppler echocardiography for serial evaluation of LV diastolic function among neonates.

Ultrasonography in Undergraduate Medical Education: A Systematic Review

The purpose of this study was to conduct a systematic review of the evidence of educational outcomes associated with teaching ultrasonography (US) to medical students.

The Incidence of Apnea after Discharge in Infants Less Than 34 Weeks Gestation with Normal Pre-Discharge Pneumocardiograms

The Incidence of Apnea after Discharge in Infants Less Than 34 Weeks Gestation with Normal Pre-Discharge Pneumocardiograms

Screening Documented Event Monitors in Healthy Premature Infants for Pathologic Apnea and Bradycardia

Screening Documented Event Monitors in Healthy Premature Infants for Pathologic Apnea and Bradycardia

Evaluation of Feeding Related Problems and Apparent Life Threatening Events in Infancy. 1237

Evaluation of Feeding Related Problems and Apparent Life Threatening Events in Infancy. 1237

Automatic Border Dectection in the Evaluation of Diastolic Function in Normal Neonates 129

Automatic border detection (ABD) is an alternative method to Doppler echocardiography (DE) for assessment of LV diastolic function. To date, no information is available regarding the utility of ABD to assess diastolic function among normal neonates. Methods: To compare ABD to standard DE parameters and to assess the reproducibility of ABD among observers, we studied 17 normal full-term neonates (mean birth wt 3.5±0.3 kg) at birth (17.4±3.9 hr) and again at 14.8±2.2 days of life to evaluate LV diastolic function by both methods. DE parameters obtained at the mitral leaflet tips were: Peak E-and A-wave velocity; E/A ratio; E, A, and total time velocity integrals (TVI); deceleration time. Rapid and atrial filling fractions were derived from the TVIs. Isovolumic relaxation time was measured. ABD parameters including rapid filling fraction (RFF) area change, atrial filling fraction (AFF) area change, ratio RFF/AFF, peak rapid and atrial filling rates and their ratio were obtained in the short-axis view after proper gain and region of interest were set. An average of 5 cardiac cycles was used for each measurement. Results: No significant change was observed in any ABD or DE parameter between birth and later studies. Interobserver variability for individual ABD measurements ranged from 0-11%. In comparison to DE, the RFF was greater and the AFF was less by ABD. Regression analysis showed only weak correlation between each measure by the 2 methods. However, the relationship between RFF and AFF obtained by each method was constant across the studies. Similarly, weak correlations were observed when peak E velocity by DE and peak rapid filling rate by ABD and peak A velocity by DE and peak atrial filling rate by ABD were compared.Conclusions: (1) Similar to traditional DE parameters, the ABD method showed that no significant change in LV diastolic function occurred in the first 2 weeks of life. (2) Weak correlation between ABD and DE parameters of filling was observed which may relate to technical differences between methods. (3) ABD was a reproducible and reliable method to assess LV diastolic function in neonates.