Craig S. Scott

Anxiety and stress reduction in medical education: an intervention.

Objectives  To assess the effectiveness of a stress reduction elective on Year 2 medical students and to assess the sustainability of any noted improvement.

Frequency and effect of negative comments ("badmouthing") on medical students' career choices.

BACKGROUND: Some call it “medical bigotry,” and others describe it as the “hidden curriculum,” but, by any name, the superficial and demeaning comments that students hear about particular career choices are thought to play a major role in discouraging the selection of primary care careers. This paper explores the frequency and effect of “badmouthing” on career choice with the hypothesis that it is more frequently heard about primary care disciplines but has relatively little influence on actual career choice. METHOD: In 1993, 129 (79%) of the 163 University of Washington School of Medicine graduates responded to a two-page questionnaire about badmouthing. This information was used to refine the questionnaire. In 1994, 1,447 graduating students from nine medical schools were surveyed with the revised questionnaire. The schools were chosen to represent schools that had high, medium, and low proportions of students going into primary care careers. RESULTS: A total of 1,114 questionnaires were returned, for a response rate of 77%. Badmouthing was heard frequently (76% of the responding students) and often occurred as early as the first and second years of medical school. The students heard badmouthing about their career choices most frequently when they selected surgery (91%) and family medicine (87%) and least frequently when they chose pediatrics (57%), p < .001. The students reported that the influence on career choice was low in general, but 186 students (17% of all respondents) did report altering their choices based on badmouthing. CONCLUSION: Primary care fields and non-primary care fields were equally affected by career changes due to badmouthing. This study indicates that badmouthing, while pervasive across all disciplines and an unattractive aspect of the educational experience, cannot alone account for the low proportion of graduates choosing primary care careers.

A comparison of self-report and chart audit in studying resident physician assessment of cardiac risk factors

OBJECTIVE: To examine the relationship between resident physicians’ perceptions of their preventive cardiology practices and a chart audit assessment of their documented services.DESIGN: A criterion standard comparison of two methods used to assess resident physicians’ practices: self-report and chart audit.SETTING: Physician ambulatory care in a residency program.PATIENTS AND OTHER PARTICIPANTS: Coronary artery disease (CAD) risk factor assessment was evaluated by self-report for 72 resident physicians and by chart audit of randomly selected records of 544 of their patients who did not have CAD or a debilitating chronic disease during a one-year period.INTERVENTION: Measurements of the residents’ perceived CAD risk factor assessment practice by self-report, and chart audit assessments of their recorded care.MAIN OUTCOME: The relationship between self-reported and chart audit assessments of CAD risk factors.RESULTS: Chart audit assessment of CAD risk factor management was highly significantly (p<0.01) lower than self-reported behaviors for evaluation of cigarette smoking, diet, physical activity, stress, plasma cholesterol, blood pressure, and body weight/obesity.CONCLUSIONS: Three different interpretations of these findings are apparent. 1) Physician self-report is a poor tool for the measurement of clinical behavior, and therefore research of physician behavior should not rely solely on self-reported data; 2) physicians’ chart recording of their clinical practice is insufficient to reflect actual care; or 3) neither is an accurate measure of actual practice.

Clinical behaviors and skills that faculty from 12 institutions judged were essential for medical students to acquire

This paper describes a 1988–1989 collaborative mail survey of faculty opinion about clinical behaviors and skills that students should be expected to demonstrate prior to graduation from undergraduate medical school (hereafter called “exit objectives”). Selected faculty from 12 American and Canadian medical schools indicated whether each of 77 objectives was essential for every student to know or demonstrate prior to graduation; useful but not essential at the undergraduate level; or not applicable to their undergraduate program. Their responses provide a glimpse into faculty expectations regarding some of the exit behaviours and skills they deemed essential. Forty-two percent (32) of the 77 objectives were regarded as essential by 75% or more of the faculty members who responded. Essential objectives involved conducting organ system examinations, formulating problems and hypotheses, and gathering fundamental interview, physical, and screening examination data, including emergency examinations of the airway and circulatory systems. Other essential objectives involved collaboration and communication, demonstrating concern for legal and ethical values, and keeping abreast of current information within the discipline. Exit objectives related to the diagnosis and management of specific conditions were regarded as useful but not essential at the undergraduate level. Implications for medical education are discussed.

Chinese nursing students' HIV/AIDS knowledge, attitudes, and practice intentions.

Nurses have important roles in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) treatment and educational programs. Chinese senior nursing students completed a survey on HIV/AIDS knowledge, attitudes, and practice intentions. A weak positive relationship between attitudes and practice intentions (r = .140, P = .036) was noted. No significant associations between knowledge levels, attitudes, and practice intentions were found. Although the majority exhibited adequate knowledge of basic HIV transmission mechanisms, many disconcerting misconceptions were evident. Although most were empathetic to people with HIV/AIDS, stigmatization of high-risk groups persisted. Improved patient care will require intensified educational efforts and more positive attitudes toward persons with HIV/AIDS.

A follow-up study of the characteristics of dean's letters.

Purpose To assess the content and quality of deans letters since the publication of guidelines recommended by the Association of American Medical Colleges (AAMC) in 1989. Method In 1998, the deans letter writers at all 124 U.S. medical schools were surveyed. The questionnaire incorporated items from two previous surveys (1981 and 1992). In addition, samples of deans letters (n = 451) from all U.S. medical schools for the graduating class of 1998 were rated based on the AAMCs guidelines. Results The response rate of the 1998 survey (66%) was lower than those of the two previous surveys (87% for 1992 and 85% for 1981). Schools that prepared letters that followed the AAMCs guidelines were somewhat more likely to have responded. According to the letter writers in 1998, close to 300,000 letters (approximately 1,050,000 pages total) were sent to residency directors, at an estimated cost of

Information and Informatics Literacy: Skills, Timing, and Estimates of Competence

26,000 per school. A total of 65% of schools produced adequate deans letters based on the 1989 AAMCs guidelines, compared with 55% in 1992. Many schools were organizing the deans letter in more readable formats, and more schools provided information that allowed for a comparison of students within the same school. Conclusion The improvements in deans letters are encouraging, but ten years after the AAMCs guidelines, 35% of U.S. schools still produce unacceptable letters. With the addition of the electronic submission of information, it is time to review further improvements to the deans letter.

Survey Correlations: Proficiency and Adequacy of Nutrition Training of Medical Students

Background: Computing and biomedical informatics technologies are providing almost instantaneous access to vast amounts of possibly relevant information. Although students are entering medical school with increasingly sophisticated basic technological skills, medical educators must determine what curricular enhancements are needed to prepare learners for the world of electronic information. Purpose: The purpose was to examine opinions of academic affairs and informatics administrators, curriculum deans and recently matriculated medical students about prematriculation competence and medical education learning expectations. Methods: Two surveys were administered: an Information Literacy Survey for curriculum/informatics deans and a Computing Skills Survey for entering medical students. Results: Results highlight differences of opinion about entering competencies. They also indicate that medical school administrators believe that most basic information skills fall within the domain of undergraduate medical education. Conclusions: Further investigations are needed to determine precise entry-level skills and whether information literacy will increase as a result of rising levels of technical competence.

Curricular influences on preventive-care attitudes

Objective: The majority of graduating US medical students reported inadequate nutrition training over the past decade. This trend could in part be due to the lack of valid measures to assess the relationship between adequacy of nutrition training and proficiency on nutrition topics deemed essential. The studys objective was to test the hypothesis that self-reported nutrition proficiency is positively correlated with the perceived adequacy (quality, quantity, coverage and importance) of nutrition training of University of Washington medical students. Method: Cross-sectional e-mail survey of 1st to 4th year medical students (n = 708), including a survey prompt and three e-mail follow-up measures. To reduce and interpret the survey data, principal components analysis was employed, followed by Varimax rotation with Kaiser normalization. To assess internal consistency reliability, alpha (α) of nutrition proficiency items and factors was determined. Results: A 44.5% response rate was achieved (n = 315 respondents). The 31-item questionnaire was reduced to 6 factors, explaining 60.2% of the total variance (α = 0.947). Self reported nutrition proficiency was positively correlated with the perceived quality, quantity and coverage of nutrition training in all 6 essential nutrition factors or topics determined after factor analysis (P < 0.01). Conclusion: Quality and coverage may be effective gauges of adequacy of nutrition training and related nutrition proficiency in medical education. Current national medical education evaluation measures focus on the quantity of nutrition instruction. The lowest reported proficiency topics; nutrition and disease management, micronutrients and complementary and alternative medicine are recommended for particular curricular emphasis.

Predicting performance during clinical years from the new medical college admission test

Attitudes are one of the most important outcomes of medical education, but little is known about curricular influences on specific attitudes. This study examined changes in attitudes toward 20 preventive-care services in a cohort of 175 medical students. Specifically, a cohort of medical students was followed over a 30-month interval that spanned the period from medical school entry through the first 6 months of clinical clerkships. Perceived importance, as well as student confidence in the ability of primary-care physicians to provide 20 preventive-care services, was examined. Importance ratings for preventive-care services remained stable, while levels of confidence in the ability of physicians to provide the services increased. Implications of the results are discussed in relation to the possibilities for emphasizing disease prevention content in medical education.