Dale Berg

A comparison of medical students’ self-reported empathy with simulated patients’ assessments of the students’ empathy

Background: Empathy is necessary for communication between patients and physicians to achieve optimal clinical outcomes. Aim: To examine associations between Simulated Patients’ (SPs) assessment of medical students’ empathy and the students’ self-reported empathy. Methods: A total of 248 third-year medical students completed the Jefferson Scale of Physician Empathy (JSPE). SPs completed the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and a global rating of empathy in 10 objective clinical skills examination encounters during a comprehensive end of third-year clinical skills examination. Results: High correlation was found between the scores on the JSPPPE and the global ratings of empathy completed by the SPs (r = 0.87, p < 0.01). A moderate but statistically significant correlation was observed between scores of the JSPE and the JSPPPE (r = 0.19, p < 0.05). Significant differences were observed on the JSPE and global ratings of empathy among top, middle and low scorers on the JSPPPE in the expected direction. Conclusions: While significant associations exist between students’ self-reported scores on the JSPE and SPs’ evaluations of students’ empathy, the associations are not large enough to conclude that the two evaluations are redundant.

Standardized patient assessment of medical student empathy: ethnicity and gender effects in a multi-institutional study.

Purpose To examine, primarily, the effects of ethnicity and gender, which could introduce bias into scoring, on standardized patient (SP) assessments of medical students and, secondarily, to examine medical students’ self-reported empathy for ethnicity and gender effects so as to compare self-perception with the perceptions of SPs. Method Participants were 577 students from four medical schools in 2012: 373 (65%) were white, 79 (14%) black/African American, and 125 (22%) Asian/Pacific Islander. These students were assessed by 84 SPs: 62 (74%) were white and 22 (26%) were black/African American. SPs completed the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) and the Global Ratings of Empathy tool. Students completed the Jefferson Scale of Empathy and two Interpersonal Reactivity Index subscales. The investigators used 2,882 student–SP encounters in their analyses. Results Analyses of SPs’ assessments of students’ empathy indicated significant interaction effects of gender and ethnicity. Female students, regardless of ethnicity, obtained significantly higher mean JSPPPE scores than men. Female black/African American, female white, and female Asian/Pacific Islander students scored significantly higher on the JSPPPE than their respective male counterparts. Male black/African American students obtained the lowest SP assessment scores of empathy regardless of SP ethnicity. Black/African American students obtained the highest mean scores on self-reported empathy. Conclusions The significant interaction effects of ethnicity and gender in clinical encounters, plus the inconsistencies observed between SPs’ assessments of students’ empathy and students’ self-reported empathy, raise questions about possible ethnicity and gender biases in the SPs’ assessments of medical students’ clinical skills.

Development and Evaluation of a Program to Strengthen First Year Residents’ Proficiency in Leading End-of-Life Discussions

Purpose: Multiple interventions have been developed to teach and improve internal medicine residents’ end-of-life communication skills, but have not been easily adaptable to other institutions. The purpose of this study was to develop and evaluate a program to enhance physicians’ end-of-life communication with families of dying patients using a format that could be incorporated into an existing curriculum for first-year internal medicine residents. Methods: An end-of-life educational program was developed and evaluated in the context of educating first-year residents at an urban academic medical center during the 2008-2009 academic year. The program consisted of three sessions including an interactive workshop flanked by pre- and post-workshop evaluations in simulated encounter and clinical vignette formats. Simulated encounters were recorded on video and residents’ performances were rated by two independent observers using a 23 point checklist. Results: Complete data were available for 24 (73%) of 33 residents who participated in the program. The residents’ checklist scores increased significantly from a mean of 48.1 at baseline to 73.9 at follow-up. The increase in the scores on the clinical vignettes was also statistically significant, but of lesser magnitude. Conclusions: A short, focused intervention can have significant impact on residents’ communication skills in the setting of an end-of-life objective structured clinical examination (OSCE).

The development of a validated checklist for thoracentesis: preliminary results.

Thoracentesis is an invasive procedure known to result in complications. Procedure skills should be taught and evaluated more effectively to improve health care quality. Validated checklists are central to teaching and assessing procedural skills. The results of the first step of the validation of a thoracentesis checklist are described. A comprehensive literature review of articles published on thoracentesis did not yield a validated checklist. A modified Delphi technique, involving a panel of 8 interdisciplinary, interinstitutional experts, was used to develop a thoracentesis checklist. The internal consistency coefficient using Cronbach’s α was .94. Developing the 23-item thoracentesis checklist for teaching and assessing thoracentesis is the first step in the validation process. For this checklist to become further validated, it should be implemented and studied in the simulation and clinical environments.

The relationship between performance on a medical school's clinical skills assessment and USMLE Step 2 CS.

Background Little is known about the relationship between performance on clinical assessments during medical school and performance on similar licensing tests. Method Correlation coefficients were computed and corrected for measurement error using data for 217 students who completed a school’s clinical assessment and took the Step 2 Clinical Skills (CS) examination. Results Observed (and corrected) correlations between the two tests were 0.18 (0.32) for Data Gathering, 0.35 (0.75) for Documentation, and 0.32 (0.56) for Communication/Interpersonal Skills. The highest correlation within each test was between Documentation and Data Gathering. The lowest was between Documentation and Communication/ Interpersonal Skills. Conclusions The pattern of correlations supports each test’s construct validity. The low correlations suggest that the tests are not redundant, and do not support using the scores on the school’s assessment to predict performance on Step 2 CS. Future studies of these relationships need to address the time between the two assessments and the effect of intervening remedial programs.

Preparedness of Hospitals to Respond to a Radiological Terrorism Event as Assessed by a Full-Scale Exercise

Hospitals and healthcare workers face the challenge of being prepared to manage victims of acts of terrorism that involve chemical, biological, and radiological agents that they do not commonly encounter. One example that is often cited as a potential terrorism scenario is the use of a conventional explosive that is mixed with radioactive material. On November 10, 2004, we conducted a regional multihospital full-scale exercise involving 11 hospitals and 358 victim-observers to evaluate hospital preparedness for such an event. Our results demonstrate that hospitals are not adequately prepared to manage mass casualties with associated radiological contamination.

Integrating Sonography Training Into Undergraduate Medical Education A Study of the Previous Exposure of One Institution’s Incoming Residents

Sonography is a crucial and versatile tool within the field of medicine. Recent advancements in technology have led to increased use of point‐of‐care sonography. We designed a survey to assess prior point‐of‐care sonography training among incoming interns at an academic teaching hospital.

The Development of a Validated Checklist for Adult Lumbar Puncture Preliminary Results

Lumbar puncture (LP) is known to result in complications. Procedure skills should be taught and evaluated more effectively to improve health care quality. Validated checklists are central to teaching and assessing procedural skills. The results of the first step of the validation of an adult LP checklist are described. A comprehensive literature review of articles published on LP did not yield a checklist validated by the Delphi method. A modified Delphi technique, involving a panel of 9 experts, was used to develop a 20-item LP checklist for teaching and assessing LP, the first step in the validation process. The internal consistency coefficient using Cronbach’s αwas 0.79. The authors used a modified Delphi method to develop a checklist for teaching and assessing LP. For this checklist to become further validated, it should be implemented and studied in the simulation and clinical environments.

Disaster Preparedness What Training Do Our Interns Receive During Medical School

Disaster preparedness training is a critical component of medical student education. Despite recent natural and man-made disasters, there is no national consensus on a disaster preparedness curriculum. The authors designed a survey to assess prior disaster preparedness training among incoming interns at an academic teaching hospital. In 2010, the authors surveyed incoming interns (n = 130) regarding the number of hours of training in disaster preparedness received during medical school, including formal didactic sessions and simulation, and their level of self-perceived proficiency in disaster management. Survey respondents represented 42 medical schools located in 20 states. Results demonstrated that 47% of interns received formal training in disaster preparedness in medical school; 64% of these training programs included some type of simulation. There is a need to improve the level of disaster preparedness training in medical school. A national curriculum should be developed with aspects that promote knowledge retention.

Evaluation of the use of patient-focused simulation for student assessment in a surgery clerkship.

BACKGROUND The purpose of this study was to evaluate the use of simulated patients in conjunction with anatomic and tissue task-training models to assess skills. METHODS Faculty reviewed the objectives of the clerkship to identify skills to be acquired. Three cases were developed related to rectal examination, suturing, and inserting intravenous lines and nasogastric tubes. Student scores were based on their ability to gather data from simulated patients and perform procedures on simulation models. RESULTS A total of 670 students were assessed between 2006 and 2009. Alpha reliability coefficients were .97 for Communication/Interpersonal Skills, .71 for Procedures, and .58 for Data Gathering. Students receiving low ratings from faculty in the clerkship had significantly (P < .001) lower simulation scores. There were significant (P < .001) relationships between scores and grades in other clerkships. CONCLUSIONS The combination of simulated patients and simulation models yielded reliable scores for procedural and interpersonal skills, and evidence of validity related to clinical ratings.