Daniel E. Rohe

The benefits of pass-fail grading on stress, mood, and group cohesion in medical students.

OBJECTIVE To objectively measure the effect of a pass-fail grading system on stress, mood, group cohesion, and test anxiety in medical students. PARTICIPANTS AND METHODS Beginning with the class of 2006, the Mayo Medical School, Rochester, Minn, changed the grading system for first-year courses from a 5-interval grading system to a pass-fail grading system. Students in the previous class of 2005, who were graded using a 5-interval system during their first year of medical school, were compared with students in the class of 2006. Using a prospective study design, the 2 groups were compared at the end of both the first year and the second year of medical school on the Perceived Stress Scale, Profile of Mood States, Perceived Cohesion Scale, Test Anxiety Inventory, and (after year 2) the United States Medical Licensing Examination Step 1. Data collection occurred in 2002 and 2003 with the class of 2005 and in 2003 and 2004 with the class of 2006. RESULTS Students graded with the pass-fail system had less perceived stress (median, 15.0 vs 21.0; P-.01) and greater group cohesion (median, 34.5 vs 30.0; P=.02) at the end of their second year of coursework than their 5-interval graded peers. The pass-fail group had better mood (median, 46.5) than the graded group (median, 64.0), but this difference was not statistically significant (P=.07). No significant differences were found between the 2 groups in test-taking anxiety or in United States Medical Licensing Examination Step 1 board scores. CONCLUSION Pass-fail grading may reduce stress and increase group cohesion in medical students compared with traditional 5-interval grading.

The Five-Factor Model of Personality: Findings in Males with Spinal Cord Injury:

The purpose of this study was to identify common personality traits in males with traumatic spinal cord injury (SCI). One hundred and five participants with SCI completed the NEO Personality Inventory (NEO-PI). The participants averaged 41.1 years of age and 17.9 years since injury onset. Compared with the NEO-PI normative sample, the SCI sample scored significantly lower on the Conscientiousness factor and the Activity and Assertiveness facet scales. They scored significantly higher on the Excitement-Seeking scale. These results suggest that males with SCI are less determined, have lower energy levels, are socially retiring, and that they tend to seek stimulation. These findings may reflect the contribution of both preinjury personality traits and adaptation to the limitations imposed by SCI.

Vocational Interests After Recent Spinal Cord Injury: Comparisons Related to Sex and Race

OBJECTIVE To compare vocational interests as a function of sex and race among persons with recent spinal cord injury (SCI), because previous research used almost exclusively white men. Limited research from nearly 2 decades ago suggested SCI selectively occurs to men whose vocational interests are consistent with the Realistic theme of the Holland typology, indicative of a preference for activities and occupations requiring physical strength and dexterity. DESIGN The Strong Interest Inventory (SII) was completed an average of 50 days after SCI onset. SETTING Data were collected at a specialty hospital and analyzed at a medical university. PARTICIPANTS Adults with traumatic SCI (N=500) were assessed during inpatient rehabilitation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The SII, a 317-item measure of vocational interests. RESULTS Although the findings for white men were consistent with elevation of the Realistic theme when compared with the reference group, the interests of women and black participants were substantially different. Women scored highest on Social, Enterprising, and Conventional themes compared with the reference group. Black participants reported significantly higher elevations than whites on 5 themes (all except Realistic), with elevations on the Social, Enterprising, and Conventional themes exceeding standardized norms. The Artistic and Investigative themes were least descriptive of the overall sample. CONCLUSIONS Rehabilitation professionals should be aware of likely differences in patterns of vocational interests as a function of race and sex, and use vocational interests as a means of facilitating postinjury adaptation.

Frequency of sexual activity and prostatic health: fact or fairy tale?

OBJECTIVES To evaluate whether the symptoms associated with benign prostatic hyperplasia can be aggravated by infrequent sex, which has been suggested historically, using cross-sectional data from the Olmsted County Study of Urinary Symptoms and Health Status Among Men. METHODS In 1989 and 1990, 2115 white men between the ages of 40 and 79 years were recruited from a random sample of Olmsted County residents (55% participation rate). During follow-up, these men completed a self-administered questionnaire that assessed lower urinary tract symptom severity, and 81% reported the frequency of ejaculation during the previous month. RESULTS Overall, men who reported ejaculating at least once a week were less likely to have moderate to severe (International Prostate Symptom Score greater than 7) symptoms than men reporting no ejaculations (odds ratio 0.62, 95% confidence interval 0.51 to 0.75). The dose-response relation was strong, with men who reported more frequent ejaculations having the lowest prevalence of moderate to severe symptoms. Similar associations were seen for peak urinary flow rates, prostate volume, and health-related quality of life. The associations with urologic measures did not exist within the age decade, however. Thus, after adjusting for age, the odds ratio for ejaculation frequency and symptom severity was 0.99 (95% confidence interval 0.79 to 1.24) and was similar for peak urinary flow rates and prostate volume. CONCLUSIONS These cross-sectional data suggest that the frequency of ejaculation has no effect on lower urinary tract symptoms, peak urinary flow rates, or prostate volume; the apparent protective association appears to be an artifact caused by the confounding effects of age.

Promoting optimal functioning in spinal cord injury: the role of rehabilitation psychology.

Comprehensive treatment and rehabilitation includes attention to the psychological needs of individuals with SCI and their families. This chapter is designed to familiarize neurologists and other practitioners with psychological issues and care in SCI. While psychologists play a key role, attention to psychosocial health is a responsibility shared by all members of the rehabilitation team, beginning with the patient and family, and including clinicians who are not formally identified as mental health providers. Treatment planning for a person with SCI begins with a thorough assessment of the cognitive, emotional, personality, and social factors that influence functioning and rehabilitation. Rehabilitation psychologists use a mixture of assessment tools, including clinical interviews, behavioral observations, and a wide range of standardized test instruments. Psychological interventions can involve direct intervention with the patient, in individual, family or group-based therapies. Other psychological strategies involve assistance through less direct methods - consultation and training to other rehabilitation team members or facilitating peer role-modeling and support groups. The chapter provides an overview of core clinical issues (emotional responses, substance use, pain, cognitive deficits, sexuality and vocational rehabilitation), delineates the process of psychological assessment and intervention, and provides guidance on incorporation of rehabilitation psychology into SCI rehabilitation.

Stress-coping skills and neuroticism in apical ballooning syndrome (Takotsubo/stress cardiomyopathy)

Introduction Apical ballooning syndrome (ABS) is typically associated with an antecedent stressful situation. Affected patients have been reported to have higher frequencies of premorbid affective disorders. We hypothesised that patients with ABS would have elevated levels of neuroticism (tendency to experience negative affect) and greater vulnerability to stress. Methods In this cross-sectional study, all active participants in the Mayo Clinic ABS prospective follow-up registry were invited to complete the third edition of the NEO Personality Inventory (NEO-PI-3). The NEO-PI-3 is the universally accepted measure of the ‘Five-Factor Model’ of personality. Inventory responses were scored using the NEO-PI-3 computer program and the data were compared with US normative sample used in standardisation of the inventory. Significance was set at 0.0014 to account for multiple comparisons. Results Of 106 registry participants approached, 53 completed the inventory. There was no difference in age, gender, time from ABS diagnosis, type of antecedent stressor (emotional, physical or none) or severity of initial illness between the responders and non-responders. Responders had mean Neuroticism T-scores of 48.0±10.6 (95% CI 45.1 to 50.9); p=0.18, when compared with the normal mean of 50. There was also no significant difference in the facet scale of Vulnerability: 46.9±8.4 (44.6 to 49.2), p=0.038, at α=0.0014. Conclusions Contrary to our hypothesis, patients with ABS do not manifest higher levels of neuroticism and do not have greater vulnerability to stress than the general population. These findings have implications for the clinicians’ perception of, and approach to, patients with ABS.

STRESS COPING SKILLS IN PATIENTS WITH APICAL BALLOONING SYNDROME (TAKOTSUBO CARDIOMYOPATHY)

Apical ballooning syndrome (ABS) is typically precipitated by emotional or physical stress, and affected patients are more likely to have a premorbid diagnosis of chronic anxiety disorder and depression. We hypothesized that patients with ABS have a personality profile characterized by high