David P. Way

The state of ultrasound education in U.S. medical schools: results of a national survey.

Purpose To determine the state of ultrasound education in U.S. medical schools and assess curricular administrators’ opinions on its integration in undergraduate medical education (UME). Method In 2012, curricular administrators at 134 U.S. MD-granting medical schools were surveyed concerning the nature of ultrasound education in medical school. The questionnaire sought ultrasound education program characteristics, structures, and objectives. It also sought respondents’ opinions on the role of ultrasound education in UME and barriers to its integration. Frequency and distribution analyses were conducted for survey responses; Rasch analysis was performed for barrier responses. Results Responses were received from 82 (61.2%) medical schools; these institutions were representative of the U.S. medical school population. Fifty-one respondents (62.2%) reported ultrasound training was integrated into their UME curriculum. Ultrasound was most commonly taught in the third year (38/82; 46.3%), and the purpose of training varied by curricular year. There was agreement that ultrasound should be part of the UME curriculum (56/71; 78.9%), but few respondents reported it was a priority at their institution (13/70; 18.6%). Respondents perceived lack of space in the curriculum (logit = +0.49; standard error [SE] = 0.11) and lack of financial support (logit = +0.42; SE = 0.11) as the most significant barriers to integration. Conclusions Despite a general consensus that ultrasound is an important skill to teach in medical school, the integration of ultrasound education in U.S. schools is highly variable. This study indicates a need for national standards to guide the integration of ultrasound education into U.S. medical school curricula.

Undergraduate Institutional MCAT Scores as Predictors of USMLE Step 1 Performance

Medical schools using formal undergrad-uate selectivity measures do so to compensate for the psychometricinadequacies of college grade-point averages, believing that moremeaning can be derived from the GPA if it is attached to a measureof institutional performance (academic rigor) or selectivity (strin-gent admission standards).Researchers have reported mixed results on whether formal mea-sures of undergraduate institution selectivity are useful contributorsto predicting medical student performance.

Professionalism deficiencies in a first-quarter doctor-patient relationship course predict poor clinical performance in medical school.

Background. The purpose of this study was to determine whether four types of professionalism deficiencies in medical students identified during a first-year course on doctor–patient relationships might predict poor performance in third-year clerkships. Method. Preceptors identified students who had deficiencies in interviewing patients: extreme shyness, poor process skills, paternalism, or a negative attitude toward interviewing. Deficient students were matched by academic ability to a control group. Performance on third-year clerkships was compared. Results. Students with paternalistic behavior or negative attitudes had significantly lower third-year grades. Conclusions. Professionalism deficiencies that result in the inability of the student to establish patient rapport are detectable early and predict problems in future clinical performance.

Brightness Mode Quality Ultrasound Imaging Examination Technique (B-QUIET) Quantifying Quality in Ultrasound Imaging

Ultrasound image interpretation and education relies on obtaining a high‐quality ultrasound image; however, no literature exists to date attempting to define a high‐quality ultrasound image. The purpose of this study was to design and perform a pilot reliability study of the Brightness Mode Quality Ultrasound Imaging Examination Technique (B‐QUIET) method for ultrasound quality image assessment.

Elephants in academic medicine.

Purpose To study the types, causes, and consequences of academic health center (AHC) “elephants,” which the authors define as obvious problems that impair performance but which the community collectively does not discuss or confront. Method Between April and June 2010, the authors polled all the chairs of departments of medicine and of surgery at the then 127 U.S. medical-degree-granting medical schools, using a combination of Web and postal surveys. Results Of the 254 chairs polled, 139 (55%) responded. Of 137 chairs, 95 (69%) reported that elephants in their organizations were common or widespread. The most common elephant reported was misalignment between goals and available resources. Chairs felt that the main reason faculty are silent is their perception that speaking up will be ignored and that the consequences of elephants include impaired organizational learning, flawed information resulting in poor decisions, and negative effects on morale. Chairs felt elephants were more problematic among deans and hospital leaders than in their own departments. Of 139 chairs, 87 (63%) said that elephants were discussed inappropriately, and of 137 chairs, 92 (67%) believed that creating a culture that dealt with elephants would be difficult. Chairs felt the best antidote for elephants was having senior leaders lead by example, yet 77 of 139 (55%) reported that the actions of top leaders fed, rather than dispelled, elephants. Conclusions AHC elephants are prevalent and detrimental to learning, organizational decision making, and morale, yet the academic medicine community, particularly its leadership, insufficiently confronts them.

Interprofessional education in the internal medicine clerkship: results from a national survey.

Purpose Growing data support interprofessional teams as an important part of medical education. This study describes attitudes, barriers, and practices regarding interprofessional education (IPE) in internal medicine (IM) clerkships in the United States and Canada. Method In 2009, a section on IPE was included on the Clerkship Directors in Internal Medicine annual survey. This section contained 23 multiple-choice questions exploring both core and subinternship experiences. Data were analyzed using descriptive statistics and Rasch analysis. Results Sixty-nine of 107 institutional members responded to the survey (64% response rate). Approximately 68% of responding clerkship directors believed that IPE is important to the practice of IM. However, only 57% believed that it should become a part of the undergraduate clinical curriculum. The three most significant barriers to IPE in the IM clerkship were scheduling alignment, time in the existing curriculum, and resources in time and money. Although more than half of respondents felt IPE should be included in the clinical curriculum, 81% indicated that there was no formal curriculum on IPE in their core IM clerkship, and 84% indicated that there was no formal curriculum during IM subinternship rotations at their institution. Conclusions There is limited penetration of IPE into one of the foundational clinical training episodes for medical students in Liaison Committee for Medical Education–accredited schools. This may be related to misperceptions of the relative value of these experiences and limitations of curricular time. Learning in and from successful models of interprofessional teams in clinical practice may help overcome these barriers.

Survey of care for the underserved: a control group study of practicing physicians who were graduates of The Ohio State University College of Medicine premedical postbaccalaureate training program.

Purpose Multiple publications describe short- term and intermediate outcomes of premedical postbaccalaureate programs (PBPs). However, the authors could find no control group studies reporting the service provided by graduates of PBPs to patients who are medically indigent (e.g., on Medicaid or uninsured) and/or poor. The authors explored the relationship between successful completion of a midwestern PBP and providing care for the underserved. Method In 2008, the authors surveyed 1996-2002 graduates of The Ohio State University College of Medicine who had been in practice for at least one year about their current practice population. The authors compared two groups: (1) physicians who completed the PBP and (2) a stratified random control group of physicians who graduated from the same medical school, in the same graduating classes, but did not participate in the PBP. Results The survey return rate was 70.9% (73/103). Findings suggest that PBP graduates were more likely to be practicing medicine in a federally designated underserved area (29.4% versus 5.1%, P < .009) or providing service where 40% or more of the patients were medically indigent or poor (67.6% versus 33.3%, P < .003). PBP graduates were also more likely to be volunteering their services to patients who were indigent (47.1% versus 10.3%, P < .001). Conclusions This is likely the first control group study demonstrating the increased likelihood of graduates of a PBP providing health care to patients who are medically indigent and/or poor.

The impact of a peer-designed and -led USMLE Step 1 review course: improvement in preparation and scores.

Background Medical students use several strategies for United States Medical Licensing Examination (USMLE) Step 1 preparation. At Ohio State University College of Medicine, a yearlong, peer-designed and -led Step 1 review course is a new option for our second-year students. This study aims to ascertain the value of the peer-designed and -led Step 1 review course, to assess the difference in Step 1 scores between participants and nonparticipants, and to understand the courses role in improving preparation for Step 1 among participants. Method Eligible students completed a confidential survey. Scores between participants and nonparticipants were compared, controlling for preexisting differences between groups. Results Course participants had a higher average Step 1 score than nonparticipants (P = .005). The majority of participants felt the course was a valuable use of time and would recommend it to future students. Conclusions A Step 1 review course designed and led by near-peer senior medical students, those who had successfully completed the USMLE Step 1 exam within the previous year, was shown to be valuable to second-year medical students and improved Step 1 score outcomes.

The impact of lecture attendance and other variables on how medical students evaluate faculty in a preclinical program.

Purpose High-quality audiovisual recording technology enables medical students to listen to didactic lectures without actually attending them. The authors wondered whether in-person attendance affects how students evaluate lecturers. Method This is a retrospective review of faculty evaluations completed by first- and second-year medical students at the Ohio State University College of Medicine during 2009–2010. Lecture-capture technology was used to record all lectures. Attendance at lectures was optional; however, all students were required to complete lecturer evaluation forms. Students rated overall instruction using a five-option response scale. They also reported their attendance. The authors used analysis of variance to compare the lecturer ratings of attendees versus nonattendees. The authors included additional independent variables—year of student, student grade/rank in class, and lecturer degree—in the analysis. Results The authors analyzed 12,092 evaluations of 220 lecturers received from 358 students. The average number of evaluations per lecturer was 55. Seventy-four percent (n = 8,968 evaluations) of students attended the lectures they evaluated, whereas 26% (n = 3,124 evaluations) viewed them online. Mean lecturer ratings from attendees was 3.85 compared with 3.80 by nonattendees (P ⩽ .05; effect size: 0.055). Student’s class grade and year, plus lecturer degree, also affected students’ evaluations of lecturers (effect sizes: 0.055–0.3). Conclusions Students’ attendance at lectures, year, and class grade, as well as lecturer degree, affect students’ evaluation of lecturers. This finding has ramifications on how student evaluations should be collected, interpreted, and used in promotion and tenure decisions in this evolving medical education environment.

Teaching Emotional Intelligence: A Control Group Study of a Brief Educational Intervention for Emergency Medicine Residents

Introduction Emotional Intelligence (EI) is defined as an ability to perceive another’s emotional state combined with an ability to modify one’s own. Physicians with this ability are at a distinct advantage, both in fostering teams and in making sound decisions. Studies have shown that higher physician EI’s are associated with lower incidence of burn-out, longer careers, more positive patient-physician interactions, increased empathy, and improved communication skills. We explored the potential for EI to be learned as a skill (as opposed to being an innate ability) through a brief educational intervention with emergency medicine (EM) residents. Methods This study was conducted at a large urban EM residency program. Residents were randomized to either EI intervention or control groups. The intervention was a two-hour session focused on improving the skill of social perspective taking (SPT), a skill related to social awareness. Due to time limitations, we used a 10-item sample of the Hay 360 Emotional Competence Inventory to measure EI at three time points for the training group: before (pre) and after (post) training, and at six-months post training (follow up); and at two time points for the control group: pre- and follow up. The preliminary analysis was a four-way analysis of variance with one repeated measure: Group x Gender x Program Year over Time. We also completed post-hoc tests. Results Thirty-three EM residents participated in the study (33 of 36, 92%), 19 in the EI intervention group and 14 in the control group. We found a significant interaction effect between Group and Time (p≤0.05). Post-hoc tests revealed a significant increase in EI scores from Time 1 to 3 for the EI intervention group (62.6% to 74.2%), but no statistical change was observed for the controls (66.8% to 66.1%, p=0.77). We observed no main effects involving gender or level of training. Conclusion Our brief EI training showed a delayed but statistically significant positive impact on EM residents six months after the intervention involving SPT. One possible explanation for this finding is that residents required time to process and apply the EI skills training in order for us to detect measurable change. More rigorous measurement will be needed in future studies to aid in the interpretation of our findings.