Erica Friedman

Supportive Programs Increase Medical Students' Research Interest and Productivity

Background Advances in biomedical research during the last decade have highlighted the necessity of attracting greater numbers of physicians to careers that include a research component. Physician participation in research is essential to increase the number of clinical and translational studies performed, as well as to educate the public about the importance of clinical trials and to assist in recruiting participants. We hypothesized that attractive research opportunities that included faculty mentoring, recognition of participation, and rewards for accomplishments would encourage medical student participation. Methods The Medical Student Research Office was created at Mount Sinai School of Medicine in 1996 to develop structured research programs and advise students looking to undertake a research project. Data from students participating in the summer research program and Medical Student Research Day, from the research section of the Medical Student Performance Evaluation, were collected from 1996 to 2004. Results For the last 4 years, the majority of medical students did research following the first year of school. Students did basic and clinical research, although most preferred clinically oriented or translational projects. Participation in Research Day and the number of publications suggest that interest is growing, including that by traditionally underrepresented groups. Conclusion Although it is too early to assess the long-term effects, the research programs offered led to greater numbers of students who did research, including those in traditionally underrepresented groups. Moreover, students were highly satisfied with their experiences, with 80% feeling that it increased their interest in applying principles they learned to the practice of medicine.

Medical Students' Perspectives on and Responses to Abuse During the Internal Medicine Clerkship

Background: The abuse of medical students on clinical rotations is a recognized problem, but the effects on students and their responses warrant further study. Purpose: To determine the severity of student abuse and the effects of abuse on students during the internal medicine clerkship. Methods: Internal medicine clerks at 11 medical schools (N = 1,072) completed an exit survey. Students were asked whether they had been abused. If they had, they were asked about the severity of the abuse, whether they reported it, and its effects on them. Results: Of the responding students, 123 (11%) believed they had been abused. Only 31% of the students who felt abused reported the episodes to someone. The most common consequences of the events included poor learning environments, lack of confidence, and feelings of depression, anger, and humiliation. Conclusion: Students described a variety of personal and educational effects of abuse. They generally did not report abuse because of fear of retaliation and the belief that reporting is pointless.

Do Attending Physicians, Nurses, Residents, and Medical Students Agree on What Constitutes Medical Student Abuse?

Background Whether attending physicians, residents, nurses, and medical students agree on what constitutes medical student abuse, its severity, or influencing factors is unknown. Method We surveyed 237 internal medicine attending physicians, residents, medical students, and nurses at 13 medical schools after viewing five vignettes depicting potentially abusive behaviors. Results The majority of each group felt the belittlement, ethnic insensitivity, and sexual harassment scenarios represented abuse but that excluding a student from participating in a procedure did not. Only a majority of attending physicians considered the negative feedback scenario as abuse. Medical students rated abuse severity significantly lower than other groups in the belittlement scenario (p < .05). Respondents who felt abused as students were more likely to rate behaviors as abusive (p < .05). Conclusions The groups generally agree on what constitutes abuse, but attending physicians and those abused as students may perceive more behaviors as abusive.

Internal Medicine Clerkship Characteristics Associated With Enhanced Student Examination Performance

Purpose To determine which internal medicine (IM) clerkship characteristics are associated with better student examination performance. Method The authors collected data from 17 U.S. medical schools (1,817 students) regarding characteristics of their IM clerkships, including structural characteristics, pedagogical approaches, patient contact, and clinical teacher characteristics. Outcomes of interest were postclerkship National Board of Medical Examiners (NBME) subject examination score, United States Medical Licensing Examination (USMLE) 2 score, and change in score from USMLE 1 to 2. To examine how associations of various clerkship characteristics and examination performance may differ for students of different prior achievement, the authors categorized students into those who scored in the top ¼ of the cohort on USMLE 1 and the bottom ¼. The authors conducted analyses at both the school and the individual student levels. Results In school-level analyses (using a reduced four-variable model), independent variables associated with higher NBME subject examination score were more small-group hours/week and use of community-based preceptors. Greater score increase from USMLE 1 to 2 was associated with students caring for more patients/day. Several variables were associated with enhanced student examination performance at the student level. The most consistent finding was that more patients cared for per day was associated with higher examination performance. More structured learning activities were associated with higher examination scores for students with lower baseline USMLE 1 achievement. Conclusion Certain clerkship characteristics are associated with better student examination performance, the most salient being caring for more patients per day.

Training tomorrow's teachers today: a national medical student teaching and leadership retreat

Introduction: Challenges to American academic medical centers have diverted attention and resources away from the core missions of teacher and leader development. To train the next generation of medical education leaders, substantial and institutionalized new programs are necessary. Methods: The American Medical Student Association, with the Mount Sinai School of Medicine, designed the Training Tomorrows Teachers Today national medical student retreat. The week-long course endeavors to enhance participants’ clinical teaching and academic leadership skills. The program also trains students to execute a required medical education project. At the end of the course, attendees evaluated their baseline and post-course teaching and leadership effectiveness. Long-term follow-up was also completed. Results: Attendees (n = 23) self-reported statistically significant (p < 0.05) improvement in teaching and leadership. The greatest improvements in teaching scores were in the area of communicating goals. The largest leadership score improvements were: defining goals; defining constituents, allies, and opponents; and delineating organization strengths/weaknesses. 13 participants engaged in medical education projects. Conclusion: This program helps fill a gap in medical education training. Program data suggest enhancement of students’ teaching and leadership skills. A competitive application process demonstrates interest in such training. These results suggest that medical schools should offer and/or fund undergraduate teaching and leadership training.

A Model for the Assessment of Medical Students’ Competency in Medical Ethics

Background: This article focuses on the goals of our medical ethics education program and our formative assessments of students’ competency at various points during this education. Methods: Because of the critical relationship between a programs goals and the design of an assessment strategy, we provide an overview of the theoretical basis of our curriculum, our programs objectives, and teaching methods. In order to verify that our students had achieved minimum competency in the objectives of our ethics curriculum, we developed assessments that evaluated their ability to identify and apply ethical principles to clinical cases and to use moral reasoning to resolve dilemmas. We verified the reliability of these assessment instruments by correlating two different Mount Sinai raters’ scores of the same assessments with each other and the validity of these assessments with external reviewers. Results: For interrater reliability, paired raters scored the same student written exercise within 5 points of each other on 119 of the exercises (87% rater consensus). Therefore, we found our assessment tools to be reliable. Regarding validity, all three expert external reviewers agreed that our instruments were well suited for evaluating medical student competency in medical ethics and that they measured what we intended to measure. Conclusions: Our efforts in medical ethics education and competency assessment have produced an integrated model of goals, methodology, curriculum, and competency assessment. The entire model is directed at providing students with the ethical knowledge, skills, and attitudes required of an exemplary physician. We have developed reliable and valid assessment tools that allow us to evaluate the competency of students in medical ethics and to identify students who require remediation, and that are useful for other ethics programs.

Professionalism in Medical Education

The broad goal of medical education is to provide students with professional training; that is, to produce graduates with the knowledge and skills they will need to be good physicians. This entails helping students (including residents) to understand the content and the justiacation of their special responsibilities as physicians as well as to accept their professional responsibilities as important and overriding. It also involves promoting the development of habits of disposition and attitude that are essential to performance as a good physician; that is, the character (i.e., virtues) of a good physician and the development of skills to communicate competence, caring, and respect in their interaction with patients. In other words, medical education must acknowledge that its mission includes nurturing and evaluating medical professionalism and integrating ethics into clinical skills development (Moros and Rhodes 2002; Pellegrino 2002). In that light, we agree with several of the points made by Delese Wear and Mark G. Kuczewski (2004). They are correct to note that reports arising out of the au courant interest in professionalism have produced lists of abstract characteristics that “have failed to create pedagogical practices” that are effective in promoting professionalism. Also, the reports do not provide “a curricular theory of professional development,” and they do not address the importance of “the learning environment for professional development.” Nevertheless, we take issue with Wear and Kuczewski’s view of how to identify an appropriate theory and how to use it to guide medical education.

Expectations for Medical Student Work Hours in Inpatient Clinical Clerkships

Background: No standards regarding what should be learned during medical school exist. Purpose: We investigated what medical students and clerkship directors (CDs) believe students are, and should be, doing during clerkships. Methods: From January to June 2011, Mount Sinai School of Medicine CDs (n = 4) and 3rd-year students (n = 132) estimated how students spend time and should spend time during clerkships. Mann-Whitney U-tests compared students’ and CDs’ replies. Results: All CDs and 105 of 132 students (79.5%) participated. Medicine CDs believed that students did more rounding and studying, and surgery CDs perceived that students did more note writing and studying and less waiting than students reported. Medicine CDs felt students should round more, whereas surgery CDs felt students should spend more total time in the hospital as well as in educational activities and studying than students did ( p < .05). Conclusions: Students and CDs disagree about how students allocate (and should allocate) time during clerkships.

Using Standardized Patients to Assess Hospitalist Communication Skills.

&NA; Standardized patients (SPs) have been used to assess communication skills in undergraduate medical education, but no published studies describe the use of SPs in assessing practicing physicians on their communication skills. In this study, done with 23 hospitalists at a large urban academic hospital, 3 SP scenarios, daily rounding, discharge, and interacting with a difficult patient, were created. After each encounter, each hospitalist reviewed their videotape and received feedback from their SP based on a checklist that had 3 core domains: Listen, Courtesy and Respect, and Explain. These domains correlated with the 3 questions in the Hospital Consumer Assessment of Healthcare Providers and Systems survey that relate to doctors. Hospitalists performed significantly better in the Listen domain, with a mean percent adequate score of 90.2% (95% confidence interval [CI], 72.2%‐100%; P < 0.05), and significantly worse in the Explain domain, with a mean percent adequate score of 65.0% (95% CI, 49.2%‐83.6%; P < 0.05). Checklist items in the Explain domain that were most commonly not performed adequately were summarizing information at the end of the encounter, teach back, encouraging additional questions, managing team and self‐up, setting expectations about length of stay, and timing of tests. After the SP encounters, hospitalists felt more confident in their communication skills. SPs can be used to assess and give feedback to hospitalists and increase confidence in several aspects of communication.

An innovative educational pipeline programme for under-represented youth: the Sophie Davis Biomedical Education/CUNY School of Medicine model

adepartment of Sociomedical Sciences, columbia university mailman School of Public Health, new york, ny, uSa; bcolumbia university college of dental medicine, new york, ny, uSa; cdepartment of community Health and Social medicine, the city college of new york Sophie davis Biomedical Education/cuny School of medicine, new york, ny, uSa; doffice of admissions, the city college of new york Sophie davis Biomedical Education/cuny School of medicine, new york, ny, uSa; edepartment of medical Education, the city college of new york Sophie davis Biomedical Education/cuny School of medicine, new york, ny, uSa