Gregory W. Briscoe

Medical Student Documentation in Electronic Health Records: A Collaborative Statement From the Alliance for Clinical Education

Purpose: The electronic health record (EHR) is an important advancement in health care. It facilitates improvement of health care delivery and coordination of care, but it creates special challenges for student education. This article represents a collaborative effort of the Alliance for Clinical Education (ACE), a multidisciplinary group formed in 1992. ACE recognizes the importance of medical student participation in patient care including the ability of documentation. This article proposes guidelines that can be used by educators to establish expectations on medical student documentation in EHRs. Summary: To provide the best education for medical students in the electronic era, ACE proposes to use the following as practice guidelines for medical student documentation in the EHR: (a) Students must document in the patients chart and their notes should be reviewed for content and format, (b) students must have the opportunity to practice order entry in an EHR—in actual or simulated patient cases—prior to graduation, (c) students should be exposed to the utilization of the decision aids that typically accompany EHRs, and (d) schools must develop a set of medical student competencies related to charting in the EHR and state how they would evaluate it. This should include specific competencies to be documented at each stage, and by time of graduation. In addition, ACE recommends that accreditation bodies such as the Liaison Committee for Medical Education utilize stronger language in their educational directives standards to ensure compliance with educational principles. This will guarantee that the necessary training and resources are available to ensure that medical students have the fundamental skills for lifelong clinical practice. Conclusions: ACE recommends that medical schools develop a clear set of competencies related to student in the EHR which medical students must achieve prior to graduation in order to ensure they are ready for clinical practice.

Synthetic cannabinoid induced psychosis in a previously nonpsychotic patient.

Synthetic cannabinoids are relatively new substances that have become rapidly popular among young adults. Despite their legal status in most states, they are virtually unregulated and unstudied. Nevertheless, recent case studies have brought new attention to their potentially harmful side effects, such as psychosis, agitation, and withdrawal. This case report examines the acute psychosis displayed by a psychiatric patient after smoking “Spice,” a substance comprised of various synthetic cannabinoids, on three separate occasions. Furthermore, in comparing this patient’s lack of psychotic symptoms after tetrahydrocannabinol (THC) use, to the episodes of psychosis experienced after “Spice” consumption this case study explores the possibility that synthetic cannabinoids are more potent than their organic counterpart. This is the first case report of synthetic cannabinoid-induced psychosis in a previously nonpsychotic patient. “Spice,” comprised of various synthetic cannabinoids, is a growing trend within substance use in young adults. It has been tried by up to 6% of 15to 18-year-olds in Germany.1 Despite the current lack of data revealing the prevalence of “Spice” use within any age group in the United States, case reports are documenting a recent increase in emergency room and forensic presentations related to its use.2,3 To date, there are no studies of inhaled synthetic cannabinoid use in humans. Nevertheless, recent case reports have shown a correlation between synthetic cannabinoid consumption and acute psychosis2,4 and agitation.3 Another study describes acute withdrawal in a patient smoking up to 3 g/day for 8 months.5 Despite mounting public health concerns and concomitant legislative effort to remove it from the public domain, this compound is still legal in various forms in most states. Given its increased potency compared to harvested

Medical School Factors Associated with Higher Rates of Recruitment into Psychiatry

ObjectiveThe medical school a student attends appears to be a factor in whether students eventually match into psychiatry. Knowledge of which factors are associated with medical schools with higher recruitment rates into psychiatry may assist in developing strategies to increase recruitment.MethodsPsychiatry leaders in medical student education in the 25 highest and lowest recruiting US allopathic schools were surveyed concerning various factors that could be important such as curriculum, educational leadership, and presence of anti-psychiatry stigma. The relationship between the survey results of high recruiting schools versus those of low recruiting schools was evaluated using Mann-Whitney U tests.ResultsFactors significantly associated (p < .05) with higher recruiting schools included better reputation of the psychiatry department and residents, perceived higher respect for psychiatry among non-psychiatry faculty, less perception that students dissuaded other students from pursuing psychiatry, and longer clerkship length.ConclusionsEducational culture and climate factors may have a significant impact on psychiatry recruitment rates. Clerkship length was associated with higher recruiting schools, but several previous studies with more complete samples have not shown this.

The Community Preceptor Crisis: Recruiting and Retaining Community-Based Faculty to Teach Medical Students—A Shared Perspective From the Alliance for Clinical Education

ABSTRACT Issue: Community-based instruction is invaluable to medical students, as it provides “real-world” opportunities for observing and following patients over time while refining history taking, physical examination, differential diagnosis, and patient management skills. Community-based ambulatory settings can be more conducive to practicing these skills than highly specialized, academically based practice sites. The Association of American Medical Colleges and other national medical education organizations have expressed concern about recruitment and retention of preceptors to provide high-quality educational experiences in community-based practice sites. These concerns stem from constraints imposed by documentation in electronic health records; perceptions that student mentoring is burdensome resulting in decreased clinical productivity; and competition between allopathic, osteopathic, and international medical schools for finite resources for medical student experiences. Evidence: In this Alliance for Clinical Education position statement, we provide a consensus summary of representatives from national medical education organizations in 8 specialties that offer clinical clerkships. We describe the current challenges in providing medical students with adequate community-based instruction and propose potential solutions. Implications: Our recommendations are designed to assist clerkship directors and medical school leaders overcome current challenges and ensure high-quality, community-based clinical learning opportunities for all students. They include suggesting ways to orient community clinic sites for students, explaining how students can add value to the preceptors practice, focusing on educator skills development, recognizing preceptors who excel in their role as educators, and suggesting forms of compensation.

Psychiatry Clerkship Students’ Preparation, Reflection, and Results on the NBME Psychiatry Subject Exam

ObjectivePsychiatry clerkship training involves many learning components, one of which is acquisition of scholarly knowledge. The authors investigate the reading materials and learning methods used by clinical clerks in their preparation for the National Board of Medical Examiners (NBME) Psychiatry Subject Exam (PSE).MethodsClerkship students from six U.S. medical schools who had recently completed their psychiatry clerkship and PSE were surveyed regarding reading material use, teaching methods encountered, and other relevant resources which may have influenced their PSE scores.ResultsThe most frequently used PSE preparation material was a “step-or-prep” book, followed by practice questions, handouts and assigned texts. No single preparation material type or combination proved significantly different in influencing PSE scores. The didactic methods used in clerkships did differ significantly in their influence on PSE scores. Students in the top quartile used slightly more books and different combinations of books than students in the bottom quartile.ConclusionStudents exhibited several trends in their preparation for the PSE. The most striking findings were the heavy student reliance on step-or-prep books over other learning resources and that step-or-prep books did not demonstrate significance as a superior preparation resource for the PSE. These trends in third-year psychiatric rotations have important implications for medical student education.

Improving child and adolescent psychiatry education for medical students: An inter-organizational collaborative action plan

ObjectiveA new Child and Adolescent Psychiatry in Medical Education (CAPME) Task Force, sponsored by the Association for Directors of Medical Student Education in Psychiatry (ADMSEP), has created an inter-organizational partnership between child and adolescent psychiatry (CAP) educators and medical student educators in psychiatry. This paper outlines the task force design and strategic plan to address the longstanding dearth of CAP training for medical students.MethodThe CAPME ADMSEP Task Force, formed in 2010, identified common challenges to teaching CAP among ADMSEP’s CAPME Task Force members, utilizing focus-group discussions and a needs-assessment survey. The Task Force was organized into five major sections, with inter-organizational action plans to address identified areas of need, such as portable modules and development of benchmark CAP competencies.ResultsThe authors predict that all new physicians, regardless of specialty, will be better trained in CAP. Increased exposure may also improve recruitment into this underserved area.

Medical Student Psychiatric Educators’ Perceptions of Supports, Resources, and Rewards

ObjectiveThe primary purpose of this study was to determine the adequacy of resources for medical student education in psychiatry in US medical schools.MethodsAn e-questionnaire was deployed to psychiatric educators in the Association of the Directors of Medical Student Education in Psychiatry (ADMSEP) regarding resources for fulfilling their educational mission.ResultsMedical student educators in psychiatry were neutral as to whether they had adequate mentoring, yet did report support from their chair. Participants’ roles in medical student education and membership in ADMSEP enhanced their work satisfaction, career satisfaction, and career development. Many participants reflected a lack of adequate resources to achieve student education goals.ConclusionsThere are opportunities for improvement in provision of teaching resources, mentoring for medical student educators, greater protected time for teaching and administration, and rewards (salary and non-monetary) for educators. If actualized, these improvements would promote optimization of medical student education in psychiatry.

Integration of Basic and Clinical Science in the Psychiatry Clerkship

ObjectiveIntegration of basic and clinical science is a key component of medical education reform, yet best practices have not been identified. The authors compared two methods of basic and clinical science integration in the psychiatry clerkship.MethodsTwo interventions aimed at integrating basic and clinical science were implemented and compared in a dementia conference: flipped curriculum and coteaching by clinician and physician-scientist. The authors surveyed students following each intervention. Likert-scale responses were compared.ResultsParticipants in both groups responded favorably to the integration format and would recommend integration be implemented elsewhere in the curriculum. Survey response rates differed significantly between the groups and student engagement with the flipped curriculum video was limited.ConclusionsFlipped curriculum and co-teaching by clinician and physician-scientist are two methods of integrating basic and clinical science in the psychiatry clerkship. Student learning preferences may influence engagement with a particular teaching format.

Current Technology in Advancing Medical Education: Perspectives for Learning and Providing Care

Healthcare and medical training have no immunity to universal, rapidly changing technology. In medical education, advances like simulations, virtual patients, and e-learning have evolved as pedagogical strategies to facilitate an active, learner-centered teaching approach. According to Chhetri et al., contemporary generations of trainees have grown up immersed in various technologies and are now less functional in the traditional classroom setting [1]. Yet, not all of today’s medical trainees or educators are equally adept and comfortable with technology. Educators are tasked with selecting and filtering appropriate technology-based curricula [1]. Advancement in education requires discerning which learning-assisting technologies merit usage in specific scenarios. To better improve patient care in contemporary times, continual innovative efforts between psychiatric educators and trainees remain essential for fully exploiting technology’s potential. The objective of this commentary is to discuss the various available medical training technologies and subsequent perceptions of trainees to these modalities. Additionally, this commentary considers how educationbased technologies could improve or hinder the learning experience of medical trainees.