James A. Clardy

Is There Hardening of the Heart During Medical School

Purpose To determine whether vicarious empathy (i.e., to have a visceral empathic response, versus role-playing empathy) decreases, and whether students choosing specialties with greater patient contact maintain vicarious empathy better than do students choosing specialties with less patient contact. Method The Balanced Emotional Empathy Scale was administered at the beginning of each academic year at the University of Arkansas for Medical Sciences for four classes, 2001–2004. Students also reported their gender and specialty choice. Specialty choice was classified as core (internal medicine, family medicine, obstetrics–gynecology, pediatrics, and psychiatry) or noncore (all other specialties). Results Vicarious empathy significantly decreased during medical education (P < .001), especially after the first and third years. Students choosing core careers had higher empathy than did those choosing noncore careers. Men choosing core careers initially had empathy exceeding population norms, but their empathy fell to be comparable with that of norms by the end of their third year. The empathy of men choosing noncore careers was comparable with that of norms. Women choosing core careers had empathy scores comparable with those of norms, but the scores of women choosing noncore careers fell below those of the norms by their second year. Conclusions The findings suggest that undergraduate medical education may be a major determinant differentially affecting the vicarious empathy of students on the basis of gender and/or specialty choice. The greatest impact occurred in men who chose noncore specialties. The significant decrease in vicarious empathy is of concern, because empathy is crucial for a successful physician–patient relationship.

Optimal learning environments from the perspective of resident physicians and associations with accreditation length.

Background Indicators of program quality in graduate medical education have not been thoroughly well developed or studied. This study explores resident physicians’ perceptions of program quality and associations with an external quality indicator. Method Responses to two open-ended questions about program strengths and areas in need of improvement were analyzed for 392 residents from 14 specialty programs that were reaccredited between 1999 and 2005. Computerized text analysis facilitated reliable categorization of 1,502 comments. Mann–Whitney U tests and nonparametric analyses for correlated data were used to examine associations between resident perceptions and accreditation length. Results The most frequently mentioned program strengths were related to the quality of faculty, exposure to patients, education, and the social environment. Of these core strengths, residents in programs with longer cycle lengths had significantly more comments about the quality of faculty in their program. Conclusions Resident feedback can provide beneficial information about dimensions of program quality and the learning environment.

Money matters: a resident curriculum for financial management.

BACKGROUND A 2005 survey reported 87% of surgery program directors believed practice management training should occur during residency. However, only 8% of program directors believed residents received adequate training in practice management [1]. In addition to the gap in practice financial management knowledge, we recognized the need for training in personal finance among residents. A literature review and needs assessment led to the development of a novel curriculum for surgery residents combining principles of practice management and personal finance. METHODS An 18-h curriculum was administered over the 2012 academic year to 28 post graduate year 1-5 surgery residents and faculty. A self-assessment survey was given at the onset and conclusion of the curriculum [2]. Pre-tests and post-tests were given to objectively evaluate each twice monthly sessions content. Self-perception of learning, interest, and acquired knowledge were analyzed using the Wilcoxon signed ranks test. RESULTS Initial self-assessment data revealed high interest in practice management and personal finance principles but a deficiency in knowledge of and exposure to these topics. Throughout the curriculum, interest increased. Residents believed their knowledge of these topics increased after completing the curriculum, and objective data revealed various impacts on knowledge. CONCLUSIONS Although surgery residents receive less exposure to these topics than residents in other specialties, their need to know is no less. We developed, implemented, and evaluated a curriculum that bridged this gap in surgery education. After the curriculum, residents reported an increase in interest, knowledge, and responsible behavior relating to personal and practice financial management.

Identifying Areas for Curricular Program Improvement Based on Perceptions of Skills, Competencies, and Performance

ObjectiveEducational program evaluation and program improvement are processes that can be enhanced by involving multiple stakeholders and measurement tools. The purpose of this study was to compare faculty and resident physician perceptions of both teaching quality and resident competence for 13 core psychiatric skills and the six Accreditation Council for Graduate Medical Education general competencies. Additionally, resident performance as assessed by portfolios was descriptively examined relative to these perceptions of skills and competencies. Using this combination of data, the authors propose a useful approach for identifying areas for improvement within a medical residency’s program curriculum.MethodsTen teaching faculty members (100%) and 18 residents (82%) within a psychiatry department completed parallel surveys. Trained raters scored resident-completed portfolio entries. Nonparametric and descriptive analyses were used to compare the various data sources.ResultsIn general, faculty and residents showed congruence in their perceptions about resident performance. They agreed on the quality of teaching skills and general competencies. General competency scores from the portfolios were congruent with this perspective. However, there were mismatches in perceptions and performance on portfolios for some areas. Of the 13 core psychiatric skills examined, only one area, neuropsychiatry, was rated below average by both faculty and residents, while the median portfolio performance score was below competent for four skills, including neuropsychiatry. Faculty rated resident competence significantly higher than residents rated themselves for biopsychosocial formulation and medical psychiatry.ConclusionThis study describes and highlights the usefulness of a multidimensional approach that includes resident and faculty perspectives and externally rated performance measures to assist in identifying potential target areas for curriculum improvement.

A Graduate Medical Education Initiative to Promote Professional Excellence Among Residency Program Coordinators

Background: The authors describe the scope and impact of a professional development program for residency and fellowship program coordinators (PCs) at the University of Arkansas for Medical Sciences (UAMS) College of Medicine. PCs are vital in the success of their residency programs, yet few articles to date have addressed their increasingly complex roles. Purpose: This exploratory study examines PCs’ professional characteristics, perceptions that influence professional development meeting attendance, and the impact of the Program Coordinators’ Organization (PCO). Methods: All 44 PCs serving 53 residency and fellowship programs at UAMS were surveyed about their perceptions of the PCO in January 2006. Results: The majority of respondents agreed that the PCO has improved their abilities and interactions with their supervisors, colleagues, and residents and that the PCO has made an institution-wide impact on residency education. Conclusions: Sponsoring a PCO may be an effective tool for organizations to enhance the role of PCs and their graduate medical education programs.