Karly Pippitt

The Two-Stage Examination: A Method to Assess Individual Competence and Collaborative Problem Solving in Medical Students.

Problem Effectively solving problems as a team under stressful conditions is central to medical practice; however, because summative examinations in medical education must test individual competence, they are typically solitary assessments. Approach Using two-stage examinations, in which students first answer questions individually (Stage 1) and then discuss them in teams prior to resubmitting their answers (Stage 2), is one method for rectifying this discordance. On the basis of principles of social constructivism, the authors hypothesized that two-stage examinations would lead to better retention of, specifically, items answered incorrectly at Stage 1. In fall 2014, they divided 104 first-year medical students into two groups of 52 students. Groups alternated each week between taking one- and two-stage examinations such that each student completed 6 one-stage and 6 two-stage examinations. The authors reassessed 61 concepts on a final examination and, using the Wilcoxon signed ranked tests, compared performance for all concepts and for just those students initially missed, between Stages 1 and 2. Outcomes Final examination performance on all previously assessed concepts was not significantly different between the one-and two-stage conditions (P = .77); however, performance on only concepts that students initially answered incorrectly on a prior examination improved by 12% for the two-stage condition relative to the one-stage condition (P = .02, r = 0.17). Next Steps Team assessment may be most useful for assessing concepts students find difficult, as opposed to all content. More research is needed to determine whether these results apply to all medical school topics and student cohorts.

Team-based approach to addressing simvastatin safety concerns

OBJECTIVE To describe acceptance of systematic and organized pharmacist interventions to address simvastatin safety concerns. SETTING University of Utah Redwood Health Center and Pharmacy, June 2011 to February 2012. PRACTICE DESCRIPTION Redwood Health Center is an outpatient multispecialty clinic associated with University of Utah Health Care with approximately 85,000 annual visits between primary care and specialty practices. In addition to filling approximately 175,000 prescriptions per year, pharmacists provide disease management and education under collaborative practice agreements. PRACTICE INNOVATION All patients identified as being treated outside the revised simvastatin labeling were included (n = 158). After pharmacist review, recommendations were made to providers via the electronic medical record to promote adherence with the June 2011 Food and Drug Administration (FDA) safety guidelines. In addition to recommendations regarding the FDA guidelines (n = 76), additional recommendations were made to optimize treatment based on low-density lipoprotein cholesterol goal or laboratory evaluation (n = 25). MAIN OUTCOME MEASURES Acceptance rate of recommendations and resources needed to provide pharmacist interventions. RESULTS Recommendations were accepted 92% of the time without modification and 7% of the time with modification. Total pharmacist time to conduct the interventions was 21.5 hours, and 3.9 hours of technician time were spent contacting patients. CONCLUSION Targeted pharmacist interventions were effective in promoting adherence with this complex medication safety alert. A standardized, comprehensive approach to patient assessment, including use of evidence to support pharmacist recommendations, resulted in a high level of acceptance by prescribers.

Developing a situational judgment test blueprint for assessing the non-cognitive skills of applicants to the University of Utah School of Medicine, the United States

Purpose: The situational judgment test (SJT) shows promise for assessing the non-cognitive skills of medical school applicants, but has only been used in Europe. Since the admissions processes and education levels of applicants to medical school are different in the United States and in Europe, it is necessary to obtain validity evidence of the SJT based on a sample of United States applicants. Methods: Ninety SJT items were developed and Kane’s validity framework was used to create a test blueprint. A total of 489 applicants selected for assessment/interview day at the University of Utah School of Medicine during the 2014-2015 admissions cycle completed one of five SJTs, which assessed professionalism, coping with pressure, communication, patient focus, and teamwork. Item difficulty, each item’s discrimination index, internal consistency, and the categorization of items by two experts were used to create the test blueprint. Results: The majority of item scores were within an acceptable range of difficulty, as measured by the difficulty index (0.50-0.85) and had fair to good discrimination. However, internal consistency was low for each domain, and 63% of items appeared to assess multiple domains. The concordance of categorization between the two educational experts ranged from 24% to 76% across the five domains. Conclusion: The results of this study will help medical school admissions departments determine how to begin constructing a SJT. Further testing with a more representative sample is needed to determine if the SJT is a useful assessment tool for measuring the non-cognitive skills of medical school applicants.

Patients With Migraine Have Substantial Reductions in Measures of Visual Quality of Life

Migraine is associated with several important visual symptoms, during both acute attacks and headache‐free intervals. The purpose of this investigation was to use validated vision‐related quality of life instruments to assess the effect of migraine on visual quality of life.

Vaccination Rates in Patients With Medical Indications for the Pneumococcal Polysaccharide Vaccine in a Family Medicine Clinic

Background: Pneumococcal vaccination rates among high-risk patients (eg, diabetes, asthma, smoking) seen in 2 family medicine clinics are unknown. Objectives: To assess differences in pneumococcal polysaccharide vaccination rates and reasons for nonvaccination among patients with diabetes and asthma and patients who smoke. Methods: A chart review at 2 family medicine residency training clinics showed 425 patients with a medical indication for PPSV23 were seen between April 1, 2015, and April 30, 2015. One reviewer searched the electronic health records to assess reasons for nonvaccination. Results: Rates of nonvaccination were 29.8% in patients with diabetes, 58.7% in patients with asthma, and 62.5% in patients who smoke cigarettes. Patients were classified into 3 groups based on the reasons for nonvaccination: documented patient refusal, not being addressed by a provider, and being documented as low risk despite the presence of a medical indication. Conclusion: The 3 reasons for nonvaccination were vaccination not being addressed, misclassification of high-risk patients as low-risk patients for infection, and documented patient refusal. Providers overlooked vaccination more often in patients with asthma and cigarette use than in patients with diabetes. Patients seeing pharmacists were most likely to be vaccinated, whereas patients seeing physician assistants were least likely to be vaccinated. Pharmacists see patients to provide medication management and preventive care, whereas other providers treat more urgent conditions. Because indications are often overlooked and not addressed, pharmacists can play a larger role in identifying and vaccinating high-risk patients.

Re: The Diversity of Providers on the Family Medicine Team

The recent policy brief by Bazemore et al[1][1] points out the need for increased diversity among team members for an optimally functioning patient-centered medical home. The clinical pharmacist is an optimal member of this team based on their training, which complements that of physicians. Multiple