Sonia J. Crandall

Applying Theory to the Design of Cultural Competency Training for Medical Students: A Case Study.

Although literature suggests that providing culturally sensitive care promotes positive health outcomes for patients, undergraduate medical education currently does not provide adequate cultural competency training. At most schools, cultural competency, as a formal, integrated, and longitudinal thread within the overall curriculum, is still in its infancy. In this article, the authors summarize the current practice of cultural competency training within medical education and describe the design, implementation, and evaluation of a theoretically based, year-long cultural competency training course for second-year students at Wake Forest University School of Medicine. Evaluation of the results indicate that the course was successful in improving knowledge, attitudes, and skills related to cultural competence as well as bringing about positive changes in the medical schools approach to cultural competency training. Also discussed are the implications of the outcomes for the development of culturally competent physicians and how using appropriate theory can help achieve desired outcomes.

Helping medical learners recognise and manage unconscious bias toward certain patient groups.

Medical Education 2012: 46: 80–88

Commentary: ambiguity and uncertainty: neglected elements of medical education curricula?

Despite significant advances in scientific knowledge and technology, ambiguity and uncertainty are still intrinsic aspects of contemporary medicine. To practice confidently and competently, a physician must learn rational approaches to complex and ambiguous clinical scenarios and must possess a certain degree of tolerance of ambiguity. In this commentary, the authors discuss the role that ambiguity and uncertainty play in medicine and emphasize why openly addressing these topics in the formal medical education curriculum is critical. They discuss key points from original research by Wayne and colleagues and their implications for medical education. Finally, the authors offer recommendations for increasing medical student tolerance of ambiguity and uncertainty, including dedicating time to attend candidly to ambiguity and uncertainty as a formal part of every medical school curriculum.

Are Medical Students Aware of Their Anti-Obesity Bias?

Purpose Anti-obesity prejudices affect the quality of care obese individuals receive. The authors sought to determine the prevalence of weight-related biases among medical students and whether they were aware of their biases. Method Between 2008 and 2011, the authors asked all third-year medical students at Wake Forest School of Medicine to complete the Weight Implicit Association Test (IAT), a validated measure of implicit preferences for “fat” or “thin” individuals. Students also answered a semantic differential item assessing their explicit weight-related preferences. The authors determined students’ awareness of their biases by examining the correlation between students’ explicit preferences and their IAT scores. Results Of 354 medical students, 310 (88%) completed valid surveys and consented to participate. Overall, 33% (101/310) self-reported a significant (“moderate” or “strong”) explicit anti-fat bias. No students self-reported a significant explicit anti-thin bias. According to the IAT scores, over half of students had a significant implicit weight bias: 39% (121/310) had an anti-fat bias and 17% (52/310) an anti-thin bias. Two-thirds of students (67%, 81/121) were unaware of their implicit anti-fat bias. Only male gender predicted an explicit anti-fat bias (odds ratio 3.0, 95% confidence interval 1.8–5.3). No demographic factors were associated with an implicit anti-fat bias. Students’ explicit and implicit biases were not correlated (Pearson r = 0.03, P = .58). Conclusions Over one-third of medical students had a significant implicit anti-fat bias; few were aware of that bias. Accordingly, medical schools’ obesity curricula should address weight-related biases and their potential impact on care.

Revising the Tool for Assessing Cultural Competence Training (TACCT) for curriculum evaluation: Findings derived from seven US schools and expert consensus

Abstract Background: The 67-item TACCT currently used for needs assessment has potential for evaluating evolving cultural competence (CC) curricula. Purpose: To validate a shortened, more practical TACCT measure. Methods: The 67-item TACCT was administered to students and course directors at US schools. Course directors and students reported which of 67 TACCT items were taught. Intraclass correlation coefficients (ICC) examined faculty-student agreement. Under-addressed content was identified. A new and shortened TACCT configuration was proposed and validated with expert educator input. Results: Across-school faculty and student response rates ranged from 75% to 100%. Aggregate ICC was 0.90 (95% CI: 0.84, 0.94) for the 67-item TACCT, demonstrating faculty-student agreement. Experts agreed on reduction from 67 to 42 items and domain revision from five to six domains to match under-addressed content. Item analysis showed high internal consistency for all 6 new domains and the total revised 42-item TACCT. Conclusions: A shorter, more practical TACCT measure is valid and reliable and focuses on under-addressed CC content. Use for curricular evaluation is suggested.

Assessment of matriculating medical students' knowledge and attitudes towards professionalism

Background: Students’ perceptions of traditional attributes of professionalism are important for understanding their professional development needs, and determining appropriate curricular initiatives and assessment methods. Aim: This study assessed the knowledge and attitudes towards professionalism of three classes of matriculating students at two institutions. Methods: Subjects completed four instruments: a multiple-choice test and a clinical scenario instrument assessed knowledge; and a semantic differential scale and Likert-format statement instrument assessed attitudes. Items reflected traditional professionalism attributes. Factor analysis identified scales and descriptive statistics were computed for each scale. Results: Six hundred and forty six students (82%) completed the instruments. Correlations among scales were low to moderate. Knowledge scores were highest for the attributes ‘humanism’ and ‘professional responsibility’ and lowest for the attribute ‘professional commitment’. Attitude scores were highest for ‘humanistic values’ and lowest for ‘subordinating self-interests’. Conclusions: Results indicate students’ attitudes are positive about several of the attributes associated with traditional professionalism definitions; however, there were cases where students’ knowledge and attitudes towards professionalism appear incongruent with traditional definitions. Further development of self-assessments of knowledge and attitudes towards professionalism are suggested.

Obesity Educational Interventions in U.S. Medical Schools: A Systematic Review and Identified Gaps

Background: Obesity is the second leading cause of preventable death in the United States. However, physicians feel poorly trained to address the obesity epidemic. This article examines effective training methods for overweight and obesity intervention in undergraduate medical education. Using indexing terms related to overweight, obesity, and medical student education, we conducted a literature searched PubMed PsycINFO, Cochrane, and ERIC for relevant articles in English. References from articles identified were also reviewed to located additional articles. Summary: We included all studies that incorporated process or outcome evaluations of obesity educational interventions for U.S. medical students. Of an initial 168 citations, 40 abstracts were retrieved; 11 studies were found to be pertinent to medical student obesity education, but only 5 included intervention and evaluation elements. Quality criteria for inclusion consisted of explicit evaluation of the educational methods used. Data extraction identified participants (e.g., year of medical students), interventions, evaluations, and results. These 5 studies successfully used a variety of teaching methods including hands on training, didactic lectures, role–playing, and standardized patient interaction to increase medical students’ knowledge, attitudes, and skills regarding overweight and obesity intervention. Two studies addressed medical student bias toward overweight and obese patients. No studies addressed health disparities in the epidemiology and bias of obesity. Conclusions: Despite the commonly cited “obesity epidemic,” there are very few published studies that report the effectiveness of medical school obesity educational programs. Gaps still exist within undergraduate medical education including specific training that addresses obesity and long-term studies showing that such training is retained.

Measuring medical student attitudes and beliefs regarding patients who are obese.

Purpose Research shows obesity bias to undermine the patient–doctor relationship and lead to substandard care. The authors developed and tested an instrument to measure medical students’ attitudes and beliefs about obese patients. Method The authors conducted a literature search to identify validated measures of obesity bias. Because they identified no appropriate scale, they decided to design a novel survey instrument: the Nutrition, Exercise and Weight Management (NEW) Attitudes Scale. An expert panel generated items which focus groups of third-year medical students then discussed. Next, experienced medical educators judged and weighted the remaining revised items. Then, second- and fourth-year medical students completed the scale alongside two previously validated measures of obesity bias, the Anti-Fat Attitudes Questionnaire (AFA) and Beliefs About Obese Persons Scale (BAOP). Third-year students completed the NEW Attitudes Scale before and after a simulated encounter with an obese standardized patient instructor. The authors tested the validity and reliability. Results The final instrument comprised 31 items. A sample of 201 judges rated the items. A sample of 111 second- and fourth-year medical students completed the survey (mean score 24.4, range −37 to 76 out of a possible −118 to 118; higher scores indicate more positive attitudes). Pearson correlations between the NEW Attitudes Scale and AFA and BAOP were, respectively, −0.47 and 0.23. Test–retest reliability was 0.89. Students scored 27% higher after completing the standardized patient–instructor encounter (P < .001). Conclusion The NEW Attitudes Scale has good validity and reliability and may be used in future studies.

Cognitive and Noncognitive Predictors of Academic Difficulty and Attrition.

No abstract available.

Using Interviews as a Needs Assessment Tool.

&NA; This article concentrates on using interviews as an approach to conducting continuing education needs assessments. Topics reviewed in this article are the advantages and disadvantages of using interviews and important considerations for using interviews as a needs assessment technique, that is, designing the interview plan, handling the mechanics of the interview, interpersonal aspects of the interview, and data collection and management. Also offered is a synopsis of some of the literature that is recommended reading for the continuing professional education provider who is considering incorporating interviews in the needs assessment plan.