Terry D. Stratton

Emotional intelligence and clinical skills: preliminary results from a comprehensive clinical performance examination.

Background The recognition of emotional states in one’s self and others, emotional intelligence (EI) may play a key role in patient care. This study examines the relationship between EI and students’ clinical skills in a required, comprehensive performance examination (CPX). Method Prior to taking a 12-station CPX, third-year students in 2003 and 2004 (n = 165) completed the Trait Meta-Mood Scale and Davis’ Interpersonal Reactivity Index. Dimensional subscales were computed and correlated with selected aspects of students’ clinical skills as recorded by standardized patients in each objective structured clinical examination (OSCE)-type encounter. Results The internal consistencies (&agr;) of subtests ranged from .73-.90. Attention to Feelings, Empathic Concern, and Perspective Taking were significantly (p = ≪ .05) positively correlated with communication skills, while the latter two were also significantly negatively associated with physical examination skills. Conclusions Various aspects of EI are modestly implicated in students’ clinical skills as assessed by standardized patients in an OSCE.

Assessing residents' clinical performance: Cumulative results of a four-year study with the Objective Structured Clinical Examination

BACKGROUND The Objective Structural Clinical Examination (OSCE) is an objective method for assessing clinical skills and can be used to identify deficits in clinical skill. During the past 5 years, we have administered 4 OSCEs to all general surgery residents and interns. METHODS Two OSCEs (1993 and 1994) were used as broad-based examinations of the core areas of general surgery; subsequent OSCEs (1995 and 1997) were used as needs assessments. For each year, the reliability of the entire examination was calculated with Cronbachs alpha. A reliability-based minimal competence score (MCS) was defined as the mean performance (in percent) minus the standard error of measurement for each group in 1997 (interns, junior residents, and senior residents). RESULTS The reliability of each OSCE was acceptable, ranging from 0.63 to 0.91. The MCS during the 4-year period ranged from 45% to 65%. In 1997, 4 interns, 2 junior residents, and 2 senior residents scored below their groups MCS. MCS for the groups increased across training levels in developmental fashion (P < .05). CONCLUSIONS Given the relatively stable findings observed, we conclude (1) the OSCE can be used to identify group and individual differences reliably in clinical skills, and (2) we continue to use this method to develop appropriate curricular remediation for deficits in both individuals and groups.

Service Learning in the Medical Curriculum: Developing and Evaluating an Elective Experience.

Background: Medical educators are seeking ways to nurture the service commitments of their medical students while promoting interactions with the communities they serve. Service learning is a pedagogy that links community service with academic experience. Description: The University of Kentucky College of Medicine has developed and implemented an experiential service learning elective. The elective is based in local community agencies where small groups of students perform an asset-needs assessment and design a service project based on their findings. The elective is linked to a behavioral science course that provides accompanying biopsychosocial instruction. Evaluation: Over the 2-year project period, we used multiple methods (i.e., surveys, interviews, reflection questionnaires, evaluations of student performance, and course evaluations) to gather information on the motivations, observations, and assessments of students, faculty preceptors, and community agency partners. Conclusion: Linking a service learning elective to a pre-existing course worked well, achieved its objectives, and will be continued.

Stories from the field: students' descriptions of gender discrimination and sexual harassment during medical school.

Purpose Previous studies have documented the prevalence of gender discrimination and sexual harassment during medical training, but very few have examined the behaviors that students perceive as discriminatory or harassing. The authors addressed this lack of information by examining graduating medical students’ written descriptions of personal experiences with such behaviors during medical school. Method The authors reviewed the responses of graduating seniors at 12 U.S. medical schools to a questionnaire, administered in 2001–02, that asked them to provide written descriptions of their personal experiences with gender discrimination and sexual harassment. Seven response categories were created on the basis of recurring themes: educational inequalities; stereotypical comments; sexual overtures; offensive, embarrassing, or sexually explicit comments; inappropriate touching; sexist remarks; and not classifiable. The three authors examined the students’ written accounts and placed each into one or more of the categories. Results Of the students’ responses, 290 (36.6%) contained 313 written descriptions of personal experiences that the students perceived as either discriminatory or harassing. The most frequently reported experiences involved educational inequalities; experiences in this category were reported more frequently by men than by women. All other categories of experiences were reported more frequently by women. Conclusions The results support earlier findings of the prevalence of gender discrimination and sexual harassment during undergraduate medical education. Perhaps formal antiharassment policies should provide examples of unacceptable behavior that are based on categories such as those revealed by this analysis. Perhaps, too, medical students’ comments could be used to develop educational interventions for physicians in supervisory positions.

Interprofessional education in US medical schools

IntroductionInterprofessional education (IPE) is called for in United States health professionseducation (Institute of Medicine, 2003). The Association of American Medical Colleges(AAMC) includes interprofessional health education and practice as a strategic area inwhich the organization and members should engage (AAMC, 2007). The current statusof IPE within United States medical schools has remained largely unexamined.Therefore, we sought to learn the current practice of IPE in US medical schools,including program features, institutional governance and resource contexts, and barriersto implementation.MethodsWe surveyed college of medicine education deans or dean designees of 126 US medicalschools as identified by the AAMC in late summer, 2008, using an instrument we developedfollowing a literature review. The instrument was composed of three sections: (1) adescription of specific IPE offerings at the school, (2) information regarding institutionalsupports and IPE resources, and (3) perceptions of potential barriers to IPE. With respect tothe description of specific IPE offerings, respondents were asked the following: (a) if offeringwas required or elective, (b) learner disciplines involved, (c) faculty disciplines involved, (d)type of learning experience, (e) type of learning setting, (f) general content area of offering,and (g) student assessment methods. With respect to institutional supports and resourcesfor IPE, respondents were asked the following: (a) administrative unit with responsibility forcoordinating IPE, (b) budget for IPE, (c) governance of IPE, (d) resources (monetary and

Emotional intelligence and medical specialty choice : findings from three empirical studies

Context  Despite only modest evidence linking personality‐type variables to medical specialty choice, stereotypes involving empathy and ‘emotional connectedness’ persist, especially between primary care providers and surgeons or subspecialists. This paper examines emotional intelligence (EI) and specialty choice among students at three US medical schools.

Domestic violence: increasing knowledge and improving skills with a four-hour workshop using standardized patients

Purpose. Domestic violence (DV) is common, yet physicians feel unprepared to address it. Educational interventions may improve the care provided to DV victims, yet the effectiveness of interventions is often unproven. Method. Written questions and DV-specific standardized patient (SP) checklist items from an end-of-clerkship and fourth-year comprehensive multispecialty (the Clinical Performance Examination or CPX) examinations of medical students participating in a DV workshop using SPs was compared with nonparticipants. Results. DV workshop participants’ and nonparticipants’ written question mean scores were 93.2% and 85.8%, respectively, p = .02. End-of-clerkship SP examination DV-specific checklist scores for participants and nonparticipants was 76.3% and 60.0%, respectively, p = .002. Workshop participants scored 44.1% on the CPX DV-specific checklist items versus 35.6% for the nonparticipants, p = .01. Conclusion. A DV workshop improved knowledge and skills assessed four and an average of 27 weeks later.

Effects of an Expanded Medical Curriculum on the Number of Graduates Practicing in a Rural State.

In 1973 the University of North Dakota School of Medicine (UNDSM), following the national trend toward four-year medical programs, expanded its previous two-year medical school curriculum to include all four years of medical education. It was hoped that this change, along with a renewed emphasis on primary care-oriented residency training within the state, would encourage medical students to establish practices within the state. In 1985 the UNDSMs Center for Rural Health mailed questionnaires to the 2,230 living graduates of the UNDSM to document a variety of their personal and practice characteristics. Based on the responses to the 924 completed questionnaires, the authors found that (1) the students from rural North Dakota were more likely than were urban students to practice in rural areas of the state, as were the students with primary care specialty training; and (2) the alumni completing residencies in North Dakota following the curriculum expansion (1976–1985) were more than twice as likely to establish practices in North Dakota. It was concluded that recruiting medical students (preferably in-state “natives”) from rural areas, training them in primary care specialty areas, and enabling them to remain in North Dakota for the duration of their medical training (including residency training) combined to exert a considerable “retaining” effect on the UNDSM alumni.

Measuring the emotional intelligence of medical school matriculants.

507 and professionalism during the first semester, using lectures, small groups, communication labs, and interactions with standardized patients. Within the first few weeks, the students and faculty complete the Emotional Quotient Inventory (EQi) developed by Bar-On, listen to one lecture on emotional intelligence, and subsequently receive personal EQi results, which are distributed at a small-group session. The faculty tutors share personal interpretations and reflections on their own scores and permit the students, if they so choose, to discuss their own scores in a safe setting. The focus on professionalism continues throughout the two-year course with additional small-group sessions and standardizedpatient experiences promoting the ideas of self-reflection and growth. Plans are to readminister the EQi in the students’ second and third years. Discussion: Most students are selected into medical school based on history of academic and cognitive successes, yet each possesses a unique emotional make-up that reflects personal life experience, coping skills, and core values and beliefs. To be able to practice medicine, the student must have the ability to understand the views and needs of a wide variety of people, remain sensitive and empathic to patient concerns, and be able to keep his or her personal emotional reactions in perspective, handle stress, and promote social responsibility—all concepts that the EQi attempts to measure. We believe the first step is for students to examine and understand their own emotional intelligence, which will, if developed, assist them in the ability to identify and accept the views of their patients. This process has long been expected to occur on its own through the hidden curriculum of medical education and the presence of excellent role models. Use of the EQi will formalize this process, will direct both faculty and students to utilize opportunities to become skilled in the physician–patient interaction, and will provide a means for assessment of intrapersonal change. Inquiries: Peggy J. Wagner, PhD, Department of Family Medicine, HB3040, Medical College of Georgia, August, GA 30912-3500.

Retainment Incentives in Three Rural Practice Settings: Variations in Job Satisfaction Among Staff Registered Nurses

Researchers have demonstrated repeatedly the importance of the relationship linking job satisfaction to employee retention. In rural areas of the country, where a persistent maldistribution of nurses continues to hamper health care delivery, the potential benefits of bolstering retention via enhancements in job satisfaction are of utmost utility to administrators and providers alike. Data were gathered from a multistate survey of registered nurses (RNs) practicing in rural hospitals, skilled nursing facilities, and community/public health settings (N = 1,647; response rate = 40.3%). The investigators found that the use of tuition reimbursement corresponded significantly with increased levels of job satisfaction among nurses in all three practice environments, as did day care services for nurses in acute care settings. Also, among hospital-based RNs, level of nursing education was found to be a significant factor in the relationship between tuition reimbursement and job satisfaction, with the highest level occurring among diploma-prepared nurses.