August 2023


This is about the time that many of us are saying “where did the summer go”? As we move closer to ‘normal life’ (whatever that means), we find ourselves taking stock at the end of summer and thinking of all the projects still on the ‘to do’ list.

Don’t leave COMSEP Journal Club on your ‘to-do’ list. Take a look now—maybe there’s something in here that will help you with your teaching, or a scholarly project, or just something that you will find interesting as a pediatric educator.


Amit, Jon and Karen

Sorry---I missed that---I was texting….

Mayl JJ, Vaala SE, Patel PV, Ritter MB, Richardson KM. Media Multitasking in Medical Students: A Theory-Based Approach to Understanding this Behavior. Teaching and Learning in Medicine 2023; Vol 35(3): 265-276.

Reviewed by Emily Xiao

What was the study question?

What is the extent and academic impact of in-class media multitasking (MM) among medical students, and what factors underlie this behavior?

How was the study done?

The authors conducted a survey of preclinical medical students at their institution in May 2020. Students were asked about the amount and frequency of in-class media multitasking behavior (defined as use of digital devices for non-educational purposes), as well as related beliefs. Block grades and average quarter grades were used to measure academic performance. The authors utilized the Integrative Model of Behavioral Prediction, a framework for studying cognitive factors (e.g., attitudes, norms, self-efficacy) that drive a specific behavior in a population of interest.

What were the results?

The survey was completed by 39% (N =119) of students. There were no significant differences between students who attended in-person lectures and those who viewed asynchronous recordings. MM was common, with only 9% of students reporting they did not engage in any MM behavior during a lecture. The most frequently reported behaviors were texting, social media use, and reading online news. In a hierarchical linear regression model incorporating course-related and cognitive variables, the strongest predictor of both frequency and amount of MM behavior was the expectation of boredom without device use (p < .001 for amount; p < .03 for frequency). The authors found no significant association between MM and grades.

How can I apply this to my work in education?

This study highlights the utility of exploring underlying cognitive beliefs prior to implementing a behavioral change intervention. In this study group, reducing expectations of boredom (e.g., by highlighting clinical relevance of material) would likely be more influential than targeting other cognitive beliefs like social inappropriateness or impact on grades.

Editor's Note: This should make us think as educators when we see students perform MM since it had no impact on grades. We don’t know what students did outside the class to ensure equal performances. What I found most interesting was that MM use was the same both in-person and asynchronous, slightly disproving that in-person activities reduce this behavior. (AKP).

Medical students with learning disabilities--how do they do?

Botan V, Williams N, Law GR, Siriwardena AN. The effect of specific learning difficulties on general practice written and clinical assessments. Med Educ 2023 Jun;57(6):548-555.

Reviewed by Gary L. Beck Dallaghan

What was the study question?

Are there any differences between performance of candidates with declared specific learning disabilities and those without declared disabilities on both written and clinical skills assessments?

How was the study done?

Using linked longitudinal data, 2016 licensing and demographic data from general practice physicians in the United Kingdom were collected.  Their medical licensing examination, structured clinical skills examination, and workplace-based assessments reported on the Annual Review of Competence Progression scores were used. Declared disability included: none, specified (dyslexia, dyspraxia, dyscalculia), and other disability (hearing impairment, visual impairment, physical disability, other). Analyses included multivariable logistic regression and descriptive statistics.

What were the results?

The sample included 2,070 doctors, with 214 (10.34%) declaring a specified disability. Physicians with a specified disability were significantly less likely to pass the clinical skills assessment (OR 0.43, p = 0.001). These physicians, although having lower scores, were not statistically different on the medical licensing examination. They were also more likely to have difficulties with workplace-based assessments (OR 0.28, p < 0.001). When analyzing the clinical skills assessment subdomains, physicians with learning disabilities scored significantly lower on interpersonal skills (B = -0.70, p = 0.007).

How can I apply this to my work in education?

Although the authors suggest the main implications of this work center around considerations for high stakes examinations, I would suggest that they go beyond the testing environment.  Their findings that knowledge-based examination differences were minimal is important, but the differences in clinical skills examination performance have implications for addressing performance gaps in real clinical settings for students with specific learning disabilities as well.   Such difficulties may necessitate different methods of training and/or remediating clinical performance.

Editor’s Note:  Another aspect of the study that may have broader implications ---many more students with disabilities (more than 60%) needed more than one test to pass either the knowledge or the clinical skills exam.   Additional testing may mean additional time and money for the students and/or the institutions that are training them. (JG)


Lights, Camera…Listen

Rusiecki, JM. Orlov, NM, Dolan, JA, ; Smith, MP, Zhu, M, ; Chin, MH..  Exploring the Value of Improvisational Theater in Medical Education for Advancing the Doctor–Patient Relationship and Health Equity .  Academic Medicine; 98(6S): S46-S53.

Reviewed by Gilliann Minviel

What was the study question?

Will incorporation of improvisational theater (improv) in medical school curriculum teach students about implicit biases and structural barriers that affect patients of marginalized backgrounds?

How was it done?

Sixty first-year medical students participated in a 90-minute virtual improv workshop as part of required coursework. Students were randomly assigned to six small groups.  Exercises included basic improv games and discussion questions with the objectives of improving students’ ability to form trustworthy relationships with their patients, effectively communicate, and care for diverse patients by understanding systemic inequities.  Participating students were sent an online survey with Likert scale and open-ended questions to assess the workshop’s impact.  A subset  then participated in one-on-one structured interviews with an aim of interviewing a certain number of Asian American, Black, Latinx, and White students to provide a range of perspectives.   Transcripts of interviews were coded and themes identified.

What were the results?

37 students ((62%) completed the survey.   Most reported that the workshop improved their active listening and observation skills.

11 students who had completed the workshop participated in the interviews. Themes identified included  interpersonal skills (the improv approach helped them be fully present during patient conversations) and personal growth (students  gained awareness of how their perceptions of self and others can impact trust-building). Some students desired a more serious, deliberate discussion about systemic inequities and associated clinical applications.

How can this be applied to my work in education?

Incorporation of improv exercises can teach students the importance of active listening and remaining flexible in conversations with patients to best meet their needs. These exercises may also allow students to think about the perspectives of their patients that may have had different lived experiences. Longitudinal workshops that include deliberate discussions about structural discrimination throughout the medical school curriculum may promote students’ social consciousness and allow them to better care for their patients.

Editor’s Note: It is impressive that these workshops were conducted virtually and still managed to engage students with lessons about observing others.  I can imagine that their power might be even greater in a live session.  I look forward to the sequel.  (JG)

View a PDF of the Journal Club