Hello COMSEP!
Today is Black Press Day, commemorating the publication of the first newspaper produced by Black Americans in 1827. Very appropriate given our upcoming meeting’s theme of diversity, equity and inclusion.
Looking forward to seeing many of you soon!
Enjoy,
Amit, Karen and Jon
Cheaper is not lower quality!
Graduates’ perspectives on education quality, the learning environment, residency readiness, debt, burnout, and career plans. Leong SL, Gillespie C, Jones B, et al. Accelerated 3-year MD pathway programs:. Academic Medicine. 2022;97:254-261. https://dx.doi.org/10.1097/ACM.0000000000004332
Reviewed by Molly Rideout
What was the question?
How do perspectives of graduates from accelerated 3-year MD programs differ from graduates of traditional 4-year MD programs in areas of education quality, residency preparedness, learning environment, burnout, debt and career plans?
What was done?
A modified Graduation Questionnaire (GQ) was administered by the AAMC in 2017 and 2018. Aggregate data was compared for students in accelerated programs (AP) from the 9 US schools that offer them, with students in both 4-year programs at the same schools and also students from all US 4-year MD programs.
What were the results?
Ninety AP students, 2573 students from 4-year MD programs at the same 9 schools, and 38,116 students from all 4-year MD programs completed the GQ. There was no significant difference among groups in reported educational quality or perceived residency preparedness. There was also no significant difference in emotional climate, burnout, or exhaustion scores, although student/faculty interaction was rated higher among the AP group. There was a significant difference in the debt accrued; 67% of AP students had less than $100,000 in debt compared to approximately 40% in other groups, and 14% of AP students had greater than $150,000 in debt compared with approximately 50% in other groups. A greater number of AP students versus other groups planned to pursue family medicine, work in underserved communities, and reported that family expectations and plans had a strong influence on their decisions.
What are the implications?
It would be difficult to argue for the universal benefit of the fourth year for all students if AP students are indeed equally prepared for residency and the quality of education and learning environment is similar, since there is such a difference in the debt burden. Accelerated programs partnered with residency programs are a promising approach since they eliminate the time taken up by the NRMP process. Residency program input and intern performance data are important next steps.
Editor’s Comments: The primary reason described for 3-year programs has been to address the continuing physician shortage, so that graduating students can enter the workforce sooner. However, the findings of decreased debt load in students from three-year programs are striking. As we consider issues of EDI and diversification of the physician workforce, accelerated programs may be an important opportunity for students from lower socioeconomic backgrounds for whom the exorbitant cost of medical education makes it inaccessible. (KFo)
With behavioral and mental health, practice makes…interest in more practice
Where Do Future Pediatricians Learn Behavioral and Mental Health Skills?
Green CM, Leyenaar JK, Nuncio B, Leslie LK.. Academic Pediatrics 2021; 21(7):1288-1296. https://dx.doi.org/10.1016/j.acap.2021.04.015
Reviewed by Benjamin Martinez
What was the study question?
In which rotations do pediatric residents learn behavioral and mental health (B/MH) skills? Is interest in B/MH problems associated with learning these skills?
How was it done?
Pediatric residents and recent graduates in the U.S. who were applying for their initial American Board of Pediatrics certifying exam completed a voluntary survey related to their B/MH training. The survey included demographic questions, questions on which rotations trainees received training on 7 B/MH assessment skills and 8 B/MH treatment skills, and a 5-point Likert scale to rate overall interest in B/MH problems. Learning sites included continuity clinics, development and behavior (DB) rotations, adolescent rotations, subspecialty rotations, child psychiatry rotations, and other rotations. Analysis was conducted to characterize where respondents reported learning B/MH skills and to explore the association between multisite learning of skills and overall interest in B/MH problems using logistic regression models.
What were the results?
The survey had a 62.4% response rate with 2121 participants. The majority of trainees reported training in all B/MH skills and that this training occurred across multiple sites/rotations. Continuity clinic was the most common site for learning all skills, followed by DB rotations and adolescent rotations. 63.2% of trainees reported an overall interest in B/MH problems. The odds of B/MH interest were significantly increased with each additional B/MH skill learned in >1 rotation (aOR = 1.10, 95% CI 1.05-1.15 for assessment skills; aOR = 1.08, 95% CI 1.04-1.12 for treatment skills).
What are the implications?
Given the increase in childhood B/MH issues observed during the COVID-19 pandemic, there is a need for pediatric residency and undergraduate medical education programs to foster interest in and provide learning opportunities in pediatric B/MH topics. The large role of multisite and continuity clinic learning opportunities in developing B/MH competencies and interest supports the use of early exposure to B/MH problems in multiple settings through longitudinal clerkship experiences. Additionally, faculty development for continuity clinic supervisors may better equip them with the skills to effectively teach on B/MH topics.
Editor’s Note: It makes sense that the more opportunities trainees have to practice skills in managing B/MH problems, the more confident they will feel, which will make them more interested in doing so in clinical practice. This study certainly reinforces the value of continuity clinic as a key component of resident education. (JG)
Changing How Future Physicians View People with Disabilities
Effects of a Brief Curricular Intervention on Medical Students’ Attitudes Toward People with Disabilities in Healthcare Settings Bu, Paula AB; Veloski, J. Jon MS; Ankam, Nethra S. MD, American Journal of Physical Medicine & Rehabilitation 2016; 95(12): 939-945.
https://dx.doi.org/doi: 10.1097/PHM.0000000000000535
Reviewed by: Samantha Katz
What was the study question?
Can the addition of a dedicated curriculum influence how medical students view people with disabilities (PWD)?
How was the study done?
The study included a total of 488 medical students who matriculated in 2010 (n=251) and 2011 (n=237). The 2010 students (control) received a 1 hour lecture on the Americans with Disability Act and PWD. The 2011 students (intervention) received the 1 hour lecture and an additional 2.5 hours of curricular material including an interactive session titled “Patients with Disabilities as Teachers”, the video “Ten Commandments of Communicating with PWDs”, and a 1-hour long discussion panel. All students in both years completed the Disability Attitudes in Health Care (DHAC). The DHAC consists of 17 questions on a 5-point Likert scale, and it is designed to assess attitudes and educational preparation of healthcare workers treating PWD. Students participating in the enhanced curriculum also completed a reflection on the additional coursework.
What were the results?
The intervention cohort had significantly higher scores on 6/17 items on the DHAC, including “PWD are pleasant to be with” and “I would welcome PWD into my practice”. Multiple linear regression showed completing the curriculum and female gender had positive effects on DHAC scores but prior work experience and personal experience caring for PWD did not.;. Analysis of student’s reflections revealed common themes of increased confidence working with PWD, enhanced ability to see PWD as individuals, and appreciation of the direct face to face interaction with PWD.
What are the implications?
Prior research has shown that physicians can harbor negative biases toward PWD that can directly harm patient care. This study revealed an additional 2.5 hours of coursework can have positive effects. This intervention proved to be a low cost and minimal time investment to help foster more positive attitudes. Interestingly, it was not work nor personal experience with PWD that correlated with more positive attitudes, but additional formal education and dedicated space for reflection. This curriculum could be utilized as a framework to help develop similar interventions at different institutions and students across other health professions.
Editor’s comments: This is a nice article on the effect of additional curriculum on student attitudes toward PWD. One caution is that these were not concurrent students but rather one year compared to previous thus unsure if this was curricula or overall attitude change from one year to the next. However the linear regression should correct for this phenomenon. Lastly, the amount of time can be significant depending on total contact hours in a curriculum. (AP)