Hello COMSEP!
Below is the latest edition of our Journal Club.
One more reminder in case you missed it. For every Journal Club review you agree to write between April 2024 and April 2025, your name will be entered into a raffle. At next year’s Annual Meeting, we will draw the names of one COMSEP member and one medical student--each of whom will be awarded a free meeting registration for the 2026 Annual Meeting.
There are still openings for reviewers the coming year--so reach out to sign up now.
Enjoy!
Jon, Karen and Amit
I’ll See You Tomorrow!
Sawicki JG, Sriram K, Hansen I, Good B. Association between inpatient team continuity and clerkship student academic performance. J Hosp Med. 2024;19(5):349-355. https://doi.org/10.1002/jhm.13273
Reviewed by: Dan Herchline
What was the study question?
What is the relationship between inpatient team continuity and the academic performance of clerkship students?
How was the study done?
This retrospective study looked at the association between how many days medical students on the inpatient portion of their pediatric clerkship spent with the same resident and attending and their final inpatient preceptor rating. Both attendings and residents evaluate students using Entrustable Professional Activities (EPAs) without associated numerical scores and the final evaluation is then curated by the clerkship director who converts the collated data into a numerical score ranging from 0-4.
What were the results?
Data was included from 227 students over the course of two academic years. The average number of days of inpatient team continuity across the study period was 8 days. For each additional day of inpatient continuity, students’ final evaluations increased by 0.04 (on a scale of 0-4). Students in the lowest quartile for inpatient team continuity, on average, received a grade of “Pass” while the students in the highest quartile, on average, received a grade of “High Pass.” Of note, student OSCE scores and shelf scores did not vary based on inpatient team continuity.
How can I apply this to my work in education?
On the face of it, this study demonstrated that students who worked with the same residents and attendings for longer periods of time during their inpatient rotation received higher final evaluations (and higher overall grades). However, the authors note several important limitations including inherent risk of biases in all preceptor evaluations and other potential confounders. Increasing team continuity does have some potential benefits but likely needs more rigorous study before we are able to ascertain any true impact on student performance.
Editor’s Comments: While this study notes higher student clerkship scores based on preceptor evaluations associated with increased continuity, it does not explore other potentially more meaningful outcomes. It would be interesting to study other aspects of continuity on the inpatient team, such as students’ learning and personal growth that may come from continuity with patients. (KFo)
Full Disclosure?
Kassam A, Antepim B, Sukhera J. A Mixed Methods Study of Perceptions of Mental Illness and Self-Disclosure of Mental Illness Among Medical Learners. Perspect Med Educ. 2024 Jun 5;13(1):336-348. https://doi.org/10.5334/pme.1152
Reviewed by Jon Gold
What was the study question?
What are medical learners’ perceptions regarding mental illness and self-disclosure of mental illness?
How was the study done?
Medical students and residents associated with any medical school in Canada were recruited through a combination of listservs from the authors’ home institutions, social media posts and snowball sampling (in which participants are invited to recruit other participants). Any student who had an experience of mental illness was eligible. Participants completed a quantitative survey that included questions about disclosure, well-being and stigma around mental illness as well as demographic variables. They were then invited to participate in a 90-minute semi-structured interview.
Quantitative data was analyzed for associations, and qualitative data (survey comments and interviews) were transcribed, coded and analyzed for themes.
What were the results?
125 learners (67 medical students, 58 residents) completed the survey. 36.3% reported having disclosed a mental illness within the learning environment; 24.7% considered disclosing a mental illness. Residents scored higher than students on scales related to negative attitudes toward mental illness (p < 0.02). Men scored higher on scales related to negative attitudes toward disclosure than women (p=0.01). Racially minoritized learners scored higher than white learners on scales related to applying stigma to oneself. (P =0.03)
12 learners completed interviews. Barriers to disclosure identified included fear of judgment or retribution. Enablers of disclosure included support from a peer or a preceptor as well as overcoming internal self stigma. Learners identified double standards in medical training toward acceptance of mental illness in doctors or learners. However, they identified positive outcomes after disclosure in terms of validation from peers and improved self-confidence and empathy.
How can I apply this to my work in education?
Despite all the recent emphasis on wellness, there is still clearly a stigma associated with mental illness among our learners. Two things that might help based on this study’s results: (1) being open and supportive of our learners if and when they report struggling with mental illness and (2) working against a culture of infallibility in doctors by disclosing our own struggles (including mental illness) when possible.
Editor’s Comments: An important and concerning finding of this study is that resident physicians demonstrate more negative attitudes towards people with mental illness and disclosing a mental illness than do medical students – suggesting that negative perceptions worsen over time and with further integration into the profession. I wonder if the transition to residency may serve as an important starting point for implementing initiatives to de-stigmatize mental illness in medicine? (KFo)
Turn your head and cough
Cappetto KD, Ehrlich B, Anderson EA, Huynh AT, Tran J, Hudon K. The benefits of undergraduate medical students delivering free preparticipation physical evaluations in collaboration with a K-12 school district. BMC Medical Education. 2024;24(1). https://dx.doi.org/10.1186/s12909-024-05806-3
Reviewed by Nicole Ferguson
What was the study question?
Could participation in a free pre-participation sports physical clinic improve the educational motivation and confidence in clinical skills of undergraduate medical student volunteers?
How was it done?
Thirty first- and second-year medical students volunteered at a free clinic where they performed pre-participation physical exams with the supervision and feedback from family medicine and pediatrics faculty. Students completed pre-volunteering and post-volunteering surveys, which included the General Self-Efficacy Scale and a 5-point Likert scale questionnaire assessing educational motivation, school engagement, clinical skills confidence, and connectedness to community. Descriptive statistics and T-test analyses were conducted.
What were the results?
Students reported statistically significant increases in their level of confidence in working with pediatric populations, communicating with patients, working in an interdisciplinary setting, and performing a standard physical exam after completing one volunteer shift. Responses also demonstrated statistically significant increases in how connected students felt to their local community and to their original reason for practicing medicine. General feedback from students found the experience valuable for practicing and improving clinical skills as well as requests for more volunteering opportunities or opportunities to interact with more patients.
How can this be applied to my work in education?
Partnerships between medical schools and local school districts can be mutually beneficial for medical students and their community. Given the current primary care shortage, timely pre-participation physical exams may be difficult for families to obtain. By providing free exams, medical schools can mitigate this barrier for students wishing to participate in school athletic activities. At the same time, this clinic model provides medical students with the opportunity to work with pediatric patients, a population which many students may not gain exposure to prior to clerkships. Establishment of similar clinic partnerships will strengthen medical students’ clinical skills while promoting a sense of self-efficacy and motivation in their studies.
Editor’s note: This is definitely a win-win for students and patients. Students receive more clinical exposure with feedback and patients can get free exams. We do have to be wary of self-ratings of confidence but the sense of community is definitely a huge positive of this study. (AP)