Abstract
Despite the growing similarities between allopathic (MD) and osteopathic (DO) medical education, few studies have examined allopathic-osteopathic collaboration. The following study focused on stereotypes and student readiness for interprofessional learning. Patient perceptions were also evaluated. Osteopathic and allopathic students were randomly allocated 1:1:1 to work in pairs (MD/DO, MD/MD, DO/DO) at the start of each shift. A questionnaire evaluating student communication was collected from patients at the end of each encounter. Surveys assessing stereotypes and interprofessional readiness were obtained from students at the end of each workday. Data collection was stopped early due to Coronavirusrelated safety measures. In the ITT analysis, there were a total of 126 participants (57 students 69 patients). A per-protocol analysis was performed to account for repeat clinic volunteers. No significant differences were detected between student pairs; however, the sensitivity analysis of the questionnaire assessing interprofessional readiness was 8 points higher in the DO/DO group compared to the MD/MD and MD/DO groups (P = 0.0503). In the content analysis of qualitative responses, the MD/DO group was more likely to respond with themes of enjoyment and less concern about stereotypes than the DO/DO group. The MD/DO group was also less likely to report concerns about differences in expectations, methods, and thinking than the MD/MD group. Early trends from this study suggest that DO students may be better positioned to engage in interprofessional learning than their MD counterparts. Additionally, the findings from our content analysis provide evidence that the collaborative experience improved feelings associated with professional legitimacy and credibility among DO students. Taken in aggregate, this study provides justification for a follow-up investigation, as well as a framework for how such studies could best be executed in the future.
Medical Education
Below are some of the articles published on topics in medicine and related to medical education.
Articles
The Human Kindness Curriculum
ABSTRACT
Background: Prior studies have shown a marked drop in empathy among students during their third (clinical) year of medical school. Curricula developed to address this problem have varied greatly in content and have not always been subjected to validated measures of impact.
Methods: In 2015, we initiated a Human Kindness (HK) curriculum for the initial 2 years of medical school. This mandatory 12‑h curriculum (6 h/year) included an innovative series of lectures and patient interactions with regard to compassion and empathy in the clinical setting. Both quantitative (Jefferson Scale of Empathy [JSE]) and qualitative data were collected prospectively to evaluate the impact of the HK curriculum. Results: In the initial Pilot Year, neither 1st (Group 1) nor 2nd (Group 2) year medical students showed pre‑post changes in JSE scores. Substantial changes were made to the curriculum based on faculty and student evaluations. In the following Implementation Year, both the new 1st (Group 3) and the now 2nd year (Group 4) students, who previously experienced the Pilot Year, showed significant improvements in post‑course JSE scores; this improvement remained valid across subanalyses of gender, age, and student career focus (e.g., internal medicine, surgery, etc.). Despite the disappointingly flat initial Pilot Year JSE scores, the 3rd year students (Group 2) who experienced only the Pilot Year of the curriculum (i.e., 2nd year students at the time of the Pilot Year) had subsequent JSE scores that did not show the typical decline associated with the clinical years. Students generally evaluated the HK curriculum positively and rated it as being important to their medical education and development as a physician. Discussion: A required preclinical curriculum focused on HK resulted in significant improvements in medical student empathy; this improvement was maintained during the 1st clinical year of training.
Keywords: Compassion, curriculum development, human kindness, Jefferson Scale of Empathy, medical education, medical humanities,
medical student empathy
Using focus groups to understand causes for morale decline after introducing change in an IM residency program
Lloyd Rucker, Johanna Shapiro, Cliff Fornwalt, Keenu Hundal, Swapna Reddy, Zarema Singson and Khanh Trieu
Background: Although program evaluation is a core requirement of Internal Medicine residencies, little is reported in the literature regarding resident satisfaction with training. Most program evaluation consists of numerical rating scales from which it is often difficult to pinpoint exact sources of dissatisfaction.
Methods: Our goal in this work is to evaluate the utility of focus group methodology to uncover in detail the reasons for residents’ deteriorating morale in an IM residency program, as well as to solicit suggestions for correction. This study employed focus groups (FG) in a qualitative research design, in which descriptive statistics from a resident program evaluation survey served to guide an intensive focus group process. Participants were 40 of 45 2nd and 3rd year internal medicine residents enrolled in the IM residency training program. Five chief residents were trained to conduct 5 focus groups with 8 residents in each group. The focus groups examined possible issues contributing to the deterioration of morale noted in the quantitative survey.
Results: Many unexpected themes were uncovered by the FGs. Residents identified the following factors as the major contributors to deteriorating morale: 1) Pace of change 2) Process of change 3) The role of chief residents in change 4) Fear of intimidation and retaliation. Groups also suggested practical recommendations for improving the culture of the residency.
Conclusion: Introducing change in residency training is a challenging process. Respectful attention to resident frustrations and solution-focused discussions are necessary to understand and improve morale. Focus groups proved to be a useful tool in revealing the precise source of pervasive resident concerns as well as providing potential solutions. In addition, FGs methodology can be adapted in a practical manner to residency evaluation.
Patient-Doctor Course
Brian S. Andrews M.B., M.D. and Johanna Shapiro, Ph.D.
A unique multidisciplinary second year medical school course, Patient-Doctor II (PD II), was established at the University of California Irvine, incorporating both clinical and non-clinical disciplines. The impetus for this course stemmed from student and faculty dissatisfaction with many isolated courses that were predominantly lecture based. The changes that have been effected include i) integration of these multiple courses into a coherent single course, ii) integration of the major basic sciences (biochemistry, pathology and pharmacology) within the course structure, iii) replacement of many formal lectures by small group discussions and peer-driven learning, with exploratory learning guided by defined objectives, iv) increased participation by students in the planning of changes in the course and v) changes in the way history taking, physical examination and clinical reasoning were taught. Since the development of PD II, there has been a marked improvement in student and faculty satisfaction, as well as a progressive increase in the scores for the USMLE (part I).
Using Focus Groups to Understand Causes for Morale Decline After Introducing Change in an IM Residency Program
Lloyd Rucker, Johanna Shapiro, Cliff Fornwalt, Keenu Hundal, Swapna Reddy, Zarema Singson and Khanh Trieu
Although program evaluation is a core requirement of Internal Medicine residencies, little is reported in the literature regarding resident satisfaction with training. Most program evaluation consists of numerical rating scales from which it is often difficult to pinpoint exact sources of dissatisfaction.
Our goal in this work is to evaluate the utility of focus group methodology to uncover in detail the reasons for residents’ deteriorating morale in an IM residency program, as well as to solicit suggestions for correction. This study employed focus groups (FG) in a qualitative research design, in which descriptive statistics from a resident program evaluation survey served to guide an intensive focus group process. Participants were 40 of 45 2nd and 3rd year internal medicine residents enrolled in the IM residency training program. Five chief residents were trained to conduct 5 focus groups with 8 residents in each group. The focus groups examined possible issues contributing to the deterioration of morale noted in the quantitative survey.
How Medical Students Think about Ethical Issues
JOHANNA SHAPIRO, PhD, and RON MILLER, MD
Many medical schools now require a course in medical ethics as part of the mandatory curriculum. Most such courses have goals of teaching students to recognize ethical issues, stimulating moral reasoning, and developing a sense of moral obligation and personal responsibility. Students generally evaluate such courses positively, and seem to appreciate their relevance to real-world medicine. However, questions remain as to whether the teaching of bioethics can make a difference in such areas as physician values, social responsibility, and the doctor-patient relationship.
Standardized Patients—Will the Questions Never End?
Using Standardized Patients to Assess Medical Students’ Professionalism
MICHAEL D. PRISLIN, DE´SIRE´E LIE, JOHANNA SHAPIRO, JOHN BOKER, and STEPHEN RADECKI
This study examines the utility of standardized patient-based assessments of professional characteristics. Comparisons are made with other measures of professionalism, such as faculty evaluation, performance on a written self-reflective exercise, and student-reported participation in community service activities.
Using Standardized Patients to Assess Medical Students’ Professionalism.
Prislin, M D, Lie, D, Shapiro, J, Boker, J, Radecki, S
The subject of professionalism is currently engendering great interest within the medical education community. Concern exists that conditions within the health care delivery environment threaten established standards of professional behavior, and, perhaps more insidiously, that the medical education experience itself may be negatively influencing the development of physicians’ professionalism. As a consequence, much energy has recently been directed toward defining competencies that reflect professionalism and in creating corresponding curricula that will foster learning in this domain.
However, having instruments that can accurately measure the attainment of professionalism remains an elusive goal. This study examines the utility of standardized patient-based assessments of professional characteristics. Comparisons are made with other measures of professionalism, such as faculty evaluation, performance on a written self-reflective exercise, and student-reported participation in community service activities.
Willingness to Treat HIV-Positive Patients at Different Stages of Medical Education and Experience
STEPHEN RADECKI, Ph.D., JOHANNA SHAPIRO, Ph.D., LAURI D. THRUPP, M.D., SABINA MALIK GANDHI, MSIV, SUMANDEEP S. SANGHA, PGYI, and RONALD B. MILLER, M.D.
The willingness of physicians to provide care to HIV-positive patients has been linked to a number of attitudinal factors, but little is known concerning the impact of premedical, medical, and residency training on these factors. The purpose of this study is to elicit responses to the same series of questions concerning HIV and its treatment from respondents at different stages of training, to detect trends in attitudes and to measure the impact of those attitudes on willingness to provide care for HIV/AIDS patients. Study data come from a cross-sectional survey in = 249) of respondents across the training continuum, from premedical students to faculty physicians, using a self-administered questionnaire at a single medical school. The response rate was 59.6%. The study showed significant decreases in personal fear and misgivings concerning HIV, coupled with a substantial decrease in the perceived need for testing of non-high-risk individuals, as respondents gained additional education and training.
Teaching the Art of Doctoring: An Innovative Medical Student Elective
JOHANNA SHAPIRO, LLOYD RUCKER & DANIEL ROBITSHEK
Medical educators often express concern at the tarnishing of medical students’ idealism and optimism during their clinical years (Marcus, 1999). Students themselves share these apprehensions (Lu, 1995), and research documents increased distress and cynicism (Newton et al., 2000; Hojat et al., 2002) as well as a deterioration in key communication skills (Prislin et al., 2000) and a plateauing of moral development (Branch, 2000). Although some observers report a ‘rebound effect’ in the fourth year of training, in general the rise of pessimism, disillusionment and burnout among medical students as they proceed through training is cause for concern.