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Objective: Psychiatry clerkship training involves many learning components, one of which is acquisition of scholarly knowledge. The authors investigate the reading materials and learning methods used by clinical clerks in their preparation for the National Board of Medical Examiners (NBME) Psychiatry Subject Exam (PSE). Methods: Clerkship students from six U.S. medical schools who had recently completed their psychiatry clerkship and PSE were surveyed regarding reading material use, teaching methods encountered, and other relevant resources which may have influenced their PSE scores. Results: The most frequently used PSE preparation material was a "step-or-prep" book, followed by practice questions, handouts, and assigned texts. No single preparation material type or combination proved significantly different in influencing PSE scores. The didactic methods used in clerkships did differ significantly in their influence on PSE scores. Students in the top quartile used slightly more books and different combinations of books than students in the bottom quartile. Conclusion: Students exhibited several trends in their preparation for the PSE. The most striking findings were the heavy student reliance on step-or-prep books over other learning resources and that step-or-prep books did not demonstrate significance as a superior preparation resource for the PSE. These trends in third-year psychiatric rotations have important implications for medical student education.

In contrast to traditional courses, in which students are accountable only to the instructor, effective implementation of any group-based instructional format, including team-based learning (TBL), requires that students be accountable to both the instructor and their peers. Unfortunately, some instructors resist using groups because of concerns about using peer evaluations or poorly designed group assignments and grading systems that in effect reward and encourage social loafing. With TBL, however, these concerns are largely eliminated by using a comprehensive feedback and grading system that ensures individual student accountability to both the instructor and peers by using a grading system that has an individual performance component, a team performance component, and a peer evaluation component. Peer assessment and evaluation are essential elements of TBL for two reasons. First, peer assessment provides formative (process) information to help individual students improve team performance over time and develop the interpersonal and team skills essential for their future success. Second, peer evaluation scores provide summative (outcome) data to the instructor that can be used to ensure fairness in grading by incorporating an assessment of each member's contributions to the success of their teams and make judgments about it. This chapter discusses the pedagogical merits of peer assessment and evaluation as mechanisms for enhancing student accountability and presents the instructional guidelines, issues, and considerations for use in the TBL classroom. It concludes with a brief description of peer assessment methods and information about how to access and use the corresponding forms.

Objective: The authors performed this study to determine whether clerkship peer evaluations, initiated as part of our "team-based learning" curriculum in 2002, correlated with other student performance measures, and to determine what qualities students rate in their peer evaluations. Method: The authors correlated peer evaluation scores with other student performance measures and performed a qualitative examination of student comments to assess reasons students gave for giving high and low scores. Results: Peer evaluation scores correlated modestly with the National Board of Medical Examiners' (NBME) subject test, in-class quiz, and clinical scores. Qualitative comments demonstrated that students made assessments based on three thematic areas: personal attributes, team contributions, and cognitive abilities. Conclusions: Peers' evaluation scores modestly predict which students will perform well on other measures. However, there may be other qualities that are also important factors in peer evaluation. For example, most students value qualities of preparation and participation. Though students sometimes dislike peer evaluations, their assessments may enhance traditional course assessments and complement a comprehensive evaluation strategy.

Objective: Finding time to teach psychiatry has become increasingly difficult. Concurrently, changes in medical student education are elevating demands for teaching. Academic psychiatry is challenged by these pressures to find innovative ways to recruit, retain, and reward faculty for teaching efforts. To address this challenge, the authors recommend a multifactorial approach to meeting the medical student educational mission of psychiatry departments. Methods: This approach includes a variety of efforts including having Chairs serve as role models, enforcing the service requirements of volunteer faculty, expanding teaching venues, providing faculty development, elevating the status of teaching through academies, attending to promotion of faculty educators, establishing and nominating faculty for teaching awards, and using medical center resources to provide rewards for teachers. Conclusion: Academic leaders must acknowledge the inherent value of teaching to the academic enterprise and delegate sufficient resources to recruit, retain, and reward educators for the essential work that they perform.

OBJECTIVE: The authors explored psychiatry clerkship usage of the National Board of Medical Examiners (NBME) Subject Test. METHODS: U.S. and Canadian psychiatry clerkship directors (N=150) were sent an 18-item questionnaire surveying evaluation and remediation practices. RESULTS: Of 111 questionnaires (74%) returned, 76 (69%) reported using the NBME Subject Test. As part of the overall grade, the test was granted a mean weight of 31% and a median weight of 25%. Of 72 clerkship directors who use the test for grading, 42% convert the percentile score and 38% convert the subject score. Of 60 clerkship directors who use the test for passing, 72% convert the raw score (mean=58.3, median=58), and 28% convert the percentile score (mean=12.2th, median=11th percentile). CONCLUSIONS: Most psychiatry clerkship directors use the NBME Subject Test, but no predominant method exists for weighing the test or converting it into a grade.

OBJECTIVE: The authors explored the time that is currently devoted to psychiatry clerkships to determine whether "shortened" clerkships differ in course director satisfaction and evaluation strategies. METHOD: An 18-item questionnaire was sent to 150 U.S. and Canadian clerkship directors. RESULTS: The return rate was 74% (111 questionnaires). Clerkship length ranged from 4 to 8 weeks, with 6 weeks being most common (49.5% of clerkships). Only 18.9% had clerkships lasting 8 full weeks. Shorter clerkships were more likely to rely on the NBME subject test, and less likely to rely on Objective Standardized Clinical Examinations (OSCEs) or oral examinations. Most clerkship directors (81.9%) felt their evaluation procedures reflected their clerkship objectives. Among those who did not or were not sure, a majority (77.7%) felt having too few weeks was among the causes, except for 8-week clerkship directors, who did not mention clerkship length as an issue. CONCLUSIONS: The number of clerkships having 2 full months devoted to psychiatry has decreased in recent years. Shorter clerkships rely heavily on the National Board of Medical Examiners (NBME) Subject Examination as an evaluation tool, testing for book knowledge rather than clinical skills.

Objective: To assess depression rates in contemporary medical students. Method: The Beck Depression Inventory (BDI) was administered anonymously to two medical school classes at matriculation, the end of first year, and the end of second year. Results: Median scores for both classes were low at all points. The proportion of students scoring in the moderate or severely depressed range increased from 5.8% at matriculation to 10.5% by end of Year 2 for the Class of 2004, and from 5.1% to 11.9% over the same time period for the Class of 2005. Overall, 75-83% of students at every administration scored in the lowest BDI score range. Conclusions: The percentage of medical students who experience depressed mood increased over time, but to a lesser degree than in previous studies.

Construct: We sought to evaluate the quality of Team-Based Learning facilitation in both large and small group settings. Background: Team Based Learning (TBL) is an increasingly popular small group instructional strategy in health science education. TBL facilitation skills are unique and differ from those needed to lecture or facilitate other types of small groups. Measuring facilitation skills and providing feedback to TBL instructors is important, yet to date no valid instrument has been developed and published for this purpose. Approach: We created an 11-item instrument (ratings of each item on a 7-point scale) designed to assess TBL facilitation skills, considering major sources of validity. Twelve experts in TBL facilitation and training developed the content of the FIT. To ensure response processes were valid, we used an immediate retrospective probing technique with 4th year medical students who were not part of the study. The Facilitator Instrument for Team-Based Learning (FIT) was piloted with 2,840 medical students in 7 schools in large (year 1 and 2) and small (year 3) courses. The internal structure of the FIT was analyzed. Results: In total, 1,559 and 1,281 medical students in large and small TBL classes, respectively (response rate 88%) rated 33 TBL facilitators. The composite mean score for the FIT was 6.19 (SD = 1.10). Exploratory factor analysis and Cronbach's alpha indicated that all items loaded on 1 factor, accounting for 77% of the item variance. Cronbach's alpha for the 11 items was 0.97. Analysis of facilitator variables and course context indicated that FIT scores were statistically significantly correlated with type of class (pre-clinical or clinical) and size of class as well as the facilitator enjoyment in using TBL as a method. Gender and the amount that facilitators used TBL each year was weakly correlated, with other factors not correlated (years facilitating TBL, confidence in facilitating TBL, and age). Conclusions: Analysis of FIT scores from 2,840 medical students across multiple institutions and teaching settings suggests the utility of the FIT in determining the quality of TBL facilitation across a range of medical education settings. Future research is needed to further analyze course contexts and facilitator variables that may influence FIT scores with additional facilitators. Additionally, FIT scores should be correlated with additional measures of TBL facilitator quality, such as direct observations, especially if these data are used for summative decision-making purposes. [ABSTRACT FROM AUTHOR]

Phenomenon: Studies of high-stakes collaborative testing remain sparse, especially in medical education. We explored high-stakes collaborative testing in medical education, looking specifically at the experiences of students in established and newly formed teams. Approach: Third-year psychiatry students at 5 medical schools across 6 sites participated, with 4 participating as established team sites and 2 as comparison team sites. For the collaborative test, we used the National Board of Medical Examiners Psychiatry subject test, administering it via a 2-stage process. Students at all sites were randomly selected to participate in a focus group, with 8-10 students per site (N = 49). We also examined quantitative data for additional triangulation. Findings: Students described a range of heightened emotions around the collaborative test yet perceived it as valuable regardless if they were in established or newly formed teams. Students described learning about the subject matter, themselves, others, and interpersonal dynamics during collaborative testing. Triangulation of these results via quantitative data supported these themes. Insights: Despite student concerns, high-stakes collaborative tests may be both valuable and feasible. The data suggest that high-stakes tests (tests of learning or summative evaluation) could also become tests for learning or formative evaluation. The paucity of research into this methodology in medical education suggests more research is needed. [ABSTRACT FROM AUTHOR]

The 32nd Annual Meeting of the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) was held June 22nd to June 24th 2006, in Annapolis, Maryland. Approximately 100 registrants from 80 medical schools were in attendance. Plenary sessions, workshops, and posters covered a wide range of educational topics, including issues of professionalism, the challenge of mentoring residents to become teachers, and analyses of psychiatric OSCE cases at various points in the curriculum. Dr. Geoffrey Norman, Canada Research Chair in Cognitive Dimensions of Clinical Expertise at McMaster University, offered the keynote address titled, "Beyond Problem-Based Learning." In his talk, he argued that the concepts of problem-based learning (PBL) tend to be learned in unsystematic order, which makes it difficult for students to truly learn and understand new material. He suggested that successful transfer of concepts to new problems requires learning from multiple problems. In his talk, he outlined the new curriculum that is being advanced at McMaster (called the COMPASS Curriculum) based on these derived principles of learning and showed how it promised to be superior to "traditional" PBL. More information about the curriculum can be obtained from http://65.39.131.180/ContentPage.aspx?name=COMPASS%20 Home. The 11 abstracts in these proceedings were chosen for their general appeal to medical student educators and because they represent the educational research undertaken by ADMSEP members and colleagues. Included are two task force reports to illustrate the organization's efforts in meeting LCME requirements and a renewed attention to update resources for meeting clinical objectives. The ADMSEP Objectives Taskforce abstract reflects the interspecialty fertilization that underlies ACE. Also included are abstracts from a student study about doctor—patient boundaries and about webbased applications for facilitating administrative responsibilities to a survey of attitudes about who should teach about sexual dysfunction. To appreciate the breadth of topics covered at the meeting, the reader is referred to the full program on the "Meetings" pages of the ADMSEP Web site, www.admsep.org. [ABSTRACT FROM AUTHOR]

This cross-sectional study compared the distribution of anxiety symptoms among pregnant, non-pregnant, and postpartum women of lower socioeconomic status. Participants were 807 women who were pregnant (24-36 weeks), postpartum (2-8 weeks), or not pregnant. Anxiety and depressive symptoms were assessed by the state-trait anxiety index and the Beck depression inventory, respectively. English and Spanish versions of the instrument were available. Group differences in anxiety were evaluated using analysis of variance. Multivariate regression was performed to evaluate differences in anxiety while controlling for marital status, education, race/ethnicity, employment, cohabitation, income, parity, history of depression/anxiety, and depressive symptoms. Anxiety scores were lower among postpartum women relative to pregnant and non-pregnant women (both P < 0.001), who did not differ (P = 0.99). After controlling for depressive symptoms and patient characteristics, anxiety remained lowest among postpartum women. Additionally, history of depression/anxiety and depressive symptoms were significant predictors of anxiety in the multivariate analysis. Comparatively low anxiety and depressive symptoms were observed among women who were 2-8 weeks postpartum. Anxiety symptoms that occur postpartum may not appear until later in the postpartum period. [ABSTRACT FROM AUTHOR]

Background: Team learning, an innovative educational method combining interactive small group learning with expert-based content delivery, was introduced into our psychiatry clerkship in 2002. The main goal was to increase classroom engagement and improve educational outcomes. Description: Eight of 16 lectures were replaced with team learning activities, including prerequisite readings, readiness assurance tests, and application exercises. Data on students 'performance and educational experiences were compared before and after curricular change. Evaluation: Following implementation of team learning, students performed significantly better on the National Board of Medical Examiners (NBME) psychiatry subject test and scored higher on attitudes about working in teams. Students perceived team learning activities to be more engaging, effective, and enjoyable than conventional didactics. Conclusion: Incorporating team learning into the psychiatry clerkship was associated with improved student performance and increased student engagement and satisfaction. Team learning is a promising educational strategy that may prove useful in other clerkships. [ABSTRACT FROM AUTHOR]

The editorial by Jeremy Shiffman, "Knowledge, moral claims and the exercise of power in global health", highlights the influence on global health priority-setting of individuals and organizations that do not have a formal political mandate. This sheds light on the way key functions in global health depend on private funding, particularly from the Bill & Melinda Gates Foundation. [ABSTRACT FROM AUTHOR]

Explores the relationship between hypnotist and subject focusing on issues of power and control. Examining the unique dynamics accompanying the use of hypnosis and their impact on the therapeutic dyad; Evidence demonstrating the power differential; Implications for training therapists in the use of hypnosis.

The authors discuss multi-source feedback (MSF), a method of evaluating the performance of teams at an individual level and provide their thoughts on its application to training physicians. They suggest that training physicians to engage in MSF during early career development can have positive impacts on the individual's ability to give and receive feedback as well as function in a team setting.

Background: Measurement of the quality of team processes in medical education, particularly in classroom-based teaching settings, has been limited by a lack of measurement instruments. Therefore, the purpose of this study was to develop and test an instrument to measure the quality of team interactions., Method: The authors created 30 items and reduced these to 18 items using factor analysis. They distributed the scale to 309 second-year medical students (RR = 95%) in a course that used teams and measured internal consistency, validity, and differences in scores between teams., Results: Cronbach's alpha for the scale was 0.97. Team ratings were variable, with a mean score of 95.7 (SD 8.5) out of 108. Team Performance Scale (TPS) scores correlated inversely with the spread of peer evaluation scores (r = -0.38, P = .003). Differences between teams were statistically significant (P < .001, eta = 0.33)., Conclusions: The TPS was short, had evidence of reliability and validity, and exhibited the capacity to distinguish between teams. This instrument can provide a measure of the quality of team interactions. More work is needed to provide further evidence of validity and generalizability.