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David W Musick,1 R Brock Mutcheson,2 David B Trinkle2 1Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; 2Department of Health System and Implementation Sciences, Virginia Tech Carilion School of Medicine, Roanoke, VA, USACorrespondence: David W Musick, Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA, 24016, USA, Tel +1 540 526-2566, Fax +1 540 581-0741, Email dwmusick@vt.eduBackground and Purpose: Health system science (HSS) has been described as the third pillar of medical education. We introduced a new health system science and interprofessional practice (HSSIP) curriculum, and measured students’ HSS knowledge and attitudes concerning health system citizenship.Methods: This pilot study involved first-year (M1) and fourth-year (M4) medical students in two cohorts across 2 years. Only M1 students in the second cohort participated in the new HSSIP curriculum. We compared student performance on a new National Board of Medical Examiners (NBME) HSS subject exam, and student attitudes toward system citizenship via a new attitudinal survey.Results: Fifty-six eligible fourth-year students (68%) and 70 (76%) study eligible first-year students participated in the study. NBME HSS exam performance by M4 students was statistically significantly higher than M1 students for both cohorts, with moderate to large effect sizes. Exam performance for M1 students not experiencing the HSS curriculum was higher than for M1 students who received HSS curricular content. Attitudes toward HSS by M4 versus M1 students were statistically significantly different on several survey items with moderate effect sizes. Scale internal consistency for the HSS attitude survey was strong (0.83 or higher).Discussion: There were differences among M4 and M1 medical students concerning knowledge of and attitudes toward HSS, with performance on the NBME subject exam similar to a national sample. Exam performance by M1 students was likely impacted by class size and other factors. Our results support the need for increased attention to HSS during medical education. Our health system citizenship survey has potential for further development and cross-institutional collaboration.Keywords: health systems science, medical education

Shala Cunningham,1 David W Musick,2 David B Trinkle3 1Doctor of Physical Therapy Program, Radford University Carilion, Roanoke, VA, USA; 2Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; 3Department of Interprofessionalism, Virginia Tech Carilion School of Medicine, Roanoke, VA, USACorrespondence: David W Musickc/o Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA, 24016, USATel +1 540 562-2566Email dwmusick@vt.eduBackground and Purpose: There is limited training for healthcare students in the performance of telephone consultations. To facilitate communication between healthcare professionals when face-to-face interactions are not possible, a telephone consultation simulation was developed. The simulation involved students in a doctor of physical therapy program and senior medical students. This study aimed to explore the development and suitability of a simulated case with a focus on interprofessional telephone consultation.Methods: A convenience sample of 28 physical therapy students and 38 medical students from two institutions in southwest Virginia participated in the simulation experience. To assess the outcomes of the simulation on interprofessional communication, the IPASS verbal handoff assessment was performed by the participants and focus group interviews occurred immediately following the experience. In addition, an assessment of key information provided during the conversation was performed for each of the seven interprofessional groups.Results: Students demonstrated near perfect agreement on the IPASS assessment. Five of the seven interprofessional groups perceived that they were able to communicate key information and collectively agree upon a recommendation for the continuation of the patient assessment. The two groups that demonstrated more difficulty with communication appeared to struggle with communicating the patient’s past medical history relevant to the current situation, despite the majority of students feeling confident in their communications. In addition, two themes were presented during the interprofessional focus group interviews: 1) clear communication to maintain patient safety and 2) efficiently conveying the patient’s background.Discussion: The health professions students participating in the scenario were able to consistently note the communication skills observed and reflect upon the need for clear communication between providers during a patient consultation. Key components of an efficient telephone consultation were identified, along with opportunities to improve this type of interaction between health professionals.Keywords: telephone medicine, interprofessional education, interprofessional clinical consultation, communication skills

Background: Little is known about medical school requirements for faculty development related to teaching (FDT) in medical education. This study examined the national landscape and local faculty perceptions of their own institution's FDT requirement., Methods: An electronic survey was disseminated to Faculty Affairs Offices in US medical schools to assess FDT requirements. A second survey was distributed to faculty within one medical school to gauge faculty perceptions related to existing FDT requirements., Results: Responses were received from approximately 33% of US medical schools and 36% of local faculty. Few responding medical schools had formal FDT requirements. There was a wide range variation of hours and activities necessary to satisfy existing requirements and consequences for noncompliance. For respondents from schools that did not have a requirement, many saw value in considering a future requirement. Many local faculty agreed that the FDT requirement improved their teaching skills. When asked to share other thoughts about the FDT requirement, several qualitative themes emerged., Conclusion: This study helps establish a national benchmark for the status of FDT requirements in medical education and revealed information on how to optimize and/or improve such requirements. The authors offer five recommendations for schools to consider regarding FDT., Competing Interests: Disclosures: The authors declare no conflict of interest., (Copyright © 2024 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education, and the Society for Academic Continuing Medical Education.)

Study Design: Clinical trial., Objective: To demonstrate that a 12-week exoskeleton-based robotic gait training regimen can lead to a clinically meaningful improvement in independent gait speed, in community-dwelling participants with chronic incomplete spinal cord injury (iSCI)., Setting: Outpatient rehabilitation or research institute., Methods: Multi-site (United States), randomized, controlled trial, comparing exoskeleton gait training (12 weeks, 36 sessions) with standard gait training or no gait training (2:2:1 randomization) in chronic iSCI (>1 year post injury, AIS-C, and D), with residual stepping ability. The primary outcome measure was change in robot-independent gait speed (10-meter walk test, 10MWT) post 12-week intervention. Secondary outcomes included: Timed-Up-and-Go (TUG), 6-min walk test (6MWT), Walking Index for Spinal Cord Injury (WISCI-II) (assistance and devices), and treating therapist NASA-Task Load Index., Results: Twenty-five participants completed the assessments and training as assigned (9 Ekso, 10 Active Control, 6 Passive Control). Mean change in gait speed at the primary endpoint was not statistically significant. The proportion of participants with improvement in clinical ambulation category from home to community speed post-intervention was greatest in the Ekso group (>1/2 Ekso, 1/3 Active Control, 0 Passive Control, p < 0.05). Improvements in secondary outcome measures were not significant., Conclusions: Twelve weeks of exoskeleton robotic training in chronic SCI participants with independent stepping ability at baseline can improve clinical ambulatory status. Improvements in raw gait speed were not statistically significant at the group level, which may guide future trials for participant inclusion criteria. While generally safe and tolerable, larger gains in ambulation might be associated with higher risk for non-serious adverse events., (© 2022. The Author(s).)

Objectives: There has been significant discussion about the quality of burnout research, especially with regard to abbreviated measurements of burnout and/or well-being. The purpose of this study was to compare a single-item, investigator-developed question measuring perceived well-being with validated multi-item measures of burnout and well-being., Methods: Between 2016 and 2017, healthcare professionals and medical students at a large academic hospital system were sent an online survey measuring the risk of burnout (Maslach Burnout Inventory), well-being (Physician or Nurse Well-Being Self-Assessment Tool), and perception of personal well-being (Burnout-Thriving Index [BTI], an investigator-developed, single-item measure). Analyses included linear and multiple regression and Pearson correlations., Results: The study sample included 1365 medical students, frontline nurses, resident physicians, supervising physicians or fellows, and advanced care practitioners. There were significant differences in all Maslach Burnout Inventory and Physician or Nurse Well-Being Self-Assessment Tool subscale scores based on BTI score (all P < 0.001). Adjusted R 2 ranged from 0.066 (religiospiritual wellness) to 0.343 (emotional exhaustion). BTI had a stronger relation with personal accomplishment in medical students compared with nurses ( P = 0.049) and a stronger relation with psychoemotional wellness in physicians and physicians-in-training compared with nurses ( P < 0.05). A low BTI score demonstrated >80% sensitivity for high emotional exhaustion, depersonalization, and low personal accomplishment., Conclusions: The BTI may be used to screen for individuals who could benefit from completing a full burnout assessment and may be used to collect a quick "big picture" impression of burnout and well-being at a healthcare institution. Further research is needed to compare BTI score with known consequences of burnout and to explore differences in the relation between BTI score and psychoemotional wellness in different professional groups.

Introduction: Assessment of medical students' knowledge in clinical settings is complex yet essential to the learning process. Clinical clerkships use various types of written examinations to objectively test medical knowledge within a given discipline. Within emergency medicine (EM), a new national standardized exam was developed to test medical knowledge in this specialty. Evaluation of the psychometric properties of a new examination is an important issue to address during test development and use. Studies have shown that student performance on selected standardized exams will reveal students' strengths and/or weaknesses, so that effective remedial efforts can be implemented. Our study sought to address these issues by examining the association of scores on the new EM national exam with other standardized exam scores., Methods: From August 2011 to April 2013, average National EM M4 examination scores of fourth-year medical students taken at the end of a required EM clerkship were compiled. We examined the correlation of the National EM M4 examination with the scores of initial attempts of the United States Medical Licensing Exam (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) examinations. Correlation coefficients and 95% confidence intervals of correlation coefficients are reported. We also examined the association between the national EM M4 examination score, final grades for the EM rotation, and USMLE Step 1 and Step 2 CK scores., Results: 133 students were included in the study and achieved a mean score of 79.5 SD 8.0 on the National EM M4 exam compared to a national mean of 79.7 SD 3.89. The mean USMLE Step 1 score was 226.8 SD 19.3. The mean USMLE Step 2 CK score was 238.5 SD 18.9. National EM M4 examination scores showed moderate correlation with both USMLE Step 1 (mean score=226.8; correlation coefficient=0.50; 95% CI [0.28-0.67]) and USMLE Step 2 CK (mean score=238.5; correlation coefficient=0.47; 95% CI [0.25-0.65]). Students scoring below the median on the national EM M4 exam also scored well below their colleagues on USMLE exams., Conclusion: The moderate correlation of the national EM M4 examination and USMLE Step 1 and Step 2 CK scores provides support for the utilization of the CDEM National EM M4 examination as an effective means of assessing medical knowledge for fourth-year medical students. Identification of students scoring lower on standardized exams allows for effective remedial efforts to be undertaken throughout the medical education process.

Hospital chaplaincy and spiritual care services are important to patients' medical care and well-being; however, little is known about healthcare providers' experiences receiving spiritual support. A phenomenological study examined the shared experience of spiritual care between hospital chaplains and hospital-based healthcare providers (HBHPs). Six distinct themes emerged from the in-depth interviews: Awareness of chaplain availability, chaplains focus on building relationships with providers and staff, chaplains are integrated in varying degrees on certain hospital units, chaplains meet providers' personal and professional needs, providers appreciate chaplains, and barriers to expanding hospital chaplains' services. While HBHPs appreciated the care received and were able to provide better patient care as a result, participants reported that administrators may not recognize the true value of the care provided. Implications from this study are applied to hospital chaplaincy clinical, research, and training opportunities.

Unlabelled: CGEA 2015 CONFERENCE ABSTRACT (EDITED). A Novel Approach to Assessing Professionalism in Preclinical Medical Students Using Paired Self- and Peer Evaluations. Amanda R. Emke, Steven Cheng, and Carolyn Dufault. CONSTRUCT: This study sought to assess the professionalism of 2nd-year medical students in the context of team-based learning., Background: Professionalism is an important attribute for physicians and a core competency throughout medical education. Preclinical training often focuses on individual knowledge acquisition with students working only indirectly with faculty assessors. As such, the assessment of professionalism in preclinical training continues to present challenges. We propose a novel approach to preclinical assessment of medical student professionalism to address these challenges., Approach: Second-year medical students completed self- and peer assessments of professionalism in two courses (Pediatrics and Renal/Genitourinary Diseases) following a series of team-based learning exercises. Assessments were composed of nearly identical 9-point rating scales. Correlational analysis and linear regression were used to examine the associations between self- and peer assessments and the effects of predictor variables. Four subgroups were formed based on deviation from the median ratings, and logistic regression was used to assess stability of subgroup membership over time. A missing data analysis was conducted to examine differences between average peer-assessment scores as a function of selective nonparticipation., Results: There was a significant positive correlation (r = .62, p < .0001) between self-assessments completed alone and those completed at the time of peer assessment. There was also a significant positive correlation between average peer-assessment and self-assessment alone (r = .19, p < .0002) and self-assessment at the time of peer assessment (r = .27, p < .0001). Logistic regression revealed that subgroup membership was stable across measurement at two time points (T1 and T2) for all groups, except for members of the high self-assessment/low peer assessment at T1, who were significantly more likely to move to a new group at T2, χ(2)(3, N = 129) = 7.80, p < .05. Linear regression revealed that self-assessment alone and course were significant predictors of self-assessment at the time of peer assessment (Fself&#95;alone = 144.74, p < .01 and Fcourse = 4.70, p < .05), whereas average peer rating, stage (T1, T2) and academic year (13-14, 14-15) were not. Linear regression also revealed that students who completed both self-assessments had significantly higher average peer assessment ratings (average peer rating in students with both self-assessments = 8.42, no self-assessments = 8.10, self&#95;at&#95;peer = 8.37, self&#95;alone = 8.28) compared to students who completed one or no self-assessments (F = 5.34, p < .01)., Conclusions: When used as a professionalism assessment within team-based learning, stand-alone and simultaneous peer and self-assessments are highly correlated within individuals across different courses. However, although self-assessment alone is a significant predictor of self-assessment made at the time of assessing one's peers, average peer assessment does not predict self-assessment. To explore this lack of predictive power, we classified students into four subgroups based on relative deviation from median peer and self-assessment scores. Group membership was found to be stable for all groups except for those initially sorted into the high self-assessment/low peer assessment subgroup. Members of this subgroup tended to move into the low self-assessment/low peer assessment group at T2, suggesting they became more accurate at self-assessing over time. A small group of individuals remained in the group that consistently rated themselves highly while their peers rated them poorly. Future studies will track these students to see if similar deviations from accurate professional self-assessment persist into the clinical years. In addition, given that students who fail to perform self-assessments had significantly lower peer assessment scores than their counterparts who completed self-assessments in this study, these students may also be at risk for similar professionalism concerns in the clinical years; follow-up studies will examine this possibility.

Background: Professionalism has been an important tenet of medical education, yet defining it is a challenge. Perceptions of professional behavior may vary by individual, medical specialty, demographic group and institution. Understanding these differences should help institutions better clarify professionalism expectations and provide standards with which to evaluate resident behavior., Methods: Duke University Hospital and Vidant Medical Center/East Carolina University surveyed entering PGY1 residents. Residents were queried on two issues: their perception of the professionalism of 46 specific behaviors related to training and patient care; and their own participation in those specified behaviors. The study reports data analyses for gender and institution based upon survey results in 2009 and 2010. The study received approval by the Institutional Review Boards of both institutions., Results: 76% (375) of 495 PGY1 residents surveyed in 2009 and 2010 responded. A majority of responders rated all 46 specified behaviors as unprofessional, and a majority had either observed or participated in each behavior. For all 46 behaviors, a greater percentage of women rated the behaviors as unprofessional. Men were more likely than women to have participated in behaviors. There were several significant differences in both the perceptions of specified behaviors and in self-reported observation of and/or involvement in those behaviors between institutions.Respondents indicated the most important professionalism issues relevant to medical practice include: respect for colleagues/patients, relationships with pharmaceutical companies, balancing home/work life, and admitting mistakes. They reported that professionalism can best be assessed by peers, patients, observation of non-medical work and timeliness/detail of paperwork., Conclusion: Defining professionalism in measurable terms is a challenge yet critical in order for it to be taught and assessed. Recognition of the differences by gender and institution should allow for tailored teaching and assessment of professionalism so that it is most meaningful. A shared understanding of what constitutes professional behavior is an important first step.

Residency training in physical medicine and rehabilitation may not contain a formal curriculum in geriatric patient care. A multidimensional geriatric curriculum to third and fourth year physical medicine and rehabilitation residents was implemented to enhance their knowledge in and attitude toward geriatrics. The curriculum consisted of a 12-wk clinical rotation at various sites of geriatric care including outpatient geriatric clinic, skilled nursing facility, continuing care retirement community, and home visits. Six online self-learning modules and multiple didactic sessions were also created. The residents' knowledge and attitude were assessed by pretest and posttest design using the Geriatric Knowledge Test, the Geriatric Attitude Scale, and the Attitudes Toward Teamwork in Healthcare Scale. In addition, the residents completed rotation evaluations to rate their learning experiences. Ten postgraduate year 3 and 4 physical medicine and rehabilitation residents participated in the geriatric curriculum, which included a required rotation. The Geriatric Knowledge Test score at baseline was 67.2%. With the completion of the curriculum, the Geriatric Knowledge Test scores showed improvement to 72.7%, although not statistically significant. The residents showed more favorable attitudes toward the geriatric population and interdisciplinary teamwork as measured by the Geriatric Attitude Scale and the Attitudes Toward Teamwork in Healthcare Scale. Overall, they rated the learning experiences highly on a 1-9 rating scale, with 9 being the highest rating; the residents assigned an average rating of 7.06 to specific learning activities within the rotation and an average rating of 6.89 to the organizational aspects of the rotation itself. The implementation of this geriatric curriculum allowed for improved geriatric training in physical medicine and rehabilitation residents.

This study evaluated the impact of a 2-wk required rotation in Physical Medicine and Rehabilitation (PM&R) on fourth-year medical students' knowledge of PM&R and attitude toward teamwork in patient care. Survey results on attitudes toward a team approach to patient care and knowledge in PM&R were compared prerotation and postrotation. One hundred thirty-eight fourth-year medical students participated in this 2-yr study. The combined response rates for the attitude and knowledge surveys were 62% and 56%, respectively. As measured by a pretest and posttest self-reported knowledge assessment, the rotation increased knowledge of PM&R (P ≤ 0.05). Four aspects of the rotation that were rated higher by students from the second year of the rotation were role and responsibility definition, incorporation of current literature, enhancement of clinical skills, and general rotation satisfaction. The rotation provides an experience for medical students to increase their knowledge of PM&R.

Purpose: This study sought to examine an inpatient consultation service delivery system at an academic teaching hospital., Method: Descriptive; retrospective; exploratory. Data from a 33 month period were analysed. Demographic profiles of patients receiving consultation were examined. A comparison was also made between alternate methods of delivering physiatric consultation., Results: Only 80% of patients admitted to a teaching hospital during the study period received consultation. Referrals increased by 75% with the institution of a full-time consultation practice model., Conclusions: The utilization of an inpatient consultation service appears to be dependent upon the service delivery format. Further studies are needed to understand referral patterns and specific challenges to consultation services in an academic setting. Future research should focus on comparing clinical outcomes for patients in diagnostic categories who do and do not receive physiatric consultation.

Typically, protection of human subjects is a shared responsibility involving the local institutional review board (IRB) and the clinical investigator, guided by federal and state law as well as local organizational policy. The IRB screens protocols to ensure subjects' safety by making sure that risks are acceptable and do not outweigh benefits. However, the recruitment of subjects, as well as obtaining consent, is the principal investigator's responsibility. Through the process of informed consent, the clinical investigator is obliged to ensure that each subject understands all treatments proposed and their potential benefits and risks. Achieving truly informed consent from people with major developmental, physical, sensory, communicative, or cognitive disabilities may be particularly difficult. Spurred on by increasing research of relevance to rehabilitation medicine and the patients served, we review legal, ethical, and moral issues surrounding the processes of obtaining informed consent and offer specific recommendations for protecting people with disabilities., (Copyright 2001 by the American Congress of Rehabilitation Medicine)

Background: Problem-based learning (PBL) in medical education has enjoyed widespread acceptance in recent years, particularly in the basic sciences. However, it has been used less frequently in the clinical education of medical students, and quite infrequently in medical student education on anesthesiology. Critics of PBL emphasize cost factors and a lack of evidence of superior educational outcomes., Methods: This study reports evaluation data on the use of PBL with fourth year medical students who rotated through a required clerkship in clinical anesthesiology and pharmacology over the course of three academic years. Students were asked to complete evaluation questionnaires concerning the clerkship, with particular attention to PBL and the performance of PBL preceptors. Preceptors were also asked to self-rate their performance by using identical questionnaires. Standardized items across all three years facilitated analysis of student and faculty satisfaction as one outcome of the PBL process., Results: Results indicate that student response to PBL was mixed. Students rated PBL preceptors more favorably than the PBL process itself, and rated resident physician preceptors more favorably than attending physician preceptors. All preceptors rated their own performance lower than did their students. Significant differences between student and faculty opinion of PBL were also noted. Interpretation of results are limited by less than ideal response rates; nevertheless, valuable insight was gained into the perception of PBL in an anesthesiology clerkship., Conclusions: The success of this educational method may be dependent upon certain factors related to "educational context". Further study is needed of contextual and other factors related to the use of PBL in medical education.

Inadequate training of physicians contributes to the undertreatment of cancer pain. To address these concerns, the University of Kentucky has introduced a 4-week course for final-year medical students that teaches the principles of clinical pharmacology and pain management. The purposes of this study are to assess the knowledge deficits of final-year medical students about the use of morphine for cancer pain and to assess the efficacy of a short course on cancer pain management. Eighty-six final-year medical students completed a 22-item questionnaire assessing their knowledge and attitudes toward the use of morphine for cancer pain. Students indicated their agreement with each statement on a four-point scale (one, strongly disagree; four, strongly agree). All students then completed a compulsory short course on pain management. The course content included a 1-hr lecture on chronic nonmalignant pain, a 1-hr lecture on acute pain management, and a 1-hr lecture on cancer pain management. In addition, students completed small-group, problem-based learning modules on several aspects of pain management. After the course, all students completed the same 22-item survey. The alpha reliability score of the pretest instrument was 0.55, and the posttest reliability was 0.86. Upon course completion, students agreed most strongly (mean +/- SEM) that morphine should be given on a regular schedule for cancer pain (3.41 +/- 0.08), that cancer pain management frequently requires co-analgesics (3.36 +/- 0.06), and that patients with good pain relief function better than those with continuing pain (3.39 +/- 0.08). A comparison of pretest and posttest means on specific items suggested that the greatest amount of learning took place in the following content areas: morphine is a good oral analgesic; increases in cancer pain should be treated by increasing the morphine dose; respiratory depression is not a concern for cancer pain patients; and morphine can be used over a wide range of doses. The regular use of morphine was recognized as the treatment drug of choice for cancer pain. The students showed improved knowledge scores on ten of the 22 items on the posttest survey. A significant increase in learning occurred on six knowledge and attitude items. On only one item (nausea as a side effect of morphine) did the knowledge scores decrease on the posttest. A significant minority (40%) of senior medical students had deficits in knowledge about the use of morphine for cancer pain. The risk of addiction, respiratory depression, and tolerance were misunderstood by a significant minority (25%) of students.