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The extent of medical student unwellness is well documented. Learner distress may impact patient care, workforce adequacy, and learners' performance and personal health. The authors describe the philosophy, structure, and content of the novel REACH (Recognize, Empathize, Allow, Care, Hold each other up) curriculum and provide a preliminary evaluation.The REACH curriculum is a mandatory, longitudinal well-being curriculum for first- and second-year medical students at the Medical College of Wisconsin (MCW) designed to prepare them for the emotional life of being a physician. The curriculum uses a framework, core concepts, and skills from the field of trauma stewardship. It builds on effective medical student well-being interventions (e.g., mindfulness-based training) and the sharing of personal stories by instructors during didactic and small-group sessions that are integrated into the regular MCW curriculum. During the first 2 years of implementation (2018-2019 and 2019-2020), the curriculum was evaluated using mid- and postcurriculum student surveys.Over 700 students have completed the REACH curriculum as of March 2022. Overall, most students who responded to the surveys in 2018-2020 reported that they felt the REACH curriculum material was important, that the curriculum met their expectations for a quality medical school course, and that they would recommend other schools incorporate a similar curriculum. Respondents to the 2019-2020 postcurriculum survey indicated the REACH curriculum helped them develop self-care (84% [85/101]), mindfulness (76% [76/101]), and help-seeking (71% [72/101]) skills.The initial outcomes show that integrating a mandatory well-being curriculum is feasible and acceptable to medical students. The authors plan to examine the relationships between student-reported well-being metrics, academic and clinical performance data, and professional identity formation. They are also prototyping electronic dashboards that will allow students to interact with their well-being data to promote timely help-seeking and behavior change.

To validate an approach to measuring professional identity formation (PIF), we explore if the Professional Identity Essay (PIE), a stage score measure of medical professional identity (PI), predicts clinical communication skills.Students completed the PIE during medical school orientation and a 3-case Objective Structured Clinical Exam (OSCE) where standardized patients reliably assessed communication skills in 5 domains. Using mediation analyses, relationships between PIE stage scores and communication skills were explored.For the 351 (89%) consenting students, controlling for individual characteristics, there were increases in patient counseling (6.5%, p0.01), information gathering (4.3%, p = 0.01), organization and management (4.1%, p = 0.02), patient assessment (3.6%, p = 0.04), and relationship development (3.5%, p = 0.03) skills for every half stage increase in PIE score. The communication skills of lower socio-economic status (SES) students are indirectly impacted by their slightly higher PIE stage scores.Higher PIE stage scores are associated with higher communication skills and lower SES.PIE predicts critical clinical skills and identifies how SES and other characteristics indirectly impact future clinical performance, providing validity evidence for using PIE as a tool in longitudinal formative academic coaching, program and curriculum evaluation, and research.

The COVID-19 pandemic continues to limit medical students' full reintegration into clinical learning environments, thus exacerbating an ongoing challenge in identifying a robust number of clinical educational activities at excellent clinical sites for all students. Because medical students across the United States were removed from direct patient care activities in mid-March 2020 due to COVID-19, medical centers have prioritized and implemented changes to the process of patient care. As some barriers are being lifted in the face of a highly contagious and deadly infection, the use of telehealth (delivery of health services remotely via telephone, video, and secure messaging), although not new, is rapidly expanding into all aspects of patient care. Health care providers have been encouraged to conduct many interactions at a physical distance. Telehealth largely replaced face-to-face visits for nonemergency care in an attempt to slow viral transmission while enabling physicians to continue to deliver patient education, manage acute and chronic illness, and nurture caring doctor-patient relationships. Health care providers, many of whom were initially reluctant to embrace telehealth technology and logistics, are becoming nimbler and more aware of the many positive aspects of telehealth. The authors suggest that integrating medical students into telehealth activities would help maintain and improve patients' health, extend the capabilities of health care teams and systems during and after the pandemic, and increase medical students' opportunities for experiential learning and professional identity formation. The authors expand on these 3 goals, suggest several concrete student telehealth activities, propose a curricular strategy, and outline opportunities to overcome key barriers to full alignment of telehealth and undergraduate medical education.

The AAMC has identified 13 Entrustable Professional Activities (EPAs) that all entering residents should be entrusted to perform on day 1 of residency, regardless of specialty choice. However, there is currently no consensus on how to best measure entrustment. This study embedded a range of entrustment measures from multiple rater perspectives in an immersive simulation event designed to assess competence in all 13 EPAs. One hundred forty-four near-graduating medical students were recruited to complete a 4-h immersive simulation designed around four clinical cases where they interacted with standardized patients, nurses, attendings, and interns. A total of 16 entrustment ratings were collected for each of the learners across 6 of the 9 simulation activities. To test the hypothesis that the given items in the immersive simulation enabled measurement of entrustment, a three-factor (entrustment) confirmatory factor analysis (CFA) was conducted with the ratings between the assessors by case allowed to correlate. A three-factor CFA model fit the data (χ2(94) = 147.28, p = 0.0002, CFI = 0.98, TLI = 0.97, RMSEA = 0.07 (CI = 0.04–0.08), p = 0.111). All but 1 of the 16 factor loadings was greater than 0.3. A three-factor model with 16 measures fit the a priori entrustment framework suggesting that entrustment, operationalized across different rater perspectives and types of questions, is measurable as a construct. Using an end-of-training event provides a timely and feasible assessment approach to capture structured entrustment judgments for the educational handoff between medical school and residency.

This paper examined measurement invariance (MI), both across gender and over time, of the Satisfaction With Life Scale adapted for Children (SWLS-C). Adapted from the adult SWLS, the SWLS-C is a self-report measure for children and adolescents to assess their life satisfaction. The sample comprised elementary school students in British Columbia, Canada (n = 4,026) who responded to the SWLS-C in Grade 4 (M(age) = 9.3, SD = 0.6; 48.9% girls) and approximately 3 years later in Grade 7. We examined MI regarding gender, time, and both gender and time (i.e., interactional invariance) using Clustered Repeated Measures Multi-Group Confirmatory Factor Analysis with a mean- and variance-adjusted weighted least squares (WLSMV) estimation. Residual invariance by gender was supported at Grades 4 and 7; scalar invariance was supported longitudinally for each gender and overall. In the "interactional" model, including gender and time, analyses indicated scalar MI, but not residual MI. Analyses of latent factor means indicated that SWLS-C scores significantly decreased for both girls and boys from Grade 4 to Grade 7. The decrease was more pronounced for girls, but gender differences at either age were not significant. The pattern of observed mean scores differed, as it indicated no significant decrease for boys' SWLS-C scores, but significant gender differences at both time points. However, given the lack of residual invariance, comparisons of observed SWLS-C mean scores across gender and over time may be compromised. The different results for latent and observed mean SWLS-C scores highlight the importance of routinely conducting MI analyses for group comparisons. (PsycINFO Database Record

Affective occupational commitment (AOC) during training is considered to prevent occupational turnover and positively influence later work-related outcomes and learning processes. However, little is known about AOC development in a training context. This study examines antecedents and consequences of AOC and its development during vocational education and training. Participants were 497 Swiss apprentices who took part in a longitudinal survey throughout their 3-year training program. The results of latent growth curve modeling showed a slight average decrease in AOC over time. Initial AOC was negatively related to occupational turnover intention and positively related to satisfaction with the apprenticeship. Perceived person–occupation fit and feelings of competence during in-company training were positively correlated with initial AOC. Change in AOC was the smallest when apprentices felt autonomous and larger when they felt competent. The results indicate how in-company training environments can be arranged that foster apprentices’ AOC.

The Satisfaction With Life Scale adapted for Children (SWLS-C) is a self-report measure of children’s quality of life and has exhibited sound psychometric properties. In light of increasing ethno-cultural diversity, it is important to understand child life satisfaction across diverse subgroups. Employing children’s language background as a proxy for cultural background among children in British Columbia, Canada, we examined (a) the cross-cultural measurement equivalence of the SWLS-C; and (b) cross-cultural relations of peer support and adult support with SWLS-C. Participants were 20,119 children (Mage 9.2; 50.2% boys) who provided data as part of a self-report child health survey (the Middle-years Development Instrument). Measurement equivalence across eight language/cultural background groups was tested via multi-group confirmatory factor analysis. Multi-level analyses were used to compare: a) SWLS-C means; and b) associations of peer support and adult support with SWLS-C scores, by language/cultural background. Findings supported strict measurement equivalence between the English language/cultural background group and all other language/cultural background groups for the SWLS-C. Relative to the English language background group, SWLS-C means differed for several language/cultural background groups. Within every language/cultural background group, however, peer and adult support scale scores were significant positive correlates of SWLS-C scores. This study provided evidence for measurement equivalence of a life satisfaction measure across children from diverse language/cultural backgrounds and identified between-group differences in the level of child life satisfaction that were generally consistent with prior theory and findings. Moreover, results provided evidence of promotive associations of adult support and peer support with life satisfaction among diverse groups of children.

Methods for detecting differential item functioning (DIF) and item bias are typically used in the process of item analysis when developing new measures; adapting existing measures for different populations, languages, or cultures; or more generally validating test score inferences. In 2007 in Language Assessment Quarterly, Zumbo introduced the concept of Third Generation DIF. In the current article we introduce a new methodology, latent class logistic regression, for Zumbo’s Third Generation DIF, whose foundation is a novel ecological model of item responding. The ecological model and the new statistical methodology are introduced, and a proof-of-concept is provided, in the context of an example of an international reading test focusing on DIF due to testing language. The new DIF framework is described and contrasted with other methods, Mplus code is provided, and the new method is shown to have potential for application in assessment.

In this study, we examined whether perceived variety in exercise prospectively predicts unique variance in exercise behavior when examined alongside satisfaction of the three basic psychological needs (for competence, relatedness, and autonomy) embedded within self-determination theory (Ryan & Deci, 2002), through the mediating role of autonomous and controlled motivation. A convenience sample of community adults (N = 363) completed online questionnaires twice over a 6-week period. The results of structural equation modeling showed perceived variety and satisfaction of the needs for competence and relatedness to be unique indirect positive predictors of exercise behavior (through autonomous motivation) 6 weeks later. In addition, satisfaction of the need for autonomy was found to negatively predict controlled motivation. Perceived variety in exercise complemented satisfaction of the needs for competence, relatedness, and autonomy in predicting motivation and (indirectly) exercise behavior, and may act as a salient mechanism in the prediction of autonomous motivation and behavior in exercise settings.

Well-designed computer-assisted instruction (CAI) can potentially transform medical education. Yet little is known about whether specific design features such as direct manipulation of the content yield meaningful gains in clinical learning. We designed three versions of a multimedia module on the abdominal exam incorporating different types of interactivity.As part of their physical diagnosis course, 162 second-year medical students were randomly assigned (1:1:1) to Watch, Click or Drag versions of the abdominal exam module. First, students' prior knowledge, spatial ability, and prior experience with abdominal exams were assessed. After using the module, students took a posttest; demonstrated the abdominal exam on a standardized patient; and wrote structured notes of their findings.Data from 143 students were analyzed. Baseline measures showed no differences among groups regarding prior knowledge, experience, or spatial ability. Overall there was no difference in knowledge across groups. However, physical exam scores were significantly higher for students in the Click group.A mid-range level of behavioral interactivity was associated with small to moderate improvements in performance of clinical skills. These improvements were likely mediated by enhanced engagement with the material, within the bounds of learners' cognitive capacity. These findings have implications for the design of CAI materials to teach procedural skills.

Background The authors developed and evaluated an interactive, Web-based module to train medical students in screening and brief intervention (SBI) for unhealthy alcohol use. Methods First-year students were randomized to module versus lecture. Change in knowledge, attitudes, and confidence were compared. Performance was assessed by objective structured clinical examination (OSCE) and analyzed by intention to treat and treatment received. Results Of 141 consenting students, 64% ( n = 90) completed an intervention (54% lecture vs. 70% Web assigned). Knowledge, confidence, and attitudes improved in both groups, with more improvement in Advise–Assist knowledge for Web students (14% vs. −3%, p = .003). Web students outperformed their lecture peers in both general communication (65% vs. 51% items well done, p = .004) and alcohol-specific tasks (54% vs. 41%, p = .021) on OSCE. Analysis by treatment received enhanced between-group differences. Conclusion Use of a Web-based module to teach SBI is associated with greater knowledge gain and skills performance compared with a lecture covering similar content. The module provides an efficient means for training in this area.

To prepare to develop a medical school curriculum on substance abuse disorders (SADs), the authors conducted a review of the quality of the sparse published literature.The authors searched MEDLINE (1950 through December 2008) using OVID, PsycINFO, and PubMed to identify all studies of SAD interventions targeted toward undergraduate medical students. Of the 1,084 studies identified initially, 31 reported sufficient data to allow the authors to evaluate quality using Medical Education Research Study Quality Instrument (MERSQI) scores. The authors also determined the impact of the studies by considering three-year citation rate and journal impact factor. A detailed review of the literature provided data on contact hours and intervention content.The three-rater intraclass correlation coefficient for total MERSQI score was 0.82 (95% confidence interval: 0.70-0.90). The mean MERSQI score was 10.42 of a possible 18 (SD 2.59; range: 6.33-14.83). MERSQI scores were higher for more recently published studies and correlated with three-year citation rate but not impact factor. The mean contact time for 26 studies was 29.25 hours (range: 0.83-200 hours).The literature provides a variety of educational methods to train medical students in SAD detection and intervention skills. This literature is of variable quality and provides limited guidance for development of curricula and medical education policy. Better methods of curriculum evaluation and publication guidelines would help ensure that this literature has a positive impact on educational practice and public health.

Researchers lack the rich evidence base and benchmark patient outcomes needed to evaluate the effectiveness of medical education practice and guide policy. The authors offer a framework for medical education research that focuses on physician-influenced patient outcomes that are potentially sensitive to medical education. Adapting the concept of ambulatory care sensitive conditions, which provided traction to health services research by defining benchmark patient outcomes to measure health system performance, the authors introduce the concept and propose the adoption of educationally sensitive patient outcomes and suggest two measures: patient activation and clinical microsystem activation. They assert that the ultimate goal of medical education is to ensure that measurement of future physicians' competence and skills is based not only on biomedical knowledge and critical clinical skills but also on the ability to translate these competencies into effective patient- and systems-level outcomes. The authors consider methodological approaches and challenges to measuring such outcomes and argue for large, multiinstitutional, prospective cohort studies and the development of a national Database for Research in Education in Academic Medicine to provide the needed infrastructure. They advocate taking the next steps to establish an educational evidence base to guide the academic medical centers of the 21st century in aligning medical education practice with health care delivery that meets the needs of individuals and populations.

Gastroenterology (GI) training programs must develop the teaching skills of their faculty and provide feedback to their fellows. Many faculty feel uncomfortable offering feedback or identifying specific areas for improvement to the fellows. We developed an Observed Structured Clinical Exam (OSCE) to assess fellows' skills and provided faculty with specific criteria to rate the fellows' performance. We propose that OSCEs can serve as tools for faculty development in delivering effective feedback.Faculty completed a Web-based training module and received written guidelines on giving feedback. Four OSCE stations were completed by each fellow with faculty using standardized checklists to assess the fellows' skills. Afterwards, faculty rated each program component and assessed their comfort level with feedback.Eight faculty members and 10 fellows from 5 GI training programs in NYC participated. 100% of the faculty agreed that feedback is an important learning tool, should include the learner's self-assessment, and that feedback skills could improve with practice. Compared to faculty skills prior to the program, 87.5% of the faculty agreed that they focused more on specific behaviors and 75% agreed that giving negative feedback was now easier.OSCEs can serve as practicums for faculty development in giving constructive feedback.

This article was migrated. The article was marked as recommended. Professional Identity Formation (PIF), the process of internalizing a profession's core values and beliefs, is an explicit goal of medical education. The Professional Identity Essay (PIE), a developmental measure of the extent to which individuals have a complex and self-defined understanding of their professional role, is a tool to both study and scaffold PIF. PIE staging has internal reliability and response process validity and correlates with a validated measure of moral reasoning. In this study, we investigate whether PIF, as measured by PIE, changes during pre-clerkship training.Medical students in the class of 2019 completed the PIE during orientation to medical school (PIE#1) and 15 months later, during orientation to clerkships (PIE#2), to the same prompts. These written responses are PIF-staged by an expert rater.On average, PIF scores reveal that 46% of the group remained at the same stage as they were on entry to medical school, 42% scored at a higher stage of PIF, and 15% of students scored at a lower stage of PIF after pre-clerkship training.This result suggests that medical students are heterogeneous with respect to the development of their medical PIF early in medical school training.

Objectives: The authors piloted unannounced standardized patients (USPs) in an emergency medicine (EM) residency to test feasibility, acceptability, and performance assessment of professionalism and communication skills. Methods: Fifteen postgraduate year (PGY)-2 EM residents were scheduled to be visited by two USPs while working in the emergency department (ED). Multidisciplinary support was utilized to ensure successful USP introduction. Scores (% well done) were calculated for communication and professionalism skills using a 26-item, behaviorally anchored checklist. Residents’ attitudes toward USPs and USP detection were also surveyed. Results: Of 27 USP encounters attempted, 17 (62%) were successfully completed. The detection rate was 44%. Eighty-three percent of residents who encountered a USP felt that the encounter did not hinder daily practice and did not make them uncomfortable (86%) or suspicious of patients (71%). Overall, residents received a mean score of 60% for communication items rated “well done” (SD ± 28%, range = 23%–100%) and 53% of professionalism items “well done” (SD ± 20%, range = 23%-85%). Residents’ communication skills were weakest for patient education and counseling (mean = 43%, SD ± 31%), compared with information gathering (68%, SD ± 36% and relationship development (62%, SD ± 32%). Scores of residents who detected USPs did not differ from those who had not. Conclusions: Implementing USPs in the ED is feasible and acceptable to staff. The unpredictability of the ED, specifically resident schedules, accounted for most incomplete encounters. USPs may represent a new way to assess real-time resident physician performance without the need for faculty resources or the bias introduced by direct observation.

Background Aims Objective structured clinical encounters (OSCEs) are used widely to educate and assess the competence of medical students and residents; they generally are absent from fellowship training. The Accreditation Council for Graduate Education has cited OSCEs as a best practice for assessing the 6 core competencies. This article reports on the use of an OSCE to assess the competence of second-year gastroenterology fellows in the difficult-to-assess core competencies: interpersonal and communication skills and professionalism. Methods We developed a 4-station, faculty-observed OSCE with 4 standardized patients. Information gathering, relationship development, patient education, and counseling skills were assessed. Professionalism skills assessed included obtaining informed consent, delivering bad news, managing difficult situations, and showing interdisciplinary respect. In each station, faculty and standardized patients completed an 18- to 24-item checklist evaluating fellows' performance and provided feedback to the fellows. Nine fellows and 5 faculty from 4 gastroenterology training programs in NYC participated. Results Fellows and faculty generally highly rated the realism of the OSCE and favorably rated the OSCE for its difficulty and their overall experience. Across all cases, fellows were rated as receiving "well dones" for 56.4% of the communication items (SD, 18.3%) and for 79.1% of the professionalism items (SD, 16.4%). Conclusions Integrating OSCEs into gastroenterology fellowship training may help enhance communication skills and prepare fellows for dealing with difficult clinical situations and provides mechanisms for constructive feedback. OSCEs developed collaboratively can assist in program self-evaluation and reduce costs by sharing resources, in addition to fulfilling Accreditation Council for Graduate Education mandates.

As part of the development of a curriculum for medical students and rehabilitation residents at New York University School of Medicine, an Objective Structured Clinical Examination (OSCE) station was developed for formative evaluation. The goal was to determine the existing knowledge and competence of medical students and rehabilitation residents in the analysis and treatment of a geriatric patient with a history of falls. This OSCE station was designed to focus on three specific clinical skills needed in assessing the elderly faller. The OSCE station was a standardized patient (SP) encounter with a 75-year-old man presenting with falls. Seventy-five medical students and 41 rehabilitation medicine residents participated in the study. There was high agreement between the SP and a geriatric physician used to assess performance on gait (Cronbach alpha=0.918) and orthostatic blood pressure (Cronbach alpha=0.887) assessment. Of the medical students, 43.5% did not check orthostatic blood pressure, 56.8% did not evaluate gait, and 92.0% did not consider assistive device prescription. Only 20.0% checked both orthostatic blood pressure and gait. Likewise, 73.8% of residents did not check orthostatic blood pressure, 38.1% did not evaluate gait and 92.9% did not consider assistive device prescription. Only 19.0% checked both orthostatic blood pressure and gait. The results of this examination are alarming and suggest that education regarding the approach to an elderly person who falls is inadequate, leaving students and residents poorly prepared to take care of the "silver tsunami."

Food label use is associated with better food choices, an essential part of the management of many chronic diseases. Previous studies suggest lack of comprehension of food labels. We studied a multimedia intervention to improve food label comprehension in a sample of low income patients in New York City.This randomized study took place at Gouverneur Healthcare Services from 2005 until 2007. The intervention group (n=29) received a Nutrition Facts Label pocket card and viewed a video explaining card use. The control group (n=27) received written materials. Participants completed a 12-item pre- and post-intervention nutrition food label quiz. Quiz scores were analyzed using repeated measures analysis of variance.The intervention group had greater improvement on the quiz than the control group (p0.001). There was a three way interaction by time with health literacy and treatment group where the greatest improvement occurred in patients with adequate health literacy in the intervention group (p0.05). There was no improvement in patients with limited health literacy.A multimedia intervention is an effective way to improve short-term food label comprehension in patients with adequate health literacy. Further research is necessary to improve understanding of food labels in patients with limited health literacy.

There has been much debate in the medical education literature regarding the extent to which feature-driven and nonanalytic (similarity-based) reasoning strategies define expertise, but the relative value of teaching these strategies, together or in isolation, remains uncertain. The purpose of this study was to compare the diagnostic accuracy achieved upon receiving instruction to use each strategy in isolation to that of a combined approach.In 2003-04, 48 undergraduate psychology students from McMaster University in Ontario, Canada, were taught to diagnose ten cardiac disorders (including normal) via electrocardiogram (ECG) presentation. Twelve students were instructed to carefully identify all features present before assigning a diagnosis (feature first). Twelve were given the same instruction with notice that some test ECGs had been seen during training (implicit combined). Twelve were simply instructed to trust familiarity and diagnose based on this impression (similarity-based). Finally, 12 students were given feature first and similarity-based instructions in combination (explicit combined).No difference in diagnostic accuracy was observed between the groups given the feature first (42%) and first impression (41%) instructions (p.4), but the groups instructed to use both strategies (explicitly or implicitly) performed significantly better (56% and 53%, respectively; p.01).The results support an additive model of clinical reasoning in which instructions to be feature oriented and to trust similarity improve performance in novice diagnosticians.

Objectives Early identification of distinct patterns of child social–emotional strengths and vulnerabilities has the potential to improve our understanding of child mental health and well-being; however, few studies have explored natural groupings of indicators of child vulnerability and strengths at a population level. The purpose of this study was to examine heterogeneity in the patterns of young children9s social and emotional health and investigate the extent to which sociodemographic characteristics were associated. Design Cross-sectional study based on a population-level cohort. Setting All kindergarten children attending public schools between 2004 and 2007 in British Columbia (BC), Canada. Participants 35 818 kindergarten children (age of 5 years) with available linked data from the Early Development Instrument (EDI), BC Ministry of Health and BC Ministry of Education. Outcome measure We used latent profile analysis (LPA) to identify distinct profiles of social–emotional health according to children9s mean scores across eight social–emotional subscales on the EDI, a teacher-rated measure of children9s early development. Subscales measured children9s overall social competence, responsibility and respect, approaches to learning, readiness to explore, prosocial behaviour, anxiety, aggression and hyperactivity. Results Six social–emotional profiles were identified: (1) overall high social–emotional functioning, (2) inhibited-adaptive (3) uninhibited-adaptive, (4) inhibited-disengaged, (5) uninhibited-aggressive/hyperactive and (6) overall low social–emotional functioning. Boys, children with English as a second language (ESL) status and children with lower household income had higher odds of membership to the lower social–emotional functioning groups; however, this association was less negative among boys with ESL status. Conclusions Over 40% of children exhibited some vulnerability in early social–emotional health, and profiles were associated with sociodemographic factors. Approximately 9% of children exhibited multiple co-occurring vulnerabilities. This study adds to our understanding of population-level distributions of children9s early social–emotional health and identifies profiles of strengths and vulnerabilities that can inform future intervention efforts.

The Objective Structured Clinical Examinations (OSCEs) is widely used in the assessment of clinical competence and the interpersonal skills of medical students and residents. The goals of this chapter were to examine (a) the validation practices of the OSCE, and (b) the extent to which the reported validity evidence conforms to contemporary views of validity theory. A total of 22 articles were found that explicitly position themselves as validation studies of the OSCE. As a general finding, the most frequently reported sources of validity evidence were construct (59.1 %) and content (40.9 %) validity. The remaining sources of validity evidence were reported less frequently. There was a difference between what authors’ reported as validity evidence to what might be classified as validity using the Test Standards. The implications of these findings and direction for future validation studies are discussed with an eye toward investigating OSCE in line with contemporary views of validity and validation.

Background Failures of communication during the transfer of patient care errors. Methods We created a new format for written sign-out material, based on aviation industry practice and cognitive psychology theory, designed to improve interns' and senior medical students' communication during transfers of patient care responsibility. We carried out a randomized, blinded, crossover trial, comparing a new, narrative, written sign-out report to a usual written sign-out. Thirty-two interns and fourth-year medical students rated their confidence across various clinical tasks and answered clinical questions regarding hypothetical patients presented to them in written, new, narrative sign-out compared with the customary format. Results There was no statistical difference in confidence when interns and senior medical students received usual versus narrative sign-outs. Conclusions Although a limited measure suggested some improvement in competence, the narrative format did not improve participants' self-rated confidence during patient-care transfer.

BackgroundThe competency of professionalism encompasses a range of behaviors in multiple domains. Residency programs are struggling to integrate and effectively assess professionalism. We report results from a survey assessing residents’ perceptions of their professional competence and the professionalism of their learning environment.MethodsA survey was developed to assess specific behaviors reflecting professionalism based on the conceptualizations of key accrediting bodies. Residents rated their ability to perform the behaviors and reported the frequency with which they observed their fellow residents failing to perform the behaviors. Eighty-five senior residents in emergency medicine, internal medicine, pediatrics, psychiatry, and surgery specialties completed the survey (response rate = 77%). Differences among domains (and among items within domains) were assessed. Correlations between perceived professionalism and the professionalism of the learning environment were described.ResultsCronbach alpha for professionalism competence was .93 and for professionalism in the learning environment it was .86. Residents reported feeling most competent in being accountable (mean score = 51.4%; F = 10.3, pConclusionsResidents reported being able to perform professionally most of the time, especially in terms of accountability and respect. However, disrespect was a feature of the learning environment for many residents and several serious lapses were witnessed by a small number of residents. Accountability in the learning environment may be an important indicator of or influence on residents’ professionalism.

The ‘patient’ begins the session by asking the ‘doctor’ for the most appropriate drug and for information on its mechanism of action, side-effects, monitoring and follow-up based on the current best evidence. The ‘doctor’ must answer all the queries posed by the ‘patient’. Group members are then invited to comment and provide feedback. Finally, the teacher provides constructive feedback on the factual content and the communication skills required to ensure patient involvement and compliance. Evaluation of results and impact This method of learning was commenced in September 2008 and to date 90 students have participated. All the students have given positive feedback with regard to their ability to use these newly acquired skills in the future application of therapeutics in real-life clinical settings in which they will have to deal with patients’ queries. There was a significant improvement in the end-of-posting examination using short-answer questions on the management of dyslipidaemia. The mean score for the cohort of students exposed to this innovative learning method was 7.8 out of 10. The mean score of students from previous groups tested before this method was initiated was 5.5 out of 10. The difference is statistically significant (P = 0.003). Learning clinical therapeutics allows students to consolidate their basic knowledge in pharmacology and teaches them to apply it effectively in clinical situations. The use of role-play creates greater awareness of the importance of patient-centred management and evidence-based medicine. Students also perceive this method as innovative and are able to retain the knowledge they acquire on clinical pharmacology for longer. This method also incorporates practice of the communication skills required to ensure the patient’s agreement to and continued compliance with therapy.

As part of the development of a curriculum for medical students and rehabilitation residents at New York University School of Medicine, an Objective Structured Clinical Examination (OSCE) station was developed for formative evaluation. The goal was to determine the existing knowledge and competence of medical students and rehabilitation residents in the analysis and treatment of a geriatric patient with a history of falls. This OSCE station was designed to focus on three specific clinical skills needed in assessing the elderly faller. The OSCE station was a standardized patient (SP) encounter with a 75-year-old man presenting with falls. Seventy-five medical students and 41 rehabilitation medicine residents participated in the study. There was high agreement between the SP and a geriatric physician used to assess performance on gait (Cronbach alpha=0.918) and orthostatic blood pressure (Cronbach alpha=0.887) assessment. Of the medical students, 43.5% did not check orthostatic blood pressure, 56.8% did not evaluate gait, and 92.0% did not consider assistive device prescription. Only 20.0% checked both orthostatic blood pressure and gait. Likewise, 73.8% of residents did not check orthostatic blood pressure, 38.1% did not evaluate gait and 92.9% did not consider assistive device prescription. Only 19.0% checked both orthostatic blood pressure and gait. The results of this examination are alarming and suggest that education regarding the approach to an elderly person who falls is inadequate, leaving students and residents poorly prepared to take care of the "silver tsunami."

Physicians must effectively evaluate and treat obesity. To design a needs-driven curriculum intended to improve patient outcomes, physicians were surveyed about their self-perceived knowledge and skills.The objective of this study was to determine the expressed needs of residents and faculty regarding obesity care training across three specialties.The study used a survey given to faculty and residents in General Internal Medicine, Pediatrics, and Psychiatry.Survey questions were generated from comprehensive nutrition curriculum and clinical recommendations, administered online, and then organized around a validated behavioral health framework-the 5As (assess, advise, agree, assist, arrange). Analyses were conducted to evaluate differences in perceived knowledge and skills between specialties and across training levels.From an overall response rate of 65% (65 residents and 250 faculty members), nearly 20% reported inadequate competency in every item with 48% of respondents reporting an inability to adequately counsel patients about common treatment options. Internists reported the lowest competency in arranging referrals and follow-up. Psychiatrists reported the lowest competency in assessment skills.This survey demonstrated a critical need for training in specific areas of obesity care. The proposed curriculum targets these areas taking into consideration observed differences across specialties.

OBJECTIVES Building on the advice of previous research to avoid parsing diagnostic strategies too finely, recent studies have shown that teaching novices to utilise analytic and non-analytic reasoning strategies yields higher diagnostic accuracy than teaching either in isolation. This study assesses the extent to which students spontaneously adopt a combined approach and compares its benefits with those experienced with a contrastive learning strategy known to enhance analogical transfer. METHODS A sample of 48 naive students were trained to identify features on electrocardiograms (ECGs) and assign diagnoses. Half the participants learned in a standard manner, encountering diagnoses (and their associated features) in sequence. The remaining participants were explicitly instructed to draw comparisons between the diagnostic category being learned and another confusable diagnostic category (contrastive learning). Half the participants in both groups were further instructed to carefully identify all features while trusting guidance provided by feelings of familiarity (a combined reasoning strategy). The remaining participants were given no instructions on how to approach the diagnostic task. RESULTS Greater diagnostic accuracy was achieved following both contrastive learning and instructions to use a combined reasoning strategy relative to the control conditions. These variables did not interact with each other, nor did they interact with novelty of the test case. The effects were observed immediately after learning and following a 1-week delay. DISCUSSION The results emphasise the importance of explicitly empowering students to utilise multiple diagnostic strategies, including non-analytic approaches. In addition, this study reveals the benefit that can be gained from contrastive learning in a medical domain.

Background Physicians frequently report negative attitudes about obesity which is thought to affect patient care. However, little is known about how attitudes toward treating obese patients are formed. We conducted a cross-sectional survey of physicians in order to better characterize their attitudes and explore the relationships among attitudes, perceived competency in obesity care, including report of weight loss in patients, and other key physician, training, and practice characteristics. Methods We surveyed all 399 physicians from internal medicine, pediatrics, and psychiatry specialties at one institution regarding obesity care attitudes, competency, including physician report of percent of their patients who lose weight. We performed a factor analysis on the attitude items and used hierarchical regression analysis to explore the degree to which competency, reported weight loss, physician, training and practice characteristics explained the variance in each attitude factor. Results The overall response rate was 63%. More than 40% of physicians had a negative reaction towards obese patients, 56% felt qualified to treat obesity, and 46% felt successful in this realm. The factor analysis revealed 4 factors–Physician Discomfort/Bias, Physician Success/Self Efficacy, Positive Outcome Expectancy, and Negative Outcome Expectancy. Competency and reported percent of patients who lose weight were most strongly associated with the Physician Success/Self Efficacy attitude factor. Greater skill in patient assessment was associated with less Physician Discomfort/Bias. Training characteristics were associated with outcome expectancies with newer physicians reporting more positive treatment expectancies. Pediatric faculty was more positive and psychiatry faculty less negative in their treatment expectancies than internal medicine faculty. Conclusion Physician attitudes towards obesity are associated with competency, specialty, and years since postgraduate training. Further study is necessary to determine the direction of influence and to explore the impact of these attitudes on patient care.

Background: Gastroenterology training programs are mandated to give feedback to their fellows but some faculty may not feel comfortable offering feedback or identifying specific areas for improvement. Training programs are also expected to develop the skills of their faculty as educators. We use Observed Standardized Clinical Encounters (OSCEs) to assess fellows' interpersonal and communication skills as well as their professionalism. The skills checklists we created provide the faculty with specific criteria to rate the performance of the fellows. We propose that OSCEs can serve as tools for faculty development in delivering effective feedback. Methods: Faculty completed a web-based 30 minute training module on giving feedback and received written guidelines about giving feedback prior to the OSCE. Four OSCE stations (obtaining informed consent, delivering bad news, apologizing for a medical complication, and transfer to surgery) were completed by each fellow and observed by faculty. The faculty used standardized behavioral specific checklists to assess the fellows' knowledge, professionalism, and communication skills. Post OSCE faculty rated the value of each faculty development program component and assessed their current comfort level with feedback as compared to before the program. Results: 8 faculty members from 5 GI training programs in NYC observed the 4 station OSCE and 10 fellows participated. Each faculty member observed one of the 4 scenarios. Immediately following each case, feedback was provided to the fellow by both the faculty observer and the standardized patient. The faculty members completed an exit survey to assess the utility of the OSCE and how well the program addressed the proposed educational objectives. 100% of the faculty agreed that feedback is an important learning tool, should include the learner's assessment and performance and that their feedback skills could improve with practice. As compared to prior to the program, 87.5% of the faculty agreed that they focused more on specific behaviors, 75% agreed that giving negative feedback was easier for them, and 62.5% felt that giving feedback was less challenging than before the training. The components of the program: the web based module, the narrative and the practicum were also rated on a scale of 1 (poor) to 5 (excellent) and the mean scores were 4.125, 4.375, and 4.875 respectively. Conclusions: OSCEs developed collaboratively can serve as practicums for giving constructive feedback and for faculty development and can help Gastroenterology training programs fulfill ACGME mandates.