Search

ProblemIn the competency-based medical education literature, investigators have typically discussed notions of trust in the context of entrustment decision-making rather than as attitudes within competency frameworks. Complementarity between concepts of entrustable professional activities and of competencies created an opportunity to infuse the latter with notions of trust.Bedside cardiac assessment (BCA) exemplified one such competency. Traditional approaches to teaching and learning BCA addressed relevant knowledge and skills but not attitudes. We conceptualized entrustability as part of an attitudinal approach to teaching and learning BCA more holistically and effectively. The purpose of this thematic analysis was to explore students’ experience, in a medicine clerkship at one U.S. medical school, of participating in a newly developed BCA curriculum that aimed to foster attitudinal growth and a holistic approach to clinical learning.ApproachBuilding upon Teaching for Understanding and conceptual change frameworks, the authors developed a flipped class curriculum utilizing pre-class short online videos and practice exercises followed by in-class activities and reflective discussions. Using a combination of content analysis and thematic analysis methodology of open-ended questionnaires administered from November 2017 to June 2018, the authors analyzed the experiences of medical students at one of the schools at which the curriculum was implemented.OutcomesThematic analysis suggested learning strategies were effective and that peer encounters, skills practice, and encounters with educators were meaningful. The analysis also revealed opportunities to improve the original instructional design.Next StepsThe authors will incorporate feedback into future iterations of the curriculum and make it widely available to better study its impact on learners’ abilities; entrustability as a construct; and transfer of learning from the classroom to the workplace. Further work is needed to clarify the value of incorporating notions of trust into competency frameworks. The authors intend this exploratory work to stimulate conversations around expanded roles of trustworthiness and entrustability in medical education.

RESUMO Neste relato de experiência como terapeuta em programa governamental na periferia da cidade de São Paulo, o objetivo foi compreender, com enfoque na metodologia socionômica, como técnicos e usuários de um serviço assistencial lidaram com seus desafios do dia a dia no contexto comunitário. Foram identificadas duas sociodinâmicas dos papéis observados: o denominado Sistema Vincular Vitimizado (SVV), que atribui grande parte da responsabilidade dos acontecimentos a terceiros, envolvendo expectativa, culpa, busca de bodes expiatórios e consequente exclusão social; e o denominado Sistema Vincular Cidadão (SVC), que atribui corresponsabilidade, envolvendo diálogo e negociação na procura de soluções viáveis e gerando inclusão social. O SVV se mostrou menos eficiente na superação de desafios e a intervenção socionômica facilitou uma transição do SVV para o SVC. ABSTRACT In this experience report as a therapist in a governmental program on the outskirts of the city of São Paulo, the goal was to understand, focusing on the socionomic methodology, how technicians and users of assistance service managed their day-to-day challenges in the community context. Two socio-dynamics were identified in the observed roles: the first one, named Victimized Bond System (VBS), assumes that most of the responsibility of the events belongs to third parties, involving expectation, guilt, scapegoating and consequent social exclusion; and the so-called Citizen Bond System (CBS), which attributes co-responsibility, involving dialogue and negotiation in search of viable solutions and generating social inclusion. VBS was proved less efficient in overcoming challenges and the socionomic intervention facilitated a transition from VBS to CBS. RESUMEN En este informe de experiencia como terapeuta en programa gubernamental en las afueras de la ciudad de São Paulo, el objetivo fue comprender, enfocándose em la metodologia socionómica, cómo técnicos y usuarios del servicio de asistencia afrontaban sus desafíos cotidianos em el contexto comunitario. Se identificaron dos sociodinámicas de los roles observados: el llamado Sistema de Enlace Victimizado (SEV), que atribuye gran parte de la responsabilidad de los eventos a terceros, lo que implica expectativas, culpa, chivos expiatorios y la consiguiente exclusión social; y el llamado Sistema de Enlace Ciudadano (SEC), que atribuye la corresponsabilidad, lo que implica el diálogo y la negociación em la búsqueda de soluciones viables y generando inclusión social. El SVV fue menos eficiente para superar los desafíos y la intervención socionómica facilitó la transición del SEV al SEC.

Objective Empathy is a crucial skill for medical students that can be difficult to evaluate. We examined if self-reported empathy in medical students was associated with clinical competence. Methods This study combined cross-sectional data from four consecutive years of medical students (N = 590) from the Boston University School of Medicine. We used regression analysis to evaluate if self-reported empathy (Jefferson Scale of Physician Empathy (JSPE)) predicted scores in clinical clerkships, United States Medical Licensing Examinations, and Objective Structured Clinical Examinations (OSCEs). We separately analyzed overall and OSCE communication scores based on interpersonal skills reported by standardized patients. We controlled for age, gender, debt, and specialty affinity. Results JSPE scores of medical students were positively associated with OSCE communication scores, and remained significant when controlling for demographics. We found that JSPE score was also predictive of overall OSCE scores, but this relationship was confounded by gender and age. JSPE scores were associated with performance in the Pediatrics clerkship, but not other clerkships or standardized tests. Conclusion JSPE scores were positively associated with OSCE communication scores in medical students. Practice implications This study supports that self-reported empathy may predict OSCE performance, but further research is needed to examine differences by gender and age.

The therapeutic attendance (TA) is a therapeutic intervention that works with the patient in varied locations – home, work etc. The auxiliary ego (AE) is a psychodrama treatment instrument that helps to bond, reveal circumstances and overcome conflicts through theinteraction between the parties, looking for developing healthier relationships. Our goal is to explain the TA focusing on its function of AE and multiplier of AEs in the community. To this end, a description of two cases of TA will be presented, which helped the development of AEs in the community so that those who were accompanied could pass through in a more satisfactory way. The presence of AEs in the community catalyzed the process of social inclusion of the accompanied ones.

Empathy is important in the physician-patient relationship. Prior studies suggest that medical student empathy declines with clinical training. We examined the trend of empathy longitudinally; determined differences in empathy according to gender and medical specialty preferences; and determined empathy and career preference differences among students admitted through different medical school admission pathways. The data for this study were collected using a longitudinal cohort design and included 2652 observations nested within 1162 individuals. Participants were medical students at a university-based medical school surveyed yearly from 2007 through 2010. Empathy was measured by the Jefferson Scale of Physician Empathy-Student Version (JSPE-S), a validated, 20-item self-administered questionnaire. Predictors of JSPE-S scores included gender, age, anticipated financial debt upon graduation and future career interest. Empathy scores of students in preclinical years were higher than in clinical years. Gender was a significant predictor of empathy, with women having higher empathy scores than men. Students preferring technology-oriented specialties had lower empathy scores. When career preference was controlled, higher levels of debt were significantly associated with greater empathy. Students with high baseline empathy decreased less than students with low baseline empathy during medical school. Students in traditional four-year medical school programs had higher baseline empathy than those in early pathway programs. Self-reported empathy for patients, a possibly critical factor in high-quality patient-centered care, wanes as students advance in clinical training, particularly among those entering technology-oriented specialties. In the era of new health care policy and primary care shortages, our research may have implications for the medical education system and admission policy.

Studies show that measures of physician and medical students' empathy decline with clinical training. Presently, there are limited data relating self-reported measures to observed behavior. This study explores a self-reported measure and observed empathy in medical students.Students in the Class of 2009, at a university-based medical school, were surveyed at the end of their 2nd and 3rd year. Students completed the Jefferson Scale of Physician Empathy-Student Version (JSPE-S), a self-administered scale, and were evaluated for demonstrated empathic behavior during Objective Structured Clinical Examinations (OSCEs).97.6% and 98.1% of eligible students participated in their 2nd and 3rd year, respectively. The overall correlation between the JSPE-S and OSCE empathy scores was 0.22, p0.0001. Students had higher self-reported JSPE-S scores in their 2nd year compared to their 3rd year (118.63 vs. 116.08, p0.0001), but had lower observed empathy scores (3.96 vs. 4.15, p0.0001).Empathy measured by a self-administered scale decreased, whereas observed empathy increased among medical students with more medical training.

Empathy is important in the physician–patient relationship. Prior studies have suggested that physician empathy may decline with clinical training. To measure and examine student empathy across medical school years. A cross-sectional study of students at Boston University School of Medicine in 2006. Incoming students plus each class near the end of the academic year were surveyed. The Jefferson Scale of Physician Empathy–Student Version (JSPE-S), a validated 20-item self-administered questionnaire with a total score ranging from 20 to 140. JSPE-S scores were controlled for potential confounders such as gender, age, anticipated financial debt upon graduation, and future career interest. 658 students participated in the study (81.4% of the school population). The first-year medical student class had the highest empathy scores (118.5), whereas the fourth-year class had the lowest empathy scores (106.6). Measured empathy differed between second- and third-year classes (118.2 vs 112.7, P

Research sponsored by the US Bureau of Reclamation. The Standard Penetration Test (SPT) N-value is widely used in geotechnical engineering as a basis for foundation design and as the primary index of liquefaction resistance. The main factor affecting the N-value is the energy delivered to the rods by the hammer. As measured N-values are conventionally corrected to a standard energy level of 60% of the standard potential energy, it is necessary to measure the energy input. Research into the measurement of energy during SPT testing has been conducted since the 1970s. The early work was based on measurement of the force time history alone (F² method). In recent years, the Force-Velocity (FV) method) has been suggested to be superior to the F² method. It requires the measurement of acceleration in addition to force, with velocity determined by integration of the acceleration. As the values of energy obtained by the F² and FV approaches are often different, this research project was conducted to investigate the reasons for such differences and to develop recommendations for equipment, instrumentation and testing procedures, which would allow more accurate and consistent energy measurements in SPT. The work consisted of review of available energy measurement data, laboratory study of the energy transfer process and of the performance of the individual components of energy measurement systems and full-scale measurements under controlled conditions in the laboratory and in the field. The experimental work was carried out in conjunction with numerical modelling of the energy transfer process. The work confirmed that the FV method is the only consistent approach for measurement of stress wave energy transmitted from the hammer to the rod and sampler system in SPT testing. It is relatively straightforward to obtain reliable measurements of force time history but reliable determinations of the velocity time history are more challenging. A rigidly mounted 20,000g accelerometer in conjunction with a data acquisition system capable of sampling the acceleration signal at over 100 kHz was shown to result in high quality stress wave energy data. Both digital and analog integration of acceleration were found to give comparable velocity time histories provided attention was paid to compatibility of all mechanical and electronic components of the measurement system. Based on the experimental and analytical work, the UBC energy measurement research system was upgraded and limited field trials were carried out. The field trials also permitted some comparisons to results from a commercially available energy measurement system. With any system, reliable energy measurements require rigorous data quality assessment in the field by qualified personnel with an understanding of wave mechanics. Guidelines for such assessments are provided in the report. A simple field apparatus and test procedure capable of transmitting a reproducible impulse wave is proposed to allow the operator to check that the instrumentation is functioning properly. Finally, recommendations are provided for instrumentation and procedures that will allow reliable measurement of energy in the field.