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Background: Clinical reasoning is essential to medical practice, but because it entails internal mental processes, it is difficult to assess. Functional magnetic resonance imaging (fMRI) and think-aloud protocols may improve understanding of clinical reasoning as these methods can more directly assess these processes. The objective of our study was to use a combination of fMRI and think-aloud procedures to examine fMRI correlates of a leading theoretical model in clinical reasoning based on experimental findings to date: analytic (i.e., actively comparing and contrasting diagnostic entities) and nonanalytic (i.e., pattern recognition) reasoning. We hypothesized that there would be functional neuroimaging differences between analytic and nonanalytic reasoning theory.Methods: 17 board-certified experts in internal medicine answered and reflected on validated U.S. Medical Licensing Exam and American Board of Internal Medicine multiple-choice questions (easy and difficult) during an fMRI scan. This procedure was followed by completion of a formal think-aloud procedure.Results: fMRI findings provide some support for the presence of analytic and nonanalytic reasoning systems. Statistically significant activation of prefrontal cortex distinguished answering incorrectly versus correctly (p < 0.01), whereas activation of precuneus and midtemporal gyrus distinguished not guessing from guessing (p < 0.01).Conclusions: We found limited fMRI evidence to support analytic and nonanalytic reasoning theory, as our results indicate functional differences with correct vs. incorrect answers and guessing vs. not guessing. However, our findings did not suggest one consistent fMRI activation pattern of internal medicine expertise. This model of employing fMRI correlates offers opportunities to enhance our understanding of theory, as well as improve our teaching and assessment of clinical reasoning, a key outcome of medical education. [ABSTRACT FROM AUTHOR]

The Uniformed Services University's (USU) F. Edward Hébert School of Medicine was chartered in 1972, with the goal of providing high-quality physicians for the Uniformed Services. In exchange for their education, USU graduates incur an active duty service obligation, after which they may choose to stay on active duty or transition to civilian practice. The purpose of this study is to describe the practice characteristics of USU graduates after this obligation has been completed in order to determine the societal benefits during this phase of their careers. To accomplish this purpose, we performed a retrospective cohort study of the first 20 years of USU graduates (1980-1999). We used the American Medical Association Physician Masterfile to determine the graduates' current practice location and characteristics, as well as their board certification status. Of these 2,760 graduates, nearly all (91%) were involved in active clinical practice in over 100 self-declared specialties, the vast majority (89%) practiced in locations other than the immediate vicinity of the medical school (i.e., Maryland and the District of Columbia), and most still worked for the federal government (71%). Finally, USU graduates in full-time clinical practice had a board certification rate of 93%, which was better than the average of all other graduates of U.S. Medical Schools (88%) in the same time period. Thus, it seems USU is attaining its goal of producing high-quality physicians who continue to benefit the nation after their service obligation has been completed, with many still in federal service. [ABSTRACT FROM AUTHOR]

Unlabelled: The Uniformed Services University of the Health Sciences (USU) houses the nation's only federal medical school, the F. Edward Hébert School of Medicine. A key aspect of the curriculum at USU is leadership education as graduates go on to serve the Department of Defense through a variety of senior positions in the military. We surveyed a specific group of USU graduates who have achieved the rank of General or Admiral ("flag officers") to enhance our understanding of successful leadership for military physicians and to gain an understanding of how USU might shape its curriculum in the future.Methods: We sent an Internet-based survey to 13 flag officer graduates. The first section of the survey contained items from the multifactor leadership questionnaire-6S, a questionnaire with evidence of reliability and validity for evaluating leadership styles. The second section of the survey contained open-ended questions addressing key characteristics of an effective leader in the Military Health System, experiences that prepared them for leadership, USU's role in leadership positions, and advice for USU for better educating future leaders. The second section of the survey was coded using the constant comparative method.Results: Eight flag officers (63%) responded to the survey. They all scored highly on transformational leadership style. Qualitative themes reached saturation for each open-ended question. The flag officers identified characteristics consistent with published literature from other fields regarding effective leadership. They endorsed USU's role in achieving their leadership positions and suggested areas for improvement.Conclusions: Characteristics of effective leadership (transformational leadership style) identified by the flag officers surveyed in this study are consistent with the literature from other fields. These finding have important implications for leadership education at USU and potentially other institutions. The results also provide additional data to support the notion that USU is meeting its societal obligation to educate future leaders in military medicine. [ABSTRACT FROM AUTHOR]

Purpose: Each year military medical students participate in a separate, military match culminating with the Joint Services Graduate Medical Education Selection Board (JSGMESB). Prior studies have explored postinterview communication that occurs during the National Resident Matching Program (NRMP), but not during the JSGMESB. We examined the frequency and nature of communication during the JSGMESB and compared it with the NRMP.Methods: Cross-sectional survey study of senior students conducted at Uniformed Services University of the Health Sciences (USU) and seven civilian U.S. medical schools during March to May 2010. Respondents answered questions regarding communication with residency programs during the match.Results: Significantly fewer USU respondents communicated with programs compared with the civilian cohort (54.1% vs. 86.4%, p < 0.01). Specific inquiries regarding rank order were more commonly experienced by USU respondents compared with civilians (17.5% vs. 4.8%, p = 0.02). USU respondents found postinterview communication both helpful (41.3%) and stressful (41.3%). 11.1% of USU respondents indicated that they moved a program higher on their final rank lists because of further communication with these programs.Conclusions: Postinterview communication during the JSGMESB process is less common and less stressful than that reported in the NRMP. USU respondents are more likely to be asked directly about their rank list and occasionally do change their lists. Uniform guidance mirroring the NRMP's dealing with direct inquiries about rank lists could potentially improve the process. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the study was to investigate the relationship between authenticity (how close to actual practice) of preclerkship instructional formats and preclerkship and clerkship outcome measures. A secondary purpose was to investigate the effect of student's small-group assignment during preclerkship period on instructional formats and preclerkship and clerkship outcome measurements.Methods: A prospective, randomized, crossover study was carried out with preclerkship students taking a clinical reasoning course. Students were randomized to small groups and exposed to three formats of differing instructional authenticity across three subject areas. Three student cohorts were taught using one instructional format per subject area with each cohort receiving a different instructional format for each of the three areas. Outcome measures at the end of the preclerkship year and the clerkship year were selected to determine the effect of each instructional format. Hierarchical linear modeling was performed to assess impact of format on outcomes and to assess potential group effect on outcomes.Results: Increasingly authentic instructional formats did not significantly improve clinical reasoning performance. Small-group assignment did not significantly contribute to the outcomes providing evidence that teacher training was successful.Conclusions: Increasing authenticity of instructional formats does not appear to significantly improve clinical reasoning performance. Faculty can be successfully trained to teach consistently in a clinical reasoning course. Medical educators should balance increasing authenticity with factors such as cognitive load and learner experience as well as engaging in frame-of-reference training to minimize group effects with designing new instructional formats. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship between self-reported research experience and medical students' performance in medical school and internship.Methods: We collected data from seven year-groups (1993-1999; N = 1,112) and examined 7 performance outcomes: medical school preclinical grade point average (GPA), medical school clinical GPA, cumulative medical school GPA, U.S. Medical Licensing Examination Step 1 and 2 scores, and scores on a previously validated program director's survey of intern professionalism and expertise. We then conducted a series of multiple linear regressions to determine the relations between self-reported research experience and our seven outcomes.Results: When compared to those who reported no prior research experience, students who reported research experience performed significantly better on U.S. Medical Licensing Examination Step 1 and had a higher medical school preclinical GPA. However, these same students scored significantly lower on intern professionalism and expertise ratings. Self-reported research experience did not show statistically significant correlations with the other outcome variables.Conclusions: The results from our large, multiyear, cohort study suggest that prior research experience may account for some variance in outcomes in the early stages of medical school education, but that variance explained diminishes considerably as trainees progress into the more senior phases of education. On the other hand, prior research experience may be negatively related to students' performance in internship. In all cases, however, effect sizes are small. [ABSTRACT FROM AUTHOR]

Background: Medical education programs need outcome measurements to promote curriculum improvement and to help meet accreditation standards.Purpose: Determine the added value of qualitative comments written by program directors (PDs) in response to a survey concerning first postgraduate year (PGY-1) graduates. We hypothesized that these comments would serve as an additional outcome measurement for our graduates, adding information not readily captured in numeric data.Methods: PD evaluation form surveys from 1993-2002. All qualitative comments offered in response to free text questions were coded and compared with numeric ratings.Results: A total of 1,247 surveys were included (80% response rate). Comments about specific graduates were coded as positive, negative, or neutral and were categorized into themes. Inter-rater reliability was high (kappa= 0.82). Compared with 4% of graduates who received one or more numeric ratings of less than satisfactory, 7% had one or more qualitative phrases classified as negative.Conclusions: Qualitative comments can serve as a useful outcome measurement. [ABSTRACT FROM AUTHOR]

Background: Medical educators grapple with predicting performance of graduates identified as struggling during medical school. Students appear before student promotions committees (SPCs) for multiple cognitive and noncognitive reasons and performance outcomes for this cohort have not been well defined in the literature. Purpose: To determine the predictive validity of SPC appearance with respect to performance on a Program Director's (PD's) Evaluation Form completed at the end of internship (PGY-1). Method: Residents were classified as 'below average,' 'average,' or 'above average' based on PD Evaluation Form ratings. This PD instrument has been shown to be feasible, reliable, and valid. Below-average residents were defined as having a below-average rating on any question on the PD Evaluation Form. We compared SPC and non-SPC cohorts with respect to these PD Evaluation Form ratings. The t test was used for statistical analysis. Results: Seven years of graduating classes from our institution were included. Of students who graduated from our institution, 119 of 856 students (14%) were presented at our SPC during medical school during our study period. There were 196 residents (23%) identified as below average. The PD Evaluation Form response rate for this period was 77%. Students who appeared at our SPC were significantly more likely to have below-average scores for almost all PD Evaluation Form questions with small to moderate effect sizes. Conclusions: Students who appear before SPCs are at higher risk of below-average performance as rated by a PD Evaluation Form at the end of PGY-1. However, only a minority of trainees that appeared before our SPC received below-average ratings during internship. These data provide predictive validity evidence that SPC appearance during medical school does identify below average performance during internship. Our data support that SPC appearance during medical school, regardless of cause, is a risk for below average performance during internship. [ABSTRACT FROM AUTHOR]

Background: The Uniformed Services University of the Health Sciences (USUHS) F. Edward Hébert School of Medicine exists to provide physicians who will become leaders in military medicine in both war and peacetime. Studying the career accomplishments of graduates who have reached or are near the end of their military career is one way to assess how well USUHS is meeting this societal charge.Methods: Self-reported survey of all 2,689 USUHS graduates since its inception in 1976. Data were collected with regard to residency completed, additional degrees obtained, leadership positions and rank obtained, deployment experience, and academic affiliations.Results: Our survey resulted in a 59% response rate (712 of 1,199 respondents) for the matriculating classes of 1980-1989 and a 68% (1,822 of 2,689 respondents) total response rate for all graduates. Career outcome data were analyzed for graduates of the 1980-1989 classes in this article. For this cohort, the board certification rate was 99%; 20% obtained additional degrees; 96% have worked as full-time clinicians; 14% received below-the-zone promotions; 51% had deployed for combat and 42% for humanitarian missions; and 57% continue to hold medical school faculty appointments.Discussion: Many accomplishments, to include high sustained board certification rates from a diverse array of specialties, broad deployment experience, achievement of high leadership responsibilities and senior rank, as well as important contributions to academic medicine were achieved by these graduates. Our results support that USUHS is accomplishing its societal charge. [ABSTRACT FROM AUTHOR]

Background: For more than a decade, primary care residency training programs have struggled to attract graduates of U.S. medical schools. Internal medicine (IM) interest groups (IMIGs) have been widely instituted to foster student interest in careers in IM. Residents can participate in many IMIG activities. Studies have not assessed the benefits gained by resident participants in such groups.Methods: A questionnaire was sent to residents at two IM residency training programs that contribute to IMIG activities at one medical school. Both participating and nonparticipating residents were included.Results: The questionnaire was completed by 44 of 58 IM residents (76% response rate; 25 participants and 19 nonparticipants). Free-text advantages reported were teaching (n=6), mentoring (n=8), and leadership (n=5) opportunities, staying current in IM (n=3), encouraging students to enter IM (n=6), and improving resident morale (n=6). Likert-scale responses were higher for participants than for nonparticipants for all questions; nonparticipants also reported that involvement in IMIG activities is beneficial for residents. Statistically significant results were seen for questions regarding the following: improves resident morale, fosters leadership opportunities, is a valuable experience, and feeling qualified to participate.Conclusions: Residents perceive that participation in an IMIG confers significant benefit, providing additional justification for conducting these interest groups. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the feasibility and construct validity of our graduate and employer survey and its potential use in programmatic evaluation. Methods: An identical survey instrument was sent to fellowship graduates from our institution and their employers. We estimated feasibility through determining our survey response rate. Construct validity was assessed by comparing graduate self-ratings and employer ratings and through comparing survey ratings with passing board-certification examinations and referrals to the National Practitioner Databank. Results: Eleven years of graduates were included (n = 38 graduates). Response rates were 84% and 82% for graduates and their employers, respectively. Mean supervisor ratings were greater than graduate self-ratings on all questions. The lowest rating consistently across survey years was in graduates' self-perception of their ability to direct a PFT lab. One fellow failed his pulmonary boards and 1 failed his critical care boards on the first attempt. No graduates were referred to the National Practitioner Databank during our study period. Conclusions: This fellowship survey appears to be feasible and have construct validity. The consistency in the relatively low self-rating of graduates in directing a PFT lab has led to important areas for curriculum reform. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine how well published expectations are being met for internal medicine (IM) clerkship directors (CDs). Method: In 2005, the Clerkship Directors in Internal Medicine (CDIM) surveyed its institutional members. One section addressed expectations, in terms of requirements and resources, of and for CDs. Survey questions were categorical (yes, no, or unsure) addressing the essential responsibilities and resources outlined in the Alliance for Clinical Education (ACE) consensus statement. Descriptive statistics, MannWhitney U, and chi-square testing were used for inferential statistical procedures. Results: Eighty-eight of 109 institutional members responded to the survey (81% response rate). For each responsibility, more than 90% of respondents reported that they were required to meet the expectation; however, for each of the 8 essential resources, the percentage of respondents who were meeting the expectation varied from 41% for additional time and resources for administering other courses to 95% for sufficient material resources to support clerkship requirements. With the exception of larger institutions having greater access to new technology (p = .038, MannWhitney U) and a defined budget (p = .012, MannWhitney U), there were no differences in demographics between respondents who did and did not meet expectations or resources. Conclusion: IM CDs reported that they are expected to achieve essential responsibility benchmarks. Essential resources were being met in a variable fashion. [ABSTRACT FROM AUTHOR]

Chest pain with electrocardiographic changes is usually a life-threatening presentation of cardiac ischemia. There are, however, a variety of noncardiac conditions that have been reported to mimic these clinical and electrocardiographic changes. An Asian woman presented with chest pain and ST segment elevations in the distribution of the left anterior descending artery. She had persisting chest pain and ST segment elevations that were refractory to medical therapy, leading to thrombolytic therapy and rescue angiography, which revealed no evidence of coronary artery disease by coronary catherization. Cholecystitis was subsequently diagnosed with hepatobiliary scintigraphy. The patient's fever and ST segment elevations promptly resolved with antibiotic treatment. Four previous cases of ST segment elevation attributed to cholecystitis have been reported. Although the electrocardiographic changes attributed to cholecystitis have been shown to be correctable, the pathophysiological mechanism underlying these changes remains unclear. Prompt recognition of cholecystitis can ensure appropriate treatment and may prevent the performance of unnecessary diagnostic and therapeutic interventions. [ABSTRACT FROM AUTHOR]

The decision to undergo pericardectomy for symptomatic pericardial constriction is usually dictated by an image of an abnormal pericardium. We report a case of symptomatic pericardial constriction despite radiographic and pathological evidence of a normal pericardium. The patient was successfully treated with a pericardectomy, with resolution of constrictive hemodynamics and symptoms. Our report suggests that a normal pericardium by computed tomography and biopsy should not preclude pericardectomy for patients who have refractory symptoms, physical findings, and intracardiac pressures diagnostic of constrictive pericarditis. [ABSTRACT FROM AUTHOR]

The Food and Drug Administration recently banned the sale of ephedra alkaloids because of their association with arrhythmic sudden death, myocardial infarction, and stroke. This has resulted in the emergence of formulations marketed for weight loss and performance enhancement that are "ephedra free" but contain other sympathomimetic substances, the safety of which has not been established. We report a case of exercise-induced syncope in a healthy 22-year-old woman that occurred 1 hour after she took the second dose of Xenadrine EFX, an ephedra-free weight-loss supplement. Electrocardiography revealed prolongation of the QT interval (corrected QT, 516 milliseconds); this resolved in 24 hours. Results of echocardiography and exercise stress testing were normal. Nine months of monitoring with an implanted loop recorder revealed no arrhythmias in the absence of Xenadrine EFX. Although this product contains a number of compounds whose pharmacologic effect is poorly characterized, notable quantities of phenylephrine are present, and the proarrhythmic potential of this compound in the setting of exercise is discussed. [ABSTRACT FROM AUTHOR]

Polyethylene glycols (PEGs) are commonly utilized as a bowel prep prior to colonoscopy. They are generally well-tolerated, and reports of allergic reactions are rare. A recent search of the literature reveals only 4 prior reported cases of allergic reactions and only 1 other case of anaphylaxis. We report a second case of anaphylaxis following the ingestion of PEG solution, making this the fifth reported case of an allergic reaction to PEG bowel prep. [ABSTRACT FROM AUTHOR]

Context A challenge for medical educators is to better understand the personal factors that lead to individual success in medical school and beyond. Recently, educational researchers in fields outside medicine have acknowledged the importance of motivation and emotion in students' learning and performance. These affective factors have received less emphasis in the medical education literature. Objectives This longitudinal study examined the relations between medical students' motivational beliefs (task value and self-efficacy), achievement emotions (enjoyment, anxiety and boredom) and academic achievement. Methods Second-year medical students (n = 136) completed motivational beliefs and achievement emotions surveys following their first and second trimesters, respectively. Academic achievement was operationalised as students' average course examination grades and national board shelf examination scores. Results The results largely confirmed the hypothesised relations between beliefs, emotions and achievement. Structural equation modelling revealed that task value beliefs were positively associated with course-related enjoyment (standardised regression coefficient [?] = 0.59) and were negatively related to boredom (? = - 0.25), whereas self-efficacy beliefs were negatively associated with course-related anxiety only (? = - 0.47). Furthermore, student enjoyment was positively associated with national board shelf examination score (? = 0.31), whereas anxiety and boredom were both negatively related to course examination grade (? = - 0.36 and - 0.27, respectively). The overall structural model accounted for considerable variance in each of the achievement outcomes: R2 = 0.20 and 0.14 for the course examination grade and national board shelf examination score, respectively. Conclusions This study suggests that medical students' motivational beliefs and achievement emotions are important contributors to their academic achievement. These results have implications for medical educators striving to understand the personal factors that influence learning and performance in medical training. [ABSTRACT FROM AUTHOR]

Background: Failure to regain consciousness after general anesthesia has a multitude of life-threatening causes, including neurological injury, metabolic derangements, or drug effects. Failure to promptly recognize the cause of unconsciousness after anesthesia can result in significant patient morbidity or mortality, costly laboratory and radiographic evaluation, and physician anxiety. Rarely, patients fail to awaken after anesthesia due to a psychiatric cause. The early recognition of psychogenic coma can result in reduced iatrogenic complications, hospital cost, and physician anxiety.Case: We present a case of a 28-year-old female who became unresponsive after general anesthesia for an upper endoscopy. Physical, laboratory, and radiographic examination after the procedure revealed no apparent organic cause for her failure to awaken. The patient spontaneously awoke after 16 hours without neurological deficit.Discussion: We reviewed the literature and identified 10 previously reported cases of postanesthesia psychogenic coma. We have compared and contrasted our case with the 10 previous reports and propose bedside clues to assist the physician with diagnosing this unusual condition. [ABSTRACT FROM AUTHOR]

Purpose: The United States is experiencing an accelerating physician shortage, especially within primary care. Medical educators are actively seeking ways to predict student specialty match and workforce requirements. Previous studies investigating specialty match have focused on factors known at the time of matriculation. This study examined whether third-year clerkship performance could be used to predict specialty match later in medical school.Method: The authors evaluated the clerkship performance of 802 students graduating from the Uniformed Services University between 2007 and 2011. They examined the relationship of students' clerkship grades and National Board of Medical Examiners' clinical subject examination scores to specialty match. In addition, the authors combined student performance in family medicine, internal medicine, and pediatrics to create composite variables and assessed their associations with the match.Results: Among 802 students, 339 (42.4%) students matched to primary care specialties. There was a positive association between higher family medicine (Odds ratio [OR] 1.65, 95% confidence interval [CI] 1.05, 2.59), general surgery (OR 1.91, 95% CI 1.22, 2.99), internal medicine (OR 2.17, 95% CI 1.35, 3.49), and pediatrics (OR 2.59, 95% CI 1.52, 4.43) clerkship grades and students matching into family medicine, general surgery, internal medicine, and pediatrics, respectively. Only family medicine showed a weak correlation between higher National Board of Medical Examiners' scores and specialty match.Conclusions: Higher clerkship performance in four of six Uniformed Services University third-year clerkships is associated with matching into the corresponding specialty. Clerkship performance provides a potential tool for educators in counseling students and predicting future specialty match. [ABSTRACT FROM AUTHOR]

Self-efficacy is a personal belief in one's capability to successfully execute the behaviors necessary to attain designated types of performances. Sometimes described as task-specific self-confidence, self-efficacy is a key component in many contemporary theories of motivation and learning. The purpose of this study was to develop a survey for measuring students' medical skills self-efficacy and to collect reliability and validity evidence for the instrument. A secondary purpose was to explore differences in students' self-efficacy from year 1 of medical school to year 4. We created 19 survey items based on the 6 core competencies of the Accreditation Council for Graduate Medical Education, and we collected data from 304 medical students. Results from an exploratory factor analysis suggested three interpretable factors: patient care self-efficacy (eight items, Cronbach's alpha = 0.92), interpersonal skills self-efficacy (three items, Cronbach's alpha = 0.76), and evidence-based medicine self-efficacy (three items, Cronbach's alpha = 0.79). We then compared students' self-efficacy at different stages of training using a one-way multivariate analysis of variance. Consistent with our expectations, we found several statistically significant differences, suggesting students' self-efficacy increased considerably from year 1 of medical school to year 4, F(9, 725) = 30.58, p < 0.001, Wilks' lambda = 0.46. Using this survey, medical educators and researchers have a psychometrically sound tool for measuring students' medical skills self-efficacy during undergraduate medical education. Practical implications and future directions are discussed. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the association between tertiary reviewer (admissions committee member) comments and medical students' performance during medical school and into internship.Methods: We collected data from seven year-groups (1993-1999) and coded tertiary reviewer comments into 14 themes. We then conducted an exploratory factor analysis to reduce the dimensions of the themes (excluding the Overall impression theme). Subsequently, we performed Pearson correlation analyses and multiple linear regression analysis to examine the relationship between the factors and seven outcome measures: medical school preclinical grade point average (GPA), medical school clinical GPA, cumulative medical school GPA, U.S. Medical Licensing Examination Step 1 and 2 scores, and scores on a program director's evaluation measuring intern professionalism and expertise.Results: We extracted seven factors from the 13 themes and found small-to-moderate, significant correlations between the factors, the Overall impression theme, and the outcome measures. In particular, positive comments on Test and Maturity were associated with higher U.S. Medical Licensing Examination Step 1 and 2 scores. Negative comments on Interview and Recommendations were associated with lower ratings of professionalism during internship. Comments on Overall impression were significantly associated with all the outcome measures.Conclusions: Tertiary reviewer comments were weakly associated with performance in medical school and internship. Compared with positive comments, negative comments had stronger associations with medical school and internship performance measures. [ABSTRACT FROM AUTHOR]

Introduction: Finding ways to improve communication and self-reflection skills is an important element of medical education and continuing professional development. This study examines the relationship between self-reflection and educational outcomes.Methods: We correlate performance in a preclinical course that focuses on self-reflection as it relates to contextual elements of patient care (Human Context of Health Care), with educational measures such as overall grade point average, clinical clerkship scores, and Medical College Admission Test (MCAT) scores.Results: Student performance in Human Context of Health Care correlated with MCAT-Verbal scores, MCAT-writing sample scores, clerkship grades, and overall medical school grade point average (R = 0.3; p < 0.001).Conclusion: Writing and self-reflection skills are often neglected in undergraduate medical curricula. Our findings suggest that these skills are important and correlate with recognized long-term educational outcomes. [ABSTRACT FROM AUTHOR]

Background: Despite published literature demonstrating deficiencies in chest radiograph (CXR)/basic radiology interpretation skills of 4th-year medical students, studies and subsequent curricula regarding the training needed to obtain these skills are lacking. Terms such as clinical exposure and radiology teaching have been used to describe the experience for these basic interpretive skills, but best practice methods of delivery, let alone common methods, have yet to be defined. Purpose: The objective is to describe the current methods of teaching and assessing CXR/basic radiology interpretation skills across institutions on the 3rd-year internal medicine (IM) clerkship. Methods: In 2005, the Clerkship Directors in Internal Medicine (CDIM), an international organization representing U.S. and Canadian medical schools, surveyed its institutional members. Twelve questions on the survey dealt with X-ray interpretation. Results: Eighty-eight of 109 members (81%) responded to the survey. Overall, 81% of respondents felt that CXR interpretation is an important clinical skill for medical students. Seventy-six percent indicated that instruction in these skills occurs on the IM clerkship. The most cited methods of instruction were lectures (56%) and teaching rounds (48%). Most schools spent on average of 2 to 4 hr during the IM clerkship on formal radiology instruction. Only 33% indicated that radiology interpretation skills are assessed during the clerkship. The most common assessment methods were written examination (19%) and OSCE (19%). Conclusion: Substantive data regarding attainment and assessment of CXR/basic radiology interpretation skills in the undergraduate curriculum are lacking. Our study provides preliminary descriptive data regarding CXR instruction and assessment on the 3rd-year IM clerkship. [ABSTRACT FROM AUTHOR]

Background: Shortages in primary care careers such as internal medicine are projected in the future. Conducting research is an explicit requirement for graduate medical education and interest in research is growing in undergraduate medical education. Purpose: We hypothesized that a medical student research initiative could increase student research productivity and foster mentoring relationships with internists. Method: We compared the number of medical student presentations, awards, and peer-reviewed publications before and after a brief research initiative at a single institution and recorded comments from student participants; data collected before the initiative were retrospective, and data after the initiative were collected prospectively. Mann-Whitney U was used for statistical analysis. Results: Twenty-seven students participated in our workshop initiative during the study period (2000-2005). Eighteen (67%) subsequently had presentations, research awards, and/or publications during the study period. Mann-Whitney U testing of groups (all pre-initiative Uniformed Services University students and initiative participants) showed a statistically significant increase in regional presentations (p = .003), research awards (p = .01), and publications (p = .02) after the research initiative. Student comments not only revealed research mentoring benefits but also commented on receiving career counseling advice from mentors. Conclusions: Our study findings support the feasibility of this initiative as well as produced significant outcomes in terms of quantified research productivity and student mentoring. [ABSTRACT FROM AUTHOR]

Background: The 4th-year internal medicine subinternship (subI), with its strong emphasis on experience-based learning and increased patient responsibilities, is an important component of undergraduate medical education. Discussions have begun amongst educational leaders on the importance of standardizing curriculum and evaluation tools utilized during the subinternship. Purpose: The objective of this survey was to describe the current state of educational practices regarding the subI curriculum, use of Clerkship Directors in Internal Medicine (CDIM) curricular guidelines, evaluation methodologies, and subintern call frequency and duty hours. Methods: The survey was a part of the CDIM annual survey sent to 109 institutional members in 2005. The subinternship survey included 17 questions that addressed the prevalence of formal curricula in the subinternship, use of CDIM curricular guidelines and resources, and the evaluation tools utilized for assessment of the subinternship. Two questions examined the call frequency and duty hours of the subinterns. Results: Eighty-eight members responded (81%). Of the respondents, 37% have a formal curriculum and 35% used CDIM curricular guidelines for the subinternship. More than half of the respondents agreed that the curricular guide helped organize their subI rotations (53%), and 48% agreed that it enhanced the quality of subI education. A global rating summative evaluation form (56%) was the most commonly used evaluation tool in the subinternship. Objective Structured Clinical Examinations1-3 (1%) and Mini-Clinical Evaluation Exercise (mini-CEX)4(2%) were much less utilized during the subinternship. The respondents expressed an interest in the development of a standardized exam (47%) and clinical assessment tools such as the mini-CEX (59%). The vast majority of IM subinterns participate in 3 to 9 calls per rotation and spend less than 80 hr in the hospital per week. Conclusions: A formal curriculum is offered in slightly more than one third of subIs. Clerkship directors expressed interest in developing standardized evaluation tools to assess subintern competencies. The majority of IM subinterns spend less than 80 hr in the hospital per week. Further studies are needed to assess barriers to incorporating a formal curriculum and develop standardized tools to assess subintern competencies. [ABSTRACT FROM AUTHOR]

Background: Evaluation methods within and across clerkships are rapidly evolving, including greater emphasis or frameworks for descriptive evaluation and direct observation of competence. Purpose: The purpose of this study is to describe current evaluation methods, use of the Reporter-Interpreter-Manager/Educator (RIME) framework, and grade assignment by internal medicine clerkship directors. Methods: In 2005, the Clerkship Directors in Internal Medicine surveyed its 109 institutional members. Topics included evaluation methods and grade contribution, use of evaluation sessions and/or RIME, and grade assignment (criterion referenced or normative). Results: Response rate was 81% (88/109). The evaluation methods were as follows: teachers' evaluations, 93% (64% of grade); National Board of Medical Examiners subject examination, 81% (25% of grade); faculty written exam, 34% (14% of grade); objective structured clinical examinations, 32% (12% of grade); direct observation, 22% (7% of grade). RIME is used by 42% of respondents. Many clerkship directors (43%) meet with teachers to discuss student performance. Criterion-referenced grading is used by 59%, and normative grading is used by 27%. Unsatisfactory grades are given for examination failures (72%), unprofessional behavior (49%), poor clinical performance (42%), and failure to meet requirements (18%). Conclusions: Internal medicine clerkship directors emphasize description and observation of students. RIME and discussions with teachers are becoming commonplace. [ABSTRACT FROM AUTHOR]

Background: Objective Structured Clinical Examinations (OSCEs) are used at the majority of U.S. medical schools. Given the high resource demands with constructing and administering OSCEs, understanding how OSCEs relate to typical performance measures in medical school could help educators more effectively design curricula and evaluation to optimize student instruction and assessment.Purpose: To investigate the correlation between second-year and third-year OSCE scores, as well as the associations between OSCE scores and several other typical measures of students' medical school performance.Methods: We tracked the performance of a 5-year cohort (classes of 2007-2011). We studied the univariate correlations among OSCE scores, U.S. Medical Licensing Examination (USMLE) scores, and medical school grade point average. We also examined whether OSCE scores explained additional variance in the USMLE Step 2 Clinical Knowledge score beyond that explained by the Step 1 score.Results: The second- and third-year OSCE scores were weakly correlated. Neither second- nor third-year OSCE score was strongly correlated with USMLE scores or medical school grade point average.Conclusion: Our findings suggest that OSCEs capture a viewpoint that is different from typical assessment measures that largely reflect multiple choice questions; these results also support tenets of situated cognition theory. [ABSTRACT FROM AUTHOR]

BACKGROUND: Step 2 Clinical Skills (CS) was recently introduced into the United States Medical Licensing Examination (USMLE) to ensure that successful candidates for licensure possess the clinical skills to provide safe and effective patient care. AIMS: To explore if medical schools had changed the objectives, content, or emphasis in their pre-clinical curriculum in response to its implementation. METHODS: In April 2005, the Clerkship Directors in Internal Medicine (CDIM) sent an electronic survey to a single member from each medical school with a CDIM member. The survey instrument included 26 pre-clinical curricular questions with nine questions specifically addressing changes in response to implementation of the Step 2 CS. RESULTS: Forty-five percent of respondents reported changes to the Introduction to Clinical Medicine (ICM) course objectives while 39% and 40% reported changes in content and emphasis. Seventy-four percent felt their students were adequately prepared for the Step 2 CS and 18% were unsure. CONCLUSIONS: Over a third of medical schools are implementing changes to the objectives, content, and/or emphasis of their curriculum, at least partially in response to the institution of Step 2 CS. [ABSTRACT FROM AUTHOR]