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Background: It is not known how well dean's letter rankings predict later performance in residency. Purpose: To assess the accuracy of dean's letter rankings to predict clinical performance in internship. Method: Participants were medical students who graduated from the University of Rochester School of Medicine and Dentistry in the classes of 2003 and 2004. In their Dean's Letter, each student was ranked as either 'Outstanding' (upper quartile), 'Excellent' (second quartile), 'Very good' (lower 2 quartiles), or 'Good' (lowest few percentile). We compared these dean's letter rankings against results of questionnaires sent to program directors 9 months after graduation. Results: Response rate to the questionnaire was 58.9% (109 of 185 eligible graduates). There were no differences in response rate across the four dean's letter ranking categories. Program directors rated students in the top two categories of dean's letter rankings significantly higher than those in the very good group. Students in all three groups were rated significantly higher than those in the good group, F (3, 105) = 13.37, p < .001. Students in the very good group were most variable in their ratings by program directors, with many receiving similarly high ratings as students in the upper 2 groups. There were no differences by gender or specialty. Conclusion: Dean's letter rankings are a significant predictor of later performance in internship among graduates of our medical school. Students in the bottom half of the class are most likely either to underperform or overperform in internship. [ABSTRACT FROM AUTHOR]

Patients with seasonal affective disorder have episodes of major depression that tend to recur during specific times of the year, usually in winter. Like major depression, seasonal affective disorder probably is underdiagnosed in primary care settings. Although several screening instruments are available, such screening is unlikely to lead to improved outcomes without personalized and detailed attention to individual symptoms. Physicians should be aware of comorbid factors that could signal a need for further assessment. Specifically, some emerging evidence suggests that seasonal affective disorder may be associated with alcoholism and attention-deficit/hyperactivity disorder. Seasonal affective disorder often can be treated with light therapy, which appears to have a low risk of adverse effects. Light therapy is more effective if administered in the morning. It remains unclear whether light is equivalent to drug therapy, whether drug therapy can augment the effects of light therapy, or whether cognitive behavior therapy is a better treatment choice. [ABSTRACT FROM AUTHOR]

Clinical and translational research is a multidisciplinary, collaborative team process. To evaluate this process, we developed a method to document emerging research networks and collaborations in our medical center to describe their productivity and viability over time. Using an e-mail survey, sent to 1,620 clinical and basic science full- and part-time faculty members, respondents identified their research collaborators. Initial analyses, using Pajek software, assessed the feasibility of using social network analysis (SNA) methods with these data. Nearly 400 respondents identified 1,594 collaborators across 28 medical center departments resulting in 309 networks with 5 or more collaborators. This low-burden approach yielded a rich data set useful for evaluation using SNA to: (a) assess networks at several levels of the organization, including intrapersonal (individuals), interpersonal (social), organizational/institutional leadership (tenure and promotion), and physical/environmental (spatial proximity) and (b) link with other data to assess the evolution of these networks.

Background: Much of the work of teachers and leaders at academic health centers involves engaging learners and faculty members in shared goals. Strategies to do so, however, are seldom informed by empirically-supported theories of human motivation., Discussion: This article summarizes a substantial body of motivational research that yields insights and approaches of importance to academic faculty leaders. After identification of key limitations of traditional rewards-based (i.e., incentives, or 'carrots and sticks') approaches, key findings are summarized from the science of self-determination theory. These findings demonstrate the importance of fostering autonomous motivation by supporting the fundamental human needs for autonomy, competence, and relatedness. In turn, these considerations lead to specific recommendations about approaches to engaging autonomous motivation, using examples in academic health centers., Summary: Since supporting autonomous motivation maximizes both functioning and well-being (i.e., people are both happier and more productive), the approaches recommended will help academic health centers recruit, retain, and foster the success of learners and faculty members. Such goals are particularly important to address the multiple challenges confronting these institutions.

Background: First-year medical students typically have limited exposure to patients in diverse care settings, such as rehabilitation facilities and nursing homes., Purpose: It is unknown whether students bring predetermined attitudes toward these patients, or whether attitudes are influenced by early exposure. We studied this in a new course that provides opportunities for students to interact with patients of various ages and disabilities., Methods: We conducted surveys of 1st-year medical students at the University of Rochester in the year prior to the new course and during its initial year. We used factor analysis to derive underlying dimensions of students' responses. We also investigated the impact that the course had on their perceptions., Results: In both years, we found that students conceptualize patient care along 2 affective dimensions (comfort and pleasure) and 2 attitudinal dimensions (bias and pessimism), rather than by type of disability., Conclusions: This 10-week course improved their affect toward these patient groups but had little effect on their general attitudes toward the value of caring for them.

Context: In response to historical trends in expectations of doctors, the goals of medical education are increasingly framed in terms of global competencies. The language of these competencies has tended to adopt a prescriptive, rather than descriptive, approach. However, despite widespread agreement on the importance of competency-based education and more than two decades of study, this effort has not generated a dependable set of assessment tools., Discussion: Because models of competency are legislated, rather than shaped by scholarly consideration of empirical data, it is unlikely that such models directly reflect actual human behaviour. Efforts to measure clinical behaviours could benefit from increased clarity in three related conceptual areas. Firstly, the language of educational constructs should be framed in terms of data-based hypotheses, rather than in terms of intuitively plausible abilities. Secondly, these constructs should be specified in terms of the situations to which they are relevant, rather than as global personal characteristics. Finally, the resources required to measure these constructs should be rigorously established because a common resource-based metric would allow for rational selection of assessment methods. Specific methods to establish each of these objectives are discussed., Conclusions: The political process of negotiating educational objectives should not be confused with the scientific work of establishing coherent and interpretable patterns of behaviour. Although the two activities can complement one another, each has its own distinct methods and style of discourse. It is thus critical to maintain boundaries between these two approaches to defining professional performance., (© Blackwell Publishing Ltd 2012.)

Background: Grading committees give excessive weight to standardized-examination scores., Purpose: Understanding that biases are often ingrained in grading processes, we sought to assess the influence of a structured grading policy in limiting this effect., Methods: All 7 clerkship grading committees derived students' clinical scores while blinded to examination scores. Scores were combined to yield a final rank order, which was used to derive grade cutoffs. Logit regression was performed to assess the contribution of clinical and examination scores to final grades. Results were compared to a similar analysis where committees were not blinded to examination scores., Results: In contrast to prior findings, grading committees consistently assigned greater weight to clinical-performance scores in assigning final grades when blinded to examination scores., Conclusions: Grading committees may be unaware of the extent to which they discount clinical assessments when they are at odds with the results of standardized examinations. This can be addressed with a procedure that blinds grading committees to examination scores.

Background and Objectives: Currently available tools to measure teamwork, an essential component of primary care, are generally very resource intensive and thus cannot be administered frequently. To explore the possibility of developing a brief teamwork-assessment instrument, we first administered 29 questions about teamwork from the Practice Environment Checklist (PEC) to all members of six clinical teams in a residency outpatient practice (n=56). We found that the scale assessed a single dimension of teamwork and that a five item survey has acceptable reliability (Cronbach alpha=0.89). In a subsequent validation study among an expanded sample of clinic staff (n=89), we found that the five-item questionnaire could be completed in less than 3 minutes. It continued to have an acceptable internal consistency (Cronbach alpha=0.82) and that all five items had sizeable item-total correlations. The resulting short form of the PEC may be useful for frequent assessment of team function.

Requirements for accreditation of medical professionals are increasingly cast in the language of general competencies. Because the language of these competencies is generally shaped by negotiations among stakeholders, however, it has proven difficult to attain consensus on precise definitions. This lack of clarity is amplified when attempting to measure these essentially political constructs in individual learners. The authors of this commentary frame these difficulties within modern views of test validity. The most significant obstacle to valid measurement is not necessarily a lack of useful tools but, rather, a general unwillingness to question whether the competencies themselves represent valid measurement constructs. Although competencies may prove useful in defining an overall social mission for organizations, such competencies should not be mistaken for measurable and distinct attributes that people can demonstrate in the context of their actual work., (© by the Association of American Medical Colleges.)

Background: Despite the use of competency-based frameworks to evaluate physicians, the role of competency-based objectives in undergraduate medical education remains uncertain., Purpose: By use of an audit methodology, we sought to determine how the six Accreditation Council for Graduate Medical Education (ACGME) competencies, conceptualized as educational domains, would map onto an undergraduate medical curriculum., Methods: Standardized audit forms listing required activities were provided to course directors, who were then asked to indicate which of the domains were represented in each activity. Descriptive statistics were calculated., Results: Of 1,500 activities, there was a mean of 2.13 domains per activity. Medical Knowledge was the most prevalent (44%), followed by Patient Care (20%), Interpersonal and Communication Skills (12%), Professionalism (9%), Systems-Based Practice (8%), and Practice-Based Learning and Improvement (7%). There was considerable variation by year and course., Conclusions: The domains provide a useful framework for organizing didactic components. Faculty can also consider activities in light of the domains, providing a vocabulary for instituting curricular change and innovation.

Context: Grades in clinical clerkships are typically based on a combination of clinical assessments from teachers, as well as results of more reliable (but perhaps less valid) scores on standardised tests of knowledge. It is not clear how these scores are combined in practice to yield a final summative grade., Methods: Our subjects were 83 students who rotated through five clinical clerkships during a single year. After computing univariate correlations between clinical assessment scores and standardised examination scores, we performed logistic regression analyses for each clerkship to predict the final grade from these two variables. We compared actual grade with predicted grade under various hypothetical policies for combining these two variables. Finally, we assessed whether some students would systematically benefit from these policies., Results: Clerkships varied in their univariate correlations between scores on clinical assessments and scores on standardised examinations. Clerkships with the lowest correlations tended to give more weight to standardised examination scores. Grading committees adjusted a substantial minority of grades to account for factors that were not reflected in either score. There did not appear to be a systematic bias in grading committee effect across the five clerkships., Conclusions: These results suggest a number of testable hypotheses about the cognitive processes by which evaluators combine various pieces of information to yield a summative performance score.

In the century since the initial publication of the Flexner Report, medical education has emphasized a broad knowledge of science and a fundamental understanding of the scientific method, which medical educators believe are essential to the practice of medicine. The enormous growth of scientific knowledge that underlies clinical practice has challenged medical schools to accommodate this new information within the curricula. Although innovative educational modalities and new curricula have partly addressed this growth, the authors argue for a systematic restructuring of the content and structure of science education from the premedical setting through clinical practice. The overarching goal of science education is to provide students with a broad, solid foundation applicable to medicine, a deep understanding of the scientific method, and the attitudes and skills needed to apply new knowledge to patient care throughout their careers. The authors believe that to accomplish this successfully, the following changes must occur across the three major stages of medical education: (1) a reshaping of the scientific preparation that all students complete before medical school, (2) an increase in individualized science education during medical school, and (3) an emphasis on knowledge acquisition skills throughout graduate medical education and beyond to assure lifelong scientific learning. As students progress through the educational continuum, the balance of standardized and personalized scientific knowledge will shift toward personalization. Greater personalization demands that physicians possess well-refined skills in information acquisition, interpretation, and application for optimal lifelong learning and effective clinical practice.

Background: Effective communication in the preanesthesia clinic is important in patient-centered care. Although patient-physician communication has been studied by recordings in other contexts, there have been no observational studies of the communication patterns of anesthesiologists and patients during the preanesthesia interview., Methods: Two experienced standardized patients were trained to portray the same clinical situation by using different coping styles (maximizing information or "monitoring" vs. minimizing information or "blunting"). Interviews of standardized patients by anesthesiologists took place in the preanesthesia clinic and recorded with the knowledge of the subjects. Audio recordings were analyzed, and the visit was separated into nine components. Discussion of the risks/informed consent process was examined, looking for discussion of common morbidities. The standardized patients completed a survey on the patient-centeredness of the interview., Results: Twenty-seven subjects participated in this study. Interviews with the monitor required more time: 17.4 min (confidence interval [CI] 15.2-19.6, n = 24) versus 14.5 min (CI 13.1-16.0, n = 25), P < 0.05. Most interview time was spent in obtaining the history; 2.4 min (CI 1.8-3.1) was spent discussing risks with the monitor, and only 1.6 min (CI 1.2-2.0) was spent with the blunter (P < 0.05). Neither the monitor nor the blunter scored the interview highly for involving the patient in determining the goals of the anesthetic and recovery., Conclusions: Direct recording of interactions with standardized patients is a feasible method of studying the communication skills of anesthesiologists. For this study, the anesthesia providers were able to modify their approach depending on patient type, but the monitor received more information.

Background: Teaching hospitals increasingly rely on transfers of patient care to another physician (hand-offs) to comply with duty hour restrictions. Little is known about the impact of hand-offs on medical students., Objective: To evaluate the impact of hand-offs on the types of patients students see and the association with their subsequent Medicine Subject Exam performance., Design: Observational study over 1 year., Participants: Third-year medical students in an Inpatient Medicine Clerkship at five hospitals with night float systems., Primary Outcome: Medicine Subject Exam at the end of the clerkship; explanatory variables: number of fresh (without prior evaluation) and hand-off patients, diagnoses, subspecialty patients, and full evaluations performed during the clerkship, and United Stated Medical Licensing Examination (USMLE) Step I scores., Main Results: Of the 2,288 patients followed by 89 students, 990 (43.3%) were hand-offs. In a linear regression model, the only variables significantly associated with students' Subject Exam percentile rankings were USMLE Step I scores (B = 0.26, P < 0.001) and the number of full evaluations completed on fresh patients (B =0.20, P = 0.048; model r (2) = 0.58). In other words, for each additional fresh patient evaluated, Subject Exam percentile rankings increased 0.2 points. For students in the highest quartile of Subject Exam percentile rankings, only Step I scores showed a significant association (B = 0.22, P = 0.002; r (2) = 0.5). For students in the lowest quartile, only fresh patient evaluations demonstrated a significant association (B = 0.27, P = 0.03; r (2) = 0.34)., Conclusions: Hand-offs constitute a substantial portion of students' patients and may have less educational value than "fresh" patients, especially for lower performing students.

Purpose: To describe the basic concepts of social network analysis (SNA), which assesses the unique structure of interrelationships among individuals and programs, and introduce some applications of this technique in assessing aspects of institutional culture at a medical center., Method: The authors applied SNA to three settings at their institution: team function in the intensive care unit, interdisciplinary composition of advisory committees for 53 federal career development awardees, and relationships between key function directors at an institution-wide Clinical Translational Sciences Institute (CTSI). (Key functions are the major administrative units of the CTSI.), Results: In the ICU setting, SNA provides interpretable summaries of aspects of clinical team functioning. When applied to membership on mentorship committees, it allows for summary descriptions of the degree of interdisciplinarity of various clinical departments. Finally, when applied to relationships among leaders of an institution-wide research enterprise, it highlights potential problem areas in relationships among academic departments. In all cases, data collection is relatively rapid and simple, thereby allowing for the possibility of frequent repeated analyses over time., Conclusions: SNA provides a useful and standardized set of tools for measuring important aspects of team function, interdisciplinarity, and organizational culture that may otherwise be difficult to measure in an objective way.

Purpose: To evaluate published evidence that the Accreditation Council for Graduate Medical Education's six general competencies can each be measured in a valid and reliable way., Method: In March 2008, the authors conducted searches of Medline and ERIC using combinations of search terms "ACGME," "Accreditation Council for Graduate Medical Education," "core competencies," "general competencies," and the specific competencies "systems-based practice" (SBP) and "practice based learning and improvement (PBLI)." Included were all publications presenting new qualitative or quantitative data about specific assessment modalities related to the general competencies since 1999; opinion pieces, review articles, and reports of consensus conferences were excluded. The search yielded 127 articles, of which 56 met inclusion criteria. Articles were subdivided into four categories: (1) quantitative/psychometric evaluations, (2) preliminary studies, (3) studies of SBP and PBLI, and (4) surveys., Results: Quantitative/psychometric studies of evaluation tools failed to develop measures reflecting the six competencies in a reliable or valid way. Few preliminary studies led to published quantitative data regarding reliability or validity. Only two published surveys met quality criteria. Studies of SBP and PBLI generally operationalized these competencies as properties of systems, not of individual trainees., Conclusions: The peer-reviewed literature provides no evidence that current measurement tools can assess the competencies independently of one another. Because further efforts are unlikely to be successful, the authors recommend using the competencies to guide and coordinate specific evaluation efforts, rather than attempting to develop instruments to measure the competencies directly.

Purpose: Nonteaching services (NTSs) are becoming increasingly prevalent in academic hospitals. This study was designed to determine whether the presence of an NTS is associated with higher acuity and altered case mix on the teaching service., Method: The authors carried out a retrospective, cross-sectional analysis of data about all general medical admissions between January 1, 2005 and June 30, 2005 to either of two teaching hospitals in Rochester, New York. A total of 6,907 inpatients were studied, of whom 1,976 (29%) were admitted to medicine resident services and 4,931 (71%) were admitted to NTSs. Hospital billing databases were used to determine patient demographics, ICD-9 diagnoses, Charlson Comorbidity Index scores, and patient disposition., Results: Compared with NTS patients, patients on resident services had higher median Charlson Comorbidity Index scores (3.0 versus 2.0, P < .001) and numbers of comorbidities (9.0 versus 8.0, P < .001) and were more likely to require intensive care (15.5% versus 7.6%, P < .001) and to die in the hospital (8.2% versus 4.5%, P < .001). Patients on the resident services were more likely to have acute renal failure, respiratory failure, septicemia, and HIV. Residents were less likely to care for patients with primary diagnoses of chest pain, cellulitis, alcohol withdrawal, and sickle cell crisis. The differences in patients' conditions between resident services and NTSs were similar in the two hospitals and also among patients who had not received intensive care., Conclusions: Patients on resident services may be more medically complex and more likely to have high-acuity diagnoses than patients on NTSs. How these differences affect residents' education, residents' career decisions, and practice styles deserves further study.

Context: Subjective rating scales for communication skills may yield more personally meaningful responses than more standardised rating schemes. It is unclear, however, whether such evaluations may be overly biased by respondents' rating styles, which may lead to unreliable measurement of examinees' communication skills., Methods: Our study involved 212 students from the classes of 2005 and 2006 at the University of Rochester School of Medicine and Dentistry. All students were rated by actors depicting standardised patients (SPs) on the same seven cases using the 19-item Rochester Communication Rating Scale (RCRS). Different students were assigned to different actors playing the same SP. We assessed the extent to which actors' personal rating styles influenced the scores they assigned to students. Main outcome measures were: between-actor variability in responses; the degree to which actors' response styles contribute to overall scores, and improvements in reliability achieved by standardising actors' ratings., Results: There were statistically significant differences between actors in their mean assigned scores. Scores aggregated over 18 separate SP cases have an expected generalisability coefficient of 0.79. If raw RCRS scores are used, a total of 27 replications of the RCRS are required to achieve a Cronbach's alpha of 0.8; standardisation reduces this number to 18., Conclusions: Although actors are variable in their use of a standardised subjective scale of communication, such differences contribute to an acceptably small proportion of the total variance if scores are combined across a large number of cases. Reliability can be markedly improved by standardising scores across raters.

Background: It is known that male and female medical students have different experiences in their clinical training., Aims: To assess whether male and female medical students change in their self-rated work habits and interpersonal habits during the first year of clinical training., Method: Longitudinal study of self- and peer-assessment among 224 medical students in 3 consecutive classes at a private US medical school. Students rated themselves on global work habits (WH) and interpersonal attributes (IA). Students also rated and were rated by 6-12 peers on the same scale., Results: In the second year of medical school, there were no differences between men and women in quartiles of self-assessed WH or IA. At the end of the third year, however, women were more likely to be in the lower quartiles of self-assessed WH (X(2) = 6.77; p = 0.03), as well as the highest quartiles of self-assessed IA (X(2) = 11.36; p = 0.003). In both years, women rated their own WH skills significantly lower than they rated their peers, while men rated themselves similarly to peers. There were no sex differences in self-assessed IA., Conclusions: Although second-year male and female medical students appear similar to one another in terms of self-assessed WH and IA, by the end of the third year women rate themselves relatively lower in WH, while men rate themselves relatively lower in IA.

Background: It is not known to what extent the dean's letter (medical student performance evaluation [MSPE]) reflects peer-assessed work habits (WH) skills and/or interpersonal attributes (IA) of students., Objective: To compare peer ratings of WH and IA of second- and third-year medical students with later MSPE rankings and ratings by internship program directors., Design and Participants: Participants were 281 medical students from the classes of 2004, 2005, and 2006 at a private medical school in the northeastern United States, who had participated in peer assessment exercises in the second and third years of medical school. For students from the class of 2004, we also compared peer assessment data against later evaluations obtained from internship program directors., Results: Peer-assessed WH were predictive of later MSPE groups in both the second (F = 44.90, P < .001) and third years (F = 29.54, P < .001) of medical school. Interpersonal attributes were not related to MSPE rankings in either year. MSPE rankings for a majority of students were predictable from peer-assessed WH scores. Internship directors' ratings were significantly related to second- and third-year peer-assessed WH scores (r = .32 [P = .15] and r = .43 [P = .004]), respectively, but not to peer-assessed IA., Conclusions: Peer assessment of WH, as early as the second year of medical school, can predict later MSPE rankings and internship performance. Although peer-assessed IA can be measured reliably, they are unrelated to either outcome.

Entrustable professional activities (EPAs) have seen widespread adoption in medical education and other health professions education. EPAs aim to provide a bridge between competency-based education and clinical practice by translating competencies into fundamental profession-specific tasks associated with clinical practice. Despite the extensive use of EPAs in health professions education, EPAs have yet to be introduced into chiropractic education. The purpose of this paper is to describe the development and introduction of EPAs as part of 2 community-based chiropractic student preceptorship education programs in the United States. EPAs were developed and introduced at 2 community-based chiropractic preceptorship sites in 5 distinct steps: (1) differentiating EPAs from competencies, learning objectives, and knowledge, skills, and attitudes; (2) identifying EPAs; (3) mapping EPAs to competencies and necessary experience, knowledge, and skills; (4) designing EPA assessment strategies; and (5) implementing the use of EPAs. A total of 13 individual EPAs were developed and mapped to Council on Chiropractic Education meta-competency outcomes and underlying experience, knowledge, and skills. Three assessment tools were created to evaluate student entrustability for EPAs and enhance student self-assessment. The EPAs and assessment tools were integrated into chiropractic student preceptorships at each site. This paper describes the development and introduction of EPAs at 2 community-based chiropractic preceptorship sites. Future research is needed to develop and standardize EPA use and assessment, and to evaluate outcomes associated with EPA use. [ABSTRACT FROM AUTHOR]

Background: Hip fracture surgery under general or spinal anesthesia is a common procedure for older adults in the United States (US). Although spinal or general anesthesia can be appropriate for many patients, and the choice between anesthesia types is preference-sensitive, shared decision-making is not consistently used by anesthesiologists counseling patients on anesthesia for this procedure. We designed an Option Grid™-style conversation aid, My Anesthesia Choice─Hip Fracture, to promote shared decision making in this interaction. This study will refine the aid and evaluate its implementation and effectiveness in clinical practice. Methods: The study will be conducted over 2 phases: qualitative interviews with relevant clinicians and patients to refine the aid, followed by a stepped wedge cluster randomized trial of the intervention at 6 settings in the US. Primary outcomes will include the percentage of eligible patients who receive the intervention (intervention reach) and the change in quality of patient/clinician communication (intervention effectiveness). Secondary outcomes addressing other RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) domains will also be collected. Outcomes will be compared between baseline data and an active implementation period and then compared between the active implementation period and a sustainment period. Implementation strategies are guided by three constructs from the Practical, Robust Implementation and Sustainability Model (PRISM): intervention, recipients, and implementation and sustainability infrastructure. Discussion: This is a novel, large-scale trial evaluating and implementing a shared decision-making conversation aid for anesthesia choices. Strong buy-in from site leads and expert advisors will support both the success of implementation and the future dissemination of results and the intervention. Results from this study will inform the broader implementation of this aid for patients with hip fractures and can lead to the development and implementation of similar conversation aids for other anesthesia choices. Trial registration: ClinicalTrials.gov, NCT06438640 [ABSTRACT FROM AUTHOR]

Background: An assessment program should be inclusive and ensure that the various components of medical knowledge, clinical skills, and professionalism are assessed. The level and the variation over time in the strength of the correlation between these components of assessment is still a matter of study. Based on the meaningful learning theory and the integrated learning theory, we hypothesize that these components increase their connections during the medical school course. Methods: This is a retrospective cohort study that analyzed data collected for a 10-year period in one medical school. We included students from the 3rd to 6th year of medical school from 2011 to 2021. Three assessment components were addressed: Knowledge, Clinical Skills, and Professionalism. For data analysis, Pearson correlation coefficients (R) and R2 were calculated to study the correlation between variables and a z-test on Fisher's r-to-z was used to determine the differences between correlation coefficients. Results: 949 medical students were included in the study. The correlation between Clinical Skills and Professionalism showed a medium to strong association (Pearson's R ranging from 0.485 to 0.734), while the correlation between Knowledge and Professionalism was weaker but exhibited a steady evolution with Pearson's R fluctuating between 0.075 and 0.218. The Knowledge and Clinical Skills correlation became statistically significant from 2013 onwards and peaking at Pearson's R of 0.440 for the cohort spanning 2016–2019. We also revealed a strengthening of correlations between Professionalism and Clinical Skills from the beginning to the end of clinical training, but not with the knowledge component. Conclusions: This analysis contributes to our understanding of the dynamics of correlations of different assessment components within an institution and provides a framework for how they interact and influence each other. Trial registration: This study was not a clinical trial, but a retrospective observational study, without health care interventions. Nevertheless, we provide herein the number of the study as submitted to the Ethics committee – CEICVS 146/2021. [ABSTRACT FROM AUTHOR]

Bedside teaching (BST) is a core element of medical education. In light of a reported decrease in BST, evidence on how to use BST time most efficiently should be developed. Given that little research into the tangible quality characteristics of good BST has been reported, we investigated the influence of various teacher and structural characteristics on the perceived quality of BST. We filmed and coded 36 BSTs involving 24 lecturers and 259 students. Structural characteristics of interest were: number of students and patients, overall duration, and the proportion of clinical examination. Lecturer questionnaires provided insight into teaching experience and intrinsic motivation, and student evaluations assessed the quality of BSTs in three dimensions. Correlations are reported using the Pearson r and a linear mixed model (LMM). The intrinsic motivation of lecturers was significantly positively correlated with perceived quality, but their experience was only weakly so correlated. In the LMM, a significant association was observed for the quality dimension of clinical teaching with the number of patients and the proportion of time spent on clinical examination. Based on our findings, we recommend including multiple patients in BSTs, and providing substantial opportunities for clinical examination. Regarding lecturers, motivation matters more than experience. [ABSTRACT FROM AUTHOR]

Context: Although peer-assessment appears promising as a method to assess interpersonal skills among medical students, results may be biased by method of peer selection, particularly if different kinds of classmates are assigned systematically by different methods. It is also unclear whether students with lower interpersonal skills may be more negative towards their classmates than students with higher levels of interpersonal skills and, if so, how much bias this may introduce into the results of peer assessment. It is also unclear whether low-rated students are more likely to ask to rate one another., Design, Setting, and Participants: Participants were 296 medical students from the classes of 2004, 2005 and 2006 at the University of Rochester School of Medicine and Dentistry. All participants were evaluated by between 6 and 12 classmates near the end of both their second and third years. In some classes peer-raters were assigned from class lists, while in other classes students were asked to recommend classmates to rate and be rated by., Main Outcome Measures: Mean numerical ratings of interpersonal-attributes scores received from peers, compared with mean scores simultaneously assigned to peers. We also examined students' selection of peer-raters, as well as scores received by their peer-raters., Results: For all 3 classes in both second and third years, students in the lowest quartile of received scores were significantly more likely to simultaneously assign lower scores to their peers. Among third-year students, such low-scoring students were significantly more likely to ask to rate and be rated by other low-scoring students. Among third-year students, low-rated students were more likely to rate and be rated by other low-rated students, irrespective of how rater assignments are made. Most students who were originally in the lowest quartile of received scores remained so after removing the scores assigned by low-rated raters. Among pre-clinical second-year students, however, low-rated students were no more likely than high-rated students to be rated by other low-rated students., Conclusion: Students with low levels of peer-assessed interpersonal attributes are more negative in their judgements of classmates. Third-year medical students with low levels of interpersonal attributes are more likely to be rated by other students with low levels of interpersonal attributes, irrespective of method of rater assignment. This effect was not seen in the second year of medical school. Biases in selection of raters among third-year students, however, do not appear to affect the results of peer assessment. Thus, medical schools that choose to institute peer assessment can select the method of peer-rater assignment based on practicality and logistical considerations. Students' affiliations with one another in the third year appear to be related to peer-assessed interpersonal attributes.

Peer assessment has been increasingly recommended as a way to evaluate the professional competencies of medical trainees. Prior studies have only assessed single groups measured at a single timepoint. Thus, neither the longitudinal stability of such ratings nor differences between groups using the same peer-assessment instrument have been reported previously. Participants were all members of 2 consecutive classes of medical students (n = 77 and n = 85) at the University of Rochester School of Medicine and Dentistry who completed Years 2 and 3 of medical school consecutively. All participants were evaluated by 6-12 classmates near the end of both Years 2 and 3. Main outcome measures were mean numerical ratings on peer-assessed scales of professional work habits (WH) and interpersonal attributes (IA). Both scales had high internal consistencies in both years (Cronbach's alpha 0.84-0.94). The IA and WH scales were moderately correlated with one another (r = 0.36 in Year 2, r = 0.28 in Year 3). Year 2 scores were predictive of Year 3 scores for both scales (WH: r = 0.64; IA; r = 0.62). Generalisability and decision analyses revealed that 1 class was consistently more discriminating with the WH scale, while the other was more discriminating with of the IA scale. Depending on the class, year and scale, the number of raters needed to achieve a reasonable reliability ranged between 7 and 28. Although Year 3 peer ratings were consistently higher than Year 2 peer ratings for both WH and IA, individual scores were highly correlated across the 2 years, despite the fact that different individuals were chosen as peer raters. Abilities appear to be stable between Years 2 and 3 of medical school. Groups may differ in their ability to discriminate different kinds of skills. Generalisability analysis can be used to discover these patterns within groups.

The Seasonal Affective Disorder (SAD) is a disorder characterized by prolonged periods of depression and various physical and psychological symptoms experienced during specific seasons, typically winter. In this review aims to provide a comprehensive overview of SAD with a specific focus on psychophysiological aspects. Through the review from ancient times to the present, this paper explores the characteristics, causes, and underlying mechanisms of SAD. Particularly, it comprehensively reviews the research findings on the relationship between external factors such as light, sunlight, climate, and their association with SAD. Furthermore, the paper discusses the interplay between SAD and psychophysiological changes, along with the latest research trends in treatment and prevention strategies. By combining theoretical and practical perspectives on SAD, this article aims to provide a holistic understanding and offer suggestions for future research directions and clinical interventions. [ABSTRACT FROM AUTHOR]

Background: Entrustable professional activities (EPAs) are observable process descriptions of clinical work units. EPAs support learners and tutors in assessment within healthcare settings. For use amongst our pharmacy students as well as pre-registration pharmacists we wanted to develop and validate an EPA for use in a clinical pharmacy setting at LMU University Hospital. Methods: The development of the clinical pharmacy EPA followed a set pathway. A rapid literature review informed the first draft, an interprofessional consensus group consisting of pharmacists, nurses, and medical doctors refined this draft. The refined version was then validated via online survey utilising clinical pharmacists from Germany. Results: We designed, refined and validated an EPA regarding medication reconciliation for assessment of pharmacy students and trainees within the pharmacy department at LMU University Hospital in Munich. Along with the EPA description an associated checklist to support the entrustment decision was created. For validation an online survey with 27 clinical pharmacists from all over Germany was conducted. Quality testing with the EQual rubric showed a good EPA quality. Conclusions: We developed the first clinical pharmacy EPA for use in a German context. Medication reconciliation is a suitable EPA candidate as it describes a clinical activity performed by pharmacists in many clinical settings. The newly developed and validated EPA 'Medication Reconciliation' will be used to assess pharmacy students and trainees. [ABSTRACT FROM AUTHOR]

Scientific research has been changing medical practice at an increasing pace. To keep up with this change, physicians of the future will need to be lifelong learners with the skills to engage with emerging science and translate it into clinical care. How medical schools can best prepare students for ongoing scientific change remains unclear. Adding to the challenge is reduced time allocated to basic science in curricula and rapid expansion of relevant scientific fields. A return to science with greater depth after clinical clerkships has been suggested, although few schools have adopted such curricula and implementation can present challenges. The authors describe an innovation at Harvard Medical School, the Advanced Integrated Science Courses (AISCs), which are taken after core clerkships. Students are required to take 2 such courses, which are offered in a variety of topics. Rather than factual content, the learning objectives are a set of generalizable skills to enable students to critically evaluate emerging research and its relationship to medical practice. Making these generalizable skills the defining principle of the courses has several important advantages: it allows standardization of acquired skills to be combined with diverse course topics ranging from basic to translational and population sciences; students can choose courses and projects aligned with their interests, thereby enhancing engagement, curiosity, and career relevance; schools can tailor course offerings to the interests of local faculty; and the generalizable skills delineate a unique purpose of these courses within the overall medical school curriculum. For the 3 years AISCs have been offered, students rated the courses highly and reported learning the intended skill set effectively. The AISC concept addresses the challenge of preparing students for this era of rapidly expanding science and should be readily adaptable to other medical schools., (Copyright © 2022 by the Association of American Medical Colleges.)

Powerful medical education (PME) involves the use of new technologies informed by the science of expertise that are embedded in laboratories and organizations that value evidence-based education and support innovation. This contrasts with traditional medical education that relies on a dated apprenticeship model that yields uneven results. PME involves an amalgam of features, conditions and assumptions, and contextual variables that comprise an approach to developing clinical competence grounded in education impact metrics including efficiency and cost-effectiveness. This article is a narrative review based on SANRA criteria and informed by realist review principles. The review addresses the PME model with an emphasis on mastery learning and deliberate practice principles drawn from the new science of expertise. Pub Med, Scopus, and Web of Science search terms include medical education, the science of expertise, mastery learning, translational outcomes, cost effectiveness, and return on investment. Literature coverage is comprehensive with selective citations. PME is described as an integrated set of twelve features embedded in a group of seven conditions and assumptions and four context variables. PME is illustrated via case examples that demonstrate improved ventilator patient management learning outcomes compared to traditional clinical education and mastery learning of breaking bad news communication skills. Evidence also shows that PME of physicians and other health care providers can have translational, downstream effects on patient care practices, patient outcomes, and return on investment. Several translational health care quality improvements that derive from PME include reduced infections; better communication among physicians, patients, and families; exceptional birth outcomes; more effective patient education; and return on investment. The article concludes with challenges to hospitals, health systems, and medical education organizations that are responsible for producing physicians who are expected to deliver safe, effective, and cost-conscious health care. [ABSTRACT FROM AUTHOR]

Background: Progress testing is an assessment method in which an examination reflecting competencies at graduation is regularly administered to students over multiple years, thereby facilitating self-directed learning. However, the significance of the objective structured clinical examination as a progress test in undergraduate education, needs to be determined. This study provides evidence of the role of the objective structured clinical examination for progress testing and optimal scoring methods for assessing students in different academic years. Methods: We conducted a sequential explanatory mixed-methods pilot study. Participants were assessed using the Item Rating Scale, the year-adjusted Global Rating Scale, and the Training Level Rating Scale. The characteristics of each scale were compared quantitatively. In addition, the influence of the objective structured clinical examination as a progress test on learning attitudes was examined. Qualitative data from a post-examination questionnaire were analyzed, using content analysis to explore influences on self-directed learning. Results: Sixth and fifth year clinical students (n = 235) took the objective structured clinical examination progress test. The total Item Rating Scales were recorded (%) as 59.03 ± 5.27 and 52.64 ± 5.08 (p < 0.01); Training Level Rating Scale was 3.94 ± 0.39 vs 3.22 ± 0.42 (p < 0.01); and the year-adjusted Global Rating Scale was 4.25 ± 0.44 vs 4.32 ± 0.52 (no significant difference), for the sixth and fifth year students, respectively. The correlations across stations and the reliability of each station were satisfactory. Four categories were identified in the qualitative analysis: "motivation to learn during the clinical clerkship was promoted," "dissatisfied with being asked about things they had not experienced," "confusion about being unable to use conventional test-taking strategies," and "insufficient understanding of competencies at graduation." The scores indicated significant differences in performance according to training year. Conclusions: This study provides evidence that the objective structured clinical examination can be used as a progress testing tool for undergraduate clinical clerkships. Further enhancement of training opportunities and dissemination of performance competency goals in clerkship curricula are required if we intend to promote self-directed learning through progress testing. [ABSTRACT FROM AUTHOR]

With the rise of competency-based medical education and workplace-based assessment (WBA) since the turn of the century, much has been written about methods of assessment. Direct observation and other sources of information have become standard in many clinical programs. Entrustable professional activities (EPAs) have also become a central focus of assessment in the clinical workplace. Paper and pencil (one of the earliest mobile technologies!) to document observations have become almost obsolete with the advent of digital technology. Typically, clinical supervisors are asked to document assessment ratings using forms on computers. However, accessing these forms can be cumbersome and is not easily integrated into existing clinical workflows. With a call for more frequent documentation, this practice is hardly sustainable, and mobile technology is quickly becoming indispensable. Documentation of learner performance at the point of care merges WBA with patient care and WBA increasingly uses smartphone applications for this purpose. This AMEE Guide was developed to support institutions and programs who wish to use mobile technology to implement EPA-based assessment and, more generally, any type of workplace-based assessment. It covers backgrounds of WBA, EPAs and entrustment decision-making, provides guidance for choosing or developing mobile technology, discusses challenges and describes best practices. [ABSTRACT FROM AUTHOR]

Abstract: With the increasing availability of large clinical registries and administrative data sets, observational (i.e., nonexperimental) orthopaedic research is being performed with increased frequency. While this research substantially advances our field, there are fundamental limitations to what can be determined through a single observational study. Avoiding overstatements and misstatements is important for the sake of accuracy, particularly for ensuring that clinical care is not inadvertently swayed by how an observational study is written up and described. We have noticed that causal language is frequently misused in observational orthopaedic research-that is, language that says or implies that 1 variable definitively causes another, despite the fact that causation can generally only be determined with randomization. In this data-backed commentary, we examine the prevalence of causal language in a random sample of 400 observational orthopaedic studies; we found that causal language was misused in 60% of them. We discuss the implications of these results and how to report observational findings more accurately: the word "association" (and its derivatives) can almost always replace or reframe a causal phrase., Competing Interests: Disclosure: The authors indicated that no external funding was for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G479)., (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.)

Problem: Health professions education has shifted to a competency-based paradigm in which many programs rely heavily on workplace-based assessment (WBA) to produce data for summative decisions about learners. However, WBAs are complex and require validity evidence beyond psychometric analysis. Here, the authors describe their use of a rhetorical argumentation process to develop a map of validity evidence for summative decisions in an entrustment-based WBA system., Approach: To organize evidence, the authors cross-walked 2 contemporary validity frameworks, one that emphasizes sources of evidence (Messick) and another that stresses inferences in an argument (Kane). They constructed a validity map using 4 steps: (1) Asking critical questions about the stated interpretation and use, (2) Seeking validity evidence as a response, (3) Categorizing evidence using both Messick's and Kane's frameworks, and (4) Building a visual representation of the collected and organized evidence. The authors used an iterative approach, adding new critical questions and evidence over time., Outcomes: The first map draft produced 25 boxes of evidence that included all 5 sources of evidence detailed by Messick and spread across all 4 inferences described by Kane. The rhetorical question-response process allowed for structured critical appraisal of the WBA system, leading to the identification of evidentiary gaps., Next Steps: Future map iterations will integrate evidence quality indicators and allow for deeper dives into the evidence. The authors intend to share their map with graduate medical education stakeholders (e.g., accreditors, institutional leaders, learners, patients) to understand if it adds value for evaluating their WBA programs' validity arguments., (Copyright © 2021 by the Association of American Medical Colleges.)

Positive interpersonal relationships between college administration and faculty are necessary as they contribute to organizational climate measures, such as a sense of belonging and perceived organizational worth. Furthermore, such relationships may combat against faculty cynicism. Interpersonal experiences are particularly relevant in a post-coronavirus disease 2019 workplace in which interactions with colleagues are infrequent. Little is known about the effects of interpersonal experiences on part-time faculty specifically, as compared with full-time faculty. This study investigates teamwork experiences and interpersonal constraints as predictors of the attitudes and perceptions of full- and part-time faculty at a four-year public teaching college in the southwestern United States. After controlling for years working at the college, teamwork was a consistent predictor of higher sense of belonging, perceived organizational worth, and lower cynicism among full- and part-time faculty. Furthermore, the presence of negative coworker relationships was a significant predictor of lower sense of belonging and perceived organizational worth among full-time faculty. Inadequate help or lack of contact with co-workers was not a significant predictor of faculty attitudes and perceptions. The results of this study suggest the need for fostering teamwork and positive relationships among full- and part-time faculty in a meaningful and systemic manner within institutions of higher education. Additionally, this study provides support for institutionalizing a team-based approach to working among all faculty to foster perceived belonging and worth, while limiting cynicism. [ABSTRACT FROM AUTHOR]

Early career faculty face many challenges, including establishing a career direction, building skills, balancing work and personal life demands, finding mentors, and establishing collegial relationships within their departments. Early career funding has been shown to augment future success in academia; less is known about the impact of early career funding on the social, emotional, and professional identity aspects of work life. One theoretical perspective to examine this issue is self-determination theory, a broad psychological paradigm explaining motivation, well-being, and development. Self-determination theory is predicated on the idea that fulfillment of three basic needs leads to the achievement of integrated well-being. Optimizing autonomy (a sense of choice and control), competence (sense of mastery), and relatedness (a sense of belonging) accompanies greater motivation, productivity, and perceived success. The authors share how applying for and implementing an early career grant affected these three constructs. Early career funding manifested challenges and beneficial outcomes in relationship to each of the three psychological needs and led to important lessons that may be generally applicable to faculty across a wide range of disciplines. The authors offer broad principles as well as specific grant-related strategies for optimizing autonomy, competence, and relatedness while applying for and executing a grant. Practice points Self-determination theory may be used to understand the social, emotional, and professional development effects of career-altering projects such as attaining major grant funding. A medical educator can use the domains of self-determination theory – autonomy, competence, and relatedness – as levers to pull to enhance work well-being and realize potential. The pursuit of scholarly work in a personal field of interest can enhance autonomy. Optimal challenges are those that stretch the medical educator beyond their current stage of development and provide opportunities to develop and realize competence. The development and cultivation of a network of mentors, sponsors, and supportive colleagues can provide a strong sense of relatedness within the work. [ABSTRACT FROM AUTHOR]

Clinical supervisors are known to assess trainee performance idiosyncratically, causing concern about the validity of their ratings. The literature on this issue relies heavily on retrospective collection of decisions, resulting in the risk of inaccurate information regarding what actually drives raters' perceptions. Capturing in-the-moment information about supervisors' impressions could yield better insight into how to intervene. The purpose of this study, therefore, was to gather "real-time" judgments to explore what drives preceptors' judgments of student performance. We performed a prospective study in which physicians were asked to adjust a rating scale in real-time while watching two video-recordings of trainee clinical performances. Scores were captured in 1-s increments, examined for frequency, direction, and magnitude of adjustments, and compared to assessors' final entrustability judgment as measured by the modified Ottawa Clinic Assessment Tool. The standard deviation in raters' judgment was examined as a function of time to determine how long it takes impressions to begin to vary. 20 participants viewed 2 clinical vignettes. Considerable variability in ratings was observed with different behaviours triggering scale adjustments for different raters. That idiosyncrasy occurred very quickly, with the standard deviation in raters' judgments rapidly increasing within 30 s of case onset. Particular moments appeared to generally be influential, but their degree of influence still varied. Correlations between the final assessment and (a) score assigned upon first adjustment of the scale, (b) upon last adjustment, and (c) the mean score, were r = 0.13, 0.32, and 0.57 for one video and r = 0.30, 0.50, and 0.52 for the other, indicating the degree to which overall impressions reflected accumulation of raters' idiosyncratic moment-by-moment observations. Our results demonstrated that variability in raters' impressions begins very early in a case presentation and is associated with different behaviours having different influence on different raters. More generally, this study outlines a novel methodology that offers a new path for gaining insight into factors influencing assessor judgments. [ABSTRACT FROM AUTHOR]