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Background The purpose of this study was to implement an objective structured clinical examination for child neurology trainees for formative feedback regarding communication skills. Effective communication skills are essential and teachable, but tools to formally assess them are limited. An objective structured clinical examination is one such tool, but these examinations have not been developed for child neurology residents. Methods We developed nine standardized scenarios that highlighted communication challenges commonly encountered in child neurology. Child neurology trainees participated in three objective structured clinical examination events with three scenarios each over three academic years. Standardized patients portrayed patients or their parents. Each trainee–standardized patient encounter was evaluated by an observing faculty member using a modified Gap-Kalamazoo Communication Skills Assessment Form, the standardized patient who provided direct feedback, and by the participating trainee. Results We refined the process of case writing, standardized patient training, and trainee evaluation throughout the three-year pilot. Results indicated rater agreement ranging from 32% to 56%. Trainees reported that the cases were challenging and reflective of real life and that the experience helped improve their communication skills. Conclusions An objective structured clinical examination can provide a standardized setting for formative feedback regarding communication skills in child neurology residency programs. The communication challenges posed by common clinical scenarios involving critically ill children, children with undetermined prognosis, and the triad of parent, child, and physician can be realistically modeled in an objective structured clinical examination. We developed cases and a process that were valuable and that we plan to sustain for resident education related to communication skills.

Objectives Ultrasound is a valuable tool for anatomy education, but limited evidence exists for using ultrasound to teach neuroanatomy and neurophysiology. Previous work demonstrated a potential increase in medical knowledge in preclinical medical students participating in a neurology ultrasound workshop, however, without comparison to a control group. After 2 years, we assessed how a neurology ultrasound workshop affected the medical knowledge of participating preclinical medical students compared to a traditional curriculum control group. Methods This quasiexperimental study compared academic performance of ultrasound workshop participants to nonparticipant classmates. The primary outcome was the overall neurologic disorders unit total score. An analysis of covariance was conducted to test for statistically significant differences while controlling for the average quiz score. Results A total of 360 medical students were included in the study. The intervention group (n = 57) showed no significant difference in the total unit score (F = 3.206; P = .074), with averages for the control and experimental groups being 87.3% ± 5.0% and 88.4% ± 4.8%, respectively. Additionally, anatomy practical scores and written final examination scores were not significantly different between groups (F = 1.035; P = .310; F = 2.035; P = .155). Conclusions Participation in a neurologic disorders ultrasound workshop did not appear to be correlated with improved curricular performance in our cohort. Further research should continue to assess ultrasound workshops in other organ systems to elucidate the relationship between learning ultrasound and the impact on medical school academic performance.

The concept of providing focused, competency-based LGBTQ+ health education outside the setting of health professional programs, specifically for undergraduates, is quite uncharted. However, the issue at the core of our rationale is one shared by those with and without clinical exposure: how to best support the development of cultural competence in providers who are or will be caring for LGBTQ+ patients. Traditional health professional education programs have enacted a number of curricular initiatives in this regard, designed for advanced learners. By focusing specifically on the undifferentiated learner, we offer a new perspective on the timing of LGBTQ+ health-related education. Our course is not intended to supplant the critical learning and application that must occur in the clinic or hospital room. Rather, we present a framework for cultivating understanding of the healthcare issues faced by the LGBTQ+ community that may help a learner to acquire and apply skills subsequently with greater cultural competence.

Background Teaching rounds are an important component of the learning environment for residents in the intensive care unit (ICU). Retrieval practice is a cognitive learning tool that helps learners consolidate information and might improve the quality and culture of teaching rounds. Objective We performed a feasibility study from October 2018 to June 2019 to investigate the incorporation of retrieval practice into ICU rounds. Methods Participants included internal medicine and family medicine residents and pulmonary and critical care medicine fellows and faculty on medical ICU (MICU) teams at a tertiary care academic medical center. For 1-week periods, residents were asked to use retrieval practice after rounds, sharing one learning point. Participants were anonymously surveyed about the feasibility and acceptability of this strategy and perceptions of the educational value of ICU rounds before and after incorporating retrieval practice. Results We enrolled 9 MICU teams, including 31 residents, 8 fellows, and 8 attendings. Pre- and postsurvey response rates were 89% and 91% (42 and 43 of 47, respectively). Sixty-nine percent of respondents (30 of 43) reported sharing learning points on at least 3 days of the intervention week. Eighty-six percent of respondents (37 of 43) said retrieval practice did not adversely affect the workflow at the end of rounds. The perception that teaching on rounds was a priority increased after the intervention (3.93 versus 4.28 on 1–5 Likert scale, P = .047). Conclusions Using retrieval practice on MICU rounds was feasible and acceptable and was associated with an increase in the perceived priority given to teaching on rounds.

Introduction Child neurology has unique challenges in communication due to complex disorders with a wide array of prognoses and treatments. Effective communication is teachable through deliberate practice and coaching. Objective structured clinical exams (OSCEs) are one method of providing practice while assessing communication skills. Yet OSCEs have not been reported for child neurology residents. Methods We developed simulated clinical cases centering on communication skills for child neurology residents, all with challenging clinical scenarios (e.g., disclosure of a medical error, psychogenic nonepileptic events). Standardized patients (SPs) portrayed the parents of pediatric patients and, in some scenarios, an adolescent patient. We used a modified Gap-Kalamazoo Communication Skills Assessment Form to assess communication skills. The assessment was completed by faculty, SPs, and the resident, and we measured agreement among raters. Residents were surveyed afterward regarding their experience. Results Nine cases were developed and piloted. A total of 27 unique resident-case encounters with 16 individual trainees occurred over three annual implementations. Scores on the 360-degree assessment of communication skills showed that residents overwhelmingly underassessed their skills compared to other rater groups. Among 18 responses on the post-OSCE survey, the majority (77%) found the experience useful to their education and felt that the feedback from the SPs was helpful (61%) and the case portrayals were realistic (89%). Discussion We implemented simulated cases for assessment and formative feedback on communication skills for child neurology residents. We provide a blueprint to develop this educational activity in other programs.

Background In 2012, the Ohio State University College of Medicine (OSUCOM) implemented a new undergraduate medical curriculum. We compare outcomes of a third year traditional clerkship format to a combined Surgery and Obstetrics/Gynecology ‘ring’. Methods Performance outcomes of 4 consecutive classes were compared between pre- (2014, 2015) and post-curricular revision (2016, 2017). Results Three hundred ninety-one students consented use of their educational data for research. We examined medical knowledge (NBME scores, USMLE Step 1 and Step 2 CK scores) and student satisfaction between pre- and post-curricular revision. Results demonstrated no statistically significant difference in the Obstetrics/Gynecology NBME shelf examination. Surgery NBME and USMLE Step 2 scores were increased and statistically significant but satisfaction of both disciplines was higher pre-curricular revision. Conclusion Medical knowledge outcomes in this combined ’ring’ were similar to or higher than performance in previous years'. Future analyses are needed to assess the impact of OSUCOM curricular revision.

The aim of this study was to evaluate whether the current state of child neurology education during pediatric residency provides adequate preparation for pediatric practice. A survey was sent to recent graduates from 3 pediatric residency programs to assess graduate experience, perceived level of competence, and desire for further education in child neurology. Responses from generalists versus subspecialists were compared. The response rate was 32%, half in general pediatric practice. Only 22% feel very confident in approaching patients with neurologic problems. This may represent the best-case scenario as graduates from these programs had required neurology experiences, whereas review of Accreditation Council of Graduate Medical Education–accredited residency curricula revealed that the majority of residencies do not. Pediatric neurologic problems are common, and pediatric residency graduates do encounter such problems in practice. The majority of pediatricians report some degree of confidence; however, some clear areas for improvement are apparent.

Context A physician workgroup of the American Academy of Hospice and Palliative Medicine sought to define curricular milestones (CMs) for hospice and palliative medicine (HPM) Fellowship Programs. The developed list of CMs would serve as components upon which to organize curriculum and standardize what to teach during training. These would complement entrustable professional activities previously developed by this group and new specialty-specific reporting milestones (RMs) for HPM developed through the Accreditation Council for Graduate Medical Education. Objectives The objective of this study was to develop and vet CMs for HPM fellowships in the U.S. Methods A draft of CMs was developed through an iterative consensus group process with repeated cycles of drafting, analyzing, and revising by a broadly representative expert workgroup who then gained input from HPM educators at a national meeting workshop. The CM draft was subsequently revised and then vetted through a national survey to 203 fellowship educators. Respondents were asked to "keep," "revise," or "exclude" each proposed CM with space for comments. An agreement of 75% among respondents was set as the criteria a priori for keeping a CM. Eighty-four of the 203 potential respondents participated in the survey. All items met the minimum agreement level of 75% or greater recommending keeping the CM. Greater than 85% of the respondents agreed to keep 19 of the 22 CMs with no revisions. Comments for revisions on other CMs were primarily related to changes in language and formatting, not conceptual underpinnings. Conclusion A group consensus method strengthened by inclusion of a national survey to HPM fellowship educators resulted in a CM document that is both carefully developed and broadly vetted. Along with entrustable professional activities and new specialty-specific RMs, these CMs offer educators and trainees tools to create more comprehensive curricula and behaviorally based assessment tools for HPM fellowships and their stakeholders.

The 'Millennial' generation faces medical education learning environment challenges differently. We explore gender differences in burnout, perceived stress, and empathic concern in third-year medical students. A sample size of 654 third-year medical students completed an annual survey over 6 years. Survey items included: the Maslach Burnout Inventory-Student Scale (MBI-SS), Interpersonal Reactivity Index (IRI), and Perceived Stress Scale (PSS). We examined demographic differences using independent sample t-tests and performed a two-way ANOVA to test for potential interactions. Female students were more likely to have higher empathic concern compared to male students (IRI) (20.9±3.9 versus 19.1±4.1, p

Background : While both patients and physicians identify communication of bad news as an area of great challenge, the factors underlying this often complex task remain largely unknown. Emotional intelligence (EI) has been positively correlated with good general communication skills and successful leadership, but there is no literature relating EI to the delivery of bad news. Purpose : Our objectives were to determine: 1) performance of first-year pediatric residents in the delivery of bad news in a standardized patient (SP) setting; and 2) the role of EI in these assessments. Our hypothesis was that pediatric trainees with higher EI would demonstrate more advanced skills in this communication task. Methods : Forty first- year residents participated. Skill in bad news delivery was assessed via SP encounters using a previously published assessment tool (GRIEV_ING Death Notification Protocol). Residents completed the Emotional and Social Competency Inventory (ESCI) as a measure of EI. Results : Residents scored poorly on bad news delivery skills but scored well on EI. Intraclass correlation coefficients indicated moderate to substantial inter-rater reliability among raters using the delivering bad news assessment tool. However, no correlation was found between bad news delivery performance and EI. Conclusions : We concluded that first-year pediatric residents have inadequate skills in the delivery of bad news. In addition, our data suggest that higher EI alone is not sufficient to effectively deliver death news and more robust skill training is necessary for residents to gain competence and acquire mastery in this important communication domain. Keywords: breaking bad news; emotional intelligence; pediatrics (Published: 17 August 2015) Citation: Med Educ Online 2015, 20: 24245 - http://dx.doi.org/10.3402/meo.v20.24245

Objective Patients and physicians identify communication of bad news as a skill in need of improvement. Our objectives were to measure change in performance of first-year pediatric residents in the delivery of bad news after an educational intervention and to measure if changes in performance were sustained over time. Methods Communication skills of 29 residents were assessed via videotaped standardized patient (SP) encounters at 3 time points: baseline, immediately post-intervention, and 3 months post-intervention. Educational intervention used was the previously published “GRIEV_ING Death Notification Protocol.” Results The intraclass correlation coefficient demonstrated substantial inter-rater agreement with the assessment tool. Performance scores significantly improved from baseline to immediate post-intervention. Performance at 3 months post-intervention showed no change in two subscales and small improvement in one subscale. Conclusions We concluded that breaking bad news is a complex and teachable skill that can be developed in pediatric residents. Improvement was sustained over time, indicating the utility of this educational intervention. Practice implications This study brings attention to the need for improved communication training, and the feasibility of an education intervention in a large training program. Further work in development of comprehensive communication curricula is necessary in pediatric graduate medical education programs.

The aim of this study was to evaluate whether the current state of child neurology education during pediatric residency provides adequate preparation for pediatric practice. A survey was sent to recent graduates from 3 pediatric residency programs to assess graduate experience, perceived level of competence, and desire for further education in child neurology. Responses from generalists versus subspecialists were compared. The response rate was 32%, half in general pediatric practice. Only 22% feel very confident in approaching patients with neurologic problems. This may represent the best-case scenario as graduates from these programs had required neurology experiences, whereas review of Accreditation Council of Graduate Medical Education-accredited residency curricula revealed that the majority of residencies do not. Pediatric neurologic problems are common, and pediatric residency graduates do encounter such problems in practice. The majority of pediatricians report some degree of confidence; however, some clear areas for improvement are apparent.

High-quality audiovisual recording technology enables medical students to listen to didactic lectures without actually attending them. The authors wondered whether in-person attendance affects how students evaluate lecturers.This is a retrospective review of faculty evaluations completed by first- and second-year medical students at the Ohio State University College of Medicine during 2009-2010. Lecture-capture technology was used to record all lectures. Attendance at lectures was optional; however, all students were required to complete lecturer evaluation forms. Students rated overall instruction using a five-option response scale. They also reported their attendance. The authors used analysis of variance to compare the lecturer ratings of attendees versus nonattendees. The authors included additional independent variables-year of student, student grade/rank in class, and lecturer degree-in the analysis.The authors analyzed 12,092 evaluations of 220 lecturers received from 358 students. The average number of evaluations per lecturer was 55. Seventy-four percent (n = 8,968 evaluations) of students attended the lectures they evaluated, whereas 26% (n = 3,124 evaluations) viewed them online. Mean lecturer ratings from attendees was 3.85 compared with 3.80 by nonattendees (P ≤ .05; effect size: 0.055). Student's class grade and year, plus lecturer degree, also affected students' evaluations of lecturers (effect sizes: 0.055-0.3).Students' attendance at lectures, year, and class grade, as well as lecturer degree, affect students' evaluation of lecturers. This finding has ramifications on how student evaluations should be collected, interpreted, and used in promotion and tenure decisions in this evolving medical education environment.

Our objective was to evaluate the utility of an educational program consisting of a workshop based on the Take the HEAT communication strategy, designed specifically for addressing patients who are angry, using a novel tool to evaluate residents' skills in employing this method.33 first-year pediatric and internal medicine-pediatrics residents participated in the study. The workshop presented the Take the HEAT (Hear, Empathize, Apologize, Take action) strategy of communication. Communication skills were assessed through standardized patient encounters at baseline and post-workshop. Encounters were scored using a novel assessment tool.After the workshop, residents' Take the HEAT communication improved from baseline total average score 23.15 to total average score 25.36 (Z=-3.428, p0.001). At baseline, empathy skills were the lowest. Intraclass Correlation Coefficient demonstrated substantial agreement (0.60 and 0.61) among raters using the tool.First-year pediatric trainees' communication with angry families improved with education focused on the Take the HEAT strategy. Poor performance by residents in demonstrating empathy should be explored further.This study demonstrates the utility of a brief communications curriculum aimed at improving pediatric residents' ability to communicate with angry families.

This article was migrated. The article was not marked as recommended. Background: Educational handoffs between medical schools and residency may facilitate the transition into graduate medical education. Attitudes of residency program directors about handoffs are largely unknown. Objective: This study assessed the opinions of residency program directors from four specialties, regarding information sharing between medical schools and residencies, and whether they desire student performance data post-match, including milestones, competency and entrustable professional activity (EPA) achievement, and capstone or boot camp-based performance data. Methods: In 2017 a thirteen question survey was sent to program directors from internal medicine, pediatrics, emergency medicine, and obstetrics/gynecology. Responses were anonymous and data was analyzed using descriptive statistics and thematic analysis. Results: Twenty percent of program directors surveyed submitted a survey (187 out of 950). Fifty-nine percent reported that unexpected remedial issues often arise within the first 6 months of internship. Twenty-four percent stated that information currently received is adequate to structure the learning environment of individual residents. Seventy-seven percent responded that they desire access to EPA-based information; seventy-four percent to milestone or competency-based data; eighty-two percent to performance data from fourth-year capstone courses or boot camps. No significant differences were found between specialties. Concerns were raised by respondents about the validity and reliability of performance metrics that would be shared with program directors. Conclusions: The majority of the program directors who responded to this survey indicated that they desire access to and would utilize medical student performance data post-match, though concerns were raised about the validity and reliability of proposed metrics.

Introduction: The oral examination is a traditional method for assessing the developing physician’s medical knowledge, clinical reasoning and interpersonal skills. The typical oral examination is a face-to-face encounter in which examiners quiz examinees on how they would confront a patient case. The advantage of the oral exam is that the examiner can adapt questions to the examinee’s response. The disadvantage is the potential for examiner bias and intimidation. Computer-based virtual simulation technology has been widely used in the gaming industry. We wondered whether virtual simulation could serve as a practical format for delivery of an oral examination. For this project, we compared the attitudes and performance of emergency medicine (EM) residents who took our traditional oral exam to those who took the exam using virtual simulation. Methods: EM residents (n=35) were randomized to a traditional oral examination format (n=17) or a simulated virtual examination format (n=18) conducted within an immersive learning environment, Second Life (SL). Proctors scored residents using the American Board of Emergency Medicine oral examination assessment instruments, which included execution of critical actions and ratings on eight competency categories (1-8 scale). Study participants were also surveyed about their oral examination experience. Results: We observed no differences between virtual and traditional groups on critical action scores or scores on eight competency categories. However, we noted moderate effect sizes favoring the Second Life group on the clinical competence score. Examinees from both groups thought that their assessment was realistic, fair, objective, and efficient. Examinees from the virtual group reported a preference for the virtual format and felt that the format was less intimidating. Conclusion: The virtual simulated oral examination was shown to be a feasible alternative to the traditional oral examination format for assessing EM residents. Virtual environments for oral examinations should continue to be explored, particularly since they offer an inexpensive, more comfortable, yet equally rigorous alternative. [West J Emerg Med. 2015;16(2):–0.]

OBJECTIVE:To evaluate the differences in burnout, empathy, and perceived stress between genders in 3rd-year medical students.METHODS:This is an IRB-approved, cross-sectional study of 657 3rd-year medical students who attended medical school from 2008 to 2014. Students responded to a Learning Environ