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BackgroundThe potential roles of affective responses to environmental stressors in individuals’ physical and mental health are complex and multi-faceted. This study, then, explores Chinese citizens’ emotional responses to COVID-19-related stressors and influence factors which may boost or buffer such effects.MethodsFrom late March to early June (2020), a cross-sectional study was conducted using an anonymous online questionnaire included demographic characteristics, COVID-19-related stressors related to individuals’ daily functioning, and the self-assessed impact of protective and adverse internal factors on emotions.Results1,662 questionnaires were received from residents in 32 Chinese provinces classified by prevalence level according to COVID-19 infections. Among the 17 positive and negative emotional responses, agglomerative hierarchical clustering revealed four subclassifications: (1) stress relations; (2) missing someone relations; (3) individual relations; and (4) social relations. Additionally, heightened regional prevalence levels positively corresponded to intensity of stress relations. Lowest intensity of social relations was found in the areas surrounding Wuhan and coastal areas. Specially, economic- and work-related stressors as well as negative self-perceptions (e.g., suppression, emotionally unstable, self-denial) implicated in negative emotions. While positive emotions were tied to demographic characteristics (e.g., high education, young age and male) and protective traits (e.g., creativity, sympathy, social responsibility), and inversely linked to relationships- and pandemic-related stressors, etc.ConclusionAssociations were clearly noted among Chinese residents’ emotions to specific stressors during pandemic. Providing appropriate psychological resources/supports during future or extended public health crises may help offset the cognitive burden of individuals striving to regain an adequate level of normalcy and emotional well-being.

Background About 83,000 COVID-19 patients were confirmed in China up to May 2020. Amid the well-documented threats to physical health, the effects of this public health crisis - and the varied efforts to contain its spread - have altered individuals’ “normal” daily functioning. These impacts on social, psychological, and emotional well-being remain relatively unexplored – in particular, the ways in which Chinese men and women experience and respond to potential behavioral stressors. Our study investigated sex differences in psychological stress, emotional reactions, and behavioral responses to COVID-19 and related threats among Chinese residents. Methods In late February (2020), an anonymous online questionnaire was disseminated via WeChat, a popular social media platform in China. The cross-sectional study utilized a non-probabilistic “snowball” or convenience sampling of residents from various provinces and regions of China. Basic demographic characteristics (e.g., age and gender) – along with residential living arrangements and conditions – were measured along with psychological stress and emotional responses to the COVID-19 pandemic. Results Three thousand eighty-eight questionnaires were returned: 1749 females (56.6%) and 1339 males (43.4%). The mean stress level,as measured by a visual analog scale, was 3.4 (SD = 2.4) - but differed significantly by sex. Besides sex, factors positively associated with stress included: age ( Conclusions The self-reported stress of Chinese residents related to the COVID-19 pandemic was significantly related to sex, age, employment, resilience and coping styles. Future responses to such public health threats may wish to provide sex- and/or age-appropriate supports for psychological health and emotional well-being to those at greatest risk of experiencing stress.

In July of 2015, the Liaison Committee on Medical Education (LCME)—the primary accrediting body for North American allopathic medical schools—formally advanced a model of “formative accreditation” by requiring that medical schools engage in “ongoing planning and continuous quality improvement processes that establish short and long-term programmatic goals, result in the achievement of measurable outcomes that are used to improve programmatic quality, and ensure effective monitoring of the medical education program’s compliance with accreditation standards.” As these and parallel forces redefine undergraduate medical education (UME) in increasingly rationalistic (i.e., operational, measureable, controllable) terms, efforts to implement meaningful continuous quality improvement (CQI) processes may be challenged to overcome perceptions of questionable purpose, worth, and impact often associated with administration mandates. This commentary discusses potential factors underlying the growing rationalism in UME and offers practical strategies to shield CQI from being passively dismissed, excessively routinized, or redirected toward other institutional ends—remaining, instead, purposefully focused on the task at hand: Enhancing teaching and learning in undergraduate medical curricula.

Introduction: For regional campuses with specific program foci, assessing applicant fit necessarily extends beyond academic and professional factors. Based on assessments of applicants to a regional Rural Physician Leadership Program (RPLP), this study explores the relationship of academic and socio-demographic factors with interviewers’ ratings of: (1) likelihood of eventually practicing in a rural area of the state; and (2) overall acceptability to medical school. Methods: The study population consisted of 163 first-time RPLP applicants interviewed independently from 2009-2016 by two faculty members at both main and regional medical campuses. Path analysis was used to calculate direct, indirect, and total effects of applicants’ socio-demographic and academic characteristics on interviewers’ composite ratings. This study protocol (#17-0198-X3B) was approved as exempt by the governing Institutional Review Board; the authors report no conflicts of interest. Results: The combined influence of being an in-state resident with rural Appalachian origins, combined with undergraduate GPA, explained 40.7% of the variance in applicants’ predicted likelihood of practicing in rural Kentucky. In terms of applicant acceptability, the strongest direct effects were exerted by academic factors, GPA and total MCAT score, and the sole preceding endogenous variable: likelihood of rural in-state practice. However, two other background factors were modestly but significantly directly associated with overall acceptability: (1) age; and (2) residence. Specifying likelihood of rural practice as an intervening variable explained 42.5% of the variance in applicant acceptability and provided a good fit to the sample data (X2 = 3.19, df = 4 , p = .526, CFI = 1.000, RLI = 1.018, RMSEA = .000). Conclusions: Interviewers appear to be assessing programmatic, mission-specific “fit” within the broader context of applicants’ abilities to navigate a demanding professional training curriculum. Future research should examine graduates’ eventual practice locations and intermediate academic performance as empirical validity of faculty interviewers’ assessments. Similarly, pre-professional pipeline efforts should better coordinate with training programs to provide consistent opportunities to nurture interest in mission-specific outcomes.

STATEMENT Despite increased attention on diversity in medicine and healthcare, heterogeneity in simulation technology has been slow to follow suit. In a nonsystematic review of simulation technology available in 2018 with respect to skin tone, age and sex, we found limited diversity in these offerings, suggesting limitations to educators' abilities to represent the full array of patients, conditions, and scenarios encountered in medicine and training. We highlight these limitations and propose basic strategies by which educators can increase awareness of and incorporate diversity into the simulation arena.

While the selection of qualified applicants often relies, in part, on scores generated from a medical school pre-admission interview (MSPI), the growth of regional medical campuses (RMCs) – many with specialized rural tracks, programs, or missions – has challenged schools to accommodate a wider range of stakeholder input. This study examines the reliabilities of main (urban) and regional (rural) campus interviewers’ assessments of applicants to a Rural Physician Leadership Program (RPLP) located in the southeastern United States. Data from RPLP applicants completing MSPIs on two campuses from 2009-2017 (n = 232) were examined in a generalizability analysis. In two separate interviews on each campus (4 total), raters independently evaluated applicants’ overall acceptability and likelihood of practicing in a rural area of the state. Results provided campus-specific and combined (composite) estimates of obtained and projected reliabilities. The person-by-campus interaction accounted for 11% and 5% of the respective variance in interviewers’ ratings of overall applicant acceptability and likelihood of rural in-state practice, and the reliability of mean scores across the four independent interviews (each with a single, unique rater) was 0.73 and 0.82. Error variances were higher among main campus interviewers, but scores correlated highly between the two campuses. While broadening the universe of generalization often results in decreased reliability, reliability was shown to be enhanced with the addition of regional (rural) campus interviews. As the RPLP matures, an examination of graduates’ actual practice locations should yield insights into the predictive validity of these pre-admissions assessments. More generally, research may wish to explore the conditions under which increasing the diversity of stakeholder input can be accommodated without concomitant reductions in overall reliability.

This article describes the characteristics and results of the Rural Physician Leadership Program (RPLP) at the University of Kentucky College of Medicine. RPLP is a successful example of a regional medical campus designed to train physicians at a regional medical campus to serve rural areas through local partnerships.

Background: Key elements in the clinical practice of prevention, health and wellness are best cultivated in medical professionals during undergraduate medical training. This study explores students' self-assessed stress relative to gender, academic expectations, and level of medical training to guide development of targeted wellness interventions. Methods: In early 2012, undergraduate (M1–M4) students in four Southeastern U.S. allopathic medical schools were surveyed about health-related attitudes and behaviors. Results: A total of 575 students returned completed questionnaires. Students in the preclinical years (M1–M2), especially females, reported significantly higher stress levels. Academic expectations and satisfaction were also significantly implicated. Discussion: These findings highlight the general areas of potential concern regarding stressors associated with medical training. Future research should guide programmatic efforts to enhance students' overall health and wellness vis-a -vis curriculum, skills training, and support services.

Summary Objective To examine the comfort level of medical students beginning their paediatric clerkships, and to identify students’ perceived concerns around interacting with children in a medical setting. Methods Prior to beginning required paediatric clerkships, third-year students in two south-eastern US medical schools completed an anonymous, 13-item questionnaire eliciting prior personal experiences with children, as well as comfort levels with selected aspects of paediatric care. Results Based on 237 responses (76.2% response rate), medical students’ total child-related experiences were significantly associated with self-assessed comfort delivering paediatric care. Female students reported more prior experiences than male medical students; however, gender was not associated with comfort working with children. A dose–response curve of experience shows a critical level of two types of experiences for comfort in working with children. Students reported significantly lower levels of comfort in performing a physical exam on a child versus obtaining a child’s medical history from a parent/caregiver. Students’ child-related experiences were significantly associated with self-assessed comfort delivering paediatric care Conclusions Medical students with little to no prior experience with children expressed significantly less comfort interacting with children in paediatric clerkships. A diversity of past experiences appeared to be a more meaningful correlate, as opposed to experience in a specific setting or context. Providing some general exposure to children during the preclinical years could instill in students greater comfort approaching their paediatric training.

Context This study explores the long-term impact of the Professional Student Mentored Research Fellowship (PSMRF) program at the University of Kentucky College of Medicine (UKCOM) on medical students’ research productivity and career paths. Methods Demographic characteristics, academic profiles, number of publications and residency placements from 2007 to 2012 were used to assess 119 PSMRF graduates against a comparison cohort of 898 UKCOM (non-PSMRF) students. Results PSMRF students had higher MCAT scores at admission (31.5 ± 0.6 vs. 30.6 ± 0.2, p = 0.007) and achieved higher USMLE Step 1 scores (228 ± 4.2 vs. 223 ± 1.5, p = 0.03) than comparison group. PSMRF students were more likely to publish PubMed-indexed papers (36.7% vs. 17.9%, p < 0.0001), achieve AOA status (19.3% vs. 8.5%, p = 0.0002) and match to top 25 US News and World Report residency programs (23.4% vs. 12.1%, p = 0.008). A greater proportion of PSMRF fellows matched to top tier competitive specialties (23% vs. 14.2%, p = 0.07), however this difference was not statistically significant. Conclusions The PSMRF program shows a significant increase in enrollment, as well as positive associations with indicators of success in medical school and subsequent quality of residency program.

There is growing evidence in the medical education literature for the aggressive need to recruit and retain the next generation of academic physicians. In 2008, the University of Kentucky College of Medicine (UK COM) developed an academic health careers (AHCs) program for preclinical medical students as an introduction into the practice of academic medicine. The goals of this elective experience included (1) highly customized training and mentorship experiences in research, teaching, and other aspects of academic medicine; (2) information and perspectives to assist students in making informed career choices, including options for academic careers; (3) access to academic career mentors and role models related to individual faculty research interests and teaching responsibilities; and (4) opportunities to network with UK COM administrators. This short communication provides a detailed overview of the AHC experience – along with preliminary findings from a 2016–17 follow-up of program graduates exploring the program’s role in their career aspirations and decisions.

Purpose: End-of-life and palliative care (EOL/PC) education is a necessary component of undergraduate medical education. The extent of EOL/PC education in internal medicine (IM) clerkships is unknown. The purpose of this national study was to investigate the presence of formal EOL/PC curricula within IM clerkships; the value placed by IM clerkship directors on this type of curricula; curricular design and implementation strategies; and related barriers and resources. Method: The Clerkship Directors in Internal Medicine conducted its annual survey of its institutional members in April 2012. The authors analyzed responses to survey items pertaining to formal EOL/PC curriculum and content using descriptive statistics. The authors used qualitative techniques to analyze free-text responses. Results: The response rate was 77.0% (94/122). Of those responding, 75.8% (69/91) believed such training should occur in the IM clerkship, and 43.6% (41/94) reported formal curricula in EOL/PC. Multiple instructional modalities were used to deliver this content, with the majority of programs dedicating four or more hours to the curriculum. Curricula covered a wide range of topics, and student assessment tools were varied. Most felt that students valued this education. The qualitative analysis revealed differences in the values clerkship directors placed on teaching EOL/PC within the IM clerkship. Conclusions: Although many IM clerkship directors have implemented formal curricula in EOL/PC, a substantial gap remains between those who have implemented and those who believe it belongs in the clerkship. Time, faculty, cost, and competing demands are the main barriers to implementation.

Medical Education 2010:44: 379–386 Objectives Evaluations in the clinical arena are fraught with problems. Current assessments of clinical teaching typically measure attributes of clinical teachers in overly broad terms, are often subjective and often succumb to the halo effect. This is in contradistinction to measurements of lectures, workshops or online educational content, which can more readily be assessed using objective criteria. As a result, clinical evaluations are often insufficient to provide focused feedback, guide faculty development or identify specific areas for clinical teachers to implement change and improvement. The aim of our study was to offset these limitations. Methods We developed a structured, 15-item objective structured clinical examination (OSCE)-type checklist of discrete teaching behaviours intended to be: (i) observable; (ii) applicable to multiple disciplines, and (iii) reliably identifiable. Our goal was to test and utilise this checklist as an objective assessment of clinical teaching across a range of in-patient teaching rounds experiences. During 2007–2008, pairs of external raters on two separate occasions observed nine attending physicians during actual in-patient paediatrics and internal medicine ward rounds at a large, academic medical centre. Observers documented the extent to which specific teaching behaviours did or did not occur. Results The internal consistency of the 15-item checklist was good (α = 0.85). A two-facet, partially nested G study found the generalisability of ratings to be generally acceptable, but inter-rater reliability varied greatly between occasions and across individual checklist items. Conclusions Despite attempts to identify discrete and observable target behaviours, placing observers on rounds to detect these behaviours may not be as straightforward as it would seem. Clinical teaching may be a more inherently subjective process, based on different teaching styles of faculty staff. However, a set of objective checklist items to be completed by trained observers on teaching rounds holds promise as a potentially viable means of identifying strengths and weaknesses of clinical instruction. Further research is needed to define what constitutes quality clinical teaching, as well as the most reliable method for assessing it.

In a climate of legal challenge, admissions officers are responsible for developing and implementing enrollment practices that continue to provide diverse populations of underrepresented students with access to a medical education. However, attempts to remedy past discrimination and/or balance stude

Objectives Internet-based information has potential to impact physician–patient relationships. This study examined medical students’ interpretation and response to such information presented during an objective clinical examination. Method Ninety-three medical students who had received training for a patient centered response to inquiries about alternative treatments completed a comprehensive examination in their third year. In 1 of 12 objective structured clinical exams, a SP presented Internet-based information on l-theanine – an amino acid available as a supplement. In Condition A, materials were from commercial websites; in Condition B, materials were from the PubMed website. Results Analyses revealed no significant differences between Conditions in student performance or patient (SP) satisfaction. Students in Condition A rated the information less compelling than students in Condition B ( z = −1.78, p = .037), and attributed less of the treatment's action to real vs. placebo effects ( z = −1.61, p = .053). Conclusions Students trained in a patient centered response to inquiries about alternative treatment perceived the credibility of the two types of Internet-based information differently but were able to respond to the patient without jeopardizing patient satisfaction. Approach to information was superficial. Training in information evaluation may be warranted.

The ability to recognize and adapt to affective states in one's self and others, emotional intelligence is thought to connote effective, compassionate doctor-patient communication. Unfortunately, medical training has been shown to erode some of the very attributes it purports to instill in students.The objective is to examine changes in students' emotional intelligence and empathy across an undergraduate medical curriculum.During M1 orientation and again following M3 clerkship training, students in the University of Kentucky College of Medicine Class of 2004 completed the Trait Meta-Mood Scale (TMMS) and Davis' Interpersonal Reactivity Index (IRI). Baseline changes in specific dimensions were examined for both male and female students.Reliability of subscales was generally acceptable (alphaor= .70). Sixty-four students provided data at both time points. Compared to baseline, two of three TMMS dimensions--attention to feelings and mood repair--were significantly (por= .05) lower at follow-up. One IRI dimension--empathic concern--was also significantly lower at Time 2, whereas another, Personal Distress, was significantly higher. However, differences generally reflected only small effect sizes. No significant gender interactions were noted.Despite quite modest effect sizes, findings suggest that students' abilities to effectively manage affective states may be subject to some minor fluctuation across the undergraduate educational continuum. However, whether these observed declines constitute meaningful, clinically relevant changes remains unclear.

Background and objectives: The wide array of treatments and modalities comprising complementary and alternative medicine (CAM) represent a growing option for many individuals. Seeking to better understand this, much research has centered on identifying sociodemographic (e.g., age, gender, race) or social–psychologic (e.g., absorption, depression, coping) correlates of using CAM therapies. In contrast, sociological perspectives recognize the influence of larger-scale, external forces on individuals' motivations to seek alternative or complementary care. Aim: This paper, then, illustrates current and potential sociological approaches to understanding CAM use, and the importance of social forces that influence persons' decisions to utilize (or not) “unconventional” medical care.

Background : Despite efforts to construct targeted medical school admission processes using applicant-level correlates of future practice location, accurately gauging applicants’ interests in rural medicine remains an imperfect science. This study explores the usefulness of textual analysis to identify rural-oriented themes and values underlying applicants’ open-ended responses to admission essays. Methods : The study population consisted of 75 applicants to the Rural Physician Leadership Program (RPLP) at the University of Kentucky College of Medicine. Using WordStat, a proprietary text analysis program, applicants’ American Medical College Application Service personal statement and an admission essay written at the time of interview were searched for predefined keywords and phrases reflecting rural medical values. From these text searches, derived scores were then examined relative to interviewers’ subjective ratings of applicants’ overall acceptability for admission to the RPLP program and likelihood of practicing in a rural area. Results : The two interviewer-assigned ratings of likelihood of rural practice and overall acceptability were significantly related. A statistically significant relationship was also found between the rural medical values scores and estimated likelihood of rural practice. However, there was no association between rural medical values scores and subjective ratings of applicant acceptability. Conclusions : That applicants’ rural values in admission essays were not related to interviewers’ overall acceptability ratings indicates that other factors played a role in the interviewers’ assessments of applicants’ acceptability for admission. Keywords : admissions; medical student selection; rural medicine; application essays; rural medical programs (Published: 19 March 2015) Citation: Med Educ Online 2015, 20 : 27081 - http://dx.doi.org/10.3402/meo.v20.27081

A case is made for the use of emotional intelligence testing on medical school applicants. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

The present research examined relationships among medical school applicants’ preferred approaches to learning, methods of instruction, and specialty areas ( n = 912). Based on confidential responses to a progressive series of paired comparisons, applicants’ preferences for lecture (L), self-study (SS), group discussion (GD), and computers (C) were assessed across three dimensions: (1) comfort; (2) effectiveness; and (3) interest. Using cluster analysis to generate four instructional “profiles,” participants’ comparative preferences for self-study/lecture versus group discussion/computers (+SS, L/−GD, C) were positively associated with interests in surgery and neurology, whereas opposing preferences (+GD, C/−L, SS) corresponded with the practice of family medicine. Using a matriculant subset ( N = 160), analyses indicated that these relationships remained after controlling for sex and psychological type.

As more students from various health professions are combined into integrated courses, evaluating the teaching quality of individual faculty in these typically large, multi-instructor contexts becomes increasingly difficult. Indeed, students who lack sufficient recall of a given faculty member or are not committed to the evaluation process may respond by marking identical responses to all evaluation items (e.g., 3-3-3-3-3), regardless of the specific content of the items on the faculty evaluation questionnaire. These "straight-lining" behaviors—more formally referred to as monotonic response patterns (MRPs)—often reflect students' inattention to the task at hand or lack of motivation to be discriminating, which may result in invalid data. This study examines the prevalence of MRP ratings in relation to indicators reflective of students' lack of attention to evaluating the quality of faculty teaching. Dental and medical students in a required, second-year (medicine) basic science course conducted by the medical school and taught primarily by medical school faculty completed seven-item faculty evaluation forms, along with an anonymous questionnaire measuring their need to evaluate, attitudes toward faculty evaluation, and recall of instructors. MRP ratings failed to correlate significantly with students' need to evaluate or their attitudes toward faculty evaluation. However, among medical students, MRP "straight-line" responses were more prevalent for raters who recalled faculty members "very well" (p=.04). For dental students, MRPs were associated with less accurate recall (p=.01). As such, the validity of faculty evaluations within integrated, multi-instructor courses may vary when students rate distinct aspects of a teacher's performance identically. In this case—in which medical students' greater recall of instructors coincides with MRPs—ratings may suffice as global, holistic assessments of an instructor's teaching. For dental students, similar ratings may be less viable. Individual item analysis is cautioned under any circumstances.

To examine the role of gender discrimination and sexual harassment in medical students' choice of specialty and residency program.Anonymous, self-administered questionnaires were distributed in 1997 to fourth-year students enrolled in 14 public and private U.S. medical schools. In addition to reporting the frequency of gender discrimination and sexual harassment encountered during preclinical coursework, core clerkships, elective clerkships, and residency selection, students assessed the impact of these exposures (none, a little, some, quite a bit, the deciding factor) on their specialty choices and rankings of residency programs.A total of 1,314 (69%) useable questionnaires were returned. Large percentages of men (83.2%) and women (92.8%) experienced, observed, or heard about at least one incident of gender discrimination and sexual harassment during medical school, although more women reported such behavior across all training contexts. Compared with men, significantly (p/= .01) more women who reported exposure indicated that gender discrimination and sexual harassment influenced their specialty choices (45.3% versus 16.4%) and residency rankings (25.3% versus 10.9%). Across all specialties, more women than men experienced gender discrimination and sexual harassment during residency selection, with one exception: a larger percentage of men choosing obstetrics and gynecology experienced such behavior. Among women, those choosing general surgery were most likely to experience gender discrimination and sexual harassment during residency selection. Interestingly, correlations between exposure to gender discrimination and sexual harassment and self-assessed impact on career decisions tended to be larger for men, suggesting that although fewer men are generally affected, they may weigh such experiences more heavily in their choice of specialty and residency program.This study suggests that exposure to gender discrimination and sexual harassment during undergraduate education may influence some medical students' choice of specialty and, to a lesser degree, ranking of residency programs.

The authors attempted to determine male and female medical students' exposures to and perceptions of gender discrimination and sexual harassment (GD/SH) in selected academic and nonacademic contexts.An anonymous, self-report questionnaire was administered in the spring of 1997 to senior medical students at 14 U.S. medical schools. Data were collected about students' exposures to GD/SH during undergraduate medical education and outside the medical training environment. Students' perceptions of GD/SH in various medical specialties and practice settings were also measured.Of the 1,911 questionnaires administered, 1,314 were completed (response rate, 69%). Both men and women reported exposures to GD/SH. More women than men reported all types of exposures to GD/SH across all academic and nonacademic contexts. Differences between men and women in the frequencies of exposures were greatest outside the medical training environment (t = 15.67, df = 1171, por=.001). Within academic medical training contexts, the differences by sex were most evident in core clerkships (t = 11.17, df = 1176, por=.001). Women students perceived the prevalence of GD/SH to be significantly (por=.001) higher in a number of medical specialties than did men. However, both groups believed these behaviors to be most common in general surgery and obstetrics-gynecology. Women perceived significantly more GD/SH in academic medical centers and community hospitals. Both groups perceived these behaviors to be significantly more prevalent in academic medical centers than in community hospitals, and more prevalent in community hospitals than in outpatient office settings.This study suggests that mistreatment in the form of GD/SH is prevalent in undergraduate medical education, particularly within core clerkships. Interventions focused on particular specialties and training periods may be helpful.

Realizing that the psychometric properties of a measure may be highly variable is especially relevant in a multi-instructor context, since an implicit assumption is that student ratings are equally reliable and valid for all faculty ratees. As a possible indicator of nonattending (i.e. invalid) responses, the authors examined the effects of monotonic response patterns on the reliabilities of students' ratings of faculty teaching – including how an alternative presentation format may reduce the prevalence of this behavior. Second-year medical and dental students(n = 130) enrolled in a required basic science course during the 1998–99 academic year were randomly assigned to one of two groups – each of which evaluated the teaching of 6 different faculty across 6 distinct dimensions (i.e. overall quality, organization, preparation, stimulation, respectfulness, and helpfulness). Using a `split ballot' design, two versions of the conceptually equivalent faculty evaluation form were distributed at random to students in each group. Form A contained the `traditional' items-within-faculty format, while Form B listed faculty-within-item. The number of monotonic forms (i.e. the identical rating of all 6 items) varied measurably across faculty ratees, as did the respective effects on scale reliabilities. Alpha was especially inflated where a sizeable proportion of monotonic patterns were located on response categories that were either very high (> +1.28 zm deviations) or very low (< −1.28 zm deviations) compared to the group mean. Lastly, the prevalence of monotonic response patterns was significantly(p = ≤ 0.01) less when a faculty-within-item format is used (Form B).These findings suggest that monotonic response patterns differentially impact the reliabilities and, hence, the validity of students' ratings of individual faculty in a multi-instructor context.

IntroductionInterprofessional education (IPE) is called for in United States health professionseducation (Institute of Medicine, 2003). The Association of American Medical Colleges(AAMC) includes interprofessional health education and practice as a strategic area inwhich the organization and members should engage (AAMC, 2007). The current statusof IPE within United States medical schools has remained largely unexamined.Therefore, we sought to learn the current practice of IPE in US medical schools,including program features, institutional governance and resource contexts, and barriersto implementation.MethodsWe surveyed college of medicine education deans or dean designees of 126 US medicalschools as identified by the AAMC in late summer, 2008, using an instrument we developedfollowing a literature review. The instrument was composed of three sections: (1) adescription of specific IPE offerings at the school, (2) information regarding institutionalsupports and IPE resources, and (3) perceptions of potential barriers to IPE. With respect tothe description of specific IPE offerings, respondents were asked the following: (a) if offeringwas required or elective, (b) learner disciplines involved, (c) faculty disciplines involved, (d)type of learning experience, (e) type of learning setting, (f) general content area of offering,and (g) student assessment methods. With respect to institutional supports and resourcesfor IPE, respondents were asked the following: (a) administrative unit with responsibility forcoordinating IPE, (b) budget for IPE, (c) governance of IPE, (d) resources (monetary and

Background: Most physicians recall specific learning events, such as patient encounters or instructional encounters, that profoundly affected their education. Formal analysis of these events may have important implications in optimizing a 4th-year acting internship in surgery (AIS). Purpose: We sought to identify and analyze critical learning events (CLEs) in an AIS. Methods: Students were asked to describe the most valuable learning experience that occurred during their AIS rotation. The 122 responses underwent critical event analysis, generating 6 categories: (a) procedures, (b) didactics, (c) call, (d) patient and perioperative care, (e) clinic, and (f) other. The critical incident category was analyzed for relations to the assigned clinical service, performance on written examination and clinical evaluation, as well as student specialty training selected upon graduation. Results: The most frequently cited critical incidents were patient and perioperative care events. The frequency of critical event th...

Despite encouraging signs suggesting that many rural hospitals are experiencing less severe staff shortages, the challenge of successfully recruiting nurses to rural practice settings continues to be a major obstacle. Based on a 1993 survey of 164 directors of nursing (DONs) practicing in rural community hospitals, exploratory factor analysis (EFA) was used to cluster 21 DON-rated recruitment barriers into factors associated with nursing delivery, local community, and professional interaction. DONs, most notably those practicing in the smallest rural facilities (or = 25 beds), reported community-related barriers such as spouse's employment as the most severe obstacles to successful registered nurse (RN) recruitment. However, upon examination conducted by using multiple regression analyses, only those factors related to nursing delivery and professional interaction were found to be statistically significant predictors of existing staff RN full-time equivalency vacancy rates. Given that barriers related to individual nursing staffs are likely to be far more amenable to change than those associated with rural environments, these findings offer encouragement to nursing administrators who are faced with the difficulties of attracting RNs to rural practice settings.

Background: The Objective Structured Clinical Examination (OSCE) is an objective method for assessing clinical skills and can be used to identify deficits in clinical skill. During the past 5 years, we have administered 4 OSCEs to all general surgery residents and interns. Methods: Two OSCEs (1993 and 1994) were used as broad-based examinations of the core areas of general surgery; subsequent OSCEs (1995 and 1997) were used as needs assessments. For each year, the reliability of the entire examination was calculated with Cronbach's alpha. A reliability-based minimal competence score (MCS) was defined as the mean performance (in percent) minus the standard error of measurement for each group in 1997 (interns, junior residents, and senior residents). Results: The reliability of each OSCE was acceptable, ranging from 0.63 to 0.91. The MCS during the 4-year period ranged from 45% to 65%. In 1997, 4 interns, 2 junior residents, and 2 senior residents scored below their group's MCS. MCS for the groups increased across training levels in developmental fashion (P

Background: The Structured Clinical Instruction Module (SCIM) provides students with a structured educational experience related to clinical skills on a single clinical topic. This study examined the effect of the SCIM on students’ performances on breast stations in an objective structured clinical examination (OSCE). Methods: Three student groups each experienced a different type of instruction about breast care and treatment (condition A = lecture; condition B = nine-station SCIM, lecture, and manual; and condition C = five-station SCIM). All students subsequently participated in a surgery OSCE that included standardized patient stations on taking a breast history and performing breast examinations. Results: One-way analysis of variance (ANOVA) tests consistently found that the mean scores of students in conditions B and C were significantly (P Conclusions: These results suggest that the SCIM is an effective patient-based standardized instructional program that enhances the instruction of clinical skills to students.

Medical students are expected to acquire a large amount of knowledge in both the basic and clinical sciences by reading. The purpose of this study was to examine the relationship between reading time and students' performance on various objective and subjective evaluative measures.The study examined the reading activities of 80 students in a third-year surgery clerkship. Students spent an average of 16 hours per week in reading activities.A modest but statistically significant correlation was found between the total amount of time spent in reading and students' performance on an objective standardized clinical examination, a standardized patient encounter, a subjective rating by faculty members, and the total objective grade. Reading time did not correlate with performance on objective measures such as quizzes or the National Board of Medical Examiners examination.Although achievement in the clerkship is associated to a minor degree with reading time, reading time alone is not a sufficient influence on achievement.

Researchers have demonstrated repeatedly the importance of the relationship linking job satisfaction to employee retention. In rural areas of the country, where a persistent maldistribution of nurses continues to hamper health care delivery, the potential benefits of bolstering retention via enhancements in job satisfaction are of utmost utility to administrators and providers alike. Data were gathered from a multistate survey of registered nurses (RNs) practicing in rural hospitals, skilled nursing facilities, and community/public health settings (N = 1,647; response rate = 40.3%). The investigators found that the use of tuition reimbursement corresponded significantly with increased levels of job satisfaction among nurses in all three practice environments, as did day care services for nurses in acute care settings. Also, among hospital-based RNs, level of nursing education was found to be a significant factor in the relationship between tuition reimbursement and job satisfaction, with the highest level occurring among diploma-prepared nurses. Copyright © 1995 by W.B. Saunders Company LTHOUGH THE SEVERITY of the nationwide shortage of nurses is thought to have eased markedly, select regions of the country continue to face uphill battles to recruit and retain adequate numbers of nursing personnel. Most notably in rural counties of the United States, where the overwhelming majority of the 622 federally designated nurse shortage areas are situated (Stratton, Ludtke, Juhl, Dunkin, & Geller, 1993), an increased supply of available nurses seemingly has been much slower to impact nursing delivery. Subsequently, the maldistribution away from rural practice settings, which has resulted in a mean registered nurse (RN)-to-population ratio roughly half that of metropolitan areas (Movassaghi, Kindig, Juhl, & Geller, 1992), does not appear likely to equalize anytime soon.

A number of researchers have suggested that nursing shortages are closely related to geographic maldistribution, specialty areas, and even individual shifts. As these findings have documented, the nursing shortage, as defined by the federal government, exists predominantly in rural areas of the country that are not adjacent to metropolitan areas. As a result, many of the economic, demographic, and health-related disparities that exist between rural and urban populations are mirrored in shortage and nonshortage counties. Higher unemployment rates and lower per capita incomes suggest an underlying relationship between economic vitality and the recruitment and retention of health care personnel. This suggests that a fundamental obstacle to staffing adequate numbers of qualified nurses in rural areas may not be a shortage of nurses, but economic barriers (domestic and health care related) deeply rooted in the rural settings themselves. In those states burdened with significant shortage areas, emphasis must be placed on easing the maldistribution of available nurses away from rural, often medically underserved settings. However, while the notion of producing appropriate "types" of nurses is well founded, the temptation to "solve" the problem simply by producing more providers should be resisted, since it will not markedly benefit those areas that are currently in greatest need. The time frame necessary for such "trickle down" approaches to affect rural areas could, when combined with other factors, render many health care delivery systems virtually unsalvageable. To address the persistent distribution problem, we could change how health professionals are educated.(ABSTRACT TRUNCATED AT 250 WORDS)

PURPOSE: Domestic violence (DV) is common, yet physicians feel unprepared to address it. Educational interventions may improve the care provided to DV victims, yet the effectiveness of interventions is often unproven. METHOD: Written questions and DV-specific standardized patient (SP) checklist items from an end-of-clerkship and fourth-year comprehensive multispecialty (the Clinical Performance Examination or CPX) examinations of medical students participating in a DV workshop using SPs was compared with nonparticipants. RESULTS: DV workshop participants' and nonparticipants' written question mean scores were 93.2% and 85.8%, respectively, p =.02. End-of-clerkship SP examination DV-specific checklist scores for participants and nonparticipants was 76.3% and 60.0%, respectively, p =.002. Workshop participants scored 44.1% on the CPX DV-specific checklist items versus 35.6% for the nonparticipants, p =.01. CONCLUSION: A DV workshop improved knowledge and skills assessed four and an average of 27 weeks later. Language: en

Prognosis of invasive ductal carcinoma (IDC) strongly correlates with tumor grade as determined by Nottingham combined histologic grade. While reporting grade as low grade/favorable (G1), intermediate grade/moderately favorable (G2), and high grade/unfavorable (G3) is recommended by American Joint Committee on Cancer (AJCC) staging system, existing TNM (Primary Tumor/Regional Lymph Nodes/Distant Metastasis) classification does not directly incorporate these data. For large tumors (T3, T4), significance of histologic grade may be clinically moot as those are nearly always candidates for adjuvant therapy. However, for small (T1, T2) node-negative (N0) tumors, grade may be clinically relevant in influencing treatment decisions, but data on outcomes are sparse and controversial. This retrospective study analyzes clinical outcome in patients with small N0 IDC on the basis of tumor grade. Our results suggest that the grade does not impact clinical outcome in T1N0 tumors. In T2N0 tumors, however, it might be prognostically significant and relevant in influencing decisions regarding the need for additional adjuvant therapy and optimal management.

It has been suggested that in rural settings, the primary difficulty that faces nursing administrators is recruitment of registered nurses (RNs). This study examines the impact of recruitment strategies and barriers by comparing and contrasting corresponding RN full-time equivalent (FTE) vacancy rates. Data were gathered from a multistate telephone survey of directors of nursing (DONs) practicing in rural hospitals, skilled nursing facilities (SNFs), and public health settings (N = 556, response rate = 89.5%). The investigators found that DONs who perceived scheduling amenities and autonomy enhancements corresponded with RN FTE vacancy rates that were most reduced from the mean of the overall sample. Regarding recruitment barriers, geographic locale/isolation and job-related factors corresponded with RN FTE vacancy rates that were most elevated from the overall sample mean.

In rural practice settings where the task of recruiting new employees is exceedingly difficult, the first step in surviving the nursing shortage should begin with maintaining existing resources. Based on a survey of 2,488 staff registered nurses working in rural community hospitals, the authors compare personal, demographic, and practice characteristics of nurses by their self-reported intentions to stay in their present positions. Specific areas of job dissatisfaction that best distinguish those who anticipate leaving in 1 year from those committed to remaining in their present job for 5 years or more are identified.

Based on Vroom's expectancy theory, this study was conducted to identify differences in job satisfaction between nurses working in public health settings, and staff nurses and administrators working in both settings. Questionnaires containing an adaptation of a job satisfaction scale were mailed to all 258 registered nurses practicing in public health and home health settings (response rate 57%) in a rural midwestern state. Respondents were asked to rate their satisfaction with various dimensions of their jobs, as well as how important each aspect was to them. Although both groups of nurses reported low satisfaction with salary, public health nurses were significantly less satisfied with their salaries than were home health nurses (F = 32.96, P < or = 0.001); home health nurses, however, were significantly less satisfied with benefits/rewards (F = 11.85, P < or = 0.001), task requirements (F = 8.37, P < or = 0.05), and professional status (F = 5.30, P < or = 0.05). Although administrators did not differ significantly from staff nurses on job satisfaction, they did perceive organizational climate (F = 4.50, P < or = 0.05) to be an important feature of satisfaction. These differences may be partially explained by divergent salaries, roles, and responsibilities between public health and home health nurses.

A correlation between job satisfaction and employment longevity has been demonstrated by a number of researchers. However, the measurable aspects of job satisfaction only partially explain an individual's tenure at a particular job. Information about the relationship between job satisfaction and retention of community health nurses in a rural state was provided by 258 community health nurses in North Dakota who responded to a mailed questionnaire. Job satisfaction assessment included measures of autonomy, task requirements, salary, benefits, rewards, professional status, organizational climate, and interpersonal interactions. Job satisfaction was analyzed by taking into account the individual importance of each component. While the majority (61%) of the responding nurses indicated that they expected to stay in their current jobs for a period of five years or more, they were dissatisfied with various aspects of their jobs. The greatest factor influencing the nurses' choice of current position was job availability, followed by preferences for the particular health care agencies or communities. These findings indicate that retention of rural nurses should focus on strategies that go beyond improving job satisfaction.

Purpose: This study examines student recipients of merit, need-based, service, or minority scholar-ships, their performance in medical school, and the relationship to future alumni association mem-bership and financial giving. Method: Retrospective data on grade-point average attained across the four-year curriculum and ex-tracurricular activities reported at graduation were collected on students at the University of Ken-tucky College of Medicine from 1981-1991. Comparisons of academic performance and participa-tion in institutional activities were made across scholarship recipients and non-recipients. These data were then linked to other data tracking alumni association membership and institutional giving. Results: Compared to other scholarship recipients and non-recipients, merit scholars were more likely to be ranked above their class medians and be involved in extracurricular activities, including membership in Alpha Omega Alpha. However, seven years post-graduation, there was no difference between scholarship recipients and non-recipients in alumni association membership or donations to the medical school. Instead, students graduating in the upper half of their class, as compared to graduates in the lower half, and UKCOM graduates who attended the University of Kentucky as un-dergraduates, rather than students who attended other in-state or out-of state institutions, were more likely to join the medical alumni association. Alumni association members were more likely than non-members to make donations to the institution. Conclusions: More should be done to ensure that graduates who received scholarships are afforded meaningful ways to give back to the institution that supported them as students.

Context Despite only modest evidence linking personality-type variables to medical specialty choice, stereotypes involving empathy and ‘emotional connectedness’ persist, especially between primary care providers and surgeons or subspecialists. This paper examines emotional intelligence (EI) and specialty choice among students at three US medical schools. Methods Results from three independent studies are presented. Study 1 used the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT ™) administered to a single cohort of 84 Year 4 medical students. Study 2 used the Trait Meta–Mood Scale (TMMS) and Davis’ Interpersonal Reactivity Index (IRI) administered to three cohorts (n = 250) of Year 3 medical students. Study 3 used the Bar-On Emotional Quotient Inventory (EQ-I®) administered to two cohorts of Year 1 medical students (n = 292). Results were linked to specialty choice data retrieved from the National Residency Match Program (NRMP). Classifications of specialty choice included: (i) primary care (family practice, internal medicine, paediatrics) versus non-primary care (all others), and (ii) primary care, hospital-based specialties (anaesthesiology, emergency medicine, pathology, radiology), and technical and surgical specialties (neurology, obstetrics and gynaecology, ophthalmology, and all surgical fields). Conclusions Across all three studies – and using both classifications of specialty choice – no significant differences in EI were found between students entering primary care and non-primary care specialties. Limitations are acknowledged, and future directions for research involving EI are identified.

In 1973 the University of North Dakota School of Medicine (UNDSM), following the national trend toward four-year medical programs, expanded its previous two-year medical school curriculum to include all four years of medical education. It was hoped that this change, along with a renewed emphasis on primary care-oriented residency training within the state, would encourage medical students to establish practices within the state. In 1985 the UNDSM's Center for Rural Health mailed questionnaires to the 2,230 living graduates of the UNDSM to document a variety of their personal and practice characteristics. Based on the responses to the 924 completed questionnaires, the authors found that (1) the students from rural North Dakota were more likely than were urban students to practice in rural areas of the state, as were the students with primary care specialty training; and (2) the alumni completing residencies in North Dakota following the curriculum expansion (1976-1985) were more than twice as likely to establish practices in North Dakota. It was concluded that recruiting medical students (preferably in-state "natives") from rural areas, training them in primary care specialty areas, and enabling them to remain in North Dakota for the duration of their medical training (including residency training) combined to exert a considerable "retaining" effect on the UNDSM alumni.

The 1980s has not been a particularly prosperous decade for many farm operators. Due to shifts in the agricultural economy, many farmers have experienced farm foreclosure and rural displacement; while many more are at serious risk of losing their farms. Within the context of the agricultural crisis, this study examines the impact of economic hardship on the probability of experiencing a farm injury. Specifically, we hypothesized that farm operators who were experiencing economic distress would be more likely to experience a farm injury. Data from the North Dakota Rural Life Poll (n=450) was used to estimate the incidence of farm accidents, as well as examine the relationship between selected farm operator characteristics and the incidence of a farm accident. The data suggests that younger farm operators with higher debt-to-asset ratios are significantly more likely to experience a farm accident. The study goes on to examine some of the dynamics of this relationship, and implications for farm safety education are addressed.

As medical, nursing, and allied health programs integrate complementary and alternative medicine (CAM) content into existing curricula, they face many of the same challenges to assessment and evaluation as do more traditional aspects of health professions education, namely, (1) specifying measurable objectives, (2) identifying valid indicators, and (3) evaluating the attainment of desired outcomes. Based on the experiences of 14 National Center for Complementary and Alternative Medicine (NCCAM) education grant recipients funded between 2000 and 2003, the authors cite selected examples to illustrate strengths and deficits to "mainstreaming" CAM content into established health professions curricula, including subjecting it to rigorous, systematic evaluation. In addition to offering recommendations for more strenuously evaluating key CAM-related educational outcomes, the authors discuss related attitudes, knowledge, and skills and how these, like other aspects of health professions training, may result in enhanced patient care through modifications in clinical (provider) behaviors.