Predictors of Student Engagement in Learning Communities.

INTRODUCTION: Little is known about what factors predict student engagement in learning communities (LCs). At our institution, we recently converted from an informal, unfunded program with volunteer mentors and no participation requirement to a formal, funded program with a structured curriculum, dedicated mentors, and required attendance. We sought to identify factors that predict student engagement in this new program. METHODS: Medical students from all 4 years were invited to complete a survey that included self-rating of their level of engagement with their LC. We hypothesized that student engagement would be (1) higher in the new, formal program compared with the informal program; (2) lower among older students; and (3) higher among students who value collective activities for stress management. RESULTS: In total, 75% of students completed the survey. Students who participated in the formal LC program reported significantly higher engagement than those who experienced the informal version. Older, out-of-state, and underrepresented in medicine (URiM) students reported lower levels of engagement compared with younger, in-state, and non-URiM students, but gender and campus assignment were not associated with level of engagement. Students who valued participation in extracurricular activities, service work, and time with friends or family all had higher levels of engagement in LCs compared with those who valued more solitary activities. DISCUSSION: The formal, structured LC program was associated with higher levels of engagement than the informal program, and engagement was maintained throughout the 4-year curriculum. Subgroups of students reported lower engagement in LCs, and future research is needed to better understand and address this variability in engagement. This study is limited by the fact that students are only surveyed once annually, at a single institution, and our measure of engagement is brief and dependent on student self-report. In addition, it is not possible to discern from this study which components of the formal LC program were most strongly associated with high engagement.

Perceived Benefits of a Peer Mentoring Program for First-Year Medical Students.

Problem: Peer mentoring has long been accepted as beneficial in a multitude of fields, but there has been limited description or study of the way these types of relationships may benefit medical students. Peer mentoring may be helpful for 1st-year medical students; however, little evidence is thus far available on which aspects of peer mentoring provide benefit and what those specific benefits are. Intervention: This study examines the perceived benefits and satisfaction derived by 1st-year medical students from participation in a semi-structured, informal cross-year peer mentoring program. It further attempts to characterize the aspects of peer mentoring relationships that are seen as beneficial to 1st-year students. Data were collected on demographic information, frequency and type of contact with mentor, perception of mentor characteristics, perceived benefits derived from the relationship, and their overall satisfaction with the relationship. Context: First-year medical students at a large academic institution were surveyed on their experience in an informal peer-mentoring program with 2nd-year students serving as mentors. Mentors had minimal training. No mandatory agenda or limitations were placed on the type or subject matter of interactions. Outcome: Mean overall satisfaction with the peer mentoring program was 7.47 (SD = 2.45) on a rating scale where 10 is the most satisfied. Students reported that their peer mentors generally exhibited beneficial attributes and behaviors. Ratings of perceived benefits were somewhat more variable and generally lower. Predictors of four outcomes-overall satisfaction, perceived academic benefit, perceived nonacademic benefit, and perceived clinical benefit-were explored using stepwise linear regression with forward entry and backward elimination to retain the most parsimonious model. Expertise in areas of mentee need was a consistent predictor of all outcomes. Regular involvement with a mentor was a consistent predictor of perceived academic and nonacademic benefit. Demographic characteristics were generally not predictive of outcomes. Lessons Learned: Peer mentoring is perceived by 1st-year medical students to provide psychosocial and academic benefits that appear to be independent of and complementary to those derived from faculty mentoring. These benefits can be established with minimal expenditure of institutional resources. Peer mentoring efficacy may be increased by more deliberate matching methods and by training mentors in provision of guidance and feedback, though further study is needed.

Class-Wide Access to a Commercial Step 1 Question Bank During Preclinical Organ-Based Modules: A Pilot Project.

PURPOSE: The authors examined the usefulness of a commercially available Step 1 question bank as a formative academic support tool throughout organ-based modules in an integrated preclinical medical curriculum. The authors also determined the extent to which correlation between question bank utilization and academic metrics varied with Medical College Admission Test (MCAT) scores. METHOD: In 2015, a cohort of 185 first-year medical students at University of Alabama School of Medicine were provided with 18-month full access to a commercially available Step 1 question bank of over 2,100 items throughout organ-based modules, although there were no requirements for use. Data on student use of the question bank were collected via an online administrative portal. Relationships between question bank utilization and academic outcomes including exams, module grades, and United States Medical Licensing Examination (USMLE) Step 1 were determined using multiple linear regression. RESULTS: MCAT scores and number of items attempted in the question bank significantly predicted all academic measures, with question bank utilization as the stronger predictor. The association between question bank utilization and academic outcome was stronger for individuals with lower MCAT scores. CONCLUSIONS: The findings elucidate a novel academic support mechanism that, for some programs, may help bridge the gap between holistic and mission-based admissions practices and a residency match process that places a premium on USMLE exam scores. Distributed formative use of USMLE Step 1 practice questions may be of value as an academic support tool that benefits all students, but particularly those entering with lower MCAT scores.

Neural mechanisms of human temporal fear conditioning.

Learning the temporal relationship between a warning cue (conditioned stimulus; CS) and aversive threat (unconditioned stimulus; UCS) is an important aspect of Pavlovian conditioning. Although prior functional magnetic resonance imaging (fMRI) research has identified brain regions that support Pavlovian conditioning, it remains unclear whether these regions support time-related processes important for this type of associative learning. Elucidating the neural substrates of temporal conditioning is important for a complete understanding of the Pavlovian conditioning process. Therefore, the present study used a temporal Pavlovian conditioning procedure to investigate brain activity that mediates the formation of temporal associations. During fMRI, twenty-three healthy volunteers completed a temporal conditioning procedure and a control task that does not support conditioning. Specifically, during the temporal conditioning procedure, the UCS was presented at fixed intervals (ITI: 20s) while in the control condition the UCS was presented at random intervals (Average ITI: 20s, ITI Range: 6-34s). We observed greater skin conductance responses and expectancy of the UCS during fixed (i.e., temporal conditioning) relative to random (i.e., control procedure) interval trials. These findings demonstrate fixed trials support temporal conditioning, while random trials do not. During fixed interval trials, greater conditioned fMRI signal responses were observed within dorsolateral prefrontal cortex, inferior parietal lobule, inferior and middle temporal cortex, hippocampus, and amygdala. The current findings suggest these brain regions constitute a neural circuit that encodes the temporal information necessary for Pavlovian fear conditioning.

An fMRI investigation of working memory and its relationship with cardiorespiratory fitness in pediatric posterior fossa tumor survivors who received cranial radiation therapy.

BACKGROUND: The present study investigated the relationship between cardiorespiratory fitness and executive functioning in pediatric brain tumor survivors who received cranial radiation. This population is known to show executive dysfunction and lower rates of aerobic exercise compared to peers. PROCEDURE: Nine adolescent survivors of pediatric posterior fossa tumor completed an n-back working memory task during a functional MRI scan, as well as cardiorespiratory fitness testing on a cycle ergometer. RESULTS: Neuroimaging findings indicated typical activation patterns associated with working memory, mainly in the frontal-parietal network. Higher cardiorespiratory fitness was related to better performance on a behavioral measure of working memory and more efficient neural functioning. CONCLUSIONS: This study provides preliminary evidence that cardiorespiratory fitness may be related to executive functioning, particularly working memory, in pediatric brain tumor survivors. Descriptions of the brain regions recruited for working memory by pediatric brain tumor survivors may be used to inform future interventions or indicators of treatment efficacy.

The Community Integration Questionnaire: factor structure across racial/ethnic groups in persons with traumatic brain injury.

OBJECTIVE: To examine the factor structure and construct validity of the Community Integration Questionnaire, a widely used measure of community participation among individuals with traumatic brain injury (TBI), among 3 racial/ethnic groups. DESIGN: Prospective longitudinal cohort study. SETTING: Enrollment in acute inpatient TBI rehabilitation with follow-up at 1 year after injury. PARTICIPANTS: A total of 1756 persons with TBI enrolled in the Traumatic Brain Injury Model Systems (TBIMS) national Database. MAIN OUTCOME MEASURE: Community Integration Questionnaire at 1 year after injury. RESULTS: The goodness of fit for the factor structure of the Community Integration Questionnaire, separating items into Home Competency, Social Integration, and Productive Activity, was satisfactory for whites but not for blacks or Hispanics. CONCLUSIONS: Clinicians and researchers should take race/ethnicity into account when utilizing measures of community integration.

Cardiorespiratory fitness in survivors of pediatric posterior fossa tumor.

Advances in medical therapies have greatly improved survivorship rates in children diagnosed with brain tumor; as a result, morbidities associated with survivorship have become increasingly important to identify and address. In general, pediatric posterior fossa tumor survivors tend to be less physically active than peers. This may be related to late effects of diagnosis and treatment, including cardiovascular, endocrine, psychological, and neurocognitive difficulties. Exercise has been shown to be effective in improving physical functioning, mood, and even cognitive functioning. Consequently, the benefits of physical exercise need to be explored and incorporated into the daily lives of pediatric posterior fossa tumor survivors. The primary aim of the present study was to establish the feasibility and safety of cardiorespiratory fitness testing in pediatric posterior fossa tumor survivors who had received cranial radiation therapy. In addition, comparing our cohort with previously published data, we found that pediatric posterior fossa tumor survivors tended to be less fit than children with pulmonary disease and healthy controls and approximately as fit as children with chronic heart disease and survivors of other types of childhood cancer. The importance of cardiorespiratory fitness in pediatric posterior fossa tumor survivors is discussed along with implications for future directions.

Early predictors of employment outcomes 1 year post traumatic brain injury in a population of Hispanic individuals.

OBJECTIVE: To determine which demographic, injury, and rehabilitation factors are associated with employment rates in Hispanic individuals 1 year post traumatic brain injury (TBI). DESIGN: Retrospective study. SETTING: Longitudinal dataset of the TBI Model Systems National Database. PARTICIPANTS: 418 Hispanic individuals with TBI hospitalized between 1990 and 2009 having year 1 follow-up data (18-55 years and not retired at injury). MAIN OUTCOME MEASURE: Competitive employment status 1 year post-injury (yes/no). RESULTS: A multiple logistic regression model indicated that pre-injury employment status, pre-injury level of education, etiology, days of posttraumatic amnesia (PTA), associated spinal cord injury, Functional Independence Measure (FIM) motor at rehabilitation discharge, and length of stay in rehabilitation were significant predictors of competitive employment post-injury, controlling for the effects of each other (all p-values ≤ 0.014). Increases in the odds of not being employed post-injury were associated with not being employed pre-injury, having lower levels of education pre-injury, etiologies due to violence or falls, increased PTA, an associated spinal cord injury, lower FIM motor scores, and greater lengths of stay in rehabilitation. CONCLUSIONS: The first year post-TBI is critical for recovery and gainful employment, particularly for Hispanic individuals. Early identification of factors influencing successful gainful employment and expeditious implementation of services to ameliorate these issues are paramount in improving employment outcomes for Hispanic individuals with TBI.

Characteristics associated with satisfaction with life 1 year post traumatic brain injury in a population of Hispanic individuals.

OBJECTIVE: To determine which demographic, injury, rehabilitation, and follow-up characteristics are associated with satisfaction with life in a population of Hispanic individuals 1 year post-traumatic brain injury (TBI). DESIGN: Retrospective study. SETTING: Longitudinal dataset of the TBI Model Systems National Database. PARTICIPANTS: 291 Hispanic adults with TBIs occurring between 1999 and 2008 having year 1 follow-up data. MAIN OUTCOME MEASURE: Satisfaction with Life Scale (SWLS) measured 1 year post-TBI. RESULTS: The relationships between SWLS 1 year post-injury and a variety of demographic, injury, rehabilitation, and follow-up characteristics were modeled using generalized linear models. The final multivariable model explained 25.2% of variability in SWLS (F (7, 261)=12.6, p < 0.001) and included quadratic effects for both age at injury and FIM cognitive scores 1 year post-injury, as well as effects for associated SCI and employment status 1 year post-injury (all p-values ≤ 0.036). In general, higher age, no associated SCI, not being unemployed at 1 year post-injury, and very high or very low FIM cognitive scores were associated with greater SWLS scores 1 year post-injury. CONCLUSIONS: These results suggest a variety of demographic, injury, and follow-up characteristics are related with SWLS 1 year post-TBI in Hispanic individuals. Focusing rehabilitation efforts on improving cognition and vocational skills may improve SWLS in Hispanics 1 year post-TBI.

Catastrophizing, acceptance, and interference: laboratory findings, subjective report, and pain willingness as a moderator.

OBJECTIVE: The present study investigated the effects of both catastrophizing and the pain willingness component of acceptance on interference in daily activities and task performance during experimentally induced ischemic pain. In addition, the potential moderating role of pain willingness on the relationship between catastrophizing and degree of pain interference was also examined. DESIGN: Sixty-seven persons with chronic low back pain completed measures of catastrophizing, acceptance, and daily pain interference. Participants underwent an ischemic pain induction procedure during which a Stroop-like task was administered. MAIN OUTCOME MEASURES: Self-reported pain interference and observed performance on a Stroop-like task during induced pain. RESULTS: The pain willingness component of acceptance and catastrophizing both contributed significantly to self-reports of pain interference. However, levels of pain willingness had an effect much stronger than the negative effects associated with catastrophizing with respect to observed pain interference during induced pain. Results also indicated that pain willingness serves as a moderator in the relationship between catastrophizing and task performance during induced pain. CONCLUSION: The pain willingness factor of acceptance and catastrophizing both appear to be strong predictors for self-reported pain interference. During an objective assessment of pain interference, however, pain willingness shows a stronger effect and attenuates the negative impact of catastrophizing on task functioning.

Impact of early administration of sertraline on cognitive and behavioral recovery in the first year after moderate to severe traumatic brain injury.

OBJECTIVE: To assess the efficacy of sertraline administered in the first 3 months after moderate to severe traumatic brain injury (TBI) in improving cognitive and behavioral outcomes. DESIGN: Double-blind, randomized controlled trial. SETTING: Academic medical center. PARTICIPANTS: Ninety-nine individuals randomized to placebo (n = 50) or sertraline 50 mg (n = 49) conditions. There were no group differences in age, gender, education, or severity of injury. INTERVENTIONS: Participants were enrolled an average of 21 days after injury (none > 8 weeks), followed by oral administration of placebo or sertraline 50 mg for 3 months. MAIN OUTCOME MEASURES: Wechsler Memory Scale-Third Edition Logical Memory, Trail Making Test, Wechsler Adult Intelligence Scale-Third Edition Working Memory Index, Symbol-Digit Modalities Test, Wisconsin Card Sorting Test (64-item), Neurobehavioral Functioning Inventory administered 3, 6, and 12 months after the onset of injury. RESULTS: Early administration of sertraline did not result in improved cognitive functioning during the year after injury compared with placebo administration. Those receiving placebo performed marginally better than the treatment group on a measure of executive function, but this appeared to be inauthentic. The treatment group followed expected recovery patterns based on existing literature. The placebo group performed better than expected on some measures, primarily due to differential dropout. CONCLUSIONS: Sertraline does not appear to prevent development of cognitive and behavioral problems following TBI, although this does not negate evidence for the treatment (as opposed to prophylactic) role of sertraline to address emotional and neurobehavioral problems in individuals with TBI.

Impact of early administration of sertraline on depressive symptoms in the first year after traumatic brain injury.

The potential for sertraline administered in the first 3 months after moderate to severe traumatic brain injury (TBI) to decrease the incidence of depression in the first year after injury was assessed in a double-blinded randomized control trial. Subjects were enrolled an average of 21 days after injury (none >8 weeks) followed by oral administration of placebo (50 subjects) or sertraline 50 mg (49 subjects) for 3 months. Subjects were not depressed at the time of study initiation. Outcome was assessed using the Hamilton Depression Rating Scale (HDRS) and the Depression Scale of the Neurobehavioral Functioning Inventory (NFI). Based on intent-to-treat and efficacy subset analyses, those receiving placebo exhibited significantly greater depressive symptoms than those receiving sertraline during the first 3 months after injury while receiving placebo/drug (10% of placebo group achieving a score of 6 or greater on the HDRS, 0% of the sertraline group; p < 0.023.). There was no significant difference in depressive symptoms during the remainder of the year between the two groups. Sertraline is effective in diminishing depressive symptoms even among those not clinically depressed while the medication is being taken. However, the results do not support the idea that administration early in recovery diminishes the expression of depressive symptoms after the drug is stopped. There is no basis from this study to assume that sertraline administered early in recovery after TBI, when neurotransmitter functioning is often altered, has ongoing effects on the serotonin system after sertraline is discontinued.

Depressive symptoms and pain evaluations among persons with chronic pain: catastrophizing, but not pain acceptance, shows significant effects.

Cognitive factors such as catastrophic thoughts regarding pain, and conversely, one's acceptance of that pain, may affect emotional functioning among persons with chronic pain conditions. The aims of the present study were to examine the effects of both catastrophizing and acceptance on affective ratings of experimentally induced ischemic pain and also self-reports of depressive symptoms. Sixty-seven individuals with chronic back pain completed self-report measures of catastrophizing, acceptance, and depressive symptoms. In addition, participants underwent an ischemic pain induction procedure and were asked to rate the induced pain. Catastrophizing showed significant effects on sensory and intensity but not affective ratings of the induced pain. Acceptance did not show any significant associations, when catastrophizing was also in the model, with any form of ratings of the induced pain. Catastrophizing, but not acceptance, was also significantly associated with self-reported depressive symptoms when these two variables were both included in a regression model. Overall, results indicate negative thought patterns such as catastrophizing appear to be more closely related to outcomes of perceived pain severity and affect in persons with chronic pain exposed to an experimental laboratory pain stimulus than does more positive patterns as reflected in measures of acceptance.

Global/local scoring modifications for the Rey-Osterrieth Complex Figure: relation to unilateral temporal lobe epilepsy patients.

Observation of figural reproductions of right temporal lobe epilepsy (RTLE) patients have revealed overall configuration errors, whereas in left temporal lobe epilepsy (LTLE) patients, the global aspect of performance is generally preserved. This study compared performance of individuals with temporal lobe epilepsy (LTLE, n=83; RTLE, n=63) on a global/local modification of the Rey-Osterrieth Complex Figure Test (RCFT). In Phase I, neuropsychologists (n=6) and neuropsychology fellows (n=3) completed a survey identifying the global and local aspects of the RCFT. Questionnaire responses were used to categorize a list of global and local items (five global, five local) for re-scoring the protocols of TLE patients during study Phase II. Results showed that the RTLE and LTLE groups were not differentiated according to the global or local indices F(1,141) = .385; p = not significant. There were lower local scores for both groups in the copy F(1,142) = 5.23; p = .024, immediate F(1,142) = 445.26; p < .001, and delay trials F(1,142) = 427.82; p < .001, indicating less retention of local information over time. Results suggest general declines in figural memory for local stimulus properties in both unilateral TLE groups. However, this relationship was weakened after controlling for global and local item verbalizability.

UFOV performance and driving ability following traumatic brain injury.

PRIMARY OBJECTIVE: To investigate the relationship between performance on the Useful Field of View Test (UFOV) and driving performance following traumatic brain injury (TBI). PARTICIPANTS: Sixty people with TBI referred for driving evaluation. MEASURES: Useful Field of View Test, Global Rating Scale and Driver Assessment Scale. RESULTS: Subject performance diminished as the complexity of the UFOV sub-tests increased. There was a significant relationship between UFOV performance, particularly on the second sub-test, and on-road driving performance. Subject age and Trail Making Test, Part B were also predictive of driving performance. CONCLUSIONS: The UFOV can be used as a screening measure to determine readiness to participate in an on-road driving assessment.

Visceral pain and life quality in persons with spinal cord Injury: a brief report.

BACKGROUND/OBJECTIVE: Few studies have examined the prevalence of visceral pain in persons with spinal cord injury (SCI), and virtually no studies have looked at the relationship between visceral pain and self-reported quality of life. We examined the frequency of reported visceral pain at 5, 10, and 15 years after injury to determine whether the presence of visceral pain is related to quality of life, and to determine to what extent visceral pain should be of concern to clinicians treating patients with SCI. METHODS: Visceral pain and quality of life in persons with SCI were compared from a combined Craig Hospital and National Model SCI Systems database at 5 (N = 33), 10 (N = 132), and 15 (N = 96) years after injury. RESULTS: The rates of visceral pain increased at each measurement (10% at year 5, 22% at year 10, and 32% at year 15); although these numbers reflect cross-sectional data, they do show a clear statistical change. Only a limited true longitudinal sample was available, but at 10 years after injury, individuals who had reported visceral pain at any time reported a significantly lower quality of life than those never experiencing visceral pain, F1,188 = 3.95, P < 0.05. CONCLUSIONS: Although visceral pain may not be as prevalent as the more researched neuropathic and musculoskeletal subtypes of pain, it may account for a higher percentage of people with SCI who report pain than previously recognized. More quantitative and longitudinal research is needed to examine the relationship of visceral pain with overall quality of life and to pursue interventions.

Self-report of cognitive abilities in temporal lobe epilepsy: cognitive, psychosocial, and emotional factors.

Self-report of cognitive functioning using the Multiple Abilities Self-Report Questionnaire (MASQ) was examined in 57 left (LTLE) and 36 right (RTLE) temporal lobe epilepsy patients. The MASQ is a 38-item self-report measure assessing five domains of self-perceived cognitive functioning: Language, Visual-Perceptual Abilities, Verbal Memory, Visual-Spatial Memory, and Attention/Concentration. Overall, LTLE patients self-reported more cognitive difficulties across all domains. Language was the only domain to emerge as a robust indicator of seizure lateralization (LTLE patients reporting more problems). Neuropsychological test performance did not emerge as a significant predictor for any domain, whereas measures of psychosocial and emotional functioning accounted for a significant but modest amount of variance in all of them. The results suggest caution in using such self-report measures as an ecological extension of objective testing, but suggest a role in assessing self-appraisal of deficits.

Confirmatory factor analysis of the california verbal learning test in patients with epilepsy: relationship to clinical and neuropathological markers of temporal lobe epilepsy.

Latent constructs involved in California Verbal Learning Test (D. C. Delis, J. H. Kramer, E. Kaplan, & B. A. Ober, 1987) performance were examined using confirmatory factor analysis in 388 epilepsy surgery candidates. Eight factor models were compared. A single-factor model was examined, along with 7 models accommodating constructs of auditory attention, inaccurate recall, and delayed recall in different combinations. The retained model consisted of 3 correlated factors: Auditory Attention. Verbal Learning, and Inaccurate Recall. Validity of this factor structure was examined in a subsample of patients with left and right temporal lobe epilepsy. All 3 factors were related to seizure focus and magnetic resonance imaging hippocampal volume. Only Verbal Learning was related to hippocampal neuropathology, supporting the distinction between learning and attention in the factor structure.

Factor structure of the Mini-Mental State Examination in adult psychiatric inpatients.

The factor structure of the Mini-Mental State Examination (MMSE) has been examined primarily in geriatric populations using differing methodology and yielding inconsistent results. This study examined the MMSE in 339 adult inpatients at a nonforensic state psychiatric hospital. Data were analyzed in the form of 30 dichotomous variables (1 for each scored response). A 5-factor oblique solution was retained, comprising factors of Orientation, Attention-Working Memory, Verbal Recall, Comprehension-Praxis, and Naming. Higher order factors of Executive Functioning and Language-Praxis were also found. The results fit the traditional neurocognitive domains of a mental status examination and generally replicated findings from the 2 largest studies published to date despite differences in population, suggesting that the obtained factors are fairly robust.