The Exceptional Teacher Initiative: Finding a Silver Lining in Addressing Medical Student Mistreatment.

PROBLEM: The Penn State College of Medicine (PSCOM) faced escalating reports of learner mistreatment in 2013-2017. As systems were implemented to gather and respond to student reports, faculty members expressed concern that these were creating a culture that focused on negative behaviors to the exclusion of acknowledging outstanding teaching that was also occurring. APPROACH: The Exceptional Teacher Initiative was introduced in August 2017 to attempt to shift the institutional conversation around learner mistreatment by balancing reports of mistreatment with reports highlighting examples of excellent teaching considered in-line with organizational values. The primary goals of the program were to make it easy for students to submit narratives describing outstanding teaching experiences and to capture the nuances of what the teacher did that were notable to the student. Students were invited to write about teachers who challenged and changed them. Narratives were sent to the named teachers and their educational and clinical leaders. OUTCOMES: Over the first 12 months of the Exceptional Teacher Initiative, learners submitted 553 narratives naming 253 different individuals across 37 departments. Faculty members and students expressed appreciation for this effort to highlight the positive. A monthly Exceptional Moments in Teaching feature was introduced in 2018, in which a named educator is featured prominently across the PSCOM. NEXT STEPS: Future plans include examining the impact of being named an exceptional teacher, ways exceptional teachers create respectful teaching interactions, and common threads within student narratives that illuminate specific techniques, behaviors, and attitudes that create exceptional teaching experiences.

Acute Postoperative Pain Management After Major Limb Amputation in a Pediatric Patient: A Case Report.

PURPOSE: Although total prevention of phantom pain is difficult, pediatric patients requiring amputation benefit from an individualized combination of analgesic techniques for phantom pain reduction using a multimodal and interprofessional approach. This is especially useful in the event a single therapy is ineffective for total pain reduction, and may ultimately lead to a reduction in chronic pain development. DESIGN: Case report with multimodal and interprofessional approach. METHODS: A 16-year-old patient with synovial sarcoma underwent a right hemipelvectomy and hip disarticulation. The patient had significant preoperative cancer pain requiring high-dose opioid analgesics prior to surgery. An interprofessional multimodal pain management strategy was used for acute and long-term reduction of postoperative phantom pain. FINDINGS: Although our patient developed acute phantom pain, multimodal therapy reduced immediate pain with resolution by 2 years follow-up. CONCLUSIONS: An individualized plan using interprofessional teamwork before surgery may provide optimal results in alleviating phantom pain after amputation for pediatric patients.

A Collaborative Response to Provocative Comments in a Medical School.

This article was migrated. The article was marked as recommended. In 2018, anonymous online provocative comments were submitted to student leaders of a Syrian Refugee Initiative (SRI) at the Penn State College of Medicine. This triggered a series of actions with students and medical school leaders aimed at identifying the person who submitted the comments, trying to understand mutual perspectives, and managing the impact of the event on the student body. We describe the history of our college's commitment to humanism and how the SRI was a direct outgrowth of that culture. Voices of the student leaders who were directly impacted by the provocative comments and educational leaders who worked to resolve the crisis are presented. We also describe a collaborative process that involved engaging cybersecurity experts to identify the perpetrator, and share how the students and educational leaders were able to develop trust despite initial skepticism by students over the leadership's avowed commitment to taking the hate speech seriously. While the perpetrator was never identified and opportunities for improvement were identified along the way, by including student leaders in the process, students and administrators were able to develop trust and reach reasonable closure on this disturbing event. Take home messages are presented to guide other institutions in navigating instances of provocative comments or speech.

ICU family communication and health care professionals: A qualitative analysis of perspectives.

OBJECTIVES: Although ineffective communication is known to influence patient and family satisfaction with care in intensive care unit [ICU] settings, there has been little systematic analysis of the features of the perceived problem from a communication theory perspective. This study was undertaken to understand perceptions of miscommunication and the circumstances in which they present. RESEARCH METHODOLOGY AND DESIGN: Semi-structured interviews were conducted with 22 health care professionals [HCPs] in five adult ICUs at an academic medical centre in the United States. FINDINGS: From qualitative analysis of the transcribed interviews, four themes emerged, each containing multiple subthemes. Person factors are problems that originate within individuals, related to education, cultural background and emotion. Structural factors are associated with boundaries and coordination of institutional roles. Information management problems result from social and psychological processes by which HCPs and family members seek, distribute and understand information. Relationship management problems arise from difficulties in interpersonal interactions. CONCLUSIONS: Ineffective communication is not a single problem, but rather several distinct problems that exist at different levels of abstraction and vary in over-time stability. These findings provide a framework for designing interventions to improve the well-being of patients and family members.

A case of deceptive mastectomy.

This paper poses the question, "what are providers' obligations to patients who lie?" This question is explored through the lens of a specific case: a 26-year-old woman who requests prophylactic bilateral mastectomy with reconstruction reports a significant and dramatic family history, but does not want to undergo genetic testing. Using a conversational-style discussion, the case is explored by a breast surgeon, genetic counselor/medical geneticist, clinical psychologist, chair of a hospital ethics committee and director of a clinical ethics consultation service.

Professionalism in medical education: the development and validation of a survey instrument to assess attitudes toward professionalism.

BACKGROUND AND AIM: This study examined attitudes toward professionalism in an academic medical center. The paper will describe the development and factorial validity of an instrument to measure attitudes toward professionalism in medical education among students, residents and faculty. METHODS: A factor analysis of the intercorrelations of responses to 36 items reflecting the American Board of Internal Medicine (ABIM) elements of professionalism for a sample of 765 medical students, residents and faculty was carried out. Data were collected during the spring of 2004. The study was conducted at the Penn State College of Medicine in Hershey, PA, USA. RESULTS: Main outcome measures include internal consistency reliability estimates (Cronbach's alpha) for each element of professionalism and a principal components analysis of the intercorrelations of responses to the 36 items in the questionnaire. Analysis of responses reveals seven identifiable factors of professionalism: accountability, altruism, duty, enrichment, equity, honor and integrity, and respect. CONCLUSIONS: The Penn State College of Medicine Professionalism Questionnaire is one of the first valid and reliable surveys of attitudes among medical students, residents, and faculty that reflects seven elements of professionalism.

Clinical associations between tinnitus and chronic pain.

OBJECTIVE: We sought to estimate the prevalence and severity of tinnitus in patients with chronic pain. STUDY DESIGN AND SETTING: We conducted a prospective nonrandomized study in which a survey and the Tinnitus Handicap Inventory (THI) were distributed at a tertiary chronic pain clinic. RESULTS: Seventy-two patients participated. 50 women (mean age, 53 years) and 22 men (mean age, 47.5 years); 54.2% reported having tinnitus. There was an even distribution of patients reporting the onset of tinnitus as before versus after the onset of pain. Four patients reported a direct association between tinnitus and pain. The mean THI score was 27 (of 100) (n = 35). Fifteen subjects scored less than 16, indicating no handicap, and 4 scored over 58, indicating a severe handicap. CONCLUSION: The study results suggest a high incidence of tinnitus within this population. There were few strong associations between pain and tinnitus. Tinnitus does not significantly handicap the majority of these patients. SIGNIFICANCE: Tinnitus is a common symptom in the chronic pain population but is not a significant problem for these patients.