Uniformed Services University Medical Student Mentorship Experiences and Gender From 2010 to 2017.

INTRODUCTION: Gender disparity in medicine has drawn increased attention in the form of root cause analysis and programmatic solutions with the goal of equity. Research indicates that mentoring, guidance, and support, which include the provision of social and academic guidance and support from more experienced practitioners, can mitigate challenges associated with gender disparity. The purpose of this study was to explore women medical students' self-reports of mentorship during their time at Uniformed Services University (USU), if women report similar levels of mentorship as compared to men, and if levels of characteristics associated with mentoring (eg, social support, academic guidance) changed over time. MATERIALS AND METHOD: Using data from the American Association of Medical College's Graduate Questionnaire, a survey sent to all medical students prior to graduation, items were coded as related to mentorship, guidance, and support and analyzed to compare responses of female and male students from graduating USU classes of 2010-2017. RESULTS: No significant difference was found between experiences of female and male survey respondents. Equitable experiences were consistent across time for the 8 years of the study. CONCLUSIONS: Although mentorship is cited as a key factor in mediating gender disparity in medicine, other STEM fields, and the military, the findings suggest that there is equity at the USU undergraduate medical education level. Further studies are needed to understand if disparities in mentorship experiences occur at other stages of a military physician's career, such as graduate medical education, faculty and academic promotion levels.

Cognitive Load Theory: implications for medical education: AMEE Guide No. 86.

Cognitive Load Theory (CLT) builds upon established models of human memory that include the subsystems of sensory, working and long-term memory. Working memory (WM) can only process a limited number of information elements at any given time. This constraint creates a "bottleneck" for learning. CLT identifies three types of cognitive load that impact WM: intrinsic load (associated with performing essential aspects of the task), extraneous load (associated with non-essential aspects of the task) and germane load (associated with the deliberate use of cognitive strategies that facilitate learning). When the cognitive load associated with a task exceeds the learner's WM capacity, performance and learning is impaired. To facilitate learning, CLT researchers have developed instructional techniques that decrease extraneous load (e.g. worked examples), titrate intrinsic load to the developmental stage of the learner (e.g. simplify task without decontextualizing) and ensure that unused WM capacity is dedicated to germane load, i.e. cognitive learning strategies. A number of instructional techniques have been empirically tested. As learners' progress, curricula must also attend to the expertise-reversal effect. Instructional techniques that facilitate learning among early learners may not help and may even interfere with learning among more advanced learners. CLT has particular relevance to medical education because many of the professional activities to be learned require the simultaneous integration of multiple and varied sets of knowledge, skills and behaviors at a specific time and place. These activities possess high "element interactivity" and therefore impose a cognitive load that may surpass the WM capacity of the learner. Applications to various medical education settings (classroom, workplace and self-directed learning) are explored.

Accuracy of medical student electronic logbook problem list entry.

BACKGROUND: The accuracy of medical student logbooks has not been extensively studied. PURPOSE: The purpose of this study was to determine accuracy of student entry of core problems and completeness of patient entry in an electronic logbook. METHODS: Third-year internal medicine clerkship students entered patient encounters as required by the clerkship. Experts entered information from the same encounters. RESULTS: A total of 1,440 patient entries generated by 37 consecutive students were compared to expert entries. Sensitivity (core problem underreporting) was low (60%, SD=22%). Percent agreement (87%, SD=7%), kappa (0.46, SD=0.19), and specificity (core problem overreporting; 95%, SD=5%) were good to excellent. Students both omitted (underreported 14%, SD=12%) and overreported (23%, sd 17%) patients. CONCLUSIONS: Under ideal study circumstances, there was significant underreporting of core problems by students. Although the high specificity, meaning that students are not reporting problems they have not encountered, is reassuring, logbook sensitivity in this study was not good enough for high-stakes evaluations of students or for medical school licensing.