An Experimental Investigation of Co-rumination, Problem Solving, and Distraction.

Co-rumination involves excessive dwelling on negative aspects of problems within a dyadic relationship (Rose, 2002). While research has focused on the tendency to co-ruminate within particular relationships, we were interested in examining the behavior of co-rumination outside the context of a preexisting relationship. Using an experimental manipulation of co-rumination, the primary goal of this study was to experimentally test the effects of co-rumination and examine its associations with negative and positive affectivity. Participants were randomly assigned to one of three interviewing style conditions: a co-ruminative style, a problem-solving style, or a distracting style. Results revealed that the co-rumination condition significantly differed from both the distraction and problem-solving conditions on overall negative affect, sadness, and anxiety, but not on hostility. There were no significant differences among groups on positive affect. In conclusion, this investigation revealed detrimental effects of co-ruminative behavior even between strangers.

Adolescents' co-rumination and stress predict affective changes in a daily-diary paradigm.

Co-rumination has been related to both high quality friendship and depressive symptoms. However, little is known regarding the extent to which co-rumination may be detrimental, its distinction from rumination and potential gender differences in co-rumination. This study used a modified version of Rose's Co-rumination Questionnaire (Rose, 2002) to examine the behaviour of daily co-rumination with daily stress and negative affect among adolescents. Results demonstrated that co-rumination did not have a main effect in predicting negative affect, but did evidence a significant interaction with life stress. Additionally, co-rumination demonstrated incremental utility above that of rumination. Finally, gender differences were not supported. In conclusion, this investigation revealed that co-rumination exacerbates the effects of life stress and is predictive of increased internalising symptoms.

An electronic orthopaedic in-training examination.

Following nearly 1 year of development, trials, surveys, and educational programs, in November 2009, the orthopaedic in-training examination (OITE) was successfully converted from the traditional print format and administered by DVD-ROM on local computers to more than 4,300 residents in 20 countries. A resident survey indicated a high level of satisfaction with the new examination. Questions with video and multislice image formats, presented as trial questions, performed well. Future versions of the OITE on DVD-ROM will eliminate some of the few difficulties experienced in 2009. The new electronic format offers excellent possibilities for improved imaging, the development of new and innovative questions, and an enhanced ability to approximate the practice environment-all of which can result in a better assessment of orthopaedic medical knowledge and an improved educational experience.

Institutional attributes associated with innovation and improvement: results of a multisite study.

BACKGROUND: To date, no studies have explored why some teaching hospitals and health systems appear to offer a more fertile environment for innovation and improvement in the learning environment. As a consequence, little is known about the role of organizational attributes and culture in fostering innovation and improvements in settings where residents learn and participate in care, though these have been studied extensively in the general literature on organizations. AIMS: The goals of our study entailed (1) gathering ground-level observations on processes and common attributes; (2) disseminating this information for adoption and adaptation; and (3) exploring whether the current accreditation model may present barriers to institution- and program-level innovation. METHODS: We conducted a qualitative study of 4 institutions, successful in innovation and improvement in their learning environment, and sought to replicate the findings with a second group of 5 institutions. RESULTS: THREE THEMES EMERGED FROM THE INTERVIEWS AND SITE VISITS OF THE PARTICIPANTS IN THE ALPHA PHASE: (1) a structure and culture that promote integration and inclusion; (2) a recognition of the value of resident education to the institution; and (3) a learning organization rooted in the extensive use of data and ongoing change, improvement, and innovation. CONCLUSIONS: Some of the concepts identified in our small sample of "innovative" institutions could be relatively easily adopted or adapted by others that seek to enhance innovation and improvement in the learning environment. In contrast, the structural factors that characterized 3 of the 4 alpha participants, particularly the organization and compensation of faculty, may not be generalizable to many other institutions.

Using patient care quality measures to assess educational outcomes.

OBJECTIVES: To report the results of a project designed to develop and implement a prototype methodology for identifying candidate patient care quality measures for potential use in assessing the outcomes and effectiveness of graduate medical education in emergency medicine. METHODS: A workgroup composed of experts in emergency medicine residency education and patient care quality measurement was convened. Workgroup members performed a modified Delphi process that included iterative review of potential measures; individual expert rating of the measures on four dimensions, including measures quality of care and educational effectiveness; development of consensus on measures to be retained; external stakeholder rating of measures followed by a final workgroup review; and a post hoc stratification of measures. The workgroup completed a structured exercise to examine the linkage of patient care process and outcome measures to educational effectiveness. RESULTS: The workgroup selected 62 measures for inclusion in its final set, including 43 measures for 21 clinical conditions, eight medication measures, seven measures for procedures, and four measures for department efficiency. Twenty-six measures met the more stringent criteria applied post hoc to further stratify and prioritize measures for development. Nineteen of these measures received high ratings from 75% of the workgroup and external stakeholder raters on importance for care in the ED, measures quality of care, and measures educational effectiveness; the majority of the raters considered these indicators feasible to measure. The workgroup utilized a simple framework for exploring the relationship of residency program educational activities, competencies from the six Accreditation Council for Graduate Medical Education general competency domains, patient care quality measures, and external factors that could intervene to affect care quality. CONCLUSIONS: Numerous patient care quality measures have potential for use in assessing the educational effectiveness and performance of graduate medical education programs in emergency medicine. The measures identified in this report can be used as a starter set for further development, implementation, and study. Implementation of the measures, especially for high-stakes use, will require resolution of significant measurement issues.

A review of medical school records to investigate the effectiveness of enrichment programs for "at risk" students.

BACKGROUND: Although considerable attention has been given to the establishment of enrichment programs, almost none has focused on evaluating their effectiveness. PURPOSE: To assess whether or not skills acquired during enrichment programs contributed to students' academic success in medical school. METHODS: Success in medical school, as characterized by lack of delaying events (DE), student status, and United States Medical Licensing Examination-Step I scores were analyzed using a general linear model procedure to determine the effect of participation in 1 or more enrichment programs. Proportional program participation was analyzed using a chi-square test of equal proportion. RESULTS: Participants from the "serious research" enrichment programs experienced significantly fewer DE (p <.01), which contributed to student success. Some enrichment programs had disproportionately higher attendance. CONCLUSIONS: Participation in research-based enrichment programs for matriculating students who are "at risk" may develop critical thinking and problem-solving skills that help students to minimize DE.