Perception of Medical Student Mistreatment: Does Specialty Matter?

PURPOSE: Medical student mistreatment is pervasive, yet whether all physicians have a shared understanding of the problem is unclear. The authors presented professionally designed trigger videos to physicians from 6 different specialties to determine if they perceive mistreatment and its severity similarly. METHOD: From October 2016 to August 2018, resident and attending physicians from 10 U.S. medical schools viewed 5 trigger videos showing behaviors that could be perceived as mistreatment. They completed a survey exploring their perceptions. The authors compared perceptions of mistreatment across specialties and, for each scenario, evaluated the relationship between specialty and perception of mistreatment. RESULTS: Six-hundred fifty resident and attending physicians participated. There were statistically significant differences in perception of mistreatment across specialties for 3 of the 5 scenarios: aggressive questioning (range, 74.1%-91.2%), negative feedback (range, 25.4%-63.7%), and assignment of inappropriate tasks (range, 5.5%-25.5%) (P ≤ .001, for all). After adjusting for gender, race, professional role, and prior mistreatment, physicians in surgery viewed 3 scenarios (aggressive questioning, negative feedback, and inappropriate tasks) as less likely to represent mistreatment compared with internal medicine physicians. Physicians from obstetrics-gynecology and "other" specialties perceived less mistreatment in 2 scenarios (aggressive questioning and negative feedback), while family physicians perceived more mistreatment in 1 scenario (negative feedback) compared with internal medicine physicians. The mean severity of perceived mistreatment on a 1 to 7 scale (7 most serious) also varied statistically significantly across the specialties for 3 scenarios: aggressive questioning (range, 4.4-5.4; P < .001), ethnic insensitivity (range, 5.1-6.1; P = .001), and sexual harassment (range, 5.5-6.3; P = .004). CONCLUSIONS: Specialty was associated with differences in the perception of mistreatment and rating of its severity. Further investigation is needed to understand why these perceptions of mistreatment vary among specialties and how to address these differences.

A Pilot Survey of Career and Professional Advising of Medical Schools in the United States.

This article was migrated. The article was marked as recommended. Purpose: Scant information is available about the makeup of Career and Professional Advising systems, and who the advisors are in U.S. medical schools. We created a survey in 2019 and collated the responses to gain information about Advisors and advising systems. Materials and Methods: An 11 question survey was emailed to 72 U.S. medical schools, querying information about whether they had a Career and Professional Advising system and what is the construct of the system. Kruskal Wallis and Fisher's Exact tests were utilized for analysis. Results: 30/72 responses were received (41.67%). Educational backgrounds of advisors included: 27/30 (90%) by physicians; 7/30 (23.3%) by PhDs; 9/30 (30%) by Masters; 4/30 (13.3%) by others. AAMC Careers in Medicine curriculum was delivered in 23/30 (75.7%). Most advising systems were in Student Affairs (27/30, 90%), although only 20/30 (66.7%) reported to the Dean of Student Affairs. Conclusion: There was no unanimity in any of the responses to the 11 questions about who Career and Professional Advisors are, or how the systems are constructed. The closest to unanimity is that most medical schools have advising systems, that they are in Student Affairs departments, and that most advisors are physicians.

Mock interviews with video-stimulated recall to prepare medical students for residency interviews.

This article was migrated. The article was marked as recommended. Purpose: The residency interview is the most important factor for residency program directors when deciding on how to rank medical student applicants. With the residency match becoming increasingly competitive, it is more important than ever for students to perform well in this high-stakes interview. Video-stimulated recall (VSR) has been shown to be an effective tool for facilitating reflection on performance and behaviors. As such, we conducted mock interviews with and without video-stimulated recall to gauge its effect on student perceptions of preparedness and confidence for residency interviews. Methods: Students completed a pre-mock interview survey followed by a video recorded interview with faculty. All students received verbal feedback on their performance immediately after the interview. Students were randomized to receive their feedback from their faculty interviewer either while reviewing their video or without the video review. Post-mock interview and post-residency interview surveys were completed. Wilcoxon signed-rank was used to compare median aggregate scores between pre/post surveys. Wilcoxon rank-sum was used to compare pre/post aggregate scores between the video review vs. no-video review groups. Results: 33 of 70 students participated (47%). 14 students (42%) reviewed their video and 19 (58%) received feedback without video. Likert scores for pre- and post-mock interview and post-residency interview surveys revealed median aggregate scores of 10 (interquartile range, or IQR=8,11), 12 (IQR=12,13), and 13 (IQR=12,13) (p <0.001, p<0.001). The change in median aggregate score between pre/post-mock interview surveys in the video review group vs. no-video review group was 3 (IQR=3,5) and 1 (IQR=0,3) (p<0.01) and from pre-mock interview to post-residency interview in the video review vs. no-video review groups was 3 (IQR=3,5) and 2 (IQR=1,4) (p=0.04). Conclusions: The mock interview for residency application improved students' perceptions of preparedness and confidence. Reviewing the video of the interview while receiving verbal feedback increased students' confidence in their interview skills.

Recording medical students' encounters with standardized patients using Google Glass: providing end-of-life clinical education.

PROBLEM: Medical education today frequently includes standardized patient (SP) encounters to teach history-taking, physical exam, and communication skills. However, traditional wall-mounted cameras, used to record video for faculty and student feedback and evaluation, provide a limited view of key nonverbal communication behaviors during clinical encounters. APPROACH: In 2013, 30 second-year medical students participated in an end-of-life module that included SP encounters in which the SPs used Google Glass to record their first-person perspective. Students reviewed the Google Glass video and traditional videos and then completed a postencounter, self-evaluation survey and a follow-up survey about the experience. OUTCOMES: Google Glass was used successfully to record 30 student/SP encounters. One temporary Google Glass hardware failure was observed. Of the 30 students, 7 (23%) reported a "positive, nondistracting experience"; 11 (37%) a "positive, initially distracting experience"; 5 (17%) a "neutral experience"; and 3 (10%) a "negative experience." Four students (13%) opted to withhold judgment until they reviewed the videos but reported Google Glass as "distracting." According to follow-up survey responses, 16 students (of 23; 70%) found Google Glass "worth including in the [clinical skills program]," whereas 7 (30%) did not. NEXT STEPS: Google Glass can be used to video record students during SP encounters and provides a novel perspective for the analysis and evaluation of their interpersonal communication skills and nonverbal behaviors. Next steps include a larger, more rigorous comparison of Google Glass versus traditional videos and expanded use of this technology in other aspects of the clinical skills training program.

A novel approach to supporting relationship-centered care through electronic health record ergonomic training in preclerkship medical education.

PROBLEM: How can physicians incorporate the electronic health record (EHR) into clinical practice in a relationship-enhancing fashion ("EHR ergonomics")? APPROACH: Three convenience samples of 40 second-year medical students with varying levels of EHR ergonomic training were compared in the 2012 spring semester. All participants first received basic EHR training and completed a presurvey. Two study groups were then instructed to use the EHR during the standardized patient (SP) encounter in each of four regularly scheduled Doctoring (clinical skills) course sessions. One group received additional ergonomic training in each session. Ergonomic assessment data were collected from students, faculty, and SPs in each session. A postsurvey was administered to all students, and data were compared across all three groups to assess the impact of EHR use and ergonomic training. OUTCOMES: There was a significant positive effect of EHR ergonomics skills training on students' relationship-centered EHR use (P<.005). Students who received training reported that they were able to use the EHR to engage with patients more effectively, better articulate the benefits of using the EHR, better address patient concerns, more appropriately position the EHR device, and more effectively integrate the EHR into patient encounters. Additionally, students' self-assessments were strongly corroborated by SP and faculty assessments. A minimum of three ergonomic training sessions were needed to see an overall improvement in EHR use. NEXT STEPS: In addition to replication of these results, further effectiveness studies of this educational intervention need to be carried out in GME, practice, and other environments.

Association between GAB2 haplotype and higher glucose metabolism in Alzheimer's disease-affected brain regions in cognitively normal APOEε4 carriers.

In a genome-wide association study (GWAS) of late-onset Alzheimer's disease (AD), we found an association between common haplotypes of the GAB2 gene and AD risk in carriers of the apolipoprotein E (APOE) ε4 allele, the major late-onset AD susceptibility gene. We previously proposed the use of fluorodeoxyglucose positron emission tomography (FDG-PET) measurements as a quantitative pre-symptomatic endophenotype, more closely related to disease risk than the clinical syndrome itself, to help evaluate putative genetic and non-genetic modifiers of AD risk. In this study, we examined the relationship between the presence or absence of the relatively protective GAB2 haplotype and PET measurements of regional-to-whole brain FDG uptake in several AD-affected brain regions in 158 cognitively normal late-middle-aged APOEε4 homozygotes, heterozygotes, and non-carriers. GAB2 haplotypes were characterized using Affymetrix Genome-Wide Human SNP 6.0 Array data from each of these subjects. As predicted, the possibly protective GAB2 haplotype was associated with higher regional-to-whole brain FDG uptake in AD-affected brain regions in APOEε4 carriers. While additional studies are needed, this study supports the association between the possibly protective GAB2 haplotype and the risk of late-onset AD in APOEε4 carriers. It also supports the use of brain-imaging endophenotypes to help assess possible modifiers of AD risk.