The Consequences of Step 2 Clinical Skills Examination Discontinuation for Medical Schools and Sustainability Plans for Clinical Skills Assessment.

PURPOSE: Comprehensive clinical skills examinations using standardized patients are widely used to assess multiple physician competencies. However, these exams are resource intensive. With the discontinuation of the Step 2 Clinical Skills (CS) exam in 2021, how medical schools will change their approaches to comprehensive clinical skills exams is unknown. This study explores school responses to this change and future directions of comprehensive clinical skills exams using the program sustainability framework. METHOD: This cross-sectional, descriptive study surveyed medical school curriculum deans at 150 Liaison Committee on Medical Education-accredited U.S. medical schools from September to October 2021. The 30-question survey included questions about medical school and participant role, current comprehensive clinical skills exams, sustainability dimensions, and challenges and future directions. Descriptive statistics were used to characterize responses, and content analysis was used to identify themes in the open-ended responses. RESULTS: Educators at 75 of 150 institutions (50%) responded. Sixty-three respondents (84%) reported conducting a comprehensive clinical skills exam. The comprehensive clinical skills exam assessed readiness for graduation (51 [81%]), provided feedback for students (49 [78%]), evaluated curricula (38 [60%]), provided information for medical student performance evaluation or communication with residency (10 [16%]), and assessed other factors (6 [10%]), including preparation for Step 2 CS in the past and readiness for advancement to fourth year of medical school (multiple responses were allowed). Factors facilitating sustainability included sufficient funding to continue the exam (55 [87%]) and the belief that clinical skills assessment in medical school is now more important after discontinuation of the Step 2 CS exam (55 [87%]). Challenges to sustainability included organizational capacity and limited interinstitutional collaboration. CONCLUSIONS: Educators remain committed to the purpose of comprehensive clinical skills exams. Adapting to changed licensing requirements while sustaining clinical skills exams enables innovation and improvement in assessment of clinical competence.

A Call to Action From the California Consortium for the Assessment of Clinical Competence: Making the Case for Regional Collaboration.

The discontinuation of the United States Medical Licensing Examination Step 2 Clinical Skills Examination emphasizes the need for other reliable standardized assessments of medical student clinical skills. For 30 years, the California Consortium for the Assessment of Clinical Competence (CCACC) has collaborated in the development of clinical skills assessments and has become a valuable resource for clinicians, standardized patient educators, psychometricians, and medical educators. There are many merits to strong multi-institutional partnerships, including the integration of data across multiple schools to provide feedback to both students and curricula, pooled test performance statistics for analysis and quality assurance, shared best practices and resources, individual professional development, and opportunities for research and scholarship. The infrastructure of the CCACC allows member schools to adapt to a changing medical landscape, from emerging trends in clinical medicine to the limitations imposed by a global pandemic. In the absence of a national examination, there is now a greater need for all medical schools to develop a comprehensive, dynamic, and psychometrically sound assessment that accurately evaluates clinical skills. Medical schools working together in regional consortia have the opportunity to create and implement innovative and robust assessments that evaluate a wide range of clinical skills, ensure that medical students have met an expected level of clinical competency before graduation, and provide a framework that contributes to ongoing efforts for the development of new national clinical skills standards.

Clinical Skills Tutoring Program (CSTP): Developing a Curriculum for Medical Student Clinical Skills Peer Tutors.

INTRODUCTION: There are few curriculum materials designed to provide training and support for peer tutors to become effective clinical skills teachers. We designed the Clinical Skills Tutoring Program (CSTP) curriculum to guide tutors to help their students reflect on clinical skills performance, create an individualized learning plan, and engage in improvement based on feedback to achieve clinical skills competencies. METHODS: Curriculum content was delivered through an in-person training session, formal curriculum written content, online resources, and longitudinal support from faculty directors. Tutors (fourth-year medical students) received surveys to evaluate the in-person training session, curriculum resources, and overall program experience. Student participants (medical students of any year) completed a survey to rate their satisfaction in working with their tutors. RESULTS: There were 12 tutors in cohort 1 and 18 tutors in cohort 2. Survey response rates ranged from 50% to 70% among tutors. The tutors were satisfied with the in-person training session, program experience, curriculum resources, support from directors, development of learning goals with the student, and clinical skills practice with the student (mean Likert ratings greater than 4 out of 5). Student participants were satisfied with their experience creating learning goals and receiving feedback from their tutors. DISCUSSION: The tutor curriculum fills a gap by training and supporting tutors before and during their work with students needing further resources and remediation in one or more clinical skills domains. The curriculum can be implemented and further adapted by other tutoring programs locally and nationally.

Leader dark traits, workplace bullying, and employee depression: Exploring mediation and the role of the dark core.

A growing body of empirical evidence now supports a negative association between dark traits in leaders and the psychological health of employees. To date, such investigations have mostly focused on psychopathy, nonspecific measures of psychological wellbeing, and have not considered the mechanisms through which these relationships might operate. In the current study (N = 508), we utilized other-ratings of personality (employees rated leaders' personality), psychometrically robust measures, and sophisticated modeling techniques, to examine whether the effects of leaders' levels of narcissism and psychopathy on employee depression are mediated by workplace bullying. Structural equation models provided clear evidence to suggest that employee perceptions of both leader narcissism and psychopathy are associated with increased workplace bullying (25.8% and 41.0% variance explained, respectively) and that workplace bullying fully mediates the effect of leader narcissism and psychopathy on employee depression (21.5% and 20.8% variance explained, respectively). However, when psychopathy and narcissism were modeled concurrently, narcissism did not explain any variance in bullying, suggesting that it is the overlap between psychopathy and narcissism, namely, the "dark core," which primarily accounts for the observed effects. We examined this assertion empirically and explored the unique effects of the subfactors of psychopathy. (PsycINFO Database Record

The Ontogeny of Gap Crossing Behaviour in Bornean Orangutans (Pongo pygmaeus wurmbii).

For orangutans, the largest predominantly arboreal primates, discontinuous canopy presents a particular challenge. The shortest gaps between trees lie between thin peripheral branches, which offer the least stability to large animals. The affordances of the forest canopy experienced by orangutans of different ages however, must vary substantially as adult males are an order of magnitude larger in size than infants during the early stages of locomotor independence. Orangutans have developed a diverse range of locomotor behaviour to cross gaps between trees, which vary in their physical and cognitive demands. The aims of this study were to examine the ontogeny of orangutan gap crossing behaviours and to determine which factors influence the distance orangutans crossed. A non-invasive photographic technique was used to quantify forearm length as a measure of body size. We also recorded locomotor behaviour, support use and the distance crossed between trees. Our results suggest that gap crossing varies with both physical and cognitive development. More complex locomotor behaviours, which utilized compliant trunks and lianas, were used to cross the largest gaps, but these peaked in frequency much earlier than expected, between the ages of 4 and 5 years old, which probably reflects play behaviour to perfect locomotor techniques. Smaller individuals also crossed disproportionately large gaps relative to their size, by using support deformation. Our results suggest that orangutans acquire the full repertoire of gap crossing techniques, including the more cognitively demanding ones, before weaning, but adjust the frequency of the use of these techniques to their increasing body size.

Awareness of Kaposi's sarcoma-associated herpesvirus among men who have sex with men.

BACKGROUND: Despite burgeoning scientific knowledge about Kaposi's sarcoma-associated herpesvirus (KSHV), the etiologic agent of Kaposi's sarcoma (KS), little is known about awareness of this virus in the general community. This is particularly the case for men who have sex with men (MSM), the group at greatest risk for infection. METHODS: The California Health Interview Survey was a random digit- dial survey of over 50,000 households. Men aged 18 to 64 years who self-identified as gay or bisexual were subsequently recontacted for a follow-up study of HIV-related knowledge and behavior in which they were asked if they had heard of KS and to describe the cause of KS. RESULTS: Of 398 MSM interviewed, 73.0% (95% CI 65.0-79.7) had heard of KS. However, only 6.4% (95% CI 4.4-9.2) of participants correctly identified that KS is caused by KSHV or a virus other than HIV. Postgraduate education, urban residence, and concurrent HIV infection were all independently associated with greater awareness of the viral origin of KS. CONCLUSION: Awareness of KSHV is very low, overall, among MSM and only somewhat higher, but still unacceptably low, among HIV-infected MSM. Significant efforts are needed to increase awareness of KSHV as a sexually transmitted infection in this population.

Density and population estimate of gibbons (Hylobates albibarbis) in the Sabangau catchment, Central Kalimantan, Indonesia.

We demonstrate that although auditory sampling is a useful tool, this method alone will not provide a truly accurate indication of population size, density and distribution of gibbons in an area. If auditory sampling alone is employed, we show that data collection must take place over a sufficient period to account for variation in calling patterns across seasons. The population of Hylobates albibarbis in the Sabangau catchment, Central Kalimantan, Indonesia, was surveyed from July to December 2005 using methods established previously. In addition, auditory sampling was complemented by detailed behavioural data on six habituated groups within the study area. Here we compare results from this study to those of a 1-month study conducted in 2004. The total population of the Sabangau catchment is estimated to be about in the tens of thousands, though numbers, distribution and density for the different forest subtypes vary considerably. We propose that future density surveys of gibbons must include data from all forest subtypes where gibbons are found and that extrapolating from one forest subtype is likely to yield inaccurate density and population estimates. We also propose that auditory census be carried out by using at least three listening posts (LP) in order to increase the area sampled and the chances of hearing groups. Our results suggest that the Sabangau catchment contains one of the largest remaining contiguous populations of Bornean agile gibbon.