An Introductory Qualitative Exploration of Medical Student Perceptions of Professionalism at One Medical University.

Introduction: Professionalism as a competency in medical education has been defined in multiple ways. Irby and Hamstra offered three frameworks of professionalism in medical education. This study examines medical students' definitions of professionalism to assess whether they align with these frameworks. Methods: We administered an open-ended questionnaire to 92 medical students at a single university in the United States. We conducted thematic coding of responses and calculated code frequencies. Results: The response rate was 54%. There were no observable differences between the responses of students in clinical versus preclinical training phases. The majority of comments (84%) reflected aspects of multiple frameworks from Irby and Hamstra and three emergent themes were identified. Most respondents (96%) cited aspects of the behavior-based framework. Most students' (66%) responses also aligned with the virtue-based framework. Emergent themes were "hierarchical nature of medicine," "academic environment/hidden curriculum," and "service and advocacy." "Service and advocacy" can be viewed as contexts for Irby and Hamstra's identity formation framework, but references did not align with the full definition. Conclusion: Our findings suggest that students view professionalism through multiple frameworks and indicate a predominance of the behavior-based framework. Experiences with organizational culture and values may be important in students' definitions of professionalism.

Comparison of Disaster Preparedness Between Urban and Rural Community Hospitals in New York State.

OBJECTIVE: The intent of this study was to determine whether there are differences in disaster preparedness between urban and rural community hospitals across New York State. METHODS: Descriptive and analytical cross-sectional survey study of 207 community hospitals; thirty-five questions evaluated 6 disaster preparedness elements: disaster plan development, on-site surge capacity, available materials and resources, disaster education and training, disaster preparedness funding levels, and perception of disaster preparedness. RESULTS: Completed surveys were received from 48 urban hospitals and 32 rural hospitals.There were differences in disaster preparedness between urban and rural hospitals with respect to disaster plan development, on-site surge capacity, available materials and resources, disaster education and training, and perception of disaster preparedness. No difference was identified between these hospitals with respect to disaster preparedness funding levels. CONCLUSIONS: The results of this study provide an assessment of the current state of disaster preparedness in urban and rural community hospitals in New York. Differences in preparedness between the two settings may reflect differing priorities with respect to perceived threats, as well as opportunities for improvement that may require additional advocacy and legislation. (Disaster Med Public Health Preparedness. 2019;13:424-428).

Assessment of community hospital disaster preparedness in New York State.

OBJECTIVE: The intent of this study was to assess disaster preparedness in community hospitals across New York. DESIGN: Descriptive and analytical cross-sectional survey study. The survey instrument consisted of 35 questions that examined six elements of disaster preparedness: disaster plan development, onsite surge capacity, available materials and resources, disaster education and training, disaster preparedness funding levels, and perception of disaster preparedness. SETTING: Community hospitals in New York. SUBJECTS: Contact information was obtained for 207 of 208 community hospitals. Email invitations to participate in the survey were sent to hospital CEOs and disaster preparedness coordinators. Completed surveys were received from 80 hospitals. MAIN OUTCOME MEASURES: Hospital responses to questions related to the six elements of disaster preparedness. RESULTS: Most (87.5 percent) hospitals had experienced a disaster event during the past 5 years (2012-2016). Eighty percent had disaster plans that addressed all of six major types of disasters. Only 17.5 percent believed their disaster plans were "very sufficient" and did not require any revisions. Nearly three-quarters (73.3 percent) of hospitals could continue operations for less than a week without external resources. Less than half (49.4 percent) reported being satisfied or very satisfied with the level of funding that they received from the Hospital Preparedness Program. Most (88.8 percent) respondents felt that barriers to disaster preparedness exist for their organizations. CONCLUSIONS: The results demonstrate the current level of disaster preparedness among New York hospitals. The study's approach is discussed as a model that will enable hospitals to identify focus areas for improvement and opportunities for legislation and advocacy.

Comparison of disaster preparedness between Upstate and Downstate community hospitals in New York.

OBJECTIVE: This study sought to determine whether differences exist in disaster preparedness between Upstate and Downstate community hospitals in New York. DESIGN: A descriptive and analytical cross-sectional survey study was conducted using a 35-element questionnaire. These questions examined six disaster preparedness components: disaster plan development, onsite surge capacity, available materials and resources, disaster education and training, disaster preparedness funding levels, and perception of disaster preparedness. SETTING: The population surveyed included community hospitals across New York. SUBJECTS: Invitations to participate in the survey were emailed to the CEOs and disaster preparedness coordinators at 207 of the 208 community hospitals in New York. Eighty hospitals completed surveys, including 41 Upstate hospitals and 39 Downstate facilities. MAIN OUTCOME MEASURES: Responses to questions pertaining to the six disaster preparedness elements. RESULTS: There were differences in disaster preparedness between Upstate and Downstate hospitals with respect to disaster plan development, available materials and resources, and disaster education and training. No differences were identified in onsite surge capacity, disaster preparedness funding levels, or perception of disaster preparedness. CONCLUSIONS: The results demonstrate the current condition of disaster preparedness in Upstate and Downstate community hospitals in New York. Differences in preparedness between hospitals in the two locations may reflect factors such as availability of resources and differing priorities with regard to threat levels. They also suggest opportunities for improvement in disaster preparedness, which may require additional government resources and advocacy organization efforts.

Clinical training in the rural setting: using photovoice to understand student experiences.

INTRODUCTION: Attracting and retaining healthcare providers in rural locations in the USA has been an issue for more than two decades. In response to this need, many health sciences education institutions in the USA have developed special programs to encourage students to become healthcare providers in rural locations. One approach is the use of community-based education experiences through rural track programs. Rural track programs seek to address the shortage of healthcare providers working in rural areas by nurturing and educating students interested in rural practice and primary care. Such programs serve both medical students and students of other health professions. Yet, little is known about student experiences in rural track programs. As such, this study aimed to generate discourse on student experiences in the rural training environment and gain insight into the impact of rural environments on student learning. METHODS: An exploratory qualitative analysis of medical and physician assistant student experiences in two rural medical education training programs was conducted using the photovoice methodology. Photovoice is a participatory research method combining photography with participant commentary and focus groups. RESULTS: Twenty-two third-year medical and six second-year physician assistant students participated in the study. Students noted that in their rural sites the learning environment extended beyond direct clinical teaching in four primary ways: (1) relationships with clinical faculty translated to a sense of meaningful participation in healthcare teams; (2) connections with community members outside of clinical settings led to increased awareness of healthcare concerns; (3) rural settings provided important space to reflect on their experiences; and (4) the importance of infrastructure was highlighted. Students also believed that diversity of occupation, education, attitude, and perception of medical care impact learning in rural environments. CONCLUSIONS: The photovoice participatory research methodology allowed for a deeper understanding of the aspects of the rural training experience that resonated most among students in real time, using visual representations of students' lived experiences as defined by the students.

Emerging practice concerning vitamin D in primary care.

The establishment of practice patterns concerning the diagnosis and management of hypovitaminosis D seems to be heterogeneous among primary care physicians. We conducted a qualitative study to explore the emerging practices among primary care providers regarding screening and treatment for hypovitaminosis D, as well as factors that influence practice patterns. Trained researchers facilitated focus groups among primary care providers. We followed a grounded theory approach to transcript coding and analysis using ATLAS.ti analysis software. Testing or screening for hypovitaminosis D and subsequent replacement or supplementation practices varied among participants. Emerging practice concerning vitamin D appears to be constructed and reinforced by patient demand; incidental reading; brief, purposeful research; conversations with colleagues; results of consultations by specialists; and more patient demand. A multifaceted approach to promoting guideline adherence will be required to influence this practice.

A qualitative study of medical students in a rural track: views on eventual rural practice.

BACKGROUND: Rural tracks (RTs) exist within medical schools across the United States. These programs often target those students from rural areas and those with primary care career interests, given that these factors are robust predictors of eventual rural practice. However, only 26% to 64% of graduates from RTs enter eventual rural practice. METHODS: We conducted a qualitative, exploratory study of medical students enrolled in one school's RT, examining their interests in rural training, specialization, and eventual rural practice, via open coding of transcripts from focus groups and in-depth individual interviews, leading to identification of emerging themes. RESULTS: A total of 16 out of 54 eligible first- and second-year preclinical medical students participated in focus group sessions, and a total of seven out of 17 eligible third- and fourth-year medical students participated in individual interviews. Analyses revealed the recognition of a "Rural Identity," typical characteristics, and the importance of "Program Fit" and "Intentions for Practice" that trended toward family medicine specialization and rural practice. However, nuances within the comments reveal incomplete commitment to rural practice. In many cases, student preference for rural practice was driven largely by a disinterest in urban practice. CONCLUSIONS: Students with rural and primary care practice interests are often not perfectly committed to rural practice. However, RTs may provide a haven for such students within medical school.

The temporal decline of idealism in two cohorts of medical students at one institution.

BACKGROUND: A number of studies have indicated that students lose idealistic motivations over the course of medical education, with some identifying the initiation of this decline as occurring as early as the second year of the traditional US curricula. This study builds on prior work testing the hypothesis that a decline in medical student idealism is detectable in the first two years of medical school. METHODS: The original study sought to identify differences in survey responses between first-year (MS1) and second-year (MS2) medical students at the beginning and end of academic year 2010, on three proxies for idealism. The current study extends that work by administering the same survey items to the same student cohorts at the end of their third and fourth years (MS3 and MS4), respectively. Survey topics included questions on: (a) motivations for pursuing a medical career; (b) specialty choice; and (c) attitudes toward primary care. Principle component analysis was used to extract linear composite variables (LCVs) from responses to each group of questions. Linear regression was then used to test the effect of the six cohort/time-points on each composite variable, controlling for demographic characteristics. RESULTS: Idealism in medicine decreased (ß = -.113, p < .001) while emphasis on employment and job security increased (ß = .146, p < .001) as motivators of pursuing a career in medicine at each medical school stage and time period. Students were more likely to be motivated by student debt over interest in content in specialty choice (ß = .077, p = .004) across medical school stages. Negative attitudes towards primary care were most sensitive to MS group and time effects. Both negative/antagonistic views (ß = .142, p < .001) and negative/sympathetic views (ß = .091, p < .001) of primary care increased over each stage. CONCLUSIONS: Our results provide further evidence that declines in medical student idealism may occur as early as the second year of medical education. Additionally, as students make choices in their medical careers, such as specialty choice or consideration of primary care, the influences of job security, student debt and social status increasingly outweigh idealistic motivations.

Decline of medical student idealism in the first and second year of medical school: a survey of pre-clinical medical students at one institution.

BACKGROUND: Idealism declines in medical students over the course of training, with some studies identifying the beginning of the decline in year 3 of US curricula. PURPOSES: This study tested the hypothesis that a decline in medical student idealism is detectable in the first two years of medical school. METHODS: We sought to identify differences in survey responses between first-year (MS1) and second-year (MS2) medical students at the beginning (T1) and end (T2) of academic year 2010 on three proxies for idealism, including items asking about: (a) motivations for pursuing a medical career; (b) specialty choice; and (c) attitudes toward primary care. Principle component analysis was used to extract linear composite variables (LCVs) from responses to each group of questions; linear regression was then used to test the effect of on each LCV, controlling for race, ethnicity, rural or urban origins, gender, and marital status. RESULTS: MS2s placed more emphasis on status/income concerns (ß=0.153, p<0.001), and much less emphasis on idealism as a motivator (ß=-0.081, p=0.054), in pursuing a medical career; more likely to consider lifestyle and family considerations (ß=0.098, p=0.023), and less likely to consider idealistic motivations (ß=-0.066, p=NS); and were more likely to endorse both negative/antagonistic (ß=0.122, p=0.004) and negative/sympathetic (ß=0.126, p=0.004) attitudes toward primary care. CONCLUSIONS: The results are suggestive that idealism decline begins earlier than noted in other studies, implying a need for curricular interventions in the first two years of medical school.