Preclinical Assessment Performance as a Predictor of USMLE Step 1 Scores or Passing Status.

PURPOSE: To determine the association between student performance on preclinical pass/fail assessments in an allopathic medical school curriculum and Step 1 scores or passing status. MATERIALS AND METHODS: This observational retrospective study involved preclinical assessments, including National Board of Medical Examiners Customized Assessment Services (NBME CAS) exams, faculty developed exams, and the United States Medical Licensing Examination (USMLE) Step 1 from 582 medical students in four cohorts (2018-2021). Analyses included descriptive statistics, Pearson's correlation coefficient (ρ) and logistic regression, presented as odds ratios (ORs) and associated p values. RESULTS: Mean scores on Component 4 end-of-block NBME CAS examinations positively correlated with Step 1 scores (ρ = 0.83, p < .001), as did mean scores on both Component 1 weekly faculty-created assessments and Component 3 end-of-block faculty-created assessments (ρ = 0.70, p < .001; ρ = 0.73, p < .001). Passing all Component 3 end-of-block faculty-created assessments in all blocks was associated with passing Step 1 (OR = 8.66, p < .001). Independently, passing all Component 4 NBME CAS exams or passing all Component 1 weekly faculty-derived assessments in all blocks did not correlate with passing Step 1 (OR = 2.40, p = .12.; OR = 0.29, p = .30). Passing all assessment types in all blocks was among the strongest correlators with passing Step 1 (OR = 9.026, p < .001). CONCLUSIONS: Scores on faculty-derived and NBME CAS end-of-block assessments were positively correlated with Step 1 scores. Passing status on institution-derived end-of-block assessments was associated with passing Step 1, whereas passing status on weekly institution-derived assessments or end-of-block NBME CAS assessments was not associated with passing Step 1. End-of-block pass/fail NBME CAS and faculty-derived preclinical examinations may help prepare students for Step 1 and predict their outcomes. Weekly faculty-created assessments should primarily be used to continuously reinforce educational material.

Infectious Diseases Simulation for Medical Students: Experiential Instruction on Personal Protective Equipment.

Introduction: The emergence of COVID-19 highlighted the critical importance of appropriate use of personal protective equipment (PPE) for the safety of patients and health care personnel. However, previously published survey data indicated that formal instruction on the correct utilization of PPE is uncommon in medical school curricula, and there is no published guidance about optimal instruction methods. The infectious disease (ID) simulation lab at Oregon Health & Science University filled this need. Methods: Second- through fourth-year medical students participated in the infection intersession, a 2-week didactic session that students were required to enroll in once during their clinical rotations. As part of the course, students completed the ID simulation lab, during which they were presented with common ID syndromes (suspected tuberculosis, C. difficile colitis, and neutropenic fever) and asked to select the proper PPE prior to interacting with standardized patients. ID physicians acted as the patients and then conducted feedback sessions, which focused on PPE choice, donning and doffing techniques, and ID diagnosis and management principles. Results: More than 500 medical students participated between 2016 and 2020, demonstrating the feasibility of the experience. The average exam scores were above 80%, and the average student evaluation score of the session was 8.9 out of 10, demonstrating acceptability. Discussion: The ID simulation lab allowed students to reinforce didactic teaching about PPE, dispel common misconceptions, and receive real-time feedback from ID clinicians. Availability of the lab and facilitators were limiting factors. Future work will focus on better understanding the efficacy of the sessions.

Measuring Coaching in Undergraduate Medical Education: the Development and Psychometric Validation of New Instruments.

BACKGROUND: Coaching is emerging as a novel approach to guide medical students toward becoming competent, reflective physicians and master adaptive learners. However, no instruments currently exist to measure academic coaching at the undergraduate medical education level. OBJECTIVE: To describe the development and psychometric assessments of two instruments designed to assess academic coaching of medical students toward creating a robust measurement model of this educational paradigm. DESIGN: Observational psychometric. PARTICIPANTS: All medical students in the 2014 and 2015 cohorts and all their coaches were invited to complete the instruments being tested, which led to 662 medical student responses from 292 medical students and 468 coaching responses from 22 coaches being included in analyses. Medical student response rates were 75.7% from 2014 and 75.5% from 2015. Overall, the coaches' response rate was 71%. MAIN MEASURES: Two 31-item instruments were initially developed, one for medical students to assess their coach and one for faculty coaches to assess their students, both of which evaluated coaching based on definitions we formulated using existing literature. Each was administered to two cohorts of medical students and coaches in 2015 and 2016. An exploratory factor analysis using principal component analysis as the extraction method and Varimax with Kaiser normalization as the rotation method was conducted. KEY RESULTS: Eighteen items reflecting four domains were retained with eigenvalues higher than 1.0 for medical students' assessment of coaching, which measured promoting self-monitoring, relationship building, promoting reflective behavior, and establishing foundational ground rules. Sixteen items reflecting two domains were retained for the faculty assessment of coaching with eigenvalues higher than 1.0: the Practice of Coaching and Relationship Formation. CONCLUSIONS: We successfully developed and psychometrically validated surveys designed to measure key aspects of the coaching relationship, coaching processes, and reflective outcomes. The new validated instruments offer a robust measurement model for academic coaching.

Factors Influencing Selection of Infectious Diseases Training for Military Internal Medicine Residents.

Background: Applications to infectious diseases fellowships have declined nationally; however, the military has not experienced this trend. In the past 6 years, 3 US military programs had 58 applicants for 52 positions. This study examines military resident perceptions to identify potential differences in factors influencing career choice, compared with published data from a nationwide cohort. Methods: An existing survey tool was adapted to include questions unique to the training and practice of military medicine. Program directors from 11 military internal medicine residencies were asked to distribute survey links to their graduating residents from December 2016 to January 2017. Data were categorized by ID interest. Result: The response rate was 51% (n = 68). Of respondents, 7% were ID applicants, 40% considered ID but reconsidered, and 53% were uninterested. Of those who considered ID, 73% changed their mind in their second and third postgraduate years and cited salary (22%), lack of procedures (18%), and training length (18%) as primary deterrents to choosing ID. Active learning styles were used more frequently by ID applicants to learn ID concepts than by those who considered or were uninterested in ID (P = .02). Conclusions: Despite differences in the context of training and practice among military trainees compared with civilian colleagues, residents cited similar factors affecting career choice. Interest in global health was higher in this cohort. Salary continues to be identified as a deterrent to choosing ID. Differences between military and civilian residents' desire to pursue ID fellowship are likely explained by additional unmeasured factors deserving further study.

Case Report: Conjunctival Infestation with Thelazia gulosa: A Novel Agent of Human Thelaziasis in the United States.

We report a case of thelaziasis in a 26-year-old female, acquired in Oregon. A total of 14 worms were removed from the patient's left eye and were morphologically identified as being Thelazia gulosa. Until now, only two species of Thelazia have been implicated in causing human disease, Thelazia callipaeda in Asia and Europe and occasional reports of Thelazia californiensis from the United States of America. Here, we describe a third, previously unreported parasite of humans, T. gulosa (the cattle eyeworm) as an agent of human thelaziasis and the first reported case of human thelaziasis in North America in over two decades.

Military Internal Medicine Resident Decision to Apply to Fellowship and Extend Military Commitment.

Introduction: Nationally, the number of internal medicine physicians practicing in primary care has decreased amidst increasing interest in hospitalist medicine. Current priorities in the Military Health System include access to primary care and retention of trained personnel. Recently, we have conducted a study of military internal medicine residents' decision to enter infectious disease. As part of our larger effort, we saw an opportunity to characterize factors impacting decision making of internal medicine residents' desire to apply for subspecialty training and to extend active duty service obligations. Materials and Methods: Questions were developed after discussion with various military graduate medical education and internal medicine leaders, underwent external review, and were added to a larger question set. The survey link was distributed electronically to all U.S. military affiliated residencies' graduating internal medicine residents in December 2016-January 2017. Data were analyzed by decision to apply to fellowship and decision to extend military obligation using Fisher's exact test or Pearon's chi-square test. Results: Sixty-eight residents from 10 of 11 military residency programs responded, for a response rate of 51%. The majority (62%) applied to fellowship to start after residency completion. Reasons cited for applying to fellowship included wanting to become a specialist as soon as possible (74%), wishing to avoid being a general internist (57%), and because they are unable to practice as a hospitalist in the military (52%). Fellowship applicants were more likely to plan to extend their military obligation than non-applicants, as did those with longer duration of military commitments. No other factors, including Uniformed Services University attendance or participation in undergraduate military experiences, were found to impact plan to extend active duty service commitment. Conclusion: The majority of graduating internal medicine residents apply for fellowship and report a desire to avoid being a general internist. Prospective fellows anticipate extending their active duty commitment, as do those with longer commitments.

Coaching: a new model for academic and career achievement.

BACKGROUND: Individualized education is emerging as an innovative model for physician training. This requires faculty coaching to guide learners' achievements in academic performance, competency development, and career progression. In addition, coaching can foster self-reflection and self-monitoring using a data-guided approach to support lifelong learning. CONTEXT: Coaching differs from mentoring or advising, and its application in medical education is novel. Because of this, definitions of the concept and the constructs of coaching as applied to medical education are needed to accurately assess the coaching relationship and coaching processes. These can then be linked to learner outcomes to inform how coaching serves as a modifier of academic and competency achievement and career satisfaction. INNOVATION: We developed definitions and constructs for academic coaching in medical education based on review of existing education and non-education coaching literature. These constructs focus on 1) establishing relationship principles, 2) conducting learner assessments, 3) developing and implementing an action plan, and 4) assessing results and revising plans accordingly. IMPLICATION: Coaching is emerging as an important construct in the context of medical education. This article lays the vital groundwork needed for evaluation of coaching programs aimed at producing outstanding physicians.

Factors Influencing Internal Medicine Resident Choice of Infectious Diseases or Other Specialties: A National Cross-sectional Study.

BACKGROUND: Only 49% of infectious diseases (ID) fellowship programs were filled in 2015 through the national match, but little is known about internal medicine (IM) resident perceptions of ID and factors related to IM resident career choice. METHODS: We conducted 25 interviews and disseminated a Web-based survey to graduating IM residents in the United States utilizing a 2-stage sampling strategy. Participants were categorized into 3 groups based on interest in ID: (1) applied/intended to apply to ID; (2) interested in ID but did not apply; (3) never interested in ID. We conducted all analysis using poststratification adjustment weights with survey data analysis procedures. RESULTS: Of the 590 participants, 42 (7%) selected category 1, 188 (32%) category 2, and 360 (61%) category 3. Most (65%) developed an interest in their ultimate career before residency. Of those interested in ID, >52% rated their ID medical school curriculum as very good and influential on their interest in ID. Ninety-one percent of category 2 participants felt mentorship was influential on career choice, although 43% identified an ID mentor. Category 2 chose salary as the most dissuading factor and the most likely intervention to increase ID interest. CONCLUSIONS: In this nationally representative sample of graduating IM residents, most develop an interest in their ultimate career before residency. Factors influencing this decision reside in both medical school and residency, which is consistent with career decision-making constructs. By identifying career determining factors and understanding how they fit into medical training frameworks, we can develop targeted initiatives to reinvigorate interest in ID.