An Internal Perspective: the Psychological Impact of Mistreatment.

OBJECTIVES: Student mistreatment remains a prominent issue in medical education. Mistreatment has been linked to negative mental health outcomes, including depression, anxiety, and burnout. Continued challenges in this arena include difficulties in identifying mistreatment and underreporting. The objective of this study was to better understand the nuances of individual students' reactions to mistreatment. METHODS: Medical students, who had experienced mistreatment, were invited to participate in this study. Individual, semi-structured, peer-to-peer interviews were conducted with 21 students. Interview transcriptions were coded using grounded theory and inductive analysis, and themes were extracted. RESULTS: The interviews generated 34 unique mistreatment incidents. Four major themes arose in students' reactions to mistreatment. (1) Descriptions-the student described the incident as inappropriate, unusual, or unnecessary. (2) Recognition-most students did not immediately recognize the incident as mistreatment. (3) Emotions-the student described negative emotions (negative self-views, anger, powerlessness, shock, discomfort) associated with the mistreatment incident. (4) Coping mechanisms-the student utilized avoidance and rationalization to process their mistreatment. CONCLUSIONS: Mistreatment generates complex emotions and coping mechanisms that impair the learning process. These complex emotions and coping mechanisms also make it difficult for trainees to identify mistreatment and to feel safe to report. Increasing understanding of the psychological impact of mistreatment can help peers and educators better screen for mistreatment in trainees and guide them in reporting decisions.

Soliciting feedback on the wards: a peer-to-peer workshop.

BACKGROUND: For medical students, soliciting feedback is a critical but difficult skill that merits proper training. This skill may be taught effectively by peers who have experienced challenges with feedback on the wards. METHODS: Two medical students developed and taught a workshop on feedback skills. The workshop was presented to 248 third-year students. The workshop trained students in soliciting, receiving and responding to feedback through interactive discussions of case scenarios. Students were given pre- and post-surveys to assess changes in their confidence in and attitudes towards the feedback process. RESULTS: There were statistically significant increases in students' likeliness to solicit feedback and confidence in their ability to solicit feedback. Students' view on the importance of feedback did not change. The most commonly cited barriers to feedback were time constraints, fear of negative feedback, emotions and skills when asking for feedback, and student-mentor relationship. The content the students valued the most was management of internal triggers to negative feedback. Students noted that the peer-to-peer format, case scenarios, and interactive questions were strengths of the workshop. DISCUSSION: Although medical students recognise the importance of feedback, they often lack the confidence and skills to obtain quality feedback. A peer-to-peer workshop on soliciting, receiving, and responding to feedback can be an effective method to improve students' confidence and skills in this area. More research needs to be done to conclude if this workshop increases the instances of students soliciting high-quality feedback on the wards and improves clinical performance.

Implementation, evaluation, and outcome of TeamSTEPPS in interprofessional education: a scoping review.

The ability to effectively work in interprofessional teams is listed as one of the five core competencies in health professions education. Though the importance of interprofessional education (IPE) has been established, results of studies have been difficult to compare due to the high variability of programs. We undertook a scoping review to examine the use of a prescribed curriculum, TeamSTEPPS, in IPE. Articles describing TeamSTEPPS implementations were extracted from Pubmed, Embase, and Scopus. Studies with two or more health professions students reporting on a clear evaluation and published in English were eligible for inclusion. Two researchers independently applied inclusion criteria to studies and reconciled conflicts for a final selection. The reference lists of selected papers were also searched for relevant studies. Data were extracted from each of the articles independently using a standard form. Twenty-four papers describing 23 unique programs were included. Programs used a variety of teaching modalities and included students from two to ten health professions, most commonly medical and nursing students. Programs used a range (n = 11) of validated IPE evaluation surveys, few of which were part of the TeamSTEPPS program. Methods included multimodal evaluations, self-assessment confidence and attitude surveys, pre/post-test models, and external evaluation of simulation performance. There was great variation in the implementation of TeamSTEPPS implying that while a consistent curriculum it can be adapted to meet the needs of different educational contexts. The variation in evaluation methods makes comparing and synthesis of results problematic. Future IPE research can expand on the use of this prescribed curriculum, especially with focus on uniform evaluation methods.

A Comparative Analysis of Academic and Nonacademic Hospitals on Outcome Measures and Patient Satisfaction.

Academic hospitals contribute to health care through patient care, research, and teaching; however, their outcomes may not be equivalent to nonacademic hospitals. Multivariate analysis of variance is used to compare publicly reported data on patient satisfaction, readmission rates, mortality rates, and hospital-acquired injury scores between 1906 academic and nonacademic hospitals, while controlling for hospital-level covariates. Results show that academic hospitals have higher levels of patient satisfaction on 7 of the 11 measures and are equivalent to nonacademic hospitals on the remaining 4 measures. Academic hospitals have lower pneumonia mortality rates than nonacademic hospitals, with no difference for other mortality or disease-specific readmissions. However, academic hospitals have a slightly higher overall readmission rate. Infection rates were equivalent between academic and nonacademic hospitals for central line-associated bloodstream infections, pressure ulcers, and wound dehiscence for abdominal and pelvic injuries, but academic hospitals have higher catheter-associated urinary tract infection rates.