Specific Incremental Test for Aerobic Fitness in Trail Running: IncremenTrail.

Trail running (TR) is performed in a natural environment, including various ranges of slopes where maximal oxygen consumption is a major contributor to performance. The aim of this study is to investigate the validity of tests performed in uphill conditions named the "IncremenTrail" (IncT), based on the incremental ascending speed (AS) to evaluate trail runners' cardiorespiratory parameters. IncT protocol included a constant gradient slope set at 25% during the whole test; the starting speed was 500 m·h-1 (25% slope and 2.06 km·h-1) and increased by 100 m·h-1 every minute (0.41 km·h-1). Twenty trail runner specialists performed the IncT and a supramaximal exercise bout to exhaustion with intensity set at 105% of maximal AS (Tlim). Oxygen consumption, breathing frequency, ventilation, respiratory exchange ratio (RER), and heart rate were continuously recorded during the exercises. The blood lactate concentration and rate of perceived exertion were collected at the end of the exercises. During the IncT test, 16 athletes (80%) reached a plateau of maximal oxygen uptake (65.5 ± 7.6 mL·kg-1·min-1), 19 athletes (95%) reached RER values over 1.10 (1.12 ± 0.02) and all the athletes achieved blood lactate concentration over 8.0 mmol·L-1 (17.1 ± 3.5 mmol·L-1) and a maximal heart rate ≥90% of the theoretical maximum (185 ± 11 bpm). Maximal values were not significantly different between IncT and Tlim. In addition, ventilatory thresholds could be determined for all runners with an associated AS. IncT provided a suitable protocol to evaluate trail runners' cardiorespiratory limitations and allowed us to obtain specific intensities based on the ascending speed useful for training purposes in specific conditions.

Grading Practices and Distributions Across Internal Medicine Clerkships.

THEORY: Clerkship evaluation and grading practices vary widely between U.S. medical schools. Grade inflation continues to exist, and grade distribution is likely to be different among U.S. medical schools. HYPOTHESES: Increasing the number of available grades curtails "grade inflation." METHOD: A national survey of all Clerkship Directors in Internal Medicine members was administered in 2011. The authors assessed key aspects of grading. RESULTS: Response rate was 76%. Among clerkship directors (CDs), 61% of respondents agreed that grade inflation existed in the internal medicine clerkship at their school, and 43% believed that it helped students obtain better residency positions. With respect to grading practices, 79% of CDs define specific behaviors needed to achieve each grade, and 36% specify an ideal grade distribution. In addition, 44% have a trained core faculty responsible for evaluating students, 35% describe formal grading meetings, and 39% use the Reporter-Interpreter-Manager-Educator (RIME) scheme. Grading scales were described as follows: 4% utilize a pass/fail system, 13% a 3-tier (e.g., Honors/Pass/Fail), 45% 4-tier, 35% 5-tier, and 4% 6+-tier system. There was a trend to higher grades with more tiers available. CONCLUSIONS: Grade inflation continues in the internal medicine clerkship. Almost half of CDs feel that this practice assists students to obtain better residency positions. A minority of programs have a trained core faculty who are responsible for evaluation. About one third have formal grading meetings and use the RIME system; both have been associated with more robust and balanced grading practices. In particular, there is a wide variation between schools in the percentage of students who are awarded the highest grade, which has implications for residency applications. Downstream users of clinical clerkship grades must be fully aware of these variations in grading in order to appropriately judge medical student performance.

Grade inflation in the internal medicine clerkship: a national survey.

BACKGROUND: Grade inflation is a growing concern, but the degree to which it continues to exist in 3rd-year internal medicine (IM) clerkships is unknown. PURPOSE: The authors sought to determine the degree to which grade inflation is perceived to exist in IM clerkships in North American medical schools. METHODS: A national survey of all Clerkship Directors in Internal Medicine members was administered in 2009. The authors assessed key aspects of grading. RESULTS: Response rate was 64%. Fifty-five percent of respondents agreed that grade inflation exists in the Internal Medicine clerkship at their school. Seventy-eight percent reported it as a serious/somewhat serious problem, and 38% noted students have passed the IM clerkship at their school who should have failed. CONCLUSIONS: A majority of clerkship directors report that grade inflation still exists. In addition, many note students who passed despite the clerkship director believing they should have failed. Interventions should be developed to address both of these problems.

Factors associated with medical students' career choices regarding internal medicine.

CONTEXT: Shortfalls in the US physician workforce are anticipated as the population ages and medical students' interest in careers in internal medicine (IM) has declined (particularly general IM, the primary specialty serving older adults). The factors influencing current students' career choices regarding IM are unclear. OBJECTIVES: To describe medical students' career decision making regarding IM and to identify modifiable factors related to this decision making. DESIGN, SETTING, AND PARTICIPANTS: Web-based cross-sectional survey of 1177 fourth-year medical students (82% response rate) at 11 US medical schools in spring 2007. MAIN OUTCOME MEASURES: Demographics, debt, educational experiences, and number who chose or considered IM careers were measured. Factor analysis was performed to assess influences on career chosen. Logistic regression analysis was conducted to assess independent association of variables with IM career choice. RESULTS: Of 1177 respondents, 274 (23.2%) planned careers in IM, including 24 (2.0%) in general IM. Only 228 (19.4%) responded that their core IM clerkship made a career in general IM seem more attractive, whereas 574 (48.8%) responded that it made a career in subspecialty IM more attractive. Three factors influenced career choice regarding IM: educational experiences in IM, the nature of patient care in IM, and lifestyle. Students were more likely to pursue careers in IM if they were male (odds ratio [OR] 1.75; 95% confidence interval [CI], 1.20-2.56), were attending a private school (OR, 1.88; 95% CI, 1.26-2.83), were favorably impressed with their educational experience in IM (OR, 4.57; 95% CI, 3.01-6.93), reported favorable feelings about caring for IM patients (OR, 8.72; 95% CI, 6.03-12.62), or reported a favorable impression of internists' lifestyle (OR, 2.00; 95% CI, 1.39-2.87). CONCLUSIONS: Medical students valued the teaching during IM clerkships but expressed serious reservations about IM as a career. Students who reported more favorable impressions of the patients cared for by internists, the IM practice environment, and internists' lifestyle were more likely to pursue a career in IM.

Prerequisite competencies for third-year clerkships: an interdisciplinary approach.

The Collaborative Curriculum Project (CCP) is one of three components of the Family Medicine Curriculum Resource Project (FMCRP), a federally funded effort to provide resources for medical education curricula at the beginning of the 21st century. Medical educators and staff from public and private geographically distributed medical schools and national specialty organizations in family medicine, internal medicine, and pediatrics developed by consensus essential clinical competencies that all students should have by the beginning of the traditional clerkship year. These competencies are behaviorally measurable and organized into the domains used for the Accreditation Council for Graduate Medical Education (ACGME) core competencies. Exemplary teaching, assessment, and faculty development resources are cited, and attention is given to budgetary considerations, application to diverse populations and settings, and opportunities for integration within existing courses. The CCP also developed a subset of competencies meriting higher priority than currently provided in the pre-clerkship years. These priority areas were empirically validated through a national survey of clerkship directors in six disciplines. The project's documents are not intended to prescribe curricula for any school but rather to provide curricular decision makers with suggestions regarding priorities for allocation of time and resources and detailed clinical competency statements and other resources useful for faculty developing clinical courses in the first 2 years of medical school.

Safe prescribing: an educational intervention for medical students.

BACKGROUND AND PURPOSE: Errors in handwritten medication orders are common and can result in patient harm. We evaluated an intervention for increasing safe prescribing by medical students. METHODS: We conducted a pre-post evaluation to evaluate a brief educational intervention to increase safe prescribing by medical students. Two 1-hr, small-group, interactive educational sessions for 3rd-year medical students were held 2 weeks apart at Washington University in St. Louis. Prescribing errors were measured with a verbal transcription test. RESULTS: Twenty-eight students participated. Following the intervention, the average number of error-free orders in the 10-order test increased 5-fold from 0.82 per student to 4.54 per student, and the average number of errors and dangerous errors per student decreased from 13.96 to 7.36 (p < .0001) and from 4.75 to 2.68 (p < .0001), respectively. CONCLUSIONS: After a brief interactive educational intervention for medical students, the frequency of error-free handwritten orders increased, and prescribing errors decreased. Additional training may be required to further improve and maintain safe prescribing.

Tapping trumps typing:how users enter data in an electronic student encounter log.

Handheld encounter logs that accurately record patient diagnoses could facilitate several educational tasks. Unfortunately, data entry on handheld computers is notoriously difficult, requiring either tapping buttons or entering text, for instance by typing. In most medical reference software, long lists of inputs adjust to match typed data, reducing the burden of data entry. Tapping is faster if the user can locate the correct target quickly, but designing and maintaining screens with many fixed targets is tedious, and the program grows large. We developed an Electronic Student Encounter Log, ESEL, allowing students to tap or type to record problems observed in ambulatory patients. The tapping interface comprises collections of related disease checkboxes organized in a shallow, broad tree structure, making 983 diagnoses visible with 2 taps. The typing interface mimics typical reference software, scrolling and searching a list of 1332 common problems in response to user-entered text. ESEL records the paths that students take through the program while trying to record diagnoses. Analysis of 62 students' ESEL records from ambulatory care settings demonstrates that they used the tapping interface much more often than the typing interface, and could record data more quickly by tapping than by typing. If accuracy proves to be acceptable, more robust tapping interfaces deserve wider consideration for data capture on handheld computers.