A Positive Youth Development Perspective on Mental Distress among American Indian/Alaska Native Youth.

Positive youth development approaches with American Indian/Alaska Native (AI/AN) youth have been particularly successful and promising. Utilizing a survey with 3,736 AI/AN students, we investigated the associations between risk and protective factors and significant mental distress of AI/AN youth. The protective factors were studied within the positive youth development framework, which includes positive developmental assets reflecting aspects of the Circle of Courage, a prior framework embodying core indigenous values for youth development and education to support youth at risk. Risk factors in the study included having experienced trauma, being bullied by peers, substance use, and skipping school; protective factors were social supports, out-of-school-time activity participation, healthy eating, and healthy sleeping behaviors. Through logistic regressions, we found that risk factors were associated with more mental distress, consistent with prior research. However, students who participated in out-of-school-time activities at least three times a week, were sleeping at least eight hours daily, and those reporting social supports, particularly family/community support and sense of empowerment, had lower likelihood of mental distress. In fact, the presence of these protective factors reduced the associations of risk factors and risky behaviors with mental distress.

Validity Evidence for Assessing Entrustable Professional Activities During Undergraduate Medical Education.

PURPOSE: To explore validity evidence for the use of entrustable professional activities (EPAs) as an assessment framework in medical education. METHOD: Formative assessments on the 13 Core EPAs for entering residency were collected for 4 cohorts of students over a 9- to 12-month longitudinal integrated clerkship as part of the Education in Pediatrics Across the Continuum pilot at the University of Minnesota Medical School. The students requested assessments from clinical supervisors based on direct observation while engaging in patient care together. Based on each observation, the faculty member rated the student on a 9-point scale corresponding to levels of supervision required. Six EPAs were included in the present analyses. Student ratings were depicted as curves describing their performance over time; regression models were employed to fit the curves. The unit of analyses for the learning curves was observations rather than individual students. RESULTS: (1) Frequent assessments on EPAs provided a developmental picture of competence consistent with the negative exponential learning curve theory; (2) This finding was true across a variety of EPAs and across students; and (3) The time to attain the threshold level of performance on the EPA for entrustment varied by student and EPA. CONCLUSIONS: The results provide validity evidence for an EPA-based program of assessment. Students assessed using multiple observations performing the Core EPAs for entering residency demonstrate classic developmental progression toward the desired level of competence resulting in entrustment decisions. Future work with larger data samples will allow further psychometric analyses of assessment of EPAs.