Cognitive enhancement drug use among future physicians: findings from a multi-institutional census of medical students.

BACKGROUND: Nonmedical use of prescription psychostimulants such as methylphenidate and amphetamine salts for the purpose of cognitive enhancement is a growing trend, particularly in educational environments. To our knowledge, no recent studies have evaluated the use of these psychostimulants in a medical academic setting. OBJECTIVE: To conduct an online census of psychostimulant use among medical students. DESIGN: In 2011, we conducted a multi-institutional census using a 31-48 item online survey regarding use of prescription psychostimulants. PARTICIPANTS: 2,732 actively enrolled medical students at four private and public medical schools in the greater Chicago area. MAIN MEASURES: Prevalence and correlates of psychostimulant use KEY RESULTS: 1,115 (41 %) of students responded to the web-based questionnaire (range 26-47 % among schools). On average, students were 25.1 years of age (SD = 2.7, range 20-49), and single (70 %). Overall, 18 % (198/1,115) of this medical student sample had used prescription psychostimulants at least once in their lifetime, with first use most often in college. Of these, 11 % (117/1,115) of students reported use during medical school (range 7-16 % among schools). Psychostimulant use was significantly correlated with use of barbiturates, ecstasy, and tranquilizers (Pearson's correlation r > 0.5, Student's t-test p < 0.01); male gender (21 % male versus 15 % female, Chi squared p = 0.007); and training at a medical school which by student self-report determined class rank (68 % versus 51 %, Chi-squared p = 0.018). Non-users were more likely to be first year students (Chi-squared p = 0.048) or to have grown up outside of the United States (Chi-squared p = 0.013). CONCLUSIONS: Use of psychostimulants, including use without a prescription, is common among medical students. Further study of the side effects, medical implications, and use during post-graduate medical training and medical practice is needed to inform evidence-based policy.

The heart truth professional education campaign on women and heart disease: needs assessment and evaluation results.

BACKGROUND: Heart disease is the leading cause of death for women in the United States. Research has identified that women are less likely than men to receive medical interventions for the prevention and treatment of heart disease. METHODS AND RESULTS: As part of a campaign to educate healthcare professionals, 1245 healthcare professionals in 11 states attended a structured 1-hour continuing medical education (CME) program based on the 2004 AHA Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women and completed a pretest and posttest evaluation. We identified significant knowledge deficits in the pretest: 45% of attendees would initially recommend lifestyle changes alone, rather than statin therapy, for women diagnosed with coronary artery disease (CAD); 38% identified statin therapy as less effective in women compared with men for preventing CAD events; 27% identified Asian American women at low risk (rather than high risk) for type 2 diabetes mellitus (DM); and 21% identified processed meat (rather than baked goods) as the principal dietary source of trans fatty acids. Overall, healthcare professionals answered 5.1 of 8 knowledge questions correctly in the pretest, improving to 6.8 questions in the posttest (p < 0.001). Family physicians, obstetrician/gynecologists, general internists, nurse practitioners/physician assistants, and registered nurses all statistically significantly improved knowledge and self-assessed skills and attitudes as measured by the posttest. CONCLUSIONS: Significant knowledge deficits are apparent in a cross-section of healthcare providers attending a CME lecture on women and heart disease. A 1-hour presentation was successful in improving knowledge and self-assessed skills and attitudes among primary care physicians, nurse practitioners, physician assistants, and registered nurses.

Physician practice behavior and practice guidelines: using unannounced standardized patients to gather data.

BACKGROUND: Measuring actual practice behaviors of physicians, particularly as they relate to established clinical guidelines, is challenging. Standardized patients provide one method of collecting such data. OBJECTIVE: To demonstrate the use of unannounced standardized patients in gathering data that may address adherence to guidelines in an office setting. DESIGN: Unannounced standardized patients (SPs) simulating an initial type 2 diabetic visit presented to community offices of 32 internists as "real" patients to record physicians' evaluation and management. PARTICIPANTS: Unannounced SPs presented to the office of 32 internists as "real" patients. MEASUREMENTS: Unannounced SPs, simulating type 2 diabetics, completed a standardized assessment sheet, based on ADA guidelines to record physicians' evaluation and management following an initial visit. Patient charts were also reviewed to determine if evaluation adhered to the guidelines. RESULTS: Unannounced SPs recorded 56 visits with 32 community internists; all SPs remained undetected. All physicians asked SPs about medications. At least 50% of physicians asked about home blood sugar monitoring, last eye exam, smoking, edema, and told patients to stop smoking. Less than 50% of physicians asked about parasthesias, performed fundoscopy, examined feet, referred the patient to a diabetic educator or ophthalmologist, or gave patients suggestions regarding glucose monitoring or exercise. HbA1c was ordered in 78%, metabolic profiles in 86%, and urinalysis/microalbumin in 41% of patients. CONCLUSIONS: Unannounced standardized patients can successfully collect important data regarding physician practices in community settings. This method may be helpful in assessing physician adherence to established clinical practice guidelines.

Does medical student membership in the gold humanism honor society influence selection for residency?

OBJECTIVES: With the creation of the Gold Humanism Honor Society (GHHS) in 2002, the Arnold P. Gold Foundation established a mechanism for recognizing medical students who demonstrate exemplary humanism/professionalism/communication skills. Currently, 80 medical schools have GHHS chapters. Selection is based on peer nomination using a validated tool. The objective of this survey was to assess the percentage of residency program directors (PDs) who are aware of and are using GHHS membership as a residency selection tool. METHODS: Surgery (SURG) and internal medicine (IM) PDs in 4 United States regions were surveyed for familiarity with GHHS and perceived rank of GHHS membership relative to Alpha Omega Alpha (AOA) membership, class rank, medical student performance evaluation (MSPE), clerkship grade, and United States Medical Licensing Examination (USMLE) score, in evaluating an applicant's humanism/professionalism, service orientation, and fit with their program. Program demographics and familiarity with GHHS were also surveyed. RESULTS: The response rate was 56% (149 respondents). IM PDs rated GHHS membership higher than did SURG PDs when evaluating professionalism/humanism and service orientation. PDs familiar with GHHS ranked membership higher when considering professionalism/humanism (4.1 vs 3.2; p < 0.05) and service orientation (4.1 vs 2.9; p < 0.01). Familiarity with GHHS correlated with being an IM PD, residency based at teaching hospital, large residency program, knowledge of residents who were GHHS members, and having a GHHS chapter at their school (p < 0.01). Familiarity with GHHS was related to rankings of GHHS (professionalism/humanism F = 3.36; p < 0.05; service orientation F = 3.86; p < 0.05) more than the PDs' specialty was. In all, 157 GHHS students (from all 4 United States regions) were also surveyed about the 1197 interviews they had with residency PDs. They reported that although a few PDs were aware of GHHS, PDs of core medical specialties were more aware of GHHS than SURG PDs. CONCLUSIONS: IM PDs were more aware of GHHS (70%) than SURG PDs (30%). Awareness was related to the favorable ranking of GHHS as a selection criterion for humanism/professionalism/service orientation. PDs familiar with GHHS were from larger programs, were likely to know residents who were members, and were likely to think that GHHS membership predicted humanistic care. Membership in GHHS may set candidates apart from their peers and allow PDs to distinguish objectively the candidates who demonstrate compassionate medical care. Increased knowledge about the GHHS may therefore serve to be a useful adjunct for PDs when selecting medical students for their residency programs.

A new approach to bridging content gaps in the clinical curriculum.

BACKGROUND: In 2004-05 Tulane University School of Medicine implemented a longitudinal Interdisciplinary Seminar Series composed of small-group interactive exercises to address topics that are often overlooked during the clinical education of medical students. The series utilizes five adult learning principles. METHODS: Each of 13 seminars is offered at a fixed time slot, repeated two to six times per year. Students are required to attend a minimum of five seminars, of their choice, during years three and four. Students access an online pre-enrollment system that maximizes learning opportunities by limiting the number of participants. Seminars emphasize active learning with small-group problem-solving exercises and multiple interactive techniques. Clinical vignettes, standardized patients, journal articles, and case-based learning are among the learning methods. RESULTS: Seminar evaluations showed strong support in program content and effectiveness (mean = 4.47 on a five-point scale), facilitators (4.63), and learning opportunities (4.51). Additionally, students strongly endorsed individual seminars to classmates (4.47). Twelve of 13 (92%) seminars received scores higher than 4.0 for program content and effectiveness, facilitators and learning opportunities. CONCLUSIONS: The Interdisciplinary Seminar Series has been a valuable addition to the Tulane clinical curriculum. Students report that the success of the series is due to: (a) their ability to select seminars based on their individualized interests and needs; and (b) faculty development of student-centered seminars with active learning opportunities. This Seminar Series differs from interclerkship initiatives at other medical schools where topics are offered less frequently and to a class as a whole. Tulane's program is a longitudinal intervention with multiple opportunities for student participation during their clinical education. Seminars are repeated to allow greater flexibility in student scheduling. Seminar discussions are rich in content since attendees include both third- and fourth-year students with variable levels of clinical skills and experiences.

The relationship between service learning and medical student academic and professional outcomes.

BACKGROUND: Little is known about the relationship between medical student participation in service and performance outcomes. PURPOSE: To examine relationships between involvement in required service learning and measures of academic and professional achievement and specialty choice. METHODS: Using preexisting, self-reported data for Tulane University School of Medicine's class of 2004, we categorized students as low, moderate, or high on commitment and involvement in service learning (CISL) and compared to multiple outcomes: class rank; election to the Alpha Omega Alpha (AOA) Honor Society; election to the Gold Humanism in Medicine Honor Society; total percent scores on 2 multistation, structured, clinical examinations; and specialty choice per 2004 residency match results. RESULTS: Service learning involvement was related to class rank. There was a marginal relationship between CISL and election to AOA but no association with election to the Gold Humanism in Medicine Honor Society, Year 2 or 3 clinical skills examination results, or specialty choice. CONCLUSIONS: High participation in service learning and service learning leadership identify a group of students less likely to be in the top quartile of their class yet who are making important contributions to the community and profession.

Effects of a disability awareness and skills training workshop on senior medical students as assessed with self ratings and performance on a standardized patient case.

BACKGROUND: People with disabilities compose one of the largest and fastest growing subgroups of the U.S. population. Disability and rehabilitation issues are not well covered in most North American medical school curricula. This article describes the development and assessment of a 3-hr workshop for medical students on disability skills and awareness. DESCRIPTION: Fourth-year medical students on a required clerkship participated in the workshop on alternate months. The efficacy of the intervention was measured by a comparison between the participant and control students using a pretest and posttest self-efficacy questionnaire and a one-station Standardized Patient (SP) Clinical Case depicting a hemiplegic patient and a caregiver. EVALUATION: Factor analysis of the survey yielded 4 subscales: Attitude, Advocacy, Interaction, Obtaining Services. There was a significant difference between the treatment and control group on the advocacy scale and on the SP communication and interstation exercises. CONCLUSION: A targeted educational intervention can have a positive effect on medical students' knowledge, skills, and attitudes toward patients with disabilities.

An innovative partnership in service.

OBJECTIVE: Stimulated by the need for better alignment of educational content and goals with evolving societal needs, practice patterns, and scientific developments, many medical schools are implementing new and creative educational experiences for students. Tulane University School of Medicine and Apple Computers have established an innovative partnership in which Apple laptop computers support and enhance students' service learning projects. The partnership also provides a unique opportunity to meet the Medical School Objectives Project (MSOP) objectives in Medical Informatics and Population Health, as outlined in Report II.(1) DESCRIPTION: Apple Computers has a commitment to the New Orleans community as part of its corporate strategic plan to support educational programs at all levels; Tulane has a longstanding commitment to and experience with student-led service learning as part of the Foundations in Medicine Course.(2) Senior administrative personnel from Tulane and Apple discussed these common interests, resulting in a partnership to enhance the potential impact on the community served. Apple agreed to donate 20 G3 Powerbooks and a complete set of the Apple Learning series of software to support new and ongoing service-learning projects. A committee of Tulane faculty and students, information technology staff, and an Apple representative developed the project. To maximize students' access to the laptops while managing the administration's liability, the laptops were identically configured with standardized software packages (database development and maintenance, Web access, word processing, presentation development and execution, automated backup, and individual project access to protected server space). To maximize the use of the laptops, students from the service-learning organizations can check out the laptops on a just-in-time basis, because the projects have different needs over time. Student-service leaders are currently defining and developing the exact uses for the laptops. We anticipate that this project will enhance the administrative management of service-learning programs (e.g., schedules, directions to sites), the presentation of educational programs (e.g., teaching in schools), the creation of new media to support programs (e.g., our restaurant choking program has a partnership with the American Heart Association to create a video and training manual to be used nationwide), and data tracking (e.g., sites and clients served, outcomes achieved). Students' use of the laptops should support the achievement of several of the MSOP Report II Medical Informatics objectives. To assess that, all first-year medical students are completing a pre- and post-project survey based on those objectives. DISCUSSION: The availability of laptops and software should significantly enhance the service-learning programs. The students participating should gain important skills in the use of computer technology related to their roles as lifelong learners, educators and communicators, researchers, and managers.(1) We plan to report the results of the pre- and post-project surveys once they have been completed. Students' feedback on the project has been very positive, and we hope it can serve as a model for other medical school, corporate, and community partnerships.