Preparing Effective Narrative Evaluations for the Medical School Performance Evaluation (MSPE).

Introduction: In 2016, the AAMC Medical School Performance Evaluation (MSPE) Task Force issued recommendations to standardize the MSPE but did not address the quality of the written narratives in that document. Narrative evaluations are hampered by code words, polite rhetoric, and bias to the detriment of students. To address this, the AAMC's Group on Student Affairs and Group on Educational Affairs convened an expert group to consider the state of narratives in the MSPE and develop resources to improve their quality. Methods: A series of interactive workshops was developed and presented at an AAMC webinar and national meetings. A presentation outlining challenges and possible approaches to improvement was followed with large-group discussion and/or small-group breakout activity to analyze and improve upon sample clinical comments and create summary clerkship paragraphs. The initial webinar used polling questions and free-text prompts to gather feedback for future workshops. Anonymous survey responses were collected at the end of each subsequent workshop to determine perceived effectiveness and potential utility at participants' institutions. Results: Over 680 administrators, faculty, and staff participated in the webinar or in one of four national-level workshops. Respondents agreed that the modules would be useful in faculty development and wanted to replicate their learning at their own institutions for overall better impact on the quality of MSPE narratives. Discussion: This resource addresses an important gap in the medical education literature. A variety of stakeholders affirmed that these workshops have value in training writers to improve their narrative comments for the MSPE.

Early Refill of an Opioid Medication: Recognizing Personal Biases Through Clinical Vignettes and OSCEs.

Introduction: Efforts to improve pain education and knowledge about prescription opioid misuse and opioid/substance use disorder in undergraduate medical education continue to be inadequate. To advance educational practices and address training needs to counter the opioid epidemic, we created a longitudinal pain and addiction curriculum that includes three patient vignettes in which the patient requests an early refill of opioid medication. The goal was to introduce students to the potential impact of personal biases on health care delivery and medical decision-making with patients who have pain and/or substance use disorders. Methods: Three clinical vignettes were presented to early matriculating medical students (MS 1s) using a progressive case disclosure approach in the format of a PowerPoint presentation with embedded audio interactions and follow-up audience response system questions. The same vignettes were converted into OSCEs for early clinical clerkship students (MS 3s). Results: A total of 180 MS 1s participated in the case presentations, and 124 MS 3s participated in the OSCE session. There was a significant difference between students' level of comfort and individual patient requests for early prescription refills in both student cohorts. MS 1s were significantly more likely to provide the early refill to the elderly female patient compared to the two middle-age male patients, whereas a majority of MS 3s wanted more information. Discussion: This module can be presented to medical students who have little clinical exposure and to health care trainees at other levels of clinical exposure.

Impact of Reflection on Empathy and Emotional Intelligence in Third-Year Medical Students.

OBJECTIVE: This study analyzed the impact that structured Reflection Rounds had on self-reported empathy and emotional intelligence scores for third-year medical students. METHODS: Third-year students at the Renaissance School of Medicine at Stony Brook University (RSOM) were required to participate in Reflection Rounds during their core clinical clerkships. Over the study period, 285 students participated. Reflection Rounds are facilitated, small-group meetings, where students reflect upon their thoughts, feelings, and emotions about clinical experiences and receive feedback from peers and a trained facilitator. Empathy and emotional intelligence (EI) scores were measured pre- and post-intervention utilizing the Jefferson scale of empathy (JSE) student version and Wong law emotional intelligence scale (WLEIS) (Hojat 2016; Wong and Law Leadersh Q. 13:243-74, 2004). RESULTS: Participation in the study was voluntary. Pre-intervention surveys were collected from 185 students for the JSE and 173 students for the WLEIS. Post survey responses were collected from 120 students for both scales. Empathy scores increased from 80.4 to 82.6 (p = 0.02) post-intervention. No significant difference in EI scores was demonstrated post-intervention, 5.4 to 5.5 (p = 0.55) CONCLUSION: Students who participated in Reflection Rounds did not demonstrate the erosion of empathy that has been previously documented following the completion of the clerkship year. Improvements in empathy scores were demonstrated. No change in EI was observed post-intervention. It is possible that an intervention such as Reflection Rounds may represent a way of preventing the empathy decline that can be seen in medical students as they progress through their training.

A pilot study of interprofessional palliative care education of medical students in the UK and USA.

BACKGROUND: Educating medical students to care for patients at the end-of-life is increasingly recognised as an essential component of training. Traditionally, medical student programmes are run by doctors, but patient care is delivered by an interprofessional team. Our programmes in the UK and USA independently developed a teaching experience led by an interprofessional team of palliative care health professionals. OBJECTIVES: This study explores the palliative care health professionals' perceptions, regarding their unique role in medical student palliative care education. METHODS: This is the first study to ascertain views of an interprofessional team delivering palliative care education to medical students. Focus groups enable interaction between members of the group as well as the generation of consensus of comments among group members. RESULTS: Two major themes were identified: perceived benefits and value of the experience, and the challenges and lessons learnt from the experiences. CONCLUSIONS: Despite different structures and settings, this experiential learning in palliative care provided a rewarding interprofessional experience that has historically been difficult to achieve.

Urine leakage during sexual activity among ethnically diverse, community-dwelling middle-aged and older women.

BACKGROUND: Urinary incontinence is associated with decreased female sexual function, but little is known about the prevalence, predictors, and impact of urine leakage during sexual activity among women in the community. OBJECTIVE: The purpose of this study was to evaluate the prevalence and impact of urine leakage during sex in ethnically diverse, community-dwelling midlife and older women. STUDY DESIGN: Urinary incontinence and sexual function were assessed by structured questionnaire in a multiethnic, community-based cohort of women enrolled in Kaiser Permanente Northern California, an integrated healthcare delivery system in California. All women were aged 40-80 years and sampled from 1 of 4 racial/ethnic groups (20% black, 20% Latina, 20% Asian, and 40% non-Latina white). Differences in frequency, bother, and fear of urine leakage during sexual activity were examined among women with monthly, weekly, and daily urinary incontinence and across different types of urinary incontinence (stress, urgency, mixed, and other type urinary incontinence), with the use of chi-square tests. Independent risk factors for urine leakage during sexual activity were identified through multivariable logistic regression. RESULTS: Of the 509 women who reported being sexually active and having at least monthly urinary incontinence, 127 of them (25%) reported experiencing any urine leakage during sex during the past 3 months. Nineteen percent of the women reported being subjectively bothered by leakage during sex, and 16% of them reported restricting sexual activity because of fear of leakage. Women with more frequent underlying urinary incontinence were more likely to report experiencing or being bothered by leakage during sex and restricting sexual activity because of fear of leakage (P<.001 for all). Participants with predominantly stress or mixed type urinary incontinence were more likely to report experiencing leakage during sex and being subjectively bothered by this leakage (P<.002 for all). Factors independently associated with leakage during sex were depression (odds ratio,1.96; 95% confidence interval, 1.20-3.20), symptomatic pelvic organ prolapse (odds ratio, 2.10; 95% confidence interval, 1.11-3.98), mixed vs urgency type urinary incontinence (odds ratio, 3.16; 95% confidence interval, 1.70-5.88), stress vs urgency type urinary incontinence (odds ratio, 1.94; 95% confidence interval, 1.01-3.70), and frequency of sexual activity (odds ratio, 1.6395% confidence interval, 1.05-2.55), but not age or race/ethnicity. CONCLUSIONS: Up to a quarter of women with at least monthly urinary incontinence in the community may experience urine leakage during sexual activity. Many incontinent women who leak urine during sex remain sexually active, which indicates that the preservation of sexual function should still be a priority in this population. Among incontinent women, depression, pelvic organ prolapse, and stress mixed-type urinary incontinence may be associated with urine leakage during sexual activity.

Impact of a Home Hospice Visit Program on Third-Year Medical Students: A qualitative analysis of student reflections.

AIM: This study evaluates the impact of an interprofessional home hospice visit (HHV) on third-year medical students' attitudes toward, and understanding of, end-of-life care and the visit's effect on students' views of their emerging professional roles and identities. METHODS: All third-year medical students at Stony Brook School of Medicine in Stony Brook, New York, USA, participated in an HHV. A didactic session preceded the HHV. Subsequently, students were required to submit a piece of reflective writing detailing the impact of the visit. We conducted a qualitative analysis of a random sample drawn from the 467 submitted reflections. RESULTS: Six themes emerged from the student reflections: three were related to the students' direct observations during the HHV, and three were related to the reflective learning of the students based on their HHV experience. CONCLUSION: The qualitative analysis of the reflective writings showed that the students gained a deep appreciation of the human identity of hospice patients and a humanistic understanding of their own role as future physicians.

Effective teaching methods for geriatric competencies.

This study assesses how effective classroom sessions are at teaching geriatric competencies to medical students. At Stony Brook Medical School, most geriatric competencies are taught in the Ambulatory Care Clerkship during small-group educational sessions. Clinical exposure to reinforce these specialized skills varies with preceptor assignment. A student's ability to perform geriatric assessments was evaluated by scores on an Objective Structured Clinical Exam (OSCE) with a geriatric patient. Scores from students who received additional clinical practice of these skills were compared with scores from students who did not. No significant difference in OSCE scores were seen between the two groups.