The purpose of this study was to understand medical students’ levels of burnout symptoms and their strategies to combat burnout during the United States Medical Licensure Examination (USMLE) Step 1 ...study period.
We administered a survey to three cohorts of medical students after they had taken the Step 1 examination. We gauged their perceptions on what worked well while studying including any insight into strategies to alleviate burnout. We used a qualitative approach to describe their experiences.
Out of the 477 students surveyed, 370 responded (RR = 77.6%), and we developed 12 key strategies to alleviate burnout during an intense study period: exercise, take days off, limit study hours per day, take breaks, develop support system, dedicate time for fun, eat well, minimize distractors, sleep well, study with others, identify suitable study space(s), and recognize feelings of burnout are normal. We provide further insight into each of these strategies.
By using these strategies, medical students can minimize levels of burnout and maintain wellness throughout the study period. We believe these strategies could be used not only for medical students, but also in the context of any intensive examination preparation period or for a major research paper such as a dissertation. Research has shown that burnout is real and we as researchers and educators must continue to develop strategies to combat it.
Purpose: This study assessed the: (1) effect of an LGBTQI + health equity curriculum (eQuality) on implicit attitudes among first (M1) and second year (M2) medical students and (2) utility of ...dedicated time to explore implicit bias.
Method: Implicit biases were assessed at baseline using implicit association tests (IAT) for all M2s and a random sample of first years (M1A). These students were then debriefed on strategies to mitigate bias. Following eQuality, all M1 and M2s completed post-intervention IATs. The remaining first years (M1B) were then debriefed. Paired sample t-tests assessed differences between pre/post. Independent sample t-tests assessed differences in post-IATs between M1 groups.
Results: IATs indicated preferences for "Straight," "White," and "Thin" at both pre and post. M2s demonstrated statistically significant improvements pre to post for sexuality (p = 0.01) and race (p = 0.03). There were significant differences in post-intervention IAT scores between M1As who received the IAT and debriefing prior to eQuality and M1Bs for sexuality (p = 0.002) and race (p = 0.046). There were no significant changes for weight.
Conclusion: eQuality reduced implicit preference for "Straight" and "White." Differences in M1 post-intervention IAT scores between groups suggest dedicating time to debrief implicit attitudes enhances bias mitigation.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Phenomenon: Disparities in health and healthcare for gender minorities (GMs) such as transgender people are significant, and medical educators have a responsibility to ensure trainees master the ...clinical skills required to provide them with quality care. We implemented a standardized patient (SP) scenario designed to measure students' ability to provide gender-affirming care and sought to understand the experiences and perceptions of the GMs who served as SPs in this case. Our key research question was: how do GM SPs describe the experience of serving as an SP on a gender-affirming care clinical case? Approach: Semi-structured focus groups were conducted with GM SPs (n = 10) to understand their experiences and gauge their perceptions of portraying a patient seeking gender-affirming care. The patient they portrayed matched their own gender identity. Focus groups were transcribed verbatim and analyzed using inductive thematic analysis. Findings: We developed three primary themes in our analysis: personal connection, gap identification, and insight into medical education. The SPs reported a personal connection to this case, enabling them to give nuanced feedback, confront bias they encountered, and foster connection to their broader community. They were able to identify specific gaps related to communication skills, assumptions, and knowledge about gender identity and gender-affirming care. They gained valuable insight into medical education such as the complexity of learning clinical skills and roadblocks to inclusive simulation. Insights: By sharing the perspectives of GMs in patient simulation, this study demonstrates that GMs can also benefit from engagement with medical education, as the SPs in our study described hope, empowerment, and engagement as positive aspects of participation. This study also shows that GMs' lived experiences seeking medical care were instrumental in their ability to note gaps, which provides valuable insight for other institutions attempting to improve students' GM clinical skills. Further, GM SPs' perspectives are valuable to provide a rationale and guidance to other schools implementing gender-affirming education. Efforts to create and implement gender-affirming care curriculum should include GMs in order to build partnerships and prioritize the voices and agency of GMs.
Abstract only
5522
Background: CCOC is a rare chemoresistant subtype of OC. ENMD-2076 is an oral multi-target kinase inhibitor with antiangiogenic/antiproliferative profile; selective activity ...against the mitotic kinase Aurora A and VEGFRs, FGFRs. Methods: This is a multi-center Phase II study of ENMD-2076 in pts with recurrent CCOC and prior platinum. Primary endpoints were ORR and 6-m PFS rate. Correlative analyses include ARID1A, PTEN expression by IHC and genome sequencing by custom capture library of 555 genes. Results: Completed study enrolled 40 pts – 37 evaluable, median age of 54 (39-78). 12 pts (31%) received prior radiation and 24 (62%), 11 (28%), 4 (10%) had 1, 2 or 3 lines of chemotherapy. Archival tissue was available for 36/37 pts. Best response was PR for 2 pts (1 unconfirmed), SD for 25 (68%) and PD for 10 (26%) pts. Median PFS was 3.7 months (m) (95%CI: 3.4-4.4). ENMD was well tolerated with main related AE: hypertension (21 pts - 8 G3), nausea (18 pts -1 G3) and diarrhea (17 pts - 4 G3). By IHC, median PFS (95%CI) in ARID1A loss (19 pts) was 4.1m (3.5-10.3) vs 3.6m (1.7-3.9) in ARID1A positive (17 pts) (p = 0.024). Whilst, by IHC, PTEN was loss in 20 pts; intact in 10 and heterogeneous in 6 pts; no difference in PFS was observed. By PI3KCA mutation status, median PFS (95%CI) in wild-type (WT) (12 pts) was 5m (3.4-19.3) vs 3.7m (167-4.4) in mutated group (20 pts) (p = 0.038). Molecular profiling showed variants in PI3KCA (27%), ARID1A (26%), TP53 (7%), BRIP1 (7%), ATM (11%), BRCA1 (5%), BRCA2 (3%), RAD50 (3%), PABL2 (1%), RAD51C (1%), FANCA (1%), CTNNB1 (3%).The patient with the longest treatment duration (22m) was PTEN WT, diploid PTEN, putative bi-allelic inactivation of ARID1A. Conclusions: The PFS at 6 months was 20% for the evaluable patients, 31% in ARID1A loss and 12% in ARID1A positive patients. Loss of ARID1A, a known negative prognostic factor, was correlated with better PFS on ENMD-2076. Additional molecular profiling of the baseline biopsy material is underway. Clinical trial information: NCT01914510.
Objective
This project aimed to understand medical students’ attitudes toward suicide prevention and their experiences in an innovative clerkship training program that engaged students in patient ...safety planning.
Methods
Medical students were invited to complete the Attitudes to Suicide Prevention (ASP) scale to explore student perceptions of suicide prevention and risk assessment. Seventy-five psychiatry clerkship students also completed a new safety planning training program with at-risk patients on psychiatry inpatient units. Each student observed a patient safety plan being completed, discussed this process with the resident or attending, completed a safety plan with another patient, and then debriefed with the observing physician. Participants completed the ASP before and after the rotation.
Results
The cross-sectional data (
n
=490) showed that student perceptions of suicide prevention were generally positive (
M
=27.8,
SD
=6.1) with variation among classes, but many students did not fully recognize the potential effectiveness of suicide risk reduction strategies. After the clerkship intervention, students were significantly more likely to report that working with suicidal patients was rewarding (
p
=0.035) and less likely to report discomfort assessing patients for suicide risk (
p
=0.001).
Conclusions
Medical educators can reinforce the process and efficacy of suicide interventions by modeling the described initiative. Psychiatry clerkship training that intentionally engages students in safety planning with patients is generalizable, and these skills could be extended to the student burnout crisis. Longitudinal studies will help determine how individual perceptions change through medical school and whether students apply safety planning skills in psychiatry and other specialties to care for suicidal patients.
Background: The increasing utilization of lymphatic mapping techniques for breast carcinoma has made intraoperative evaluation of sentinel lymph nodes attractive. Axillary lymph node dissection can ...be performed during the initial surgery if the sentinel lymph node is positive, potentially avoiding a second operative procedure. At present the optimal technique for rapid sentinel lymph node assessment has not been determined. Both frozen sectioning and intraoperative imprint cytology are used for rapid intraoperative sentinel lymph node evaluation at many institutions. The purpose of this study is to evaluate experience with imprint cytology for intraoperative evaluation of sentinel lymph nodes in patients with breast cancer. Methods: A retrospective review of the intraoperative imprint cytology results of 678 sentinel lymph node mappings for breast carcinoma was performed. Sentinel nodes were evaluated intraoperatively by either bisecting or slicing the sentinel node into 4 mm sections. Imprints were made of each cut surface and stained with H&E and/or Diff-Quik. Permanent sections were evaluated with up to four H&E stained levels and cytokeratin immunohistochemistry. Intraoperative imprint cytology results were compared with final histologic results. Results: The sensitivity of imprint cytology was 53%, specificity was 98%, positive predictive value was 94%, negative predictive value was 82% and accuracy was 84%. The sensitivity for detecting macrometastases (more than 2mm) was significantly better than for detecting micrometastases (≤2 mm), 81 versus 21%, respectively (P < 00001). Conclusions: The sensitivity and specificity of imprint cytology are similar to that of intraoperative frozen section evaluation. Imprint cytology is therefore a viable alternative to frozen sectioning when intraoperative evaluation is required. If sentinel lymph node micrometastasis is used to determine the need for further lymphadenectomy, more sensitive intraoperative methods will be needed to avoid a second operation.
Standardized patient (SP) encounters allow medical students to practice physical examination skills and clinical reasoning. SP cases are used for learning and assessment, but recorded encounters can ...also be valuable curriculum evaluation tools. We aimed to review SP encounters to improve abdominal examination skills and the broader physical examination curriculum.INTRODUCTIONStandardized patient (SP) encounters allow medical students to practice physical examination skills and clinical reasoning. SP cases are used for learning and assessment, but recorded encounters can also be valuable curriculum evaluation tools. We aimed to review SP encounters to improve abdominal examination skills and the broader physical examination curriculum.We reviewed recorded SP encounters of third-year medical students on surgery clerkship rotation. Students examined a cisgender woman presenting with acute right lower abdominal pain. We observed abdominal examinations to determine which maneuvers were attempted and completed correctly. We then used these outcomes to develop targeted clerkship training for the subsequent student cohort. Our intervention targeted abdominal examination gaps by explaining how to integrate abdominal examination findings with a focused history for surgical patients. We evaluated the intervention's impact on abdominal examination skills with third-year medical students in comparison (2021-2022, n = 119) and intervention (2022-2023, n = 132) groups.METHODSWe reviewed recorded SP encounters of third-year medical students on surgery clerkship rotation. Students examined a cisgender woman presenting with acute right lower abdominal pain. We observed abdominal examinations to determine which maneuvers were attempted and completed correctly. We then used these outcomes to develop targeted clerkship training for the subsequent student cohort. Our intervention targeted abdominal examination gaps by explaining how to integrate abdominal examination findings with a focused history for surgical patients. We evaluated the intervention's impact on abdominal examination skills with third-year medical students in comparison (2021-2022, n = 119) and intervention (2022-2023, n = 132) groups.In both the comparison and intervention groups, nearly all students attempted at least 1 general examination maneuver like auscultation, palpation, percussion, or rebound tenderness. Only 40% of students in the comparison group attempted an advanced maneuver like the Rovsing, Psoas, or Obturator sign. After the intervention, 75% of students in the intervention group attempted an advanced maneuver (χ2(1, 251) = 31.0, p < .001). Cohorts did not gain skills over time through the clerkship. Rebound tenderness was frequently assessed incorrectly by students in both groups, with many avoiding the right lower quadrant entirely.RESULTSIn both the comparison and intervention groups, nearly all students attempted at least 1 general examination maneuver like auscultation, palpation, percussion, or rebound tenderness. Only 40% of students in the comparison group attempted an advanced maneuver like the Rovsing, Psoas, or Obturator sign. After the intervention, 75% of students in the intervention group attempted an advanced maneuver (χ2(1, 251) = 31.0, p < .001). Cohorts did not gain skills over time through the clerkship. Rebound tenderness was frequently assessed incorrectly by students in both groups, with many avoiding the right lower quadrant entirely.This project highlights how medical students struggle to utilize abdominal examination maneuvers and integrate findings. The results also showed that students did not consistently learn advanced examination skills either before or during clerkship rotation, which may be commonly assumed by clinical faculty. Finally, this work demonstrates how SP encounters can be used to evaluate and improve surgical education curriculum.CONCLUSIONSThis project highlights how medical students struggle to utilize abdominal examination maneuvers and integrate findings. The results also showed that students did not consistently learn advanced examination skills either before or during clerkship rotation, which may be commonly assumed by clinical faculty. Finally, this work demonstrates how SP encounters can be used to evaluate and improve surgical education curriculum.
Palliative care is part of comprehensive family practice; however, many physicians do not feel confident in the biomedical and psychosocial realms. Although improving residency training to address ...this is necessary, there is little consensus on the best education methods.
To conduct a systematic review of postgraduate curricula in palliative care to incorporate the most effective components into a family medicine education program.
Studies of palliative care curricula conducted in postgraduate medical training programs that contained an evaluative component and published since 1980 were systematically examined by investigator pairs using standard selection criteria and data collection forms. Discrepancies were resolved by consensus. The outcomes examined were communication skills, knowledge, attitudes, and comfort/confidence level.
28 studies were included after reviewing 174 abstracts. Most studies (n = 21) used survey pre-post design with no control group. Outcomes were grouped into communication skills, knowledge and attitudes and confidence. Workshops with simulated patients or role plays improved communication skills. Relatively brief strategies such as short workshops showed objective improvements in focused knowledge areas. Either clinical rotations or multi-faceted interventions were required to produce improvements more broadly in knowledge base. Only a few studies examined the sustainability of outcomes.
An effective palliative care curriculum will need to use a multifaceted approach, incorporating a variety of intentional strategies to address the multiple competencies required. There is a need for more rigorous curricular evaluation.
The beta-subunit of the high-affinity IgE receptor (Fc epsilon RI-beta) on chromosome 11 is maternally linked to atopy, the state of enhanced IgE responsiveness underlying allergic asthma and ...rhinitis. We have identified a common variant of Fc epsilon RI-beta, lle181Leu within the 4th transmembrane domain. Leu181 shows significant association with positive IgE responses in a random patient sample. Amongst 60 unrelated nuclear families with allergic asthmatic probands, Leu181 is identified in 10 (17%), is maternally inherited in each, and shows a strong association with atopy. Our data indicate that Fc epsilon RI-beta, subject to maternal modification, may be the atopy-causing locus on chromosome 11q.
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