The impact of neighborhoods and friendships on interracial anxiety among medical students and residents: A report from the medical student CHANGES study

Objective

To examine the experience of interracial anxiety among health professionals and how it may affect the quality of their interactions with patients from racially marginalized populations. We explored the influence of prior interracial exposure—specifically through childhood neighborhoods, college student bodies, and friend groups—on interracial anxiety among medical students and residents. We also examined whether levels of interracial anxiety change from medical school through residency.

Data Source

Web-based longitudinal survey data from the Medical Student Cognitive Habits and Growth Evaluation Study.

Study Design

We used a retrospective longitudinal design with four observations for each trainee. The study population consisted of non-Black US medical trainees surveyed in their 1st and 4th years of medical school and 2nd and 3rd years of residency. Mixed effects longitudinal models were used to assess predictors of interracial anxiety and assess changes in interracial anxiety scores over time.

Principal Findings

In total, 3155 non-Black medical trainees were followed for 7 years. Seventy-eight percent grew up in predominantly White neighborhoods. Living in predominantly White neighborhoods and having less racially diverse friends were associated with higher levels of interracial anxiety among medical trainees. Trainees' interracial anxiety scores did not substantially change over time; interracial anxiety was highest in the 1st year of medical school, lowest in the 4th year, and increased slightly during residency.

Conclusions

Neighborhood and friend group composition had independent effects on interracial anxiety, indicating that premedical racial socialization may affect medical trainees' preparedness to interact effectively with diverse patient populations. Additionally, the lack of substantial change in interracial anxiety throughout medical training suggests the importance of providing curricular tools and structure (e.g., instituting interracial cooperative learning activities) to foster the development of healthy interracial relationships.     

A European evaluation of the patients’ role in clinical education: A six-country cross sectional study

AimThe aim of this study was to analyse the patients’ role in clinical education in terms of facilitative student-patient relationship in Finland, Germany, Iceland, Ireland, Lithuania and Spain and factors promoting a more facilitative relationship in clinical education.BackgroundNursing students’ bedside learning is reliant on patients and the establishment of a person-centred approach develops from the relationships with patients.DesignA multi-country, cross-sectional design was implemented.MethodsSurvey data were collected from graduating nursing students and patients between May 2018 and March 2019. The survey consisted of a 13-item facilitative sub-scale of the Student-Patient Relationship Scale as the main outcome measure, which was identical for both populations. In addition, background factors were surveyed with single questions and other scales. Associations between facilitative relationship and background factors were studied with linear models.ResultsAltogether, 1796 students and 1327 patients answered the survey. Overall, both students and patients regarded their relationship as facilitative, but students’ (median 4.23, 95% confidence interval 4.15–4.23) evaluations were higher than patients’ (median 3.75, 95% confidence interval 3.69–3.77). The students’ and patients’ evaluations differed from each other significantly in all other countries except in Ireland and Lithuania. Corresponding associations for both populations were found in terms of the country and students’ cultural confidence.ConclusionsResults signal favourable grounds for students’ bedside learning and patient participation in clinical education with the potential to foster a person-centred approach.     

Improving capacity to care for patients with intellectual and developmental disabilities: The value of an experiential learning model for family medicine residents

BackgroundPatients with intellectual and developmental disabilities (IDD) are more likely to experience poor health outcomes and family physicians receive inadequate training to provide appropriate care to this patient group. Little prior research has studied how to effectively train family physicians to care for patients with IDD.ObjectiveThe aim of this pilot study was to assess the value of adding an experiential component to didactic education strategies to improve family medicine resident perceived comfort, skills and knowledge related to caring for patients with IDD.MethodsStructured education programs for residents were implemented at three primary care practices in Ontario, Canada. Two practices received didactic information only (didactic-only group); one received didactic information and an experiential training model including clinical interactions and a written reflection on that experience (didactic plus experiential group). In this separate-sample pre-post design, residents were invited to complete a brief anonymous survey prior to and following the training assessing their perceived comfort, skills and knowledge related to patients with IDD.ResultsAt baseline, there were no significant differences between the two groups of residents. At follow up, the experiential group reported significantly higher levels of comfort, skills, and knowledge compared to baseline for most items assessed, while in the didactic-only group most items showed little or no improvement.ConclusionThis pilot study suggests that providing residents the opportunity to participate in clinical encounters with patients with IDD, as well as a structured process to reflect on such encounters, results in greater benefit than didactic training alone.     

Identifying developmental disability in national surveys: Addressing the knowledge gap with special education histories

BackgroundIn the United States nearly 20% of children ages 12–17 have developmental disorders. Some attain population-based developmental milestones after a delay, or increase functioning through special education, medication, technology, or therapy. Others have severe lasting impairments. An indicator identifying those groups in surveys of adults could help shape policies to improve lives.HypothesesWe hypothesized that survey histories of special education could indicate functional status levels.MethodsData were from the nationally representative Panel Study of Income Dynamics (1997–2017, n = 2745). With measures of diagnoses, behaviors, functional status, service use, and adult outcomes, we tested three special education groups as indicators of: (1) no impairment (no special education), (2) disorders, developmental diagnoses that adversely affect educational performance, but with development after a period of delay or only moderate disability, indicated by transfer from special education; and (3) severe lasting disability, the diagnoses combined with life-long needs for supports or services, with limitations in areas including self-care, mobility, and capacity for independent living, indicated by special education in the individual's final year of school.ResultsAcross the special education groups, from no impairment to severe lasting disability, there were trends of: increasing severe and lasting disability (respectively 4.8%, 35.6%, 76.4%); increasing special services use (13.5%, 43.1%, 83.7%); increasing severe emotional disorders (2.3%, 11.3%, 17.9%); lower percentages attaining at least an associate's degree by age 25 (42.1%, 20.7%, and 8.9%); and more chronic diseases.ConclusionsSpecial education histories provide a useful indicator of developmental disability impairment levels in adults.     

Effect of Preclinical Simulation on Family Nurse Practitioner Student’s Readiness for Practice

This project aimed to enhance clinical education preparation in a family nurse practitioner graduate program in rural central Appalachian by providing a psychomotor skills-based simulation with the use of the defusing, discovering, and deepening (3D) debriefing method. The students were surveyed after graduation to determine effectiveness. Program outcomes to measure readiness to practice were graduation, employment, and certification rates. The postgraduation surveys indicated the simulation contributed to an increase in psychomotor skill performance, practicing safe patient care, and making independent decisions in practice. Common themes emerged of feeling “prepared for practice” and being “more marketable” with the procedural skills learned in the simulation.     

Design and validation of a virtual reality trainer for ultrasound-guided regional anaesthesia

Virtual reality is a form of high-fidelity simulation that may be used to enhance the quality of medical education. We created a bespoke virtual reality trainer software using high resolution motion capture and ultrasound imagery to teach cognitive-motor needling skills necessary for the performance of ultrasound-guided regional anaesthesia. The primary objective of this study was to determine the construct validity between novice and experienced regional anaesthetists. Secondary objectives were: to create learning curves for needling performance; compare the virtual environment immersion with other high-fidelity virtual reality software; and compare cognitive task loads imposed by the virtual trainer compared with real-life medical procedures. We recruited 21 novice and 15 experienced participants, each of whom performed 40 needling attempts on four different virtual nerve targets. Performance scores for each attempt were calculated based on measured metrics (needle angulation, withdrawals, time taken) and compared between the groups. The degree of virtual reality immersion was measured using the Presence Questionnaire, and cognitive burden was measured using the NASA-Task Load Index. Scores by experienced participants were significantly higher than novices (p = 0.002) and for each nerve target (84% vs. 77%, p = 0.002; 86% vs. 79%, p = 0.003; 87% vs. 81%, p = 0.002; 87% vs. 80%, p = 0.003). Log–log transformed learning curves demonstrated individual variability in performance over time. The virtual reality trainer was rated as being comparably immersive to other high-fidelity virtual reality software in the realism, possibility to act and quality of interface subscales (all p > 0.06) but not in the possibility to examine and self-performance subscales (all p < 0.009). The virtual reality trainer created workloads similar to those reported in real-life procedural medicine (p = 0.53). This study achieved initial validation of our new virtual reality trainer and allows progression to a planned definitive trial that will compare the effectiveness of virtual reality training on real-life regional anaesthesia performance.