How good are medical students at communicating risk? An implementation study at three German medical schools

ObjectiveTo assess the objective and subjective risk communication skills of medical students in three universities in GermanyMethodsWe developed a risk communication skills Objective Structured Clinical Examination (OSCE) station and implemented it in three medical schools in Germany. 596 students contributed data to a risk communication checklist and a risk communication self-assessment. Multiple linear regression models were used to identify factors associated with the risk communication OSCE performance.ResultsParticipants in our study achieved on average 73.5% of the total risk communication skills score, which did not differ between locations (F(2-595) = 1.96; p = 0.142). The mean objective performance of students who assessed their skills as poor was significantly worse than the performance of students who assessed their skills as good (t(520) = ?5.01, p < 0.001). The risk communication skills score was associated with native language but not with gender nor General Point Average (p < 0.001).ConclusionsMedical students demonstrated acceptable risk communication skills scores and were able to self-assess their performance. However, selected communication techniques should be re-emphasised in the undergraduate medical curriculum.Practice implicationsOur research identified shortcomings in particular subgroups that can be addressed through tailored curriculum interventions.     

Do pre-admission programs make a difference in the enrollment of underrepresented-minority students at U.S. medical schools?

PURPOSE: To assess the association between the presence of pre-admission programs directed at underrepresented minority (URM) students at medical schools accredited by the Liaison Committee on Medical Education (LCME) and the first-year and total enrollments of URM students during the 1993-94 academic year. METHOD: The authors ranked 119 LCME-accredited medical schools by the percentages of their first-year classes and total enrollments made up of URM students. They then compared the schools in three ways: (1) schools ranking above versus below the median in terms of numbers of URM students; (2) the top 25% versus the lower 75%; and (3) the top 25% versus the lowest 25%. Logistic regression was used to determine the association between the presence of pre-admission programs and URM enrollment. RESULTS: Fifty-six percent of the medical schools had pre-admission programs. For both first-year and total enrollments, each comparison showed that schools ranked as having higher percentages of URM students (above the mean and in the top 25%) were more likely to have pre-admission programs than were the schools ranked lower (below the mean, lower 75%, and lowest 25%). CONCLUSION: This study suggests that the presence of pre-admission programs is positively associated with enrollment of URM students at U.S. medical schools.     

Are snoring medical students at risk of failing their exams?

STUDY OBJECTIVES: To compare the examination results of self-reported snoring and nonsnoring medical students DESIGN: We studied the examination scores obtained by medical students answering a multiple-choice test forming part of their final examinations. The students were asked to classify themselves as "nonsnorers," "occasional snorers," or "frequent snorers," and to state their age, sex, height and weight. SETTING: University Hospital, Erlangen, Germany PARTICIPANTS: 201 medical students (61% males/39% females; mean age 24.6 +/- 2.1 years; BMI 22.4 +/- 2.5 kg/m2) taking their final examinations in internal medicine. MEASUREMENTS AND RESULTS: Seventy-eight students (38.8%) claimed to be nonsnorers, 99 (49.3%) occasional snorers and 24 (11.9%) frequent snorers. The mean examination scores (adjusted for age, sex, and BMI) were 69.6 +/- 9.9% for the nonsnorers, 65.3 +/- 10.0% for the occasional snorers and 62.0 +/- 8.2% for the frequent snorers (p < 0.0001). 12.8% of the nonsnorers failed the exam, compared with 22.2% of the occasional snorers and 41.7% of the frequent snorers (p < 0.001). Logistic regression analysis showed an association between failing the exam and snoring (p = 0.013), but not between failure and age, BMI, or sex (relative risk for snorers adjusted for age, sex and BMI: 1.26; 95%--CI 1.01-1.57). CONCLUSIONS: In medical students, snoring seems to be associated with an increased risk of failing exams in a dose-response manner, even after controlling for age, sex and BMI. For the present, the mechanisms underlying this association must remain a matter of speculation. Snoring-related sleep fragmentation ("upper airway resistance syndrome") might be a causal factor.     

When do medical students become human subjects of research? The case of program evaluation.

Intense national dialogue exists around federal requirements protecting the rights of human subjects in clinical research. There is much less discussion surrounding protections for human subjects in such areas as evaluation research when the subjects are also students. Differential interpretation of 45 CFR 46 (the standing regulation on research involving human subjects) by institutional review boards (IRBs) leaves many confused about whether research using student data requires IRB review. At the heart of the uncertainty are "dual purpose activities," for example, when student data from program evaluation or routine assessments subsequently become the basis for faculty scholarship that is disseminated as "generalizable knowledge" to the community of medical educators. The authors identify two factors that should be considered as institutions develop applications and interpretations of 45 CFR 46. First, medical educators should enter into dialogues with their IRBs to become more familiar with these regulations and their application in evaluation or assessment studies. Second, for reasons of professionalism, faculty should seek opportunities to model in their role as researchers those ethical behaviors that are central to an honest relationship between physician and patient. In the educational context this means faculty disclosure of how student data may be used by faculty in their own scholarship and determination of when student consent is needed. The authors also describe how one medical school addressed this thorny challenge with assistance from the university IRB and offer suggestions to improve institutional procedures.     

Is the risk of bipolar disorder in twins equal to the risk in singletons? A nationwide register-based study

BACKGROUND: A previous study demonstrated a higher rate of schizophrenia in dizygotic twins than in the general population, and a higher rate of schizophrenia in siblings of dizygotic twins than in siblings of monozygotic twins and singletons, pointing to a common genetic predisposition for dizygotic twinning and schizophrenia. The aim of the present study was to investigate whether these findings also apply to bipolar disorder. METHODS: Through record linkage between The Danish Twin Register, The Danish Psychiatric Central Register and The Danish Civil Registration System, the rate of bipolar disorder (diagnosed for the first time during admission to hospital) in dizygotic and monozygotic twins was compared with the rate in singletons, and the rate in siblings and parents of twins was compared with the rate in siblings and parents of singletons. RESULTS: The rate of bipolar disorder was the same in dizygotic twins, monozygotic twins and singletons as well as for parents and siblings of dizygotic twins, monozygotic twins and singletons. LIMITATIONS: The study is a register-based study, only including hospitalized patients. CONCLUSION: This study shows that there is an equal rate of bipolar disorder in twins and in singletons. Assuming that DZ twinning is under some genetic influence, a differential relationship between schizophrenia and DZ twinning on one hand and bipolar disorder and DZ twinning on the other hand may suggest differences in the genetic basis of the two diseases. The finding that the rate of bipolar disorder in monozygotic twins is the same as the rate of bipolar disorder in singletons supports studies finding no association between bipolar disorder and obstetric complications.     

Is obesity related to deteriorating mental health of the U.S. working-age population?

Journal of Behavioral Medicine - This study examined whether the association between obesity and non-specific mental distress has become stronger among the working-age population over time and...     

When to conduct probabilistic linkage vs. deterministic linkage? A simulation study

IntroductionWhen unique identifiers are unavailable, successful record linkage depends greatly on data quality and types of variables available. While probabilistic linkage theoretically captures more true matches than deterministic linkage by allowing imperfection in identifiers, studies have shown inconclusive results likely due to variations in data quality, implementation of linkage methodology and validation method. The simulation study aimed to understand data characteristics that affect the performance of probabilistic vs. deterministic linkage.MethodsWe created ninety-six scenarios that represent real-life situations using non-unique identifiers. We systematically introduced a range of discriminative power, rate of missing and error, and file size to increase linkage patterns and difficulties. We assessed the performance difference of linkage methods using standard validity measures and computation time.ResultsAcross scenarios, deterministic linkage showed advantage in PPV while probabilistic linkage showed advantage in sensitivity. Probabilistic linkage uniformly outperformed deterministic linkage as the former generated linkages with better trade-off between sensitivity and PPV regardless of data quality. However, with low rate of missing and error in data, deterministic linkage performed not significantly worse. The implementation of deterministic linkage in SAS took less than 1 min, and probabilistic linkage took 2 min to 2 h depending on file size.DiscussionOur simulation study demonstrated that the intrinsic rate of missing and error of linkage variables was key to choosing between linkage methods. In general, probabilistic linkage was a better choice, but for exceptionally good quality data (<5% error), deterministic linkage was a more resource efficient choice.     

Predictors of medical students’ ethical decision-making: A pilot study using the Theory of Interpersonal Behavior

ObjectiveTo understand medical students’ (MS) ethical decision-making using the Theory of Interpersonal Behavior (TIB).MethodsWe conducted two rounds of focus groups to develop a TIB-based questionnaire by eliciting students’ perspectives on an ethical dilemma they will encounter in a standardized patient (SP) station, in which an SP “surgeon” asked them to intubate a sedated patient whom the student knew had requested no student involvement. We administrated questionnaires to 241 third-year MS following this SP station, asking for their decisions in the SP station and if a surgeon made the same request in their clerkship. Confirmatory factor analysis (CFA) was used to test whether observed data fit the proposed TIB-based model.ResultsThe CFA provided an acceptable fit to the a priori proposed model. Fifty-five percent of students indicated they would intubate in an actual situation versus 18% in the SP station (p < 0.05). Using logistic regression, TIB domains affect and facilitating factors reported significant association with students’ decisions in both the SP and hypothesized actual situations.ConclusionsThe TIB appears to be an effective theoretical framework for explaining students’ ethical decision-making.Practice implicationsThe TIB may guide design and assessment of educational programs for professional formation.     

A pilot Tuning Project-based national study on recently graduated medical students’ self-assessment of competences - the TEST study

Background

This is the first study of its kind to provide data regarding the self-reported career choice motivation and intentions after graduation of dental and dental hygiene students in Nepal. The findings of this study can be used to inform future oral health workforce planning in Nepal.

Methods

A cross-sectional survey of dentistry and dental hygiene students attending a large accredited dental college in Kathmandu, Nepal. Quantitative data were analysed using IBM® SPSS® 22. The respondents were given the opportunity to provide clarifying comments to some of the questions.

Results

Two hundred questionnaires were distributed, and 171 students completed the anonymous survey (response rate 86 %). Working in health care and serving the community were the most important initial motives for career choice, with significantly more dentistry students selecting their degree course because of the possibility to work flexible working hours (p?<?.001) compared to dental hygiene students. A majority of the students expressed concern about finding a suitable job (58 %) after graduation. Almost a quarter (23 %) reported intent to seek a job immediately after graduation, while 46 % plan further studies. Dentistry students were more likely to report planning further studies (p?=?.007) compared to the dental hygiene students. Dental hygiene students express a higher interest in going abroad (p?=?.011) following graduation. Only 10 % of all students plan to live or work in rural areas after study. Most common preferred locations to live after graduation are urban (33 %) or abroad (38 %). Data suggest a preference to combine working in a hospital with working in their own practice (44 %) while interest in solely working in their own practice is low (<2 %).

Conclusion

Many students, though enthusiastic about their profession and expressing the ambition to serve the community, fear unemployment or envision better chances abroad. Most of the students in this study expressed a preference to live in an urban area after graduation. Findings indicate that strong measures are required to incentivise students to consider rural work.

     

Does the achievement of medical identity limit the ability of primary care practitioners to be patient-centred?: A qualitative study

OBJECTIVE: To explore primary care practitioners approach to and management of menstrual disorders using a sociological perspective. METHODS: Semi-structured interviews of primary care practitioners with an iterative approach to recruitment and analysis informed by grounded theory. RESULTS: Two broad approaches to patient care were described-a biomedical approach, which concentrated on medical history taking and the search for disease, and a patient-as-person approach where a patient's individual ideas and concerns were elicited. Practitioners believed they had a role in integrating these approaches. Activities intrinsic to the biomedical approach such as the performance of examinations, the ordering of tests and making decisions about biomedical aspects of care were however not available for shared decision-making. The exercise of these decisions by medical practitioners was necessary for them to achieve their professional identity. CONCLUSION: While practitioners accepted the ideology of patient-centred care the biomedical approach had the advantage of providing practitioners with a professional identity, which protected their status in relation to patients and colleagues. PRACTICE IMPLICATIONS: The adoption of shared decision-making by medically qualified primary care practitioners is limited by practitioners need to achieve their medical identity. At present, this identity does not involve significant sharing of power and responsibility. A shift in perception of medical identity is required before more shared decision-making is seen in practice.     

Gender awareness among physicians – the effect of specialty and gender. A study of teachers at a Swedish medical school

Background

An important goal for medical education today is professional development including gender equality and awareness of gender issues. Are medical teachers prepared for this task? We investigated gender awareness among physician teachers, expressed as their attitudes towards the role of gender in professional relationships, and how it varied with physician gender and specialty. We discuss how this might be related to the gender climate and sex segregation in different specialties.

Method

Questionnaires were sent to all 468 specialists in the clinical departments and in family medicine, who were engaged in educating medical students at a Swedish university. They were asked to rate, on visual analogue scales, the importance of physician and patient gender in consultation, of preceptor and student gender in clinical tutoring and of physician gender in other professional encounters. Differences between family physicians, surgical, and non-surgical hospital doctors, and between women and men were estimated by chi-2 tests and multivariate logistic regression analyses.

Results

The response rate was 65 %. There were differences between specialty groups in all investigated areas mainly due to disparities among men. The odds for a male family physician to assess gender important were three times higher, and for a male non-surgical doctor two times higher when compared to a male surgical doctor. Female teachers assessed gender important to a higher degree than men. Among women there were no significant differences between specialty groups.

Conclusions

There was an interaction between physician teachers' gender and specialty as to whether they identified gender as important in professional relationships. Male physicians, especially from the surgical group, assessed gender important to a significantly lower degree than female physicians. Physicians' degree of gender awareness may, as one of many factors, affect working climate and the distribution of women and men in different specialties. Therefore, to improve working climate and reduce segregation we suggest efforts to increase gender awareness among physicians, for example educational programs where continuous reflections about gender attitudes are encouraged.

     

Moles and melanomas--who's at risk, who knows, and who cares? A strategy to inform those at high risk.

BACKGROUND: Malignant melanoma is uncommon but potentially fatal. Knowledge and attitudes play an important part in the early detection of this skin cancer. AIM: To assess knowledge, risk perception, and intended behaviour related to melanoma compared with actual risk status. To suggest measures to improve the primary and secondary prevention of melanoma in general practice for a high-risk group. METHOD: A prospective questionnaire survey was carried out on consecutive adults attending in 16 randomly selected group practices. Applying MacKie's personal risk factor chart for melanoma, the study assessed self-reported risk, knowledge of skin cancer--especially malignant melanoma--and self-reported preventive activity. RESULTS: A total of 3105 (69%) attenders completed the questionnaire. The responders showed greater concern for minor rather than major clinical signs in pre-existing moles. Young people and the professional classes were the least knowledgeable about skin cancer and exhibited the most risky behaviour in terms of sun exposure, failure to check their skin, and to seek medical advice about new or changing moles. The majority of an 8.7% high-risk group showed lack of awareness of their increased risk, and women in this group reported the highest desire for a suntan and the use of sunbeds. In addition to showing less concern than their low risk counterparts about moles growing in size, they were also reluctant to seek medical advice about new moles. CONCLUSION: Consideration should be given to targeting primary prevention and selective screening in general practice towards a high-risk group for malignant melanoma. Young people and the professional social class should receive particular attention.     

How do young adults perceive the risk of chlamydia infection? A qualitative study

Objectives. This study aimed to improve understanding of how young UK genito‐urinary medicine (GUM) patients perceive the risk of chlamydia, and identify implications for health education. Design. A qualitative methodology was chosen. Methods. Semi‐structured interviews with 27 respondents aged 16–22 years old were conducted. Data were subjected to thematic analysis. Results. Respondents made assessments of the perceived seriousness of, and their personal susceptibility to, chlamydia infection. Judgements about seriousness were related to beliefs about the controllability of symptoms and the long‐term health consequences of infection. Susceptibility estimates were related to beliefs about the extent to which personal exposure put them in contact with chlamydia, and about the prevalence of infection amongst their peer group. This is consistent with the content of illness risk representations proposed by Cameron (2003) . Respondents demonstrated some beliefs, which appeared to influence perceptions of seriousness and susceptibility in unhelpful ways. Conclusions. Young people may be underestimating their risk of chlamydia infection due to the presence of unhelpful beliefs. Dialogue between health professionals and patients within GUM clinics, or through consultations as part of the National Chlamydia Screening Programme (NCSP), could provide vehicles to deliver health education to target these. Suggested health education includes highlighting false reassurance provided by treatment beliefs and exposing the fallibility of using overt characteristics to judge the likelihood that a potential sexual partner poses a risk of infection.     

What are the key leadership competencies required by medical school deans in Uganda? A qualitative cross-sectional study

BackgroundEffective leadership is vital for organizational growth and sustainability. Globally, medical schools are faced with leadership challenges due to the pace of globalization, technological advances, reduced funding and changed funding cycles, increasing student enrolment, demands of accreditation, academic collaboration, innovations and research. This makes identification and selection for the right leadership competencies a priority.ObjectivesTo investigate the key leadership competencies required by deans of medical schools in Uganda.MethodA qualitative study using semi-structured interviews with the current deans and purposively selected former deans of medical schools in Uganda was conducted between March and June, 2020. We analysed the data using Grounded theory.ResultsThirteen (13) deans (9 of the 12 current deans and 4 former deans) participated in the study. We established ten (10) key roles of a dean of a medical school categorised as academic leadership, administrative leadership and professional leadership. Eleven (11) key competencies were identified as necessary for effective leadership of medical schools in Uganda, and categorized as personality-related competencies, organizational management competencies and medical/health expertise.ConclusionsA dean of a medical school in Uganda should possess a combination of personality, medical expertise, health professions training and organizational management competencies and have training in leadership, financial and resources management.