Displaying faculty grade averages during 3 year medical student clerkship evaluations: effects upon grade inflation

Background: Medical educators recognize grade inflation as a significant problem with multi-factorial etiologies beginning as early as junior medical student clerkship rotations. Colletti et al reported faculty educators’ inability or unwillingness to provide medical student trainees with unfavorable face-to-face evaluations as a source of grade inflation. The effects of un-countered grade inflation are significant, rendering academic deans and advisors less able to provide useful comparative evaluations and recommendations for matriculating students, and in one study (Speer et al), leaving nearly half of the faculty in an internal medicine clerkship concerned about “social-promotion” of failing students due to uncontrolled grade inflation. Little literature specifically addresses techniques to minimize grade inflation. Methods: Using our previously reported 360-degree web-based competency evaluation tool for 3^rd year medical student clerkships, evaluation data were collected assessing nine evaluation items based upon the six ACGME “core competencies”. During part one of the study, evaluations were completed with faculty evaluators blinded to their averaged evaluation data. During part two of the study, real-time faculty mean and standard error evaluation data were prominently displayed on the evaluation instrument during faculty evaluations. We hypothesized that passive faculty notification of evaluation data would alter evaluations toward a more centrist mean, based upon changes in clinician ordering patterns observed when cost data were displayed. Results: Prior to and during Part One of the study, mean evaluation scores were significantly greater than the anticipated mean (2.5) for all items evaluated. 2043 individual evaluation scores were acquired, equally allocated between pre- and post-notification periods of the study. Mean evaluation scores were significantly greater than the anticipated mean (2.5) for all items evaluated. Data were evaluated using parametric (t-test) and nonparametric (Wilcoxon signed ranks test) statistical analyses comparing blinded and passive faculty notification evaluation data. Mean evaluation scores were noted to increase slightly for each of the nine evaluation items after commencement of passive notification, with one item achieving and three items approaching statistical significance. Conclusions: These findings appear to contradict our hypothesis that passive notification of faculty evaluation averages decrease evaluation means or improve grade inflation. Increasingly large datasets, obtained using on-line evaluation tools, will likely achieve statistical significance demonstrating that faculty should not be shown real-time grade averages during evaluation. We believe that these data support the need to develop alternate methods of managing grade inflation, including faculty education or parametric grade re-calculation as tools to counter grade inflation.     

Youth safety education and injury prevention program

Unintentional injury remains the leading cause of death in U.S. children. This article provides a case evaluation of a school based youth safety education program based on the Think First National Injury Prevention Program curriculum. Partners for the program included an urban elementary school, a school of nursing, a Safe Kids Coalition, a regional trauma center, and pediatric, community, and critical care nurses. A convenience sample of 140 second grade children in a mid-Atlantic elementary school participated in a 1 hour-a-week injury prevention class over the course of 6 weeks. The Think First National Injury Prevention Program served as the core curriculum and evaluation framework. At the end of the program, knowledge test scores increased an average of 35% over pre-test measures. Ninety-eight percent of the faculty, staff nurses, student nurses, children, and parents indicated a positive overall value of the program and the need for it to continue on an ongoing basis. Safety resources are provided for pediatric nurses to use in their diverse practice settings.     

Evaluation of face-mounted binocular video display for laparoscopy: outcomes of psychometric skills testing and surgeon satisfaction

OBJECTIVES: Improved digital video cameras and high-resolution video displays have greatly enhanced laparoscopic surgery. However, the size and distance of the video display and the location of the monitor continue to be impediments in laparoscopy, providing unsatisfactory operative visualization and causing the development of neck and back strain in surgeons performing long procedures. The purpose of this study was to evaluate the use of a face-mounted binocular high-resolution video display by means of standardized measurements of laparoscopic skill, and to compare procedure speed and surgeon satisfaction with the binocular display, open operative visualization, and standard laparoscopic monitor views. METHODS: The surgical faculty and resident trainees (n = 22) underwent two standardized laparoscopic psychometric skills tests of fine motor control and bimanual operative facility. Testing was performed first with the use of laparoscopic instruments in direct view of the participants; sufficient repetitions were allowed so that plateau levels were obtained in task speed. Video camera-based imaging displayed on the face-mounted binocular video display and a standard video monitor were then used to repeat identical tests. Test times were compared between the open view, face-mounted display (FMD) view, and standard laparoscopic monitor view groups. A Likert-scale based assessment was conducted to examine operator impressions of neck and back strain, visual acuity, and overall satisfaction. RESULTS: Performance with the standard laparoscopic monitor was significantly slower than with the direct view on both fine motor (mean, 85.0 +/- 7.1 s vs. 56.4 +/- 5.7 s; P <.0001) and bimanual (mean, 80.8 +/- 7.0 s vs. 40.2 +/- 2.6 s; P =.009) psychometric skills tests. The FMD view performance was significantly faster than the standard laparoscopic monitor performance for both the bimanual (mean, 72.2 +/- 7.6 s vs. 85.0 +/- 7.2 s; P =.001) and fine motor (mean, 59.3 +/- 4.7 s vs. 80.8 +/- 7.0 s; P =.004) tests. The scores on a Likert Scale satisfaction survey of the use of the FMD unit for neck and back strain (mean, 4.27 +/- 0.20), visual acuity (mean, 3.93 +/- 0.10), and overall satisfaction (mean, 4.16 +/- 0.20) were high (scale: 1, worst; 5, ideal). CONCLUSIONS: A face-mounted high-resolution video display unit reduces neck and back strain and improves both visualization and overall satisfaction in comparison with standard laparoscopic display monitors; surgical performance is better than with standard laparoscopic imaging as assessed by standardized psychometric skills testing.     

The dual role of CD8+ T lymphocytes in the development of stress-induced herpes simplex encephalitis

Despite the generally restrictive nature of the blood–brain barrier (BBB), circulating lymphocytes can infiltrate into the central nervous system (CNS) during a variety of disease states. Although the contributions of these lymphocytes to CNS-associated disease have been identified in some viral models, the factors which govern this infiltration following herpes simplex virus (HSV) infection remain to be elucidated. We have developed a murine model of HSV encephalitis (HSE) to define the relationship among psychological stress, the recruitment of HSV-specific T cells into the CNS, and the development of HSE. Naive mice, as well as mice that had been vaccinated with a recombinant vaccinia virus (rVVESgB498–505) that elicits the generation of HSV-1 gB498–505-specific CD8⁺ T cells, were infected intranasally (i.n.) with HSV-1 McIntyre. Beginning one day prior to HSV-1 infection and continuing for a total of 9 days, naive and vaccinated mice were exposed to a well-established stressor, restraint stress. Naive, stressed mice exhibited increased symptoms of HSE and HSE-associated mortality as compared to non-stressed controls. A concomitant increase in CD4⁺ and CD8⁺ T cells in the brain was observed throughout the infection, with CD8⁺ T cells outnumbering CD4⁺ T cells. The development of HSE in these naive, stressed mice was accompanied by a delayed infiltration of gB498–505-specific CD8⁺ T cells after HSV spread into the brain. In contrast, both stressed and non-stressed rVVESgB498–505-vaccinated mice possessed gB498–505-specific CD8⁺ T cells prior to HSV challenge and were protected against HSE despite having detectable HSV-1 DNA in the brain. Together, these findings suggest that a delayed infiltration of CD8⁺ T cells into the brain may promote HSE in naive mice, while the presence of HSV-specific CD8⁺ T cells in the brain prior to HSV challenge is protective, possibly by limiting HSV replication and spread within the CNS.     

Startle reactivity and PTSD symptoms in a community sample of women

Exaggerated startle and PTSD symptoms have been investigated primarily in relation to acute or Type I stressors. The present study examined PTSD symptoms and startle eyeblink response in relation to chronic or Type II stressors. Type II stressors were operationally defined as high levels of childhood corporal punishment and high levels of current partner aggression. This study recruited a sample of 52 women from a metropolitan community and administered several questionnaires assessing experience of corporal punishment in childhood, current intimate partner aggression and level of PTSD symptoms. Following questionnaires, women were presented with eight auditory startle probes (white noise). Results showed that both childhood corporal punishment and intimate partner aggression were associated with women's PTSD symptom scores. However, only PTSD symptom scores were associated with reduced startle. Results are discussed in light of Type I and Type II stressors, and recent suggestions in the PTSD literature that a subgroup of individuals may experience physiological suppression rather than heightened physiological reactivity.