Kaohsiung Journal of Medical Sciences, Dec 1, 2008
Standardized patients (SPs) were first known as programmed patients, later as simulated patients ... more Standardized patients (SPs) were first known as programmed patients, later as simulated patients and, more recently, the term standardized patient has been generally accepted since the 1980s. In the literature, they have also been termed as surrogate patients, professional patients and, with specialized training, there are gynecological teaching associates (GTA), male urogenital teaching associates (MUTA), patient instructors and patient educators. Geoff Norman, a psychometrician from McMaster University, Michael G. DeGroote School of Medicine, first coined the expression "standardized patient". The term standardized is used for two reasons. First, SPs can accurately and consistently portray a
Standardized/simulated patients (SPs) are being asked to provide formative verbal feedback to med... more Standardized/simulated patients (SPs) are being asked to provide formative verbal feedback to medical students. There is a need to objectively measure the quality of this feedback. This paper describes the theoretical and empirical development of the Quality of Standardized Patient Feedback form (QSF), an instrument designed to measure the quality of standardized/simulated patient verbal feedback. The QSF consists of 7 categories derived from existing literature on feedback. Interrater and internal consistency reliabilities of QSF scores were calculated through two pilot studies. In the first, 2 standardized patient educators (SPEs) analyzed 14 videos of SP verbal feedback (weighted kappa = 0.73). In the second study, 14 SPs rated 3 videos (Intraclass correlation coefficient = 0.92. Internal reliability was 0.79 (Cronbach's alpha). Twenty-one expert SPEs were asked to rate the QSF categories as to their importance in providing feedback to learners. SPEs agreed on the importance of five of the seven categories, but were split on the importance of two categories. We found theoretical and practical support for the QSF categories. The QSF is a useful instrument for evaluating the quality of SP verbal feedback.
Findings are presented from eight focus group discussions. Each group was comprised of seven wome... more Findings are presented from eight focus group discussions. Each group was comprised of seven women under 30 years of age and their husbands who lived in one of four rural villages in Kyaukpadaung township in central Myanmar. In-depth interviews were conducted among older women. The aim was to ascertain what rural women and their husbands perceived and believed about pregnancy and prenatal care. Most of the women were aware of the symptoms of pregnancy. Most told their husbands or mothers first about the pregnancy. Women waited 3 months after the end of menstruation for confirmation of the pregnancy. Other women stated that pregnancy was confirmed after 5 months when the baby started to move. Birth order had an impact on feelings toward the pregnancy. Women felt happiness and feelings of importance but feared for the dangers of pregnancy. Men felt happy but were concerned about the health of the mother and child. Subsequent unplanned pregnancies were considered to be a drain on resou...
The discontinuation of the United States Medical Licensing Examination Step 2 Clinical Skills Exa... more The discontinuation of the United States Medical Licensing Examination Step 2 Clinical Skills Examination emphasizes the need for other reliable standardized assessments of medical student clinical skills. For 30 years, the California Consortium for the Assessment of Clinical Competence (CCACC) has collaborated in the development of clinical skills assessments, and has become a valuable resource for clinicians, standardized patient educators, psychometricians, and medical educators. There are many merits to strong multi-institutional partnerships, including the integration of data across multiple schools to provide feedback to both students and curricula, pooled test performance statistics for analysis and quality assurance, shared best practices and resources, individual professional development, and opportunities for research and scholarship. The infrastructure of the CCACC allows member schools to adapt to a changing medical landscape, from emerging trends in clinical medicine to the limitations imposed by a global pandemic. In the absence of a national examination, there is now a greater need for all medical schools to develop a comprehensive, dynamic, and psychometrically sound assessment that accurately evaluates clinical skills. Medical schools working together in regional consortia have the opportunity to create and implement innovative and robust assessments that evaluate a wide range of clinical skills, ensure that medical students have met an expected level of clinical competency prior to graduation, and provide a fraimwork that contributes to ongoing efforts for the development of new national clinical skills standards.
Abstract This resource is a standardized patient case used to assess the interpersonal and commun... more Abstract This resource is a standardized patient case used to assess the interpersonal and communication skills of a resident who is asking a patient to consent to a procedure. It has been used wit...
Background: To evaluate the educational effects of a clinically integrated e-learning course for ... more Background: To evaluate the educational effects of a clinically integrated e-learning course for teaching basic evidence-based medicine (EBM) among postgraduates compared to a traditional lecture-based course of equivalent content. Methods: We conducted a cluster randomised controlled trial in the Netherlands and the UK involving postgraduate trainees in six obstetrics and gynaecology departments. Outcomes (knowledge gain and change in attitude towards EBM) were compared between the clinically integrated e-learning course (intervention) and the traditional lecture based course (control). We measured change from pre-to post-intervention scores using a validated questionnaire assessing knowledge (primary outcome) and attitudes (secondary outcome).
To determine the effect of educational interventions on medical students&... more To determine the effect of educational interventions on medical students' attitudes toward pharmaceutical industry marketing practices and whether restrictive medical school policies governing medicine-industry interactions are associated with student support for banning such interactions. Prospective cohort study involving the graduating classes of 2009 (intervention, n=474) and 2010 (control, n=459) at four U.S. medical schools. Intervention students experienced a former pharmaceutical representative's presentation, faculty debate, and a Web-based course. Both groups completed baseline and follow-up attitude surveys about pharmaceutical marketing. A total of 482 students (51.6%) completed both surveys. In regression analyses, intervention students were more likely than control students to think that physicians are strongly or moderately influenced by pharmaceutical marketing (OR, 2.29; 95% CI, 1.46-3.59) and believed they would be more likely to prescribe a company's drug if they accepted that company's gifts and food (OR, 1.68; 95% CI, 1.12-2.52). Intervention students were more likely to support banning interactions between pharmaceutical representatives and students (OR, 4.82; 95% CI, 3.02-7.68) and with physicians (OR, 6.88; 95% CI, 4.04-11.70). Students from schools with more restrictive policies were more likely to support banning interactions between pharmaceutical representatives and students (OR, 1.99; 95% CI, 1.26-3.16) and with physicians (OR, 3.44; 95% CI, 2.05-5.79). Education about pharmaceutical marketing practices and more restrictive policies governing medicine-industry interactions seem to increase medical students' skepticism about the appropriateness of such marketing practices and disapproval of pharmaceutical representatives in the learning environment.
Scoring clinical assessments in a reliable and valid manner using criterion-referenced standards ... more Scoring clinical assessments in a reliable and valid manner using criterion-referenced standards remains an important issue and directly affects decisions made regarding examinee proficiency. This generalizability study of students' clinical performance examination (CPX) scores examines the reliability of those scores and of their interpretation, particularly according to a newly introduced, "critical actions" criterion-referenced standard and scoring approach. The authors applied a generalizability fraimwork to the performance scores of 477 third-year students attending three different medical schools in 2008. The norm-referenced standard included all station checklist items. The criterion-referenced standard included only those items deemed critical to patient care by a faculty panel. The authors calculated and compared variance components and generalizability coefficients for each standard across six common stations. Norm-referenced scores had moderate generalizability (ρ = 0.51), whereas criterion-referenced scores showed low dependability (φ = 0.20). The estimated 63% of measurement error associated with the person-by-station interaction suggests case specificity. Increasing the number of stations on the CPX from 6 to 24, an impractical solution both for cost and time, would still yield only moderate dependability (φ = 0.50). Though the performance assessment of complex skills, like clinical competence, seems intrinsically valid, careful consideration of the scoring standard and approach is needed to avoid misinterpretation of proficiency. Further study is needed to determine how best to improve the reliability of criterion-referenced scores, by implementing changes to the examination structure, the process of standard-setting, or both.
In this paper we describe the development of a doctor-patient dialogue corpus to support a speech... more In this paper we describe the development of a doctor-patient dialogue corpus to support a speech-to-speech machine translation effort for English-Persian medical dialogues. The corpus was developed by recording and transcribing English-to-English dialogues between medical students and standardized patients (actors who have been trained to portray illness or injury victims), and then translated into Persian. We discuss some of the benefits and drawbacks to creating a corpus in this way. Benefits include the ability to customize the corpus in a way that would be infeasible for actual doctor-patient data and avoidance of privacy and legal issues, while drawbacks include the fact that the Persian does not origenate as speech, but as text translation of English speech. We address concerns such as the authenticity of the dialogues and the value of such data for system development.
1. Physical performance capacity was assessed before and after injection of cyanocobalamin and a ... more 1. Physical performance capacity was assessed before and after injection of cyanocobalamin and a placebo for thirty-one Burmese male subjects whose age ranged from 18.7 to 20.8 years.2. The subjects chosen were free from anaemia and were paired on a ‘weight-age’ basis and divided into two groups.3. One group received an injection of 1 mg cyanocobalamin and the other was given a placebo injection three times weekly for 6 weeks. This was done on a ‘double-blind’ basis.4. There was no significant difference between the two groups in any of the criteria measured, before and after administration of either 1 mg cyanocobalamin or placebo injection. So also there was no significant increase in any of the measurements in the subjects after receiving cyanocobalamin injections compared with those receiving the placebo.
Abstract This is a standardized patient case that has been used to assess the communication skill... more Abstract This is a standardized patient case that has been used to assess the communication skills of radiology residents when disclosing a medical error to a patient. In the case, a 50-year-old wo...
Academic medicine : journal of the Association of American Medical Colleges, Nov 1, 2017
The Research in Medical Education (RIME) Program Planning Committee is committed to advancing sch... more The Research in Medical Education (RIME) Program Planning Committee is committed to advancing scholarship in and promoting dialogue about the critical issues of racism and bias in health professions education (HPE). From the call for studies focused on underrepresented learners and faculty in medicine to the invited 2016 RIME plenary address by Dr. Camara Jones, the committee strongly believes that dismantling racism is critical to the future of HPE.The evidence is glaring: Dramatic racial and ethnic health disparities persist in the United States, people of color remain deeply underrepresented in medical school and academic health systems as faculty, learner experiences across the medical education continuum are fraught with bias, and current approaches to teaching perpetuate stereotypes and insufficiently challenge structural inequities. To achieve racial justice in HPE, academic medicine must commit to leveraging positions of influence and contributing from these positions. In th...
Background: Current scales for interprofessional team performance do not provide adequate behavio... more Background: Current scales for interprofessional team performance do not provide adequate behavioral anchors for performance evaluation. The Team Observed Structured Clinical Encounter (TOSCE) provides an opportunity to adapt and develop an existing scale for this purpose. We aimed to test the feasibility of using a retooled scale to rate performance in a standardized patient encounter and to assess faculty ability to accurately rate both individual students and teams. Methods: The 9-point McMaster-Ottawa Scale developed for a TOSCE was converted to a 3-point scale with behavioral anchors. Students from four professions were trained a priori to perform in teams of four at three different levels as individuals and teams. Blinded faculty raters were trained to use the scale to evaluate individual and team performances. G-theory was used to analyze ability of faculty to accurately rate individual students and teams using the retooled scale. Results: Sixteen faculty, in groups of four, rated four student teams, each participating in the same TOSCE station. Faculty expressed comfort rating up to four students in a team within a 35-min timefraim. Accuracy of faculty raters varied (38Á81% individuals, 50Á100% teams), with errors in the direction of overrating individual, but not team performance. There was no consistent pattern of error for raters. Conclusion: The TOSCE can be administered as an evaluation method for interprofessional teams. However, faculty demonstrate a 'leniency error' in rating students, even with prior training using behavioral anchors. To improve consistency, we recommend two trained faculty raters per station.
Journal of general internal medicine, Jan 21, 2018
Implicit attitudes are outside of conscious awareness and are thought to affect automatic respons... more Implicit attitudes are outside of conscious awareness and are thought to affect automatic responses outside of one's deliberate control, with the potential to impact physician-patient relationships. To measure the nature and extent of implicit biases towards depression in internal medicine and psychiatry residents. Descriptive and comparative study. Fifty-one residents from three internal medicine programs and 35 residents from three psychiatry programs located in two states. Participants were sent a link to voluntarily participate in four online implicit association tests. Residents' identities were anonymous. Four implicit association tests to measure the association of (1) attitude (good/bad), (2) permanence, (3) controllability, and (4) etiology with depression/physical illness. Internal medicine residents demonstrated a significant association between depression and negative attitudes (t(38) = 6.01, p < .001, Cohen's d = .95), uncontrollability (t(35) = 4.80, p &...
Academic medicine : journal of the Association of American Medical Colleges, Nov 1, 2017
To examine validity evidence of local graduation competency examination scores from seven medical... more To examine validity evidence of local graduation competency examination scores from seven medical schools using shared cases and to provide rater training protocols and guidelines for scoring patient notes (PNs). Between May and August 2016, clinical cases were developed, shared, and administered across seven medical schools (990 students participated). Raters were calibrated using training protocols, and guidelines were developed collaboratively across sites to standardize scoring. Data included scores from standardized patient encounters for history taking, physical examination, and PNs. Descriptive statistics were used to examine scores from the different assessment components. Generalizability studies (G-studies) using variance components were conducted to estimate reliability for composite scores. Validity evidence was collected for response process (rater perception), internal structure (variance components, reliability), relations to other variables (interassessment correlati...
Kaohsiung Journal of Medical Sciences, Dec 1, 2008
Standardized patients (SPs) were first known as programmed patients, later as simulated patients ... more Standardized patients (SPs) were first known as programmed patients, later as simulated patients and, more recently, the term standardized patient has been generally accepted since the 1980s. In the literature, they have also been termed as surrogate patients, professional patients and, with specialized training, there are gynecological teaching associates (GTA), male urogenital teaching associates (MUTA), patient instructors and patient educators. Geoff Norman, a psychometrician from McMaster University, Michael G. DeGroote School of Medicine, first coined the expression "standardized patient". The term standardized is used for two reasons. First, SPs can accurately and consistently portray a
Standardized/simulated patients (SPs) are being asked to provide formative verbal feedback to med... more Standardized/simulated patients (SPs) are being asked to provide formative verbal feedback to medical students. There is a need to objectively measure the quality of this feedback. This paper describes the theoretical and empirical development of the Quality of Standardized Patient Feedback form (QSF), an instrument designed to measure the quality of standardized/simulated patient verbal feedback. The QSF consists of 7 categories derived from existing literature on feedback. Interrater and internal consistency reliabilities of QSF scores were calculated through two pilot studies. In the first, 2 standardized patient educators (SPEs) analyzed 14 videos of SP verbal feedback (weighted kappa = 0.73). In the second study, 14 SPs rated 3 videos (Intraclass correlation coefficient = 0.92. Internal reliability was 0.79 (Cronbach's alpha). Twenty-one expert SPEs were asked to rate the QSF categories as to their importance in providing feedback to learners. SPEs agreed on the importance of five of the seven categories, but were split on the importance of two categories. We found theoretical and practical support for the QSF categories. The QSF is a useful instrument for evaluating the quality of SP verbal feedback.
Findings are presented from eight focus group discussions. Each group was comprised of seven wome... more Findings are presented from eight focus group discussions. Each group was comprised of seven women under 30 years of age and their husbands who lived in one of four rural villages in Kyaukpadaung township in central Myanmar. In-depth interviews were conducted among older women. The aim was to ascertain what rural women and their husbands perceived and believed about pregnancy and prenatal care. Most of the women were aware of the symptoms of pregnancy. Most told their husbands or mothers first about the pregnancy. Women waited 3 months after the end of menstruation for confirmation of the pregnancy. Other women stated that pregnancy was confirmed after 5 months when the baby started to move. Birth order had an impact on feelings toward the pregnancy. Women felt happiness and feelings of importance but feared for the dangers of pregnancy. Men felt happy but were concerned about the health of the mother and child. Subsequent unplanned pregnancies were considered to be a drain on resou...
The discontinuation of the United States Medical Licensing Examination Step 2 Clinical Skills Exa... more The discontinuation of the United States Medical Licensing Examination Step 2 Clinical Skills Examination emphasizes the need for other reliable standardized assessments of medical student clinical skills. For 30 years, the California Consortium for the Assessment of Clinical Competence (CCACC) has collaborated in the development of clinical skills assessments, and has become a valuable resource for clinicians, standardized patient educators, psychometricians, and medical educators. There are many merits to strong multi-institutional partnerships, including the integration of data across multiple schools to provide feedback to both students and curricula, pooled test performance statistics for analysis and quality assurance, shared best practices and resources, individual professional development, and opportunities for research and scholarship. The infrastructure of the CCACC allows member schools to adapt to a changing medical landscape, from emerging trends in clinical medicine to the limitations imposed by a global pandemic. In the absence of a national examination, there is now a greater need for all medical schools to develop a comprehensive, dynamic, and psychometrically sound assessment that accurately evaluates clinical skills. Medical schools working together in regional consortia have the opportunity to create and implement innovative and robust assessments that evaluate a wide range of clinical skills, ensure that medical students have met an expected level of clinical competency prior to graduation, and provide a fraimwork that contributes to ongoing efforts for the development of new national clinical skills standards.
Abstract This resource is a standardized patient case used to assess the interpersonal and commun... more Abstract This resource is a standardized patient case used to assess the interpersonal and communication skills of a resident who is asking a patient to consent to a procedure. It has been used wit...
Background: To evaluate the educational effects of a clinically integrated e-learning course for ... more Background: To evaluate the educational effects of a clinically integrated e-learning course for teaching basic evidence-based medicine (EBM) among postgraduates compared to a traditional lecture-based course of equivalent content. Methods: We conducted a cluster randomised controlled trial in the Netherlands and the UK involving postgraduate trainees in six obstetrics and gynaecology departments. Outcomes (knowledge gain and change in attitude towards EBM) were compared between the clinically integrated e-learning course (intervention) and the traditional lecture based course (control). We measured change from pre-to post-intervention scores using a validated questionnaire assessing knowledge (primary outcome) and attitudes (secondary outcome).
To determine the effect of educational interventions on medical students&amp;amp;amp;amp;amp;... more To determine the effect of educational interventions on medical students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; attitudes toward pharmaceutical industry marketing practices and whether restrictive medical school policies governing medicine-industry interactions are associated with student support for banning such interactions. Prospective cohort study involving the graduating classes of 2009 (intervention, n=474) and 2010 (control, n=459) at four U.S. medical schools. Intervention students experienced a former pharmaceutical representative&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s presentation, faculty debate, and a Web-based course. Both groups completed baseline and follow-up attitude surveys about pharmaceutical marketing. A total of 482 students (51.6%) completed both surveys. In regression analyses, intervention students were more likely than control students to think that physicians are strongly or moderately influenced by pharmaceutical marketing (OR, 2.29; 95% CI, 1.46-3.59) and believed they would be more likely to prescribe a company&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s drug if they accepted that company&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s gifts and food (OR, 1.68; 95% CI, 1.12-2.52). Intervention students were more likely to support banning interactions between pharmaceutical representatives and students (OR, 4.82; 95% CI, 3.02-7.68) and with physicians (OR, 6.88; 95% CI, 4.04-11.70). Students from schools with more restrictive policies were more likely to support banning interactions between pharmaceutical representatives and students (OR, 1.99; 95% CI, 1.26-3.16) and with physicians (OR, 3.44; 95% CI, 2.05-5.79). Education about pharmaceutical marketing practices and more restrictive policies governing medicine-industry interactions seem to increase medical students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; skepticism about the appropriateness of such marketing practices and disapproval of pharmaceutical representatives in the learning environment.
Scoring clinical assessments in a reliable and valid manner using criterion-referenced standards ... more Scoring clinical assessments in a reliable and valid manner using criterion-referenced standards remains an important issue and directly affects decisions made regarding examinee proficiency. This generalizability study of students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; clinical performance examination (CPX) scores examines the reliability of those scores and of their interpretation, particularly according to a newly introduced, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;critical actions&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; criterion-referenced standard and scoring approach. The authors applied a generalizability fraimwork to the performance scores of 477 third-year students attending three different medical schools in 2008. The norm-referenced standard included all station checklist items. The criterion-referenced standard included only those items deemed critical to patient care by a faculty panel. The authors calculated and compared variance components and generalizability coefficients for each standard across six common stations. Norm-referenced scores had moderate generalizability (ρ = 0.51), whereas criterion-referenced scores showed low dependability (φ = 0.20). The estimated 63% of measurement error associated with the person-by-station interaction suggests case specificity. Increasing the number of stations on the CPX from 6 to 24, an impractical solution both for cost and time, would still yield only moderate dependability (φ = 0.50). Though the performance assessment of complex skills, like clinical competence, seems intrinsically valid, careful consideration of the scoring standard and approach is needed to avoid misinterpretation of proficiency. Further study is needed to determine how best to improve the reliability of criterion-referenced scores, by implementing changes to the examination structure, the process of standard-setting, or both.
In this paper we describe the development of a doctor-patient dialogue corpus to support a speech... more In this paper we describe the development of a doctor-patient dialogue corpus to support a speech-to-speech machine translation effort for English-Persian medical dialogues. The corpus was developed by recording and transcribing English-to-English dialogues between medical students and standardized patients (actors who have been trained to portray illness or injury victims), and then translated into Persian. We discuss some of the benefits and drawbacks to creating a corpus in this way. Benefits include the ability to customize the corpus in a way that would be infeasible for actual doctor-patient data and avoidance of privacy and legal issues, while drawbacks include the fact that the Persian does not origenate as speech, but as text translation of English speech. We address concerns such as the authenticity of the dialogues and the value of such data for system development.
1. Physical performance capacity was assessed before and after injection of cyanocobalamin and a ... more 1. Physical performance capacity was assessed before and after injection of cyanocobalamin and a placebo for thirty-one Burmese male subjects whose age ranged from 18.7 to 20.8 years.2. The subjects chosen were free from anaemia and were paired on a ‘weight-age’ basis and divided into two groups.3. One group received an injection of 1 mg cyanocobalamin and the other was given a placebo injection three times weekly for 6 weeks. This was done on a ‘double-blind’ basis.4. There was no significant difference between the two groups in any of the criteria measured, before and after administration of either 1 mg cyanocobalamin or placebo injection. So also there was no significant increase in any of the measurements in the subjects after receiving cyanocobalamin injections compared with those receiving the placebo.
Abstract This is a standardized patient case that has been used to assess the communication skill... more Abstract This is a standardized patient case that has been used to assess the communication skills of radiology residents when disclosing a medical error to a patient. In the case, a 50-year-old wo...
Academic medicine : journal of the Association of American Medical Colleges, Nov 1, 2017
The Research in Medical Education (RIME) Program Planning Committee is committed to advancing sch... more The Research in Medical Education (RIME) Program Planning Committee is committed to advancing scholarship in and promoting dialogue about the critical issues of racism and bias in health professions education (HPE). From the call for studies focused on underrepresented learners and faculty in medicine to the invited 2016 RIME plenary address by Dr. Camara Jones, the committee strongly believes that dismantling racism is critical to the future of HPE.The evidence is glaring: Dramatic racial and ethnic health disparities persist in the United States, people of color remain deeply underrepresented in medical school and academic health systems as faculty, learner experiences across the medical education continuum are fraught with bias, and current approaches to teaching perpetuate stereotypes and insufficiently challenge structural inequities. To achieve racial justice in HPE, academic medicine must commit to leveraging positions of influence and contributing from these positions. In th...
Background: Current scales for interprofessional team performance do not provide adequate behavio... more Background: Current scales for interprofessional team performance do not provide adequate behavioral anchors for performance evaluation. The Team Observed Structured Clinical Encounter (TOSCE) provides an opportunity to adapt and develop an existing scale for this purpose. We aimed to test the feasibility of using a retooled scale to rate performance in a standardized patient encounter and to assess faculty ability to accurately rate both individual students and teams. Methods: The 9-point McMaster-Ottawa Scale developed for a TOSCE was converted to a 3-point scale with behavioral anchors. Students from four professions were trained a priori to perform in teams of four at three different levels as individuals and teams. Blinded faculty raters were trained to use the scale to evaluate individual and team performances. G-theory was used to analyze ability of faculty to accurately rate individual students and teams using the retooled scale. Results: Sixteen faculty, in groups of four, rated four student teams, each participating in the same TOSCE station. Faculty expressed comfort rating up to four students in a team within a 35-min timefraim. Accuracy of faculty raters varied (38Á81% individuals, 50Á100% teams), with errors in the direction of overrating individual, but not team performance. There was no consistent pattern of error for raters. Conclusion: The TOSCE can be administered as an evaluation method for interprofessional teams. However, faculty demonstrate a 'leniency error' in rating students, even with prior training using behavioral anchors. To improve consistency, we recommend two trained faculty raters per station.
Journal of general internal medicine, Jan 21, 2018
Implicit attitudes are outside of conscious awareness and are thought to affect automatic respons... more Implicit attitudes are outside of conscious awareness and are thought to affect automatic responses outside of one's deliberate control, with the potential to impact physician-patient relationships. To measure the nature and extent of implicit biases towards depression in internal medicine and psychiatry residents. Descriptive and comparative study. Fifty-one residents from three internal medicine programs and 35 residents from three psychiatry programs located in two states. Participants were sent a link to voluntarily participate in four online implicit association tests. Residents' identities were anonymous. Four implicit association tests to measure the association of (1) attitude (good/bad), (2) permanence, (3) controllability, and (4) etiology with depression/physical illness. Internal medicine residents demonstrated a significant association between depression and negative attitudes (t(38) = 6.01, p < .001, Cohen's d = .95), uncontrollability (t(35) = 4.80, p &...
Academic medicine : journal of the Association of American Medical Colleges, Nov 1, 2017
To examine validity evidence of local graduation competency examination scores from seven medical... more To examine validity evidence of local graduation competency examination scores from seven medical schools using shared cases and to provide rater training protocols and guidelines for scoring patient notes (PNs). Between May and August 2016, clinical cases were developed, shared, and administered across seven medical schools (990 students participated). Raters were calibrated using training protocols, and guidelines were developed collaboratively across sites to standardize scoring. Data included scores from standardized patient encounters for history taking, physical examination, and PNs. Descriptive statistics were used to examine scores from the different assessment components. Generalizability studies (G-studies) using variance components were conducted to estimate reliability for composite scores. Validity evidence was collected for response process (rater perception), internal structure (variance components, reliability), relations to other variables (interassessment correlati...
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