Personalised medicine: a healing application within comorbid PTSD and mTBI military patient sample with a particular focus on special operators

Personalised medicine is replacing prototypical medical care. Personalised medicine focuses on enhancing patients' functioning and preventing future negative impacts of both medical disease and psychological disorders, and unfolds uniquely for each individual. The military special forces community is a group at higher risk for physical trauma, for example, traumatic brain injuries, as well as psychosocial stressors and traumas associated with combat, high operational tempos and sleep deprivation. From a system's cost-benefit perspective and resonating with community norms of resiliency, personalised medicine offers unique innovative treatments for special operators. In this article, we outline the successful applications of personalised medicine via the multidisciplinary treatment of special operators with comorbid conditions (primarily mild traumatic brain injury and post-traumatic stress disorder).

Extending growth curves: a trajectory monitoring approach to identification and interventions in struggling medical student learners

Given gaps in both identifying and providing targeted interventions to struggling learners, the purpose of this study is to both improve rapid identification and to improve individualized academic advising for learners using this visual representation of performance. Across three graduating classes, individual growth curves were calculated for each student on National Board of Medical Examiners customized assessments during the pre-clerkship period using their deviation from the class average at each assessment point. These deviation scores were cumulatively summed over time and were regressed onto the sequence of exams. We analyzed the difference between the regression slopes of those students placed on Academic Probation (AP) versus not, as well as differences in slopes based on the timing of when a struggling learner was placed on AP to explore learner trajectory after identification. Students on AP had an average growth slope of - 6.06 compared to + 0.89 for those not on AP. Findings also suggested that students who were placed on AP early during pre-clerkship showed significant improvement (positive changes in trajectory) compared to students identified later in the curriculum. Our findings suggest that earlier academic probation and intervention with struggling learners may have a positive effect on academic trajectory. Future research can better explore how academic trajectory monitoring and performance review can be regularly used in advising sessions with students.

Understanding Excellence: a Qualitative Analysis of High-Performing Learner Study Strategies

INTRODUCTION

Remediation in medical education tends to focus on the struggling learner. However, understanding successful learners may provide valuable insights to problematic academic behavior. This study explored core study strategies reported by high-performing medical school students.

METHOD

In the Fall of 2018 and 2019, high-performing first- and second-year medical students, defined as those who had performed over 90% on a national standardized assessment, were requested via e-mail to describe the study strategies that they believe contributed to their success. Student responses were analyzed using a template-driven approach, which drew upon common frameworks from cognitive learning theory.

RESULTS

Thirty-seven high-performing students provided brief unstructured descriptions of their study strategies. Retrieval practice-the cognitive learning strategy of attempting to draw out information to active recall, typically through means of self-quizzing, practice questions, or flashcards-was the most commonly endorsed strategy, followed by spaced repetition. Use of outside commercial resources was commonly referenced, and approximately one-third endorsed a perception that some form of regularly practiced self-care contributed to their academic success.

DISCUSSION

Retrieval practice, particularly combined with some form of spaced repetition, is often attributed as contributing to the success of high-performing learners. The use of commercial resources bears further exploration and consideration. Finally, the finding that self-care was identified as a contribution to academic performance goes beyond a focus on self-care solely for medical student well-being. This is an important distinction for both medical education and future research in this area.

Early identification of struggling learners: using prematriculation and early academic performance data

INTRODUCTION

A perennial difficultly for remediation programmes in medical school is early identification of struggling learners so that resources and assistance can be applied as quickly as is practical. Our study investigated if early academic performance has predictive validity above and beyond pre-matriculation variables.

METHODS

Using three cohorts of medical students, we used logistic regression modelling and negative binomial regression modelling to assess the strength of the relationships between measures of early academic performance and outcomes-later referral to the academic review and performance committee and total module score.

RESULTS

We found performance on National Board of Medical Examiners (NBME) exams at approximately 5 months into the pre-clerkship curriculum was predictive of any referral as well as the total number of referrals to an academic review and performance committee during medical school (MS)1, MS2, MS3 and/or MS4 years.

DISCUSSION

NBME exams early in the curriculum may be an additional tool for early identification of struggling learners.

Untying the Gordian knot: remediation problems in medical schools that need remediation

This position paper discusses on-going academic remediation challenges within the field of medical education. More specifically, we identify three common contemporary problems and propose four recommendations to strengthen remediation efforts. Selecting or determining what type of remediation is needed for a particular student is akin to analyzing a Gordian knot with individual, institutional and systemic contributors. More emphasis, including multi-institutional projects and research funding is needed. Recommendations regarding language use and marketing of such programs are given.

A Revision of the Extended Version of the Objective Measure of Ego Identity Status: An Identity Instrument for Use with Late Adolescents

Previous work with the Extended Objective Measure of Ego Identity Status (EOM-EIS) has improved the assessment ability of the instrument. However, the interpersonal items were less consistent in ego identity classification than the ideological items. The interpersonal items were revised and, using a sample of 106 college students, tested to establish reliability and validity. The results from the revised EOM-EIS interpersonal and original ideological items were compared with scores on identity, intimacy, selfacceptance, authoritarian and social desirability scales. Convergent, discriminate, concurrent, and predictive validity and internal consistency (reliability) analyses demonstrate the interpersonal and ideological items can adequately measure identity status during late adolescence.