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Zavodnick J, Doroshow J, Rosenberg S, Banks J, Leiby BE, Mingioni N. Hawks and Doves: Perceptions and Reality of Faculty Evaluations. J Med Educ Curric Dev 2023; 10:23821205231197079. [PMID: 37692558 PMCID: PMC10492463 DOI: 10.1177/23821205231197079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES Internal medicine clerkship grades are important for residency selection, but inconsistencies between evaluator ratings threaten their ability to accurately represent student performance and perceived fairness. Clerkship grading committees are recommended as best practice, but the mechanisms by which they promote accuracy and fairness are not certain. The ability of a committee to reliably assess and account for grading stringency of individual evaluators has not been previously studied. METHODS This is a retrospective analysis of evaluations completed by faculty considered to be stringent, lenient, or neutral graders by members of a grading committee of a single medical college. Faculty evaluations were assessed for differences in ratings on individual skills and recommendations for final grade between perceived stringency categories. Logistic regression was used to determine if actual assigned ratings varied based on perceived faculty's grading stringency category. RESULTS "Easy graders" consistently had the highest probability of awarding an above-average rating, and "hard graders" consistently had the lowest probability of awarding an above-average rating, though this finding only reached statistical significance only for 2 of 8 questions on the evaluation form (P = .033 and P = .001). Odds ratios of assigning a higher final suggested grade followed the expected pattern (higher for "easy" and "neutral" compared to "hard," higher for "easy" compared to "neutral") but did not reach statistical significance. CONCLUSIONS Perceived differences in faculty grading stringency have basis in reality for clerkship evaluation elements. However, final grades recommended by faculty perceived as "stringent" or "lenient" did not differ. Perceptions of "hawks" and "doves" are not just lore but may not have implications for students' final grades. Continued research to describe the "hawk and dove effect" will be crucial to enable assessment of local grading variation and empower local educational leadership to correct, but not overcorrect, for this effect to maintain fairness in student evaluations.
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Affiliation(s)
- Jillian Zavodnick
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | | | - Sarah Rosenberg
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Joshua Banks
- Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia, USA
| | - Benjamin E Leiby
- Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia, USA
| | - Nina Mingioni
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
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Onyeali R, Diemer G, Mingioni N, Dean H. Artist's Statement: My Perspective: Integrated Arts Curriculum to Recognize Burnout. Acad Med 2021; 96:1642. [PMID: 35134025 DOI: 10.1097/acm.0000000000004400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Rose Onyeali
- R. Onyeali is clinical associate in hospital medicine, Department of Medicine, Pennsylvania Hospital, Philadelphia, Pennsylvania. At the time of writing/creating, she was a resident, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Gretchen Diemer
- G. Diemer is senior associate dean for graduate medical education, and professor and vice chair of education, Department of Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania;
| | - Nina Mingioni
- N. Mingioni is director of phase two core clinical rotations and professor, Department of Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Heather Dean
- H. Dean is educational consultant and president, Creative Across the Curriculum Education Consulting, LLC, Madison, Wisconsin
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Dekhtyar M, Park YS, Kalinyak J, Chudgar SM, Fedoriw KB, Johnson KJ, Knoche CF, Martinez L, Mingioni N, Pincavage AT, Salas R, Sanfilippo F, Sozio SM, Weigle N, Wood S, Zavodnick J, Stern S. Use of a structured approach and virtual simulation practice to improve diagnostic reasoning. ACTA ACUST UNITED AC 2021; 9:69-76. [PMID: 34246202 DOI: 10.1515/dx-2020-0160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/25/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In 2015, the National Academy of Medicine IOM estimated that 12 million patients were misdiagnosed annually. This suggests that despite prolonged training in medical school and residency there remains a need to improve diagnostic reasoning education. This study evaluates a new approach. METHODS A total of 285 medical students were enrolled in this 8 center, IRB approved trial. Students were randomized to receive training in either abdominal pain (AP) or loss of consciousness (LOC). Baseline diagnostic accuracy of the two different symptoms was assessed by completing a multiple-choice question (MCQ) examination and virtual patient encounters. Following a structured educational intervention, including a lecture on the diagnostic approach to that symptom and three virtual patient practice cases, each student was re-assessed. RESULTS The change in diagnostic accuracy on virtual patient encounters was compared between (1) baseline and post intervention and (2) post intervention students trained in the prescribed symptom vs. the alternate symptom (controls). The completeness of the student's differential diagnosis was also compared. Comparison of proportions were conducted using χ 2-tests. Mixed-effects regressions were used to examine differences accounting for case and repeated measures. Compared with baseline, both the AP and LOC groups had marked post-intervention improvements in obtaining a correct final diagnosis; a 27% absolute improvement in the AP group (p<0.001) and a 32% absolute improvement in the LOC group (p<0.001). Compared with controls (the groups trained in the alternate symptoms), the rate of correct diagnoses increased by 13% but was not statistically significant (p=0.132). The completeness and efficiency of the differential diagnoses increased by 16% (β=0.37, p<0.001) and 17% respectively (β=0.45, p<0.001). CONCLUSIONS The study showed that a virtual patient platform combined with a diagnostic reasoning framework could be used for education and diagnostic assessment and improved correct diagnosis compared with baseline performance in a simulated platform.
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Affiliation(s)
- Michael Dekhtyar
- Department of Medical Education, University of Illinois, Chicago, IL, USA
| | - Yoon Soo Park
- Department of Health Professions Education Research, Harvard University, Boston, MA, USA
| | - Judy Kalinyak
- i-Human Patients, a Kaplan Company, Sunnyvale, CA, USA
| | - Saumil M Chudgar
- Department of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Kelly Bossenbroek Fedoriw
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Khadeja J Johnson
- Department of Internal Medicine, Medical Education, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Lisa Martinez
- Department of Integrated Medicine Science, Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL, USA
| | - Nina Mingioni
- Department of Internal Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Amber T Pincavage
- Department of Medicine, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Rachel Salas
- Department of Neurology and Nursing at Johns Hopkins Medicine, Baltimore, MD, USA
| | - Fred Sanfilippo
- Pathology and Laboratory Medicine, School of Medicine and Professor of Health Policy and Management, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Stephen M Sozio
- Department of Medicine and Epidemiology, Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nancy Weigle
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Sarah Wood
- Department of Medical Education, Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL, USA
| | - Jillian Zavodnick
- Department of Medicine, Thomas Jefferson University, Philadelphia, USA
| | - Scott Stern
- Department of Medicine, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
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Abstract
IMPORTANCE Women studying medicine currently equal men in number, but evidence suggests that men and women might not be evaluated equally throughout their education. OBJECTIVE To examine whether there are differences associated with gender in either objective or subjective evaluations of medical students in an internal medicine clerkship. DESIGN, SETTING, AND PARTICIPANTS This single-center retrospective cohort study evaluated data from 277 third-year medical students completing internal medicine clerkships in the 2017 to 2018 academic year at an academic hospital and its affiliates in Pennsylvania. Data were analyzed from September to November 2020. EXPOSURE Gender, presumed based on pronouns used in evaluations. MAIN OUTCOMES AND MEASURES Likert scale evaluations of clinical skills, standardized examination scores, and written evaluations were analyzed. Univariate and multivariate linear regression were used to observe trends in measures. Word embeddings were analyzed for narrative evaluations. RESULTS Analyses of 277 third-year medical students completing an internal medicine clerkship (140 women [51%] with a mean [SD] age of 25.5 [2.3] years and 137 [49%] presumed men with a mean [SD] age of 25.9 [2.7] years) detected no difference in final grade distribution. However, women outperformed men in 5 of 8 domains of clinical performance, including patient interaction (difference, 0.07 [95% CI, 0.04-0.13]), growth mindset (difference, 0.08 [95% CI, 0.01-0.11]), communication (difference, 0.05 [95% CI, 0-0.12]), compassion (difference, 0.125 [95% CI, 0.03-0.11]), and professionalism (difference, 0.07 [95% CI, 0-0.11]). With no difference in examination scores or subjective knowledge evaluation, there was a positive correlation between these variables for both genders (women: r = 0.35; men: r = 0.26) but different elevations for the line of best fit (P < .001). Multivariate regression analyses revealed associations between final grade and patient interaction (women: coefficient, 6.64 [95% CI, 2.16-11.12]; P = .004; men: coefficient, 7.11 [95% CI, 2.94-11.28]; P < .001), subjective knowledge evaluation (women: coefficient, 6.66 [95% CI, 3.87-9.45]; P < .001; men: coefficient, 5.45 [95% CI, 2.43-8.43]; P < .001), reported time spent with the student (women: coefficient, 5.35 [95% CI, 2.62-8.08]; P < .001; men: coefficient, 3.65 [95% CI, 0.83-6.47]; P = .01), and communication (women: coefficient, 6.32 [95% CI, 3.12-9.51]; P < .001; men: coefficient, 4.21 [95% CI, 0.92-7.49]; P = .01). The model based on the men's data also included growth mindset as a significant variable (coefficient, 4.09 [95% CI, 0.67-7.50]; P = .02). For narrative evaluations, words in context with "he or him" and "she or her" differed, with agentic terms used in descriptions of men and personality descriptors used more often for women. CONCLUSIONS AND RELEVANCE Despite no difference in final grade, women scored higher than men on various domains of clinical performance, and performance in these domains was associated with evaluators' suggested final grade. The content of narrative evaluations significantly differed by student gender. This work supports the hypothesis that how students are evaluated in clinical clerkships is associated with gender.
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Affiliation(s)
- Deborah J. Gorth
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rogan G. Magee
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sarah E. Rosenberg
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nina Mingioni
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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Chandra S, Laoteppitaks C, Mingioni N, Papanagnou D. Zooming-out COVID-19: Virtual clinical experiences in an emergency medicine clerkship. Med Educ 2020; 54:1182-1183. [PMID: 32502282 PMCID: PMC7300610 DOI: 10.1111/medu.14266] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 05/11/2023]
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Ziring D, Berg K, Mingioni N, Papanagnou D, Vaid U, Herrine S. Sidney Kimmel Medical College at Thomas Jefferson University. Acad Med 2020; 95:S444-S448. [PMID: 33626740 DOI: 10.1097/acm.0000000000003326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Abstract
Individuals with spinal cord injury/disorder (SCI/D) are at high risk for developing secondary osteoporosis. Bone loss after neurologic injury is multifactorial and is dependent on the time from and extent of neurologic injury. Most bone loss occurs in the first year after complete motor paralysis, and fractures occur most commonly in the distal femur and proximal tibia (paraplegic fracture). The 2019 International Society for Clinical Densitometry Position Statement in SCI establishes that dual-energy X-ray absorptiometry (DXA) can be used to both diagnose osteoporosis and predict lower extremity fracture risk in individuals with SCI/D. Pharmacologic treatments used in primary osteoporosis have mixed results when used for SCI/D-related osteoporosis. Ambulation, standing, and electrical stimulation may be helpful at increasing bone mineral density (BMD) in individuals with SCI/D but do not necessarily correlate with fracture risk reduction. Clinicians caring for individuals with spinal cord-related paralysis must maintain a high index of suspicion for fragility fractures and consider referral for surgical evaluation and management.
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Affiliation(s)
- Cristina L Sadowsky
- International Center for Spinal Cord Injury/Kennedy Krieger Institute, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nina Mingioni
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joseph Zinski
- Department of Cell and Developmental Biology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Herrera LN, Khodadadi R, Schmit E, Willig J, Hoellein A, Knudson C, Law K, Mingioni N, Walsh K, Estrada C, Williams W. Which Student Characteristics Are Most Important in Determining Clinical Honors in Clerkships? A Teaching Ward Attending Perspective. Acad Med 2019; 94:1581-1588. [PMID: 31192796 DOI: 10.1097/acm.0000000000002836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To explore faculty perspectives on which characteristics of high-performing clerkship students are most important when determining an honors or top grade designation for clinical performance. METHOD In 2016-2017, the authors surveyed faculty (teaching ward attendings) for internal medicine clerkships and 1 pediatrics clerkship in inpatient settings at 5 U.S. academic medical centers. Survey items were framed around competencies, 24 student characteristics, and attitudes toward evaluation. Factor analysis examined constructs defining high-performing students. RESULTS Of 516 faculty invited, 319 (62%) responded. The top 5 characteristics as rated by respondents were taking ownership, clinical reasoning, curiosity, dependability, and high ethical standards (in descending order). Twenty-one characteristics fit into 3 factors (Cronbach alpha, 0.81-0.87). Clinical reasoning did not fit into a factor. Factor 1 was the most important (mean rating, 8.7/10 [95% confidence interval (CI), 8.6-8.8]). It included professionalism components (ownership, curiosity, dependability, high ethical standards), presentation and interviewing skills, seeking feedback, and documentation. Factor 2 (mean, 7.9 [95% CI, 7.7-8.0]) included aspects of teamwork and communication, such as positive attitude and comments from others. Factor 3 (mean, 7.6 [95% CI, 7.4-7.7]) addressed systems-based thinking, including patient safety and care transitions. CONCLUSIONS Professionalism components, clinical reasoning, and curiosity were among the most important characteristics distinguishing high-performing clerkship students. These may represent behaviors that are highly valued, observable, and relevant to training stage. Improved definition of the characteristics associated with clinical honors would assist students, faculty, and residency program directors when interpreting clinical performance within core clerkships.
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Affiliation(s)
- Lauren Nicholas Herrera
- L.N. Herrera is a second-year internal medicine resident, Department of Medicine, Baylor College of Medicine, Houston, Texas. The author was a fourth-year medical student, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, at the time of the study. R. Khodadadi is a second-year internal medicine resident, Department of Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota. The author was a fourth-year medical student, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, at the time of the study. E. Schmit is a fellow, Pediatric Hospital Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama. J. Willig is associate professor of medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. A. Hoellein is associate dean for student affairs and associate professor of medicine, University of Kentucky College of Medicine, Lexington, Kentucky. C. Knudson is staff physician, Emory University Hospital Midtown, and assistant professor of medicine, Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia. K. Law is program director, J. Willis Hurst Internal Medicine Residency Program, Emory University, and associate vice chair of education and associate professor of medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia. N. Mingioni is staff physician, Thomas Jefferson University Hospital, and clinical associate professor of medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania. K. Walsh is assistant professor of clinical internal medicine, Division of Hematology and Department of Medicine, The Ohio State University, Columbus, Ohio. C. Estrada is staff physician, Birmingham Veterans Affairs Medical Center, and professor of medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. W. Williams is clerkship codirector and assistant professor of medicine, Department of Medicine, University of Alabama at Birmingham, and staff physician, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
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Affiliation(s)
- Elizabeth K Jones
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nina Mingioni
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jason B Lee
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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