The Role of Telemedicine in Glaucoma Care Triggered by the SARS-CoV-2 Pandemic: A Qualitative Study

Purpose

To explore and report on how glaucoma care was impacted by the SARS-CoV-2 pandemic (COVID-19) in New York City (NYC) with a specific emphasis on the role of telemedicine.

Patients and Methods

This was a qualitative, cross-sectional study that engaged glaucoma clinicians in semi-structured interviews to elicit perspectives on telemedicine and patient care experiences during the pandemic. Interview responses were coded and analyzed thematically.

Results

Twenty clinicians participated. Mean participant age was 48.8 ± 12.3 years, and the mean number of years in practice post-glaucoma fellowship was 17.5 ± 12.4 years. Four main themes pertinent to the role of telemedicine triggered by the COVID-19 pandemic were identified: (1) The Need to Ensure Patient and Staff Safety Drove Telemedicine Uptake; (2) Telemedicine Allowed Providers to Address Subjective Complaints; (3) Telemedicine was Discontinued Due To Concerns of Compromised Patient Safety and Measurement Inaccuracy; (4) Technological Advances are Needed for Continued Telemedicine Usage and Uptake in Glaucoma Care. The interviews suggested that telemedicine usage dropped markedly within just a few months during the pandemic, and for most physicians interviewed, telemedicine is no longer part of their clinical practice. Several clinicians reported optimism towards future implementation of telemedicine as the technology develops.

Conclusion

This study identified 4 themes outlining the uptake, application, discontinuation and overall perspectives on telemedicine by glaucoma clinicians. The role of telemedicine, as triggered by the COVID-19 pandemic, may have lasting implications for patient safety, continuity of care, and glaucoma care delivery beyond this public health crisis.

Outcomes of Remote Pathology Instruction in Student Performance and Course Evaluation

The coronavirus disease 2019 (COVID-19) pandemic has disrupted undergraduate medical education, including preclinical class-based courses, by requiring social distancing and essentially eliminating in-person teaching. The aim of this study was to compare student performance and satisfaction before and after implementation of remote instruction in a first-year introductory pathology course. Assessments (3 quizzes, 1 practical exam, and 1 final) were compared between courses given before (January 2020) and during (January 2021) the COVID-19 pandemic, in terms of mean scores, degree of difficulty, and item discrimination, both overall and across different question types. Students’ evaluations of the course (Likert scale-based) were also compared between the 2 years. Significantly higher mean scores were observed during remote instruction (compared to the prior, in-person year) on verbatim-repeated questions (94.9 ± 8.8 vs 89.4 ± 12.2; P = .002) and on questions incorporating a gross specimen image (88.4 ± 7.5 vs 84.4 ± 10.3; P = .007). The percentage of questions that were determined to be moderate/hard in degree of difficulty and good/very good in item discrimination remained similar between the 2 time periods. In the practical examination, students performed significantly better during remote instruction on questions without specimen images (96.5 ± 7.0 vs 91.2 ± 15.2; P = .004). Finally, course evaluation metrics improved, with students giving a higher mean rating value in each measured end point of course quality during the year of remote instruction. In conclusion, student performance and course satisfaction generally improved with remote instruction, suggesting that the changes implemented, and their consequences, should perhaps inform future curriculum improvements.

Key Insights From the Development and Implementation of a Novel Virtual Interview Process for Medical School Admissions During the COVID-19 Pandemic

PROBLEM

During the COVID-19 pandemic, medical schools have offered a virtual application process. Minimal literature is available to guide best practices.

APPROACH

The Icahn School of Medicine at Mount Sinai (ISMMS) implemented a completely virtual interview (VI) process in April/May 2020. Large-group sessions for applicants, interviews with applicants, and ISMMS Admissions Committee meetings occurred via Zoom (Zoom Video Communications, Inc., San Jose, California). Large-group sessions and committee meetings occurred via communal conference calls, while one-on-one, semistructured interviews occurred in individual breakout rooms. ISMMS offered live, virtual question-and-answer sessions with students and faculty, plus digital resources describing program features. After the interview day, applicants and interviewers were invited to complete anonymous surveys regarding their experiences with and perspectives of VI.

OUTCOMES

Of 125 applicants and 20 interviewers, 99 (79%) and 18 (90%), respectively, completed at least part of the survey. Of the applicants, 85/95 (89%) agreed VI met or exceeded expectations, with many praising the day's organization and convenience, and 71/95 (75%) agreed they received a sufficient sense of the student body. A minority (n = 39/95 [41%]) felt limited in their ability to learn about the institution (commonly related to their inability to tour campus), and a majority (n =74/91 [81%]) would have preferred an in-person interview. Most interviewers felt comfortable assessing applicants' verbal communication skills (n = 13/16 [81%]), and most (n = 12/17 [71%]) felt VI should be an option for future applicants.

NEXT STEPS

VI, likely to be a temporary-but-universal fixture of upcoming application cycles, may benefit applicants and interviewers alike by saving resources and diversifying those involved. Next steps are developing programming that will permit applicants to virtually explore the institution and connect more with current students. Future research should evaluate potential bias in VI to ensure an equitable application process for all.

Ophthalmology Services at Student-Run Free Clinics: A National Survey

IMPORTANCE

Student-run free clinics (SRFCs) primarily service the uninsured and are a unique way for medical students to gain hands-on exposure to ophthalmology. The free clinic model takes many different forms- some with episodic and longitudinal models-- and this is mirrored in corresponding eye services.

OBJECTIVE

To describe SRFC ophthalmology services nationwide.

DESIGN

This was a telephone survey study administered from June through July of 2018.

SETTING

This study surveyed medical school SRFC clinics across the United States.

PARTICIPANTS

Survey request was sent to 19 SRFCs previously identified as having ophthalmology services via internet search. Fourteen SRFCs (73%) participated; participants were either student clinic leaders or medical directors. One respondent no longer had a distinct eye clinic so was excluded from relevant results.

MAIN OUTCOME AND MEASURE

Characteristics of ophthalmology SRFCs including participants, frequency of sessions, common diagnoses treated, and challenges encountered were assessed through this survey.

RESULTS

On average, each SRFC provided 5.15 hours per month of ophthalmology services. The mean number of medical students involved per session was 8.7. Lack of infrastructure to ensure adequate patient follow-up and faculty recruiting were cited as the main challenges in providing ophthalmology services. Most SRFC leaders indicated exposure to ophthalmology and practice with the exam as the main experiences that students sought and achieved. The most common conditions treated were refractive error (92.3%) and diabetic retinopathy (69.2%).

CONCLUSION

There are a small number of SRFCs that have ophthalmology services, and they share common features in terms of participants, staffing, and, barriers to sustainability. Ophthalmology services at SRFCs offer a unique venue for medical students to gain exposure to an under-represented field in medical school curricula. The growth of this critical venue for medical student training could be enhanced by recruitment strategies aimed at ophthalmology faculty with a strong interest in service and teaching.

Impact of Near-Peer Education in a Student-Run Free Ophthalmology Clinic on Medical Student Teaching Skills

OBJECTIVE

To determine the impact of near-peer teaching experiences in the ophthalmology branch of the East Harlem Health Outreach Program (EHHOP), a student-run clinic, on teaching skills of fourth-year medical student Teaching Seniors (TS).

DESIGN

Mixed-methods observational study, including online survey and telephone interview.

SETTING

Student-run ophthalmology clinic affiliated with the Icahn School of Medicine at Mount Sinai and Mount Sinai Hospital, a tertiary-care center in New York, NY.

PARTICIPANTS

All EHHOP TS alumni from 2014 to 2019 were eligible for inclusion in our study. All 14 alumni participated in the survey, and 8 participated in the follow-up interview.

METHODS

EHHOP ophthalmology TS alumni were surveyed via an online survey and subsequent, optional, individual telephone interview. The web survey queried former TS on the impact of EHHOP ophthalmology experiences on self-reported teaching skills and comfort with teaching. Quantitative analysis of survey questions and qualitative analysis of telephone responses was performed and analyzed for themes.

RESULTS

Majority of participants reported increased comfort teaching ophthalmology concepts, teaching the slit-lamp exam, and serving as mentors as a result of their experience. Qualitative analysis of telephone interviews revealed 4 major themes: (1) TS were a self-selected group of individuals with prior interest in teaching, (2) Teaching experiences in EHHOP had a positive impact in many teaching-related domains, (3) TS perceptions of teaching skills gained did not necessarily align with junior students' perceptions of teaching received, and (4) despite increased confidence and satisfaction with teaching experiences, TS desired more formal instruction in teaching.

CONCLUSIONS

While TS perceptions of teaching skills gained in EHHOP ophthalmology were overwhelmingly positive, TS still desired formal instruction in teaching. Additionally, the effectiveness of near-peer education in a subspecialty like ophthalmology, with limited formal curricular time, may be more effective later in training, when a more solid foundation of knowledge is acquired.

Medical Students' Experiences of Unplanned Leaves of Absence

CONTEXT

Many medical students take leaves of absence (LOA), both planned and unplanned. Unplanned LOA relate to personal or academic situations which arise and create the need for a student to temporarily suspend their medical education. This can be a high-stakes decision for the student and the school. However, there is a dearth of published literature regarding the experience of students who take a LOA to guide decision-makers. The aim of this study is to examine the experiences of medical students who took an unplanned LOA and subsequently returned to school.

METHODS

A phenomenological analysis of semi-structured interviews of eight medical students returning from unplanned LOAs at two urban, academic medical centers was conducted. Transcripts were analyzed and themes were coded, and consensus regarding all themes was reached through an iterative process.

RESULTS

Eight themes were identified. Some important concerns included having a sense of choice to take a LOA, the burden of logistical issues, clear communication from administrators, and worries about stigma upon return. The students retrospectively viewed their LOA as helpful and their subsequent return as less stressful than feared.

DISCUSSION

The experiences of these students indicate several primary concerns that medical schools can anticipate in order to support students considering or taking an unplanned LOA. The more information a school is able to share with these students, the greater the potential to reduce anxiety at this vulnerable stage. Future research should attempt to explore these findings in a larger sample and correlate them with academic and other outcomes.

Investigating a Quantitative Measure of Student Self-authorship for Undergraduate Medical Education

CONSTRUCT

In this study, the authors investigated the validity of a quantitative measure of self-authorship among medical students. Self-authorship is a cognitive-structural theory incorporating the ability to define one's beliefs, identity, and social relations to operate in a complex, ambiguous environment.

BACKGROUND

Competency-based medical education (CBME) provides learners with the opportunity to self-direct their education at an appropriate pace to develop and exhibit required behaviors while incorporating functioning relationships with supervisors and trainers. Students must develop skills to adjust and succeed in this educational climate. Self-authorship is a theoretical lens that is relevant to identifying the development of the skills necessary to succeed in a CBME curriculum. Understanding the level of attained self-authorship by medical students can provide important information about which professional characteristics are more prevalent among those who are more self-authored and about how students succeed in medical school. Although there are calls in the extant literature for the application of self-authorship in medical education, there is no quantitative measure to assess its development among medical students.

APPROACH

The authors developed a survey to measure self-authorship, including a free text question regarding the thought process around a hypothetical ethical situation during training. Data were collected in 2014 and 2015 from undergraduate medical students and analyzed using factor analysis and qualitative analysis of the free text. Validity evidence was sought regarding content, internal structure, and relationships to other variables.

RESULTS

Analysis supports the use of a 22-item instrument to assess 3 constructs of self-authorship: asserting independence and autonomy, knowledge processing, and sense of self in ethical situations. Content analysis of text responses supported the ability of the instrument to separate development, or a lack thereof, of self-authorship.

CONCLUSIONS

The authors identified an instrument that measures multidimensional, higher-order characteristics that intersect with self-authorship. This instrument can be useful at a macro level for curricular and student assessment of self-authorship. Development of these characteristics can help foster success in a CBME environment and support curricular efforts in this regard. Understanding a student's level of self-authorship can help identify areas for support as well as allow for comparisons of different student characteristics.

It's Time for Medical Schools to Introduce Climate Change Into Their Curricula

Climate change presents unprecedented health risks and demands universal attention to address them. Multiple intergovernmental organizations, health associations, and health professions schools have recognized the specific importance of preparing physicians to address the health impacts of climate change. However, medical school curricula have not kept pace with this urgent need for targeted training.The authors describe the rationale for inclusion of climate change in medical education and some potential pathways for incorporating this broad topic into physician training and continuing medical education. Reasons include the magnitude and reach of this transboundary issue, the shared responsibility of the U.S. health care sector as a major contributor to greenhouse gas emissions, and the disproportionate effects of climate change on vulnerable populations. The integration of climate-change-related topics with training of essential physician skills in a rapidly changing environment is feasible because many health topic areas already exist in medical school curricula in which climate change education can be incorporated. To fully integrate the health topics, underlying concepts, and the needed clinical and system-wide translations, content could be included across the scope of training and into continuing medical education and faculty development. The authors provide examples of such an approach to curricular inclusion.

Parental Knowledge of AAP Juice Guidelines Is Associated With Parent and Children's Consumption of Juice and Sugar-Sweetened Beverages in an Underserved Population

This study tested whether parental knowledge of the American Academy of Pediatrics' (AAP) recommendations on juice limits for children is associated with decreased consumption of juice and sugar-sweetened beverages (SSBs) among parents and children. Fifty-two parents with children 2 to 12 years old in a resident continuity clinic in East Harlem, New York, completed a survey asking about children's and parent's practice and quantitative consumption of juice and SSBs as well as parental knowledge of the AAP recommendations on juice limits. Parent's total daily consumption of juice and SSBs ( P < .01), parent's score on the test of AAP guidelines ( P = .04), and parent's post-high school education ( P = .01) were associated with children's juice and SSB consumption in a multivariable linear regression model. Children's consumption of juice and SSBs is positively associated with parental consumption of juice and SSBs and negatively associated with parental formal education and knowledge of the AAP recommendations on juice limits.

Using Standardized Patients to Assess Hospitalist Communication Skills

Standardized patients (SPs) have been used to assess communication skills in undergraduate medical education, but no published studies describe the use of SPs in assessing practicing physicians on their communication skills. In this study, done with 23 hospitalists at a large urban academic hospital, 3 SP scenarios, daily rounding, discharge, and interacting with a difficult patient, were created. After each encounter, each hospitalist reviewed their videotape and received feedback from their SP based on a checklist that had 3 core domains: Listen, Courtesy and Respect, and Explain. These domains correlated with the 3 questions in the Hospital Consumer Assessment of Healthcare Providers and Systems survey that relate to doctors. Hospitalists performed significantly better in the Listen domain, with a mean percent adequate score of 90.2% (95% confidence interval [CI], 72.2%-100%; 𝑃 < 0.05), and significantly worse in the Explain domain, with a mean percent adequate score of 65.0% (95% CI, 49.2%-83.6%; 𝑃 < 0.05). Checklist items in the Explain domain that were most commonly not performed adequately were summarizing information at the end of the encounter, teach back, encouraging additional questions, managing team and self-up, setting expectations about length of stay, and timing of tests. After the SP encounters, hospitalists felt more confident in their communication skills. SPs can be used to assess and give feedback to hospitalists and increase confidence in several aspects of communication.

The Effect of Burnout on Medical Errors and Professionalism in First-Year Internal Medicine Residents

BACKGROUND

Burnout is a common issue in internal medicine residents, and its impact on medical errors and professionalism is an important subject of investigation.

OBJECTIVE

To evaluate differences in medical errors and professionalism in internal medicine residents with and without burnout.

METHODS

A single institution observational cohort study was conducted between June 2011 and July 2012. Burnout was measured using the Maslach Burnout Inventory to generate subscores for the following 3 domains: emotional exhaustion, depersonalization, and sense of personal accomplishment. By convention, burnout was defined as a high emotional exhaustion or depersonalization subscore. Medication prescription error rate was the chosen measure of medical errors. Professionalism was measured cumulatively through examining discharge summaries completed within 48 hours, outpatient charts completed within 72 hours, and the average time to review outpatient laboratory tests.

RESULTS

Of a total of 54 eligible first-year residents, 53 (98%) and 32 (59%) completed the initial and follow-up surveys, respectively. Residents with year-end burnout had a lower rate of medication prescription errors (0.553 versus 0.780, P = .007). Discharge summaries completed within 48 hours of discharge (83.8% versus 84.0%, P = .93), outpatient charts completed within 72 hours of encounter (93.7% versus 94.3%, P = .31), and time (minutes) to review outpatient laboratory test results (72.3 versus 26.9, P = .28) were similar between residents with and without year-end burnout.

CONCLUSIONS

This study found a small decrease in medical errors in residents with year-end burnout compared to burnout-free residents and no difference in selected measures of professionalism.

Postpartum Depression in a General Pediatric Practice: Practical Methods for Improving Screening and Referrals

Postpartum depression (PPD) is a common problem in new mothers. Untreated PPD is associated with behavioral and developmental problems in children. We examined the effects of an educational session about PPD and modification of the electronic medical record (EMR) on providers' screening for PPD. An education session was given to the physicians and pre and post surveys compared comfort and self-reported screening. Following the EMR change, a retrospective chart review was conducted from three time periods: group 1-before the conference, group 2-after the conference but before EMR change, and group 3-after screening in the EMR. Documented screening increased from 0% in group 1, to 2% in group 2, to 74% in group 3 (P < .001). Ten percent screened positive, but only 14% had documented referrals to a provider for treatment. The combination of provider education and screening questions integrated into the EMR enhanced PPD screening rates among physicians in a busy practice.

A Randomized Controlled Trial to Decrease Job Burnout in First-Year Internal Medicine Residents Using a Facilitated Discussion Group Intervention

Background Burnout is common in internal medicine (IM) trainees and is associated with depression and suboptimal patient care. Facilitated group discussion reduces burnout among practicing clinicians. Objective We hypothesized that this type of intervention would reduce incident burnout among first-year IM residents. Methods Between June 2013 and May 2014, participants from a convenience sample of 51 incoming IM residents were randomly assigned (in groups of 3) to the intervention or a control. Twice-monthly theme-based discussion sessions (18 total) led by expert facilitators were held for intervention groups. Surveys were administered at study onset and completion. Demographic and personal characteristics were collected. Burnout and burnout domains were the primary outcomes. Following convention, we defined burnout as a high emotional exhaustion or depersonalization score on the Maslach Burnout Inventory. Results All 51 eligible residents participated; 39 (76%) completed both surveys. Initial burnout prevalence (10 of 21 [48%] versus 7 of 17 [41%], P = .69), incidence of burnout at year end (9 of 11 [82%] versus 5 of 10 [50%], P = .18), and secondary outcomes were similar in intervention and control arms. More residents in the intervention group had high year-end depersonalization scores (18 of 21 [86%] versus 9 of 17 [53%], P = .04). Many intervention residents revealed that sessions did not truly free them from clinical or educational responsibilities. Conclusions A facilitated group discussion intervention did not decrease burnout in resident physicians. Future discussion-based interventions for reducing resident burnout should be voluntary and effectively free participants from clinical duties.

The impact of duty hours restrictions on job burnout in internal medicine residents: a three-institution comparison study

PURPOSE

Internal medicine (IM) residents commonly develop job burnout, which may lead to poor academic performance, depression, and medical errors. The extent to which duty hours restrictions (DHRs) can mitigate job burnout remains uncertain. The July 2011 DHRs created an opportunity to measure the impact of decreased work hours on developing burnout in IM residents.

METHOD

A survey was administered twice to first-year IM residents at three academic medical centers between June 2011 and July 2012. To estimate the impact of the 2011 DHRs, data from this cohort, including demographics, sleepiness, hospital-based patient service characteristics, and burnout measures, were compared with data from 2008-2009 from first-year IM residents at the same institutions.

RESULTS

Of eligible residents, 128/188 (68%) from the 2011-2012 cohort and 111/180 (62%) from the 2008-2009 cohort completed both surveys. Year-end burnout prevalence (92/123 [75%] versus 91/108 [84%], P = .08) and incidence (59/87 [68%] versus 55/68 [81%], P = .07) did not differ significantly between cohorts. There was no difference in year-end prevalence of excessive Epworth sleepiness (72/122 [59%] versus 71/108 [66%], P = .29) between cohorts; however, a greater percentage of residents who developed burnout in the 2011-2012 cohort reported caring for > 8 patients on their service (2011-2012 versus 2008-2009) (29/59 [49%] versus 5/34 [15%], P < .01).

CONCLUSIONS

Job burnout and self-reported sleepiness in IM resident physicians were unchanged after the 2011 DHRs at three academic institutions. Further investigation into the determinants of burnout can inform effective interventions.

A patient safety and transitions of care curriculum for third-year medical students

The elderly are the most vulnerable to adverse events during and after hospitalization. This study sought to evaluate the effectiveness of a curriculum on patient safety and transitions of care for medical students during an Internal Medicine-Geriatrics Clerkship on students' knowledge, skills, and attitudes. The curriculum included didactics on patient safety, health literacy, discharge planning and transitions of care, and postdischarge visits to patients. Analysis of pre- and postassessments showed afterwards students were significantly more comfortable assessing a patient's health literacy and confident performing a medication reconciliation, providing education regarding medications, and identifying barriers during transitions. More students were able to identify the most common source of adverse events after discharge (86% vs. 62% before), risk factors for low health literacy (28% vs. 14%), and ways to assess a patient's health literacy (14% vs. 2%). It was feasible to implement a postdischarge visit assignment in an urban tertiary care setting and only required on average of approximately an one and one half hours for students to complete.

Medical students' experiences with authorship in biomedical research: a national survey

PURPOSE

To explore authorship issues related to medical students' primary research projects, assess medical students' knowledge about authorship issues in biomedical research, and determine their interest in learning about authorship guidelines.

METHOD

In 2011, the authors developed and conducted an electronic survey of 243 U.S. medical students who attended an educational event at the National Institutes of Health as part of their funded, yearlong research fellowship programs. The authors then analyzed the results using descriptive statistics.

RESULTS

Of 243 students, 152 (63%) responded. Most (120/151; 79%) had completed or were in the process of writing a manuscript based on their projects. Of these, most (95/119; 80%) wrote the entire manuscript independently or with guidance. Whereas almost two-thirds (99/152; 65%) indicated that expectations and criteria for authorship were clarified for them, 26% (40/152) indicated that they were not. Most students (108/118; 92%) were in the authorship position they expected and had no concerns about who the other authors were (91/119; 77%). Of those with concerns, 52% (11/21) did not raise the issue for fear of challenging their mentor. Two-thirds (95/145; 66%) never received formal training in authorship guidelines, and 41% (42/103) believed such training would be valuable.

CONCLUSIONS

Although a majority of students had conversations about authorship and were clear about the guidelines for ethical authorship, additional work is needed. The authors recommend that academic institutions develop a menu of options for teaching students about this important area in research ethics.

The incidence and predictors of job burnout in first-year internal medicine residents: a five-institution study

PURPOSE

Job burnout is prevalent among U.S. internal medicine (IM) residents and may lead to depression, suboptimal patient care, and medical errors. This study sought to identify factors predicting new burnout to better identify at-risk residents.

METHOD

The authors administered surveys to first-year IM residents at five institutions twice between June 2008 and June 2009, linking individual pre- and postresponses. Surveys measured job burnout, sleepiness, personality traits, and other characteristics. Burnout was defined using the most commonly identified definition and another stricter definition.

RESULTS

Of 263 eligible residents, 185 (70%) completed both surveys. Among 114 residents who began free of burnout and completed both surveys, 86 (75%) developed burnout, with no differences across institutions. They were significantly more likely to report a disorganized personality style (9 versus 0; 11% versus 0%; P = .019) and less likely to report receiving regular performance feedback (34 versus 13; 63% versus 87%; P = .057). Using a stricter definition, 50% (78/156) of residents developed burnout. They were less likely to plan to pursue subspecialty training (49 versus 63; 78% versus 93%; P = .016) or have a calm personality style (59 versus 70; 77% versus 90%; P = .029). There were no significant associations between burnout incidence and duty hours, clinical rotation, demographics, social supports, loan debt, or psychiatric history.

CONCLUSIONS

This study identified a high burnout incidence. The associations observed between burnout incidence and personality style, lack of feedback, and career choice uncertainty may inform interventions to prevent burnout and associated hazards.

The prevalence and correlations of medical student burnout in the pre-clinical years: a cross-sectional study

Burnout is a psychological syndrome of emotional exhaustion, depersonalization, and impaired personal accomplishment induced by repeated workplace stressors. Current research suggests that physician burnout may have its origins in medical school. The consequences of medical student burnout include both personal and professional distress, loss of empathy, and poor health. We hypothesized that burnout occurs prior to the initiation of the clinical years of medical education. This was a cross-sectional survey administered to third-year medical students at the Mount Sinai School of Medicine (MSSM) in New York, New York (a traditional-style medical school with a marked division between pre-clinical and clinical training occurring at the beginning of the third year). Survey included an instrument used to measure job burnout, a sleep deprivation screen, and questions related to demographic information, current rotation, psychiatric history, time spent working/studying, participation in extracurricular activities, social support network, autonomy and isolation. Of the 86 medical students who participated, 71% met criteria for burnout. Burnt out students were significantly more likely to suffer from sleep deprivation (p = 0.0359). They were also more likely to disagree with the following statements: "I have control over my daily schedule" (p = 0.0286) and "I am confident that I will have the knowledge and skills necessary to become an intern when I graduate" (p = 0.0263). Our findings show that burnout is present at the beginning of the third year of medical school, prior to the initiation of the clinical years of medical training. Medical student burnout is quite common, and early efforts should be made to empower medical students to both build the knowledge and skills necessary to become capable physicians, as well as withstand the emotional, mental, and physical challenges inherent to medical school.

Regulation of medical student work hours: a national survey of deans

PURPOSE

Because of the impact of resident duty hours on resident and medical student education, it is important to determine curriculum deans' opinions toward and current status of student work hours regulations.

METHOD

In 2008, the authors electronically surveyed the curriculum deans at the 126 U.S. medical schools accredited by the Liaison Committee on Medical Education (LCME) regarding student work hours at their schools.

RESULTS

Sixty-six respondents (82%) had a written policy restricting their students' work hours, and in 63% of these, the policy also extended to students visiting their institution. Policies applied to mandatory and elective (84%) or only mandatory (16%) rotations. About half the respondents supported a universal policy across medical schools, but of those who supported a policy, there was an equal split between whether individual schools or the LCME should create the policy. Deans felt strongly (>80%) that student well-being would be improved by work hours regulation, yet 48% noted that it would negatively affect scheduling required clerkship activities. Fifty-four percent supported the Accreditation Council for Graduate Medical Education work hours policy for students, and most (82%) felt that students should work no more than 80 hours/week. Students are always supervised, yet extended work hours can affect learning and patient and team interactions.

CONCLUSIONS

Without a mandate, many schools have created policies to restrict student work hours. This study describes the current status and offers an opportunity for consensus building around this important issue.

Taking note of the perceived value and impact of medical student chart documentation on education and patient care

PURPOSE

To determine the extent of restrictions to medical student documentation in patients' records and the opinions of medical education leaders about such restrictions' impact on medical student education and patient care.

METHOD

Education deans (n = 126) of medical schools in the United States and Canada were surveyed to determine policies regarding placement of medical student notes in the patient record, the value of medical students' documentation in the medical record, and the use of electronic medical records (EMRs) for patient notes. The instrument was a 23-item anonymous Web survey.

RESULTS

Seventy-nine deans responded. Over 90% believed student notes belong in medical records, but only 42% had a policy regarding this. Ninety-three percent indicated that without student notes, student education would be negatively affected. Fewer (56%) indicated that patient care would be negatively affected. Most thought limiting students' notes would negatively affect several other issues: feeling a part of the team (96%), preparation for internship (95%), and students' sense of involvement (94%). Half (52%) reported that fourth-year students could place notes in paper charts at "all" affiliated hospitals, and 6% reported that fourth-year students could do so at "no" hospitals.

CONCLUSIONS

Although students' ability to enter notes in patients' records is believed to be important for student education, only about half of all hospitals allow all students' notes in the EMR. Policies regarding placement of student notes should be implemented to ensure students' competency in note writing and their value as members of the patient care team.

Prevalence of resident burnout at the start of training

BACKGROUND

Job burnout is characterized by emotional exhaustion, depersonalization, and feelings of decreased personal accomplishment, and it may be linked to depression and suboptimal patient care. Burnout among American internal medicine residents ranges between 55% and 76%.

PURPOSE

We aim to further characterize burnout prevalence at the start of residency.

METHODS

Between 2006 and 2007, all incoming internal medicine interns at Mount Sinai Hospital and Elmhurst Hospital Center were asked to complete a survey at orientation. The survey included an instrument to measure burnout, a sleep deprivation screen, a personality inventory and demographic information. Comparison tests were conducted to identify statistically significant differences.

RESULTS

The response rate was 94% (145/154). Overall burnout prevalence was 34% (50/145). Interns self-identifying as anxious (51% vs. 28%, p= .01) or disorganized (60% vs. 31%, p= .03) were more likely to have burnout.

CONCLUSIONS

Our study found higher levels of burnout among beginning medical interns than reported in the literature. Burnout correlated with some self-reported personality features.

The use of standardised patients to assess clinical competence: does practice make perfect?

CONTEXT

The use of standardised patients (SPs) is now an integral component of the United States Medical Licensing Examination (USMLE). This new requirement has caused more schools to include SP examinations (SPEs) in their curricula. This study reviews the effect of prior experience with SPs in a medical school curriculum on SPE pass rates.

METHODS

This study reviewed the mean scores and pass rates on a 4-station SPE, comparing the performance of 121 US medical school graduates (USMGs) with that of 228 international medical graduates (IMGs). The analysis of USMGs' performance was based upon whether the resident had had previous exposure to an SPE during medical school, while the analysis of IMGs' performance was based upon whether the IMG had taken the Clinical Skills Assessment (CSA) for certification by the Education Commission for Foreign Medical Graduates. A distinction was made between those who had received prior exposure at Mount Sinai School of Medicine's Morchand Center, where the cases utilised were identical to those of the SPE, and those who had gained exposure elsewhere.

RESULTS

Neither the mean scores of the IMGs and the USMGs nor the percentage who failed was significantly different relative to prior exposure to SPs.

CONCLUSION

Prior exposure to SPs does not appear to have a positive effect on subsequent performance on an SPE unless similar or identical cases are used. However, the type and site of prior exposure limited the influence of the review. In view of the increased use of SPEs in medical schools, the content of prior exposure needs to be more fully established.