Browsing by Author "Vu, T. Robert"

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    Drivers of Application Inflation: a National Survey of Internal Medicine Residents
    (Elsevier, 2018) Angus, Steven V.; Williams, Chris M.; Kwan, Brian; Vu, T. Robert; Harris, Linda; Muntz, Marty; Pereira, Anne; Medicine, School of Medicine
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    Experiences of Female and Male Medical Students With Death, Dying, and Palliative Care: One Size Does Not Fit All
    (Sage, 2018-06) Hoffman, Leslie A.; Mehta, Rakesh; Vu, T. Robert; Frankel, Richard M.; Anatomy and Cell Biology, School of Medicine
    Background: Medical students learn about death, dying, and palliative care (DDPC) through formal curricular offerings and informal clinical experiences; however, the lessons learned in the clinic may be at odds with the formal curriculum. Reflective writing is a means for students to “bracket” their DDPC experiences and reconcile conflicts between the formal and informal curriculum. Objectives: The aim of this study is to compare the level of reflection demonstrated in medical students’ narratives on DDPC with other experiences and to examine the domains of professionalism that students perceive to be prevalent in their DDPC experiences. Methods: Third-year medical students submitted professionalism narratives during their internal medicine clerkship. We identified a subset of narratives related to DDPC (n = 388) and randomly selected control narratives (n = 153). We assessed the level of reflection demonstrated in the narratives using a validated rubric and analyzed the professionalism domains that students identified as relevant to their experience. Results: There was no difference in reflective level between DDPC and control narratives. Within the DDPC group, female students demonstrated higher reflection (2.24 ± 0.71) than male students (2.01 ± 0.77; P < .001). Caring, compassion and communication, and honor and integrity were prominent among DDPC narratives. More females identified caring, compassion, and communication as relevant to their DDPC experiences, whereas more males identified altruism. Conclusion: Males and females have different perceptions of DDPC experiences, and female students appear to be more deeply impacted. These findings can help clinical faculty engage students more effectively with this challenging topic.
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    An exploration of reflective writing and self-assessments to explain professionalism lapses among medical students
    (2014-07) Hoffman, Leslie Ann; Frankel, Richard M.; Brokaw, James J.; Pike, Gary R. (Gary Robert), 1952-; Shew, Ronald L.; Vu, T. Robert
    Background: Recent literature on medical professionalism claims that self-awareness and the ability to reflect upon one’s experiences is a critical component of professionalism; however there is a paucity of empirical evidence to support this claim. This study employed a mixed methods approach to explore the utility of reflective writing and self- and peer assessments in explaining professionalism lapses among medical students. Methods: A retrospective case-control study was conducted using students from Indiana University School of Medicine (IUSM) who had been disciplined for unprofessional behavior between 2006-2013 (case group; n=70). A randomly selected control group (n=230) was used for comparison. Reflective ability was assessed using a validated rubric to score students’ professionalism journals. Mean reflection scores and assessment scores were compared using t-tests. Logistic regression analysis was used to determine the impact of reflection scores and self- and peer assessment scores on the likelihood of having been disciplined for unprofessional behavior. Subsequent qualitative analysis further explored when and how students learned professionalism during their clinical experiences. Results: The study found that students in the case group exhibited lower reflective ability than control students. Furthermore, reflective ability was a significant factor in explaining the odds that a student had been cited for professionalism lapses. There were no differences in self-assessment scores between the two groups, but students in the case group had significantly lower peer assessment scores than control students. Peer assessment scores also had the greatest influence on the odds that a student had been cited for professionalism deficiencies during medical school. Qualitative analysis revealed that students learn professionalism from role models who demonstrated altruism and respect (or lack thereof). Conclusions: These findings suggest that students should be provided with guidance and feedback on their reflective writing to promote higher levels of reflection, which may reduce the number of students who are cited for professionalism lapses. These findings also indicate that peer assessments can be used to provide students with insightful feedback regarding their professional development. Finally, role models have a strong influence on students’ professional development, and therefore must be cognizant of the implicit messages their behaviors convey.
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    The Internal Medicine Subinternship--Now More Important than Ever: A Joint CDIM-APDIM Position Paper.
    (Springer, 2015-09) Vu, T. Robert; Angus, S. V.; Aronowitz, P. B.; Harrell, H. E.; Levine, M. A.; Carbo, A.; Wheton, S.; Ferris, A.; Appelbaum, J. S.; McNeill, D. B.; Ismail, N. J.; Elnicki, D. M.; Department of Medicine, IU School of Medicine
    For decades, the internal medicine (IM) subinternship has served as a critical interface between undergraduate and graduate medical education. As such, the vast majority of U.S. medical schools offer this rotation to help students prepare for post-graduate training. Historically an experiential rotation, a formal curriculum with specific learning objectives was eventually developed for this course in 2002. Since then, graduate medical education (GME) has changed significantly with the regulation of duty hours, adoption of competency-based education, and development of training milestones and entrustable professional activities. In response to these and many other changes to residency training and medical practice, in 2010, the Association of Program Directors in Internal Medicine (APDIM) surveyed its members-with input from the Clerkship Directors in Internal Medicine (CDIM) Subinternship Task Force-to determine which core skills program directors expected from new medical school graduates. The results of that survey helped to inform a joint CDIM-APDIM committee's decision to re-evaluate the goals of the IM subinternship in an effort to enhance the transition from medical school to residency. This joint committee defined the minimum expectations of what constitutes an IM subinternship rotation, proposed recommended skills for IM subinterns, and discussed challenges and future directions for this crucial course.
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    Which Internal Medicine Clerkship Characteristics Are Associated With Students’ Performance on the NBME Medicine Subject Exam? A Multi-Institutional Analysis
    (Wolters Kluwer, 2020-09) Fitz, Matthew M.; Adams, William; Haist, Steven A.; Hauer, Karen E.; Ross, Linette P.; Raff, Amanda; Agarwal, Gauri; Vu, T. Robert; Appelbaum, Jonathan; Lang, Valerie J.; Miller, Chad; Grum, Cyril; Medicine, School of Medicine
    Purpose To identify which internal medicine clerkship characteristics may relate to NBME Medicine Subject Examination scores, given the growing trend toward earlier clerkship start dates. Method The authors used linear mixed effects models (univariable and multivariable) to determine associations between medicine exam performance and clerkship characteristics (longitudinal status, clerkship length, academic start month, ambulatory clinical experience, presence of a study day, involvement in a combined clerkship, preclinical curriculum type, medicine exam timing). Additional covariates included number of NBME clinical subject exams used, number of didactic hours, use of a criterion score for passing the medicine exam, whether medicine exam performance was used to designate clerkship honors, and United States Medical Licensing Examination Step 1 performance. The sample included 24,542 examinees from 62 medical schools spanning 3 academic years (2011–2014). Results The multivariable analysis found no significant association between clerkship length and medicine exam performance (all pairwise P > .05). However, a small number of examinees beginning their academic term in January scored marginally lower than those starting in July (P < .001). Conversely, examinees scored higher on the medicine exam later in the academic year (all pairwise P < .001). Examinees from schools that used a criterion score for passing the medicine exam also scored higher than those at schools that did not (P < .05). Step 1 performance remained positively associated with medicine exam performance even after controlling for all other variables in the model (P < .001). Conclusions In this sample, the authors found no association between many clerkship variables and medicine exam performance. Instead, Step 1 performance was the most powerful predictor of medicine exam performance. These findings suggest that medicine exam performance reflects the overall medical knowledge students accrue during their education rather than any specific internal medicine clerkship characteristics.