Browsing by Subject "medical students"
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Item Barriers to Medical Students’ Electronic Health Record Access Can Impede Their Preparedness for Practice(Wolters Kluwer, 2018-01) Welcher, Catherine M.; Hersh, William; Takesue, Blaine; Elliott, Victoria Stagg; Hawkins, Richard E.; Medicine, School of MedicineMedical students need hands-on experience documenting clinical encounters as well as entering orders to prepare for residency and become competent physicians. In the era of paper medical records, students consistently acquired experience writing notes and entering orders as part of their clinical experience. Over the past decade, however, patient records have transitioned from paper to electronic form. This change has had the unintended consequence of limiting medical students’ access to patient records. This restriction has meant that many students leave medical school without the appropriate medical record skills for transitioning to residency. In this article, the authors explore medical students’ current access to electronic health records (EHRs) as well as policy proposals from medical societies, innovative models implemented at some U.S. medical schools, and other possible solutions to ensure that students have sufficient experiential learning opportunities with EHRs in clinical settings. They also contend that competence in the use of EHRs is necessary for students to become physicians who can harness the full potential of these tools rather than physicians for whom EHRs hinder excellent patient care. Finally, the authors argue that meaningful experiences using EHRs should be consistently incorporated into medical school curricula and that EHR-related skills should be rigorously assessed with other clinical skills.Item Determining Language Needs of English as a Second Language Medical Students(2021-09-18) Bah, Fatoumata; Shin, Sun-Young; Yu, CorinnaItem Does an AHEC-sponsored Clerkship Experience Strengthen Medical Students’ Intent to Provide Care for Medically Underserved Patients?(Springer, 2015-12) Taylor, Jennifer D.; Kiovsky, Richard D.; Kayser, Ann; Kelley, Andrea; Department of Family Medicine, IU School of MedicineThe mission of Area Health Education Centers (AHECs) is to recruit and educate students to serve as practicing health care professionals in rural, primary care, and medically underserved communities. We sought to determine if participation in an AHEC-sponsored family medicine clerkship experiences during medical school are significantly associated with a self-reported intent to practice primary care in a medically underserved environment upon graduation. The study was a prospective cohort study comparing third-year family medicine students with the Indiana University School of Medicine who participated in either an AHEC-sponsored family medicine clerkship to those who completed their required family medicine clerkship outside of the AHEC setting. Following the 160-h clinical clerkship, all students completed a mandatory, electronic survey and were asked to self-report their intent to the following question: “Which of the following statements best describes the impact of the family medicine clerkship on your intention to provide care to underserved patients when you complete residency training?” The question was integrated into a mandatory post-clerkship evaluation form required by the Indiana University School of Medicine, Department of Family Medicine. A Chi square test of independence as well as a multivariate logistic regression analysis was used to determine the independent association of AHEC clerkship participation and reported intent. A total of 1138 students completed the survey. There were not significant differences in age, gender, race, and ethnicity between students that completed an AHEC clerkship and those that did not. After adjusting for gender, race, and ethnicity, AHEC participants were significantly more likely to report an intention to practice primary care in a medically underserved setting upon graduation. Female students were found to be 1.2–3.4 times as likely to report increased intent compared to male students (95 % CI 1.241–3.394). Participation in an AHEC-supported clerkship was associated with a significant increase in self-reported intent to practice primary care in a medically underserved setting. Additional research is required to determine if participation and/or reported intent are predictive of practice selection after graduation.Item Effect of Socioeconomic Status Bias on Medical Student–Patient Interactions Using an Emergency Medicine Simulation(Wiley, 2017-04) Pettit, Katie E.; Turner, Joseph S.; Kindrat, Jason K.; Blythe, Gregory J.; Hasty, Greg E.; Perkins, Anthony J.; Ashburn-Nardo, Leslie; Milgrom, Lesley B.; Hobgood, Cherri D.; Cooper, Dylan D.; Emergency Medicine, School of MedicineObjectives Implicit bias in clinical decision making has been shown to contribute to healthcare disparities and results in negative patient outcomes. Our objective was to develop a high‐fidelity simulation model for assessing the effect of socioeconomic status (SES) on medical student (MS) patient care. Methods Teams of MSs were randomly assigned to participate in a high‐fidelity simulation of acute coronary syndrome. Cases were identical with the exception of patient SES, which alternated between a low‐SES homeless man and a high‐SES executive. Students were blinded to study objectives. Cases were recorded and scored by blinded independent raters using 24 dichotomous items in the following domains: 13 communication, six information gathering, and five clinical care. In addition, quantitative data were obtained on the number of times students performed the following patient actions: acknowledged patient by name, asked about pain, generally conversed, and touching the patient. Fisher's exact test was used to test for differences between dichotomous items. For continuous measures, group differences were tested using a mixed‐effects model with a random effect for case to account for multiple observations per case. Results Fifty‐eight teams participated in an equal number of high‐ and low‐SES cases. MSs asked about pain control more often (p = 0.04) in patients of high SES. MSs touched the low‐SES patient more frequently (p = 0.01). There were no statistically significant differences in clinical care or information gathering measures. Conclusions This study demonstrates more attention to pain control in patients with higher SES as well as a trend toward better communication. Despite the differences in interpersonal behavior, quantifiable differences in clinical care were not seen. These results may be limited by sample size, and larger cohorts will be required to identify the factors that contribute to SES bias.Item Examining Influential Factors in Providers’ Chronic Pain Treatment Decisions: A Comparison of Physicians and Medical Students(Office of the Vice Chancellor for Research, 2014-04-11) Free, Charnelle A.; Hollingshead, Nicole A.; Meints, Samantha M.; Middleton, Stephanie; Hirsh, Adam T.Reports have found that chronic pain management guidelines are unclear and conflicting. Due to this confusion, it is critical to understand factors that influence providers’ treatment decisions for chronic pain. Little is known about which factors providers use to make treatment decisions or whether providers of different training levels endorse using similar factors. The purpose of this study was to examine the factors that providers report using to make their chronic pain treatment decisions. We hypothesized that providers would: (1) prioritize objective factors over subjective factors, (2) be particularly interested in information about patients’ substance use, and (3) endorse using different factors depending on their training level (physicians vs. medical students). Eighty-five providers (35 medical students, 50 physicians) viewed 16 computer-simulated patients; each included a picture with text describing the patients’ condition (i.e., chronic lower back pain, open to any treatment, presence/absence of depression). After making treatment decisions, participants selected from a list the factors they used and would have used (if the information had been available) to make their treatment decisions. Most providers reported being influenced by patients’ pain histories (97.6%) and pain descriptions (95.3%). Providers indicated they would have used information about patients’ previous treatments (97.6%), average pain ratings (96.5%), and current pain (96.5%) had this information been available. Compared to physicians, medical students endorsed more often that they would have used patients’ employment and/or disability status (p<.01), illicit drug use (p=.09), and alcohol use (p=.08) to make treatment decisions. These results indicate that providers rely on objective and subjective information to make pain treatment decisions, and compared to physicians, medical students place a stronger emphasis on patients’ substance abuse and social history when making treatment decisions. Future studies should examine additional provider and patient factors that influence decisions for specific pain treatment options.Item 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. RobertBackground: 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.Item A Familty Day Program Enhances Knowledge about Medical School Culture and Necessary Supports(Springer Nature, 2004-03) Bell, Mary A.; Smith, Paula S.; Brokaw, James J.; Cushing, Herbert E.Background. A Family Day Program was implemented at Indiana University School of Medicine to educate the families and friends of in-coming medical students about the rigors of medical school and the factors that contribute to stress. Methods. Surveys that assessed knowledge, beliefs, and attitudes about medical school were administered to participants before and after the program. Results. After the program, participants showed a significant improvement in their understanding of medical school culture and the importance of support systems for medical students. Post-test scores improved by an average of 29% (P < 0.001) in each of the two years this program was administered. Conclusions. The inclusion of family members and other loved ones in pre-matriculation educational programs may serve to mitigate the stress associated with medical school by enhancing the students' social support systems.Item Gender bias and its negative impact on cardiothoracic surgery(Elsevier, 2019) Ceppa, DuyKhanh P.; Dolejs, Scott C.; Boden, Natalie; Phelan, Sean; Yost, Kathleen J.; Edwards, Melanie; Donington, Jessica; Naunheim, Keith S.; Blackmon, Shanda; Medicine, School of MedicineItem Impact of COVID-19 on Medical Education: Perspectives From Students(Wolters Kluwer, 2021-11) Walters, Marie; Alonge, Taiwo; Zeller, Matthew; Emergency Medicine, School of MedicineThis article provides an overview of issues facing medical students in such key areas as communication, preclinical and clinical education, increased isolation, disruption to time-based curricula, inequities in virtual learning, racial trauma, medical student activism, increased conversations surrounding race and racism, LGBTQIA+ students, dual-degree students, and the virtual residency cycle. This article described challenges navigated by medical students during the COVID-19 pandemic, as well as triumphs resulting from the disruption, and actionable recommendations in key areas. While the pandemic presented new challenges for medical students, it also uncovered or exacerbated longstanding problems. The intent is for medical schools and institutions to utilize these recommendations to create learning environments that do not depend on medical student resilience. The main takeaways for medical schools are to: (1) maintain an individualized and learner-centered ethos while remaining dynamic, flexible, and ready to embrace both immediate and incremental change; (2) maintain open lines of communication; (3) implement policies and practices that support students’ academic, physical, and mental well-being; (4) engage and support students who bear historically disadvantaged identities on the basis of race, ethnicity, sexual orientation, gender, or disability; and (5) support creative and collaborative partnerships between medical institutions and students to ensure the ongoing evolution of medical education to meet the needs of learners and patients.Item Introduction to the Emergency Medicine Team Approach for Research & Healthcare Delivery: A Summer Immersion Experience for Medical Students(2020-03-06) Coffee, R. Lane; Cico, Stephen J.