Background Medical Students Research Articles

Applying equity-centered principles in an interprofessional global health course: a mixed methods study

BackgroundMedical students, practitioners and other health professionals are commonly unprepared to address the many complex issues that emerge while conducting research in the Global South. As a response to identified deficiencies in global health education, a hybrid online/face-to-face multi-institutional credit course was developed based on the equity-centered principles advanced by the Canadian Coalition for Global Health Research (CCGHR), namely Authentic partnering, Inclusion, Shared benefits, Commitment to the future, Responsiveness to causes of inequities, and Humility. This study aimed to analyze the extent to which the course was effective in fortifying attitudes consistent with the CCGHR principles; identify successes and challenges; and assess how a course such as this can fill an identified gap.MethodsThis interprofessional course was offered to 25 graduate and postgraduate students in various health professions and public health. Faculty were drawn from medicine, public health, nursing and social sciences from four universities in Western Canada. A pre-post retrospective survey, key informant interviews and participant observation were used to gather data for this study.ResultsFindings showed that student attitudes regarding global health research and practice significantly evolved towards views consistent with the principles articulated. The multiple instructors and hybrid course format created both opportunities and challenges; the interprofessional nature of the cohort was considered a strong asset, as was the fact that many students came from the Global South. Some students suggested that the course could be further strengthened by concretely partnering with institutions in the Global South rather than offered solely to learners registered in universities in the Global North.ConclusionsWhile weaknesses were identified, results support the conclusion that a course focused on the CCGHR principles could be useful in preparing the next generation of global health researchers and practitioners to mitigate historical limitations in this field. Longitudinal follow-up is warranted to provide more definitive conclusions.

Medical Student Utilization of a Novel Web-Based Platform (Psy-Q) for Question-Based Learning in Psychiatry: Pilot Questionnaire Study.

BackgroundMedical students are turning to new and expanding web-based resources for learning during their psychiatry clerkships; however, there have not been concomitant efforts by educators to utilize web-based tools to promote innovative teaching.ObjectiveUtilizing a free learning platform (Psy-Q) created by our team, we sought to explore how digital technology may engage medical student learners, promote colearning between educators and medical students, and support sustainability of web-based platforms through crowdsourcing.MethodsBetween 2017 and 2019, seven medical schools offered access to the platform during medical students’ psychiatry clerkships. Use of the web-based platform was voluntary and not monitored or related to clerkship evaluation. Medical students completed a paper and pencil assessment of the platform at the end of their clerkship. Anonymous and aggregated website use data were gathered in accordance with institutional review board approval.ResultsA total of 203 medical students across seven distinct psychiatry clerkships completed the survey. Of these students, 123 (60.6%) reported using the platform and reported accessing a mean of 45 questions. The most common device used to access the platform was a laptop and the second most common was a smartphone. The most common location to access the platform was home and the second most common was the hospital. Although few students contributed new questions, website utilization data suggested that all rated the quality and difficulty of the questions. Higher quality questions were medical students’ main suggestion for further improvement.ConclusionsOur results suggest the feasibility and potential of educator- and learner-created web-based platforms to augment psychiatry education and develop relevant accessible resources in the digital sphere. Future work should focus on measuring objective educational outcomes of question taking and writing, as well as optimizing technology and exploring sustainable trainee-faculty partnership models for the creation and curation of content.

A 3D printed suturing trainer for medical students.

Medical students must be able to suture competently upon graduation. To learn suturing technique, students must have access to practice materials. The purpose of this pilot study was to develop a novel suturing trainer and to evaluate its ability to provide realistic and accessible suturing practice. A cohort of senior students at one institution compared the device with standard suture-training media (porcine feet and sponges). Using 3D printing and silicone casting, a novel suturing trainer was developed and a cohort of senior medical students trialed the device in a standardised suturing workshop. Participants evaluated the novel suturing trainer, porcine feet and sponges for simulating human tissue with regard to: (i) tissue layers; (ii) tissue texture; (iii) ability to perform interrupted suturing; (iv) running subcuticular suturing; and (v) knot tying. Compared with porcine feet and sponges, the suturing trainer had significantly higher mean scores (p<0.001) for the simulation of human tissue layers and texture, as well as for the ability to facilitate the practice of interrupted suturing, running suturing and knot tying. All (n=32) participants identified the silicone trainer as the best tool upon which to practice suturing, and 92% (n=23) responded that their suturing skills would improve if the silicone trainer replaced porcine feet and sponges. The silicone suturing device provides a more realistic and accessible suture learning experience than porcine feet and sponges. Further validation is required to assess its long-term effectiveness in medical education.

Wikipedia in Vascular Surgery Medical Education: Comparative Study.

BackgroundMedical students commonly refer to Wikipedia as their preferred online resource for medical information. The quality and readability of articles about common vascular disorders on Wikipedia has not been evaluated or compared against a standard textbook of surgery.ObjectiveThe aims of this study were to (1) compare the quality of Wikipedia articles to that of equivalent chapters in a standard undergraduate medical textbook of surgery, (2) identify any errors of omission in either resource, and (3) compare the readability of both resources using validated ease-of-reading and grade-level tools.MethodsUsing the Medical Council of Canada Objectives for the Qualifying Examination, 8 fundamental topics of vascular surgery were chosen. The articles were found on Wikipedia using Wikipedia’s native search engine. The equivalent chapters were identified in Schwartz Principles of Surgery (ninth edition). Medical learners (n=2) assessed each of the texts on their original platforms to independently evaluate readability, quality, and errors of omission. Readability was evaluated with Flesch Reading Ease scores and 5 grade-level scores (Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index), quality was evaluated using the DISCERN instrument, and errors of omission were evaluated using a standardized scoring system that was designed by the authors.ResultsFlesch Reading Ease scores suggested that Wikipedia (mean 30.5; SD 8.4) was significantly easier to read (P=.03) than Schwartz (mean 20.2; SD 9.0). The mean grade level (calculated using all grade-level indices) of the Wikipedia articles (mean 14.2; SD 1.3) was significantly different (P=.02) than the mean grade level of Schwartz (mean 15.9; SD 1.4). The quality of the text was also assessed using the DISCERN instrument and suggested that Schwartz (mean 71.4; SD 3.1) had a significantly higher quality (P=.002) compared to that of Wikipedia (mean 52.9; SD 11.4). Finally, the Wikipedia error of omission rate (mean 12.5; SD 6.8) was higher than that of Schwartz (mean 21.3; SD 1.9) indicating that there were significantly fewer errors of omission in the surgical textbook (P=.008).ConclusionsOnline resources are increasingly easier to access but can vary in quality. Based on this comparison, the authors of this study recommend the use of vascular surgery textbooks as a primary source of learning material because the information within is more consistent in quality and has fewer errors of omission. Wikipedia can be a useful resource for quick reference, particularly because of its ease of reading, but its vascular surgery articles require further development.

Depression, anxiety, and burnout among medical students and residents of a medical school in Nepal: a cross-sectional study

BackgroundMedical students and residents were found to have suffered from depression, anxiety, and burnout in various studies. However, these entities have not been adequately explored in the context of Nepal. We proposed to determine the prevalence of depression, anxiety, burnout, their associated factors, and identify their predictors in a sample of medical students and residents in a Nepalese medical school.MethodsIt was a cross-sectional study with 651 medical students and residents chosen at random between December 2018 and February 2019. The validated Nepali version of Hospital Anxiety and Depression Scale, the Copenhagen Burnout Inventory, and Medical Students’ Stressor Questionnaire were used to assess depression, anxiety, burnout, and stressors respectively. We used univariate and multivariable logistic regression analyses to identify the correlation of predictor variables with depression, anxiety, and burnout.ResultsThe overall prevalence of burnout (48.8%; 95% CI 44.9–52.7) and anxiety (45.3%; 95% CI 41.4–49.2) was more than that of depression (31%; 95% CI 27.5–34.7). Burnout and depression were more prevalent in residents than in medical students (burnout: 64.5% vs 37.6%, P-value < 0.0001; depression: 33.7% vs 29.1%, P-value 0.21). Whereas, medical students were found more anxious than residents (46.3% versus 43.96%, P-value 0.55). Academic related stressors caused high-grade stress to participants. Multivariable model for depression significantly showed anxiety, personal burnout, and work-related burnout as risk enhancing correlates; satisfaction with academic performance as a protective correlate. Similarly, the multivariate model for anxiety significantly identified female gender, depression, personal burnout, teaching and learning related stressors, and past history of mental illness as risk enhancing correlates; being satisfied with academic performance, getting adequate sleep, and being a second-year resident as protective correlates. The logistic model for burnout significantly showed being a first-year resident, depression, anxiety, and drive and desire related stressors as positive predictors. None of the variables were identified as significant negative predictors of burnout.ConclusionsA high prevalence of depression, anxiety, and burnout was seen among medical students and residents. Most of them were stressed with academic-related factors. A strong correlation between teaching and learning-related stressors with depression and anxiety may be a call for an efficient and more student-friendly curriculum.

Mindful medical practice: An innovative core course to prepare medical students for clerkship.

BackgroundMedical students show a decline in empathy and ethical reasoning during medical school that is most marked during clerkship. We believe that part of the problem is that students do not have the skills and ways of being and relating necessary to deal effectively with the overwhelming clinical experience of clerkship.ApproachAt McGill University in Montreal, starting in January 2015, we have taught a course on mindful medical practice that combines a clinical focus on the combination of mindfulness and congruent relating that is aimed at giving students the skills and ways of being to function effectively in clerkship. The course is taught to all medical students in groups of 20, weekly for 7 weeks, in the 6 months immediately prior to clerkship, a time when students are very open to learning the skills they need to take effective care of patients.EvaluationThe course has been well accepted by students as evidenced by their engagement, their evaluations, and their comments in the essays that they write at the end of the course. In a follow-up session at the simulation centre one year later students remember clearly and enact what they were taught in the course.ReflectionThe next steps will be to conduct a formal evaluation of the effect of our teaching that will involve a combination of qualitative methods to clarify the nature of the impact on our students and a quantitative assessment of the difference the course makes to students’ experience and performance in clerkship.

Prevalence of depression and anxiety and correlations between depression, anxiety, family functioning, social support and coping styles among Chinese medical students

BackgroundMedical students experience depression and anxiety at a higher rate than the general population or students from other specialties. While there is a growing literature on the high prevalence of depression and anxiety symptoms and about potential risk factors to the prevalence of depression and anxiety symptoms among medical students, there is a paucity of evidence focused on the prevalence of depression and anxiety symptoms and associations with family function, social support and coping styles in Chinese vocational medicine students. This study aims to investigate the prevalence of depression and anxiety symptoms among Chinese medical students and assess the correlation between depression/anxiety symptoms and family function, social support and coping styles.MethodsA sample of 2057 medical students from Chongqing Medical and Pharmaceutical College in China was investigated with a self-report questionnaire, which included demographic information, Zung self-rating depression scale, Zung Self-Rating Anxiety Scale, Family APGAR Index, Social Support Rating Scale and Trait Coping Style Questionnaire.ResultsThe prevalence of depression and anxiety symptoms among the medical students was 57.5 and 30.8%, respectively. Older students(≥20 years) experienced higher levels of depression and anxiety. More depression and anxiety symptoms were exhibited among students with big financial burden, big study-induced stress and poor sleep quality. Students with large employment pressure showed more anxiety symptoms. Students who live alone or had bad relationship with their lovers or classmates or friends showed higher depression and anxiety scores. Depression and anxiety symptoms had highly significant correlations with family functioning, social support and coping style.ConclusionsAcademic staffs should take measures to reduce depression and anxiety among medical students and to provide educational counseling and psychological support for students to cope with these problems.

Understanding the health risks in basic science medical students: a cross sectional survey.

This article was migrated. The article was marked as recommended. Background Medical students are usually subjected to a high workload environment and stress is one of the most important health risks that medical students encounter. The negative impact of stress on the student's mental and general health in basic science has often been under reported. Methods and Materials A cross-sectional questionnaire survey was performed in Avalon University School of Medicine (AUSOM), Curacao, amongst the first to fourth semester basic science students with an objective to explore and understand their perspectives on different health risks. ResultsMore than ⅔ of the students (79.61%, n=82) were feeling stressed out during their basic sciences. The mean stress level among the basic science students was 7.42 ± 2.13 (scale:1-10). Common health issues encountered by the students were: sleep problems, impaired concentration, low mood, mood swings, difficulty in making decisions, emotional distress, anxiety, substance abuse, and abnormal weight gain. Conclusion Although lack of sleep and behavioral problems are the most common health issues encountered by the pre-clinical medical students. There is an urgent need to implement health promotion strategies in medical curriculum for mental and physical well-being of the students.

Study protocol of a multicenter randomized controlled trial of mindfulness-based intervention versus relaxation to reduce emotional exhaustion in medical students in France: the \u201cMust prevent\u201d study

BackgroundMedical students are exposed to an emotionally exhausting training/work environment and to stressful academic demands. Consequently, psychopathologies, burnout and suicidal ideation are frequent in this population. These factors can also affect their empathy and quality of care. Therefore, the development and implementation of programs to promote resilience to stress specifically in medical students and the evaluation of their efficiency are a priority. Here, we describe the protocol of the first French study to assess the long-term effectiveness and acceptability of a mindfulness-based intervention (MBI) compared with relaxation training (RT) to reduce emotional exhaustion in medical students.MethodsThis multicenter randomized controlled trial (“Must prevent”) plans to enroll 612 students in the fourth and fifth year of medical studies from nine French universities. After inclusion, they will be assigned randomly to the MBI or RT group. Both interventions are structured around an 8-week program that includes one group class per week and daily at-home exercises. The primary endpoint is the emotional exhaustion score assessed with the Maslach Burnout Inventory at month 12 of the follow-up. Secondary endpoints include anxiety-depressive symptomatology, suicidality, psychoactive substance use, depersonalization, psychological and physical pain, empathy, emotional regulation, self-compassion, mindfulness, quality of life, and program acceptability. Evaluations will be done before and immediately after the 8-week intervention, and at month 6 and 12 of the post-intervention follow-up.DiscussionIf the proposed interventions are well accepted and useful to decrease negative emotions and/or increase wellbeing among medical students, they should be disseminated among this population and even included as part of the training on emotional skills needed for the routine medical practice.Trial registrationThis trial is registered under the number NCT04026594 (July 18, 2019).

Impact of general surgery rotation exposure on surgery clerkship performance

BackgroundMedical students often have variable exposures to general surgery (GS) and subspecialty surgery (SS) during their surgical clerkship. We will evaluate the relationship between clinical exposure to GS and performance on the NBME Subject Examination in Surgery. MethodsStudent data was collected retrospectively from 2015 to 2018 at a single academic institution. Students were categorized based on their clinical clerkship exposure to GS. A linear model was used to estimate the mean difference in NBME performance between GS and strictly SS exposed students while controlling for prior standardized examination scores and completion of an internal medicine clerkship prior to surgery. Results365 (67%) of 547 students were exposed to a GS rotation prior to their NBME exam. Performance on the NBME exam was comparable between GS versus SS students (μdiff = 0.37, 95% CI: −0.73 to 1.48; p = .51). ConclusionsExposure to a GS rotation is not advantageous on the NBME surgery examination. Students who completed the medicine clerkship prior to surgery demonstrated superior performance on the NBME surgery examination.

Communication skills supervisors\u2019 monitoring of history-taking performance: an observational study on how doctors and non-doctors use cues to prepare feedback

BackgroundMedical students need feedback to improve their patient-interviewing skills because self-monitoring is often inaccurate. Effective feedback should reveal any discrepancies between desired and observed performance (cognitive feedback) and indicate metacognitive cues which are diagnostic of performance (metacognitive feedback). We adapted a cue-utilization model to studying supervisors’ cue-usage when preparing feedback and compared doctors’ and non-doctors’ cue usage.MethodTwenty-one supervisors watched a video of a patient interview, choose scenes for feedback, and explained their selection. We applied content analysis to categorize and count cue-use frequency per communication pattern (structuring/facilitating) and scene performance rating (positive/negative) for both doctors and non-doctors.ResultsBoth groups used cognitive cues more often than metacognitive cues to explain their scene selection. Both groups also used metacognitive cues such as subjective feelings and mentalizing cues, but mainly the doctors mentioned ‘missing information’ as a cue. Compared to non-doctors, the doctors described more scenes showing negative performance and fewer scenes showing positive narrative-facilitating performance.ConclusionsBoth groups are well able to communicate their observations and provide cognitive feedback on undergraduates’ interviewing skills. To improve their feedback, supervisors should be trained to also recognize metacognitive cues, such as subjective feelings and mentalizing cues, and learn how to convert both into metacognitive feedback.

A systematic review of depression and anxiety in medical students in China

BackgroundMedical students in China face severe depression and anxiety because of their difficult circumstances, such as the long length of schooling, academic pressure, and the stress of clinical practice. Although there have been many empirical studies about depression or anxiety in medical students in China, no previous studies have conducted a related systematic review about this topic in English. This analysis can convey the general findings from China to other areas of the world.MethodsA systematic review and meta-analysis of depression or anxiety in medical students and related determinants were conducted. Three Chinese and three English databases were searched for the review, with no restrictions on language. Articles published between January 1, 2000 and April 1, 2018 were included.ResultsTwenty-one articles investigating a total of 35,160 individual Chinese medical students were included in this review. The prevalence of depression ranged from 13.10 to 76.21% with a mean of 32.74%, and the prevalence of anxiety ranged from 8.54 to 88.30% with a mean of 27.22%. Based on the meta-analysis, gender, grade level, residence, satisfaction with current major and monthly household income per capita were significantly associated with depression. Grade level and satisfaction with current major were significantly associated with anxiety. Other risk factors were identified and described using a narrative approach.ConclusionThe mean prevalence of depression was 32.74% amongst medical students in China, whereas the mean prevalence of anxiety was 27.22%. The determinants of depression and anxiety included individual factors, social and economic factors, and environmental factors. More measures should be taken towards at-risk medical students based on the identified risk factors.

Mitigating “Educational Groundhog Day” – The Role of Learner Handoffs Within Clinical Rotations: A Survey of Pediatric Educational Leaders

BackgroundMedical students decry frequent changes in faculty supervision, leading to the experience of “educational groundhog day.” The discontinuity in supervision, cursory relationships, and uncoordinated feedback impede students’ skill acquisition and delay entrustment decisions. Whereas patient handoff bundles are common, little is known about similarly structured approaches to learner handoffs (LHs). ObjectiveTo describe current LH procedures and practices within pediatric clerkships and subinternships and to gauge interest in a future LH bundle. MethodsNine items included in the 2016 Council on Medical Student Education in Pediatrics annual member survey were analyzed using mixed-methods. ResultsThe response rates were 66% (101 of 152) and 40% (165 of 411) for institutions and individuals, respectively. After limiting data to complete responses to programs with traditional block rotations, 54% of individual respondents (76 of 141) identified as inpatient faculty and about a quarter endorsed providing LHs. Inpatient faculty most commonly supervise medical students for 5 to 7 days. Most endorsed needing 1 to 3 days to determine a student's baseline performance and 5 days or more to make entrustment decisions. Three-quarters of inpatient faculty endorsed interest in LHs, while fewer than 16% of course directors currently provide LH expectations. Four themes emerged: instrument features, stakeholder buy-in, impact, and utility. ConclusionsTypical inpatient faculty service days approximate the time required for making entrustment decisions about clinical students. While most inpatient faculty desire a LH bundle for use within a clinical rotation, few institutions and faculty currently use LHs. LHs could accelerate entrustment decisions by allowing coordinated feedback that might hasten learner clinical-skill development.

Association of Physical Activity and Sleep Quality with Academic Performance Among Fourth-year MBBS Students of Rawalpindi Medical University.

BackgroundMedical students face greater academic stress and devote more time to their studies due to the tough nature of medical education, at the cost of sleep and physical activity. Good sleep quality and physical activity improve the mental ability and academic performance of the students.Objectives and rationaleThe study aims to assess sleep quality and physical activity levels among fourth-year MBBS students of Rawalpindi Medical University. We compare these levels with gender and boarding status and correlate them with the academic performance of the students. This may provide new target areas to improve the academics of students performing below average.Materials and methodsIt was a descriptive, cross-sectional study conducted in March 2019 on 344 medical students enrolled in the fourth-year MBBS class of Rawalpindi Medical University. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI), physical activity levels by the Global Physical Activity Questionnaire (GPAQ), and academic performance by the marks attained in the most recent pathology class test. The students who could not prepare for the test in the usual manner were excluded from the study. Two-hundred nineteen (219) students were part of the final study sample. Data analysis was performed using SPSS v.22.0 (IBM Corp, Armonk, NY, US). A chi-squared test, independent samples t-test, Pearson’s correlation, and a multiple linear regression model were used to assess the variables.ResultsSleep quality and physical activity were significantly correlated with academic performance (p-values of the chi-square and t-test were <0.000). Pearson’s correlation coefficient was -0.69 for PSQI (p<0.000) and 0.62 for GPAQ (p 0.003) with test scores. Gender showed significant association with sleep and physical activity levels (male students had better physical activity level and poorer sleep quality than female students) but no association with test scores. Boarding status was significantly associated with all three variables. Boarders had lower mean test scores and poorer sleep and physical activity indices as compared to non-boarders. The multiple linear regression model was valid (p-value of the F test was <0.000), with beta coefficients of -2.53 ( p=0.002) for sleep quality and 1.37 (p=0.01) for physical activity. The R2 value was 0.84 (84%).ConclusionsOur study indicates an overall poor sleep quality and physical activity level among fourth-year medical students, particularly boarding students, who have lower test scores and worse sleep and physical activity levels. In general, male students have better GPAQ scores and female students have better PSQI scores. Both the PSQI and GPAQ scores are significantly correlated with test scores and provide potential target areas to improve the exam performance of the students.

Radiological Imaging Interpretation Skills of Medical Interns

ABSTRACT Background Medical students’ skills in radiographic image interpretation is neither known nor assessed in the case of most medical schools in Brazil. Objective The purpose of this study was to assess intern students’ performance in the interpretation of radiographic images of the chest and abdomen. Methods A 10-item test was developed using non-contrasted radiological images from the chest and abdomen. Internship students from two public medical schools (Classroom Group, n=50) and doctors (Control Group, n=20) answered the test. A third group (Online Group, n=38) composed of students from different medical schools answered a web-based form with the same 10-item test. Results Doctors and students were able to accurately interpret only 30% of the radiographic images; 50% of the students and 30% of the doctors performed poorly. The rest produced average levels of performance. There were minimal differences between the Classroom and Online Groups. A point-by-point analysis of their answers has been presented and discussed. Conclusion Efforts must be made, including the framing of medical curricula interventions, to improve student interns’ skills in radiological image interpretation.

The effects of academic adaptability on academic burnout, immersion in learning, and academic performance among Chinese medical students: a cross-sectional study

BackgroundMedical students struggle with a heavy workload during their comparatively long course of study in China. The future of medical science depends largely on whether or not medical students become qualified. This study aims to explore whether medical students’ academic adaptability affects learning outcomes. This paper will not only provide scientific evidence for educators and administrators of medical schools but will also benefit students by improving their aptitude and adaptability through a thorough discussion on their educational environment.MethodsWe conducted a cross-sectional survey from September to December 2016. A total of 1977 respondents completed the questionnaire with a response rate of 79.08%. A cross-sectional survey was used in this study. Descriptive statistics, factor analysis, General Linear Model (GLM) analysis, standard multiple regression, and hierarchical multiple regression were performed for data analysis using the Statistical Package for Social Sciences software (SPSS Version 19.0, SPSS Inc., Chicago, IL, USA).ResultsOut of the 1977 students, 1586 (80.2%) had mean academic adaptability levels over 3. Findings suggested that academic adaptability (Mean = 3.32), immersion in learning (Mean = 3.20), and academic performance (Mean = 3.39), were at the middle level while academic burnout (Mean = 2.17) was at a low level. Academic adaptability of medical students showed a significant negative relation to academic burnout (Beta = − 0.705, P<0.01), there was a significant positive relation between academic adaptability and immersion in learning (Beta = 0.655, P<0.01) and academic performance (Beta = 0.407, P<0.01).ConclusionsHigher levels of academic adaptability are associated with lower levels of burnout and higher levels of immersion in learning and academic performance. It might be helpful for medical schools to consider academic adaptability and ways of enhancing such skills in order to enhance student performance and engagement while in school.

Copy-and-Paste in Medical Student Notes: Extent, Temporal Trends, and Relationship to Scholastic Performance.

Medical students may observe and subsequently perpetuate redundancy in clinical documentation, but the degree of redundancy in student notes and whether there is an association with scholastic performance are unknown. This study sought to quantify redundancy, defined generally as the proportion of similar text between two strings, in medical student notes and evaluate the relationship between note redundancy and objective indicators of student performance. Notes generated by medical students rotating through their medicine clerkship during a single academic year at our institution were analyzed. A student-patient interaction (SPI) was defined as a history and physical and at least two contiguous progress notes authored by the same student during a single patient's hospitalization. For some students, SPI pairs were available from early and late in the clerkship. Redundancy between analogous sections of consecutive notes was calculated on a 0 to 100% scale and was derived from edit distance, the number of changes needed to transform one text string into another. Indicators of student performance included United States Medical Licensing Exam (USMLE) scores. Ninety-four single SPIs and 58 SPI pairs were analyzed. Redundancy in the assessment/plan section was high (40%) and increased within individual SPIs (to 60%; p < 0.001) and between SPI pairs over the course of the clerkship (by 30-40%; p < 0.001). Students in the lowest tertile of USMLE step II clinical knowledge scores had higher redundancy in the assessment/plan section than their classmates (67 ± 24% vs. 38 ± 22%; p = 0.002). During the medicine clerkship, the assessment/plan section of medical student notes became more redundant over a patient's hospital course and as students gained clinical experience. These trends may be indicative of deficiencies in clinical knowledge or reasoning, as evidenced by performance on some standardized evaluations.

Training Professionalism Using Hidden Curriculum in an Internship Course: Account of Experiences of Undergraduate Students of Surgical Technology

Background Medical students are in direct contact with patients due to their clinical situation, and one of the important goals of medical education is professional development of these students. Objectives The purpose of this study was to explain students’ experiences regarding professionalism training using hidden curriculum. Methods This study was carried out through content analysis, and data were collected through semi-structured interviews with 6th and 8th semester undergraduate students of surgical technology. The participants were entered into the study using the purposive sampling method and each individual interview lasted for about 35 - 45 minutes. Semi-structured questions were used to conduct the interviews and then follow-up and exploratory questions were used to clarify the concept and to deepen the interview process. Results Overall, 358 primary codes and the two main themes of observing patient rights and professional accountability were extracted. The theme of observing patient rights includes three sub-themes, including observing patient privacy, respect for patient’s dignity and patient safety, and the theme of professional accountability comprised the three sub-themes of compliance with professional standards, professional communication and instructor as ethics teacher. Conclusions Professors’ familiarity with the training and development of professionalism among medical students, and attention to the role of hidden curriculum in the formulation of values, norms and behaviors regarding professionalism is suggested.

Pertussis vaccination status and vaccine acceptance among medical students: multicenter study in Germany and Hungary

BackgroundMedical students are at risk of contracting and transmitting infectious diseases such as pertussis. Complete vaccination status is important to protect own, patient and public health. Knowing own vaccination status is elementary for following current vaccination recommendations, including boosters. We aimed to assess pertussis vaccination status and vaccination acceptance among medical students of different nationalities.MethodsA cross-sectional multicenter health survey at German and Hungarian universities enclosed international medical students in the 1st, 3rd and 5th year of study. Self-reported data from 2655 students regarding pertussis vaccination status were analyzed. Subgroup analysis enclosed data of German (n = 1217), Hungarian (n = 960) and other nationality (n = 478) students (“other”).ResultsMore Hungarians reported basic immunization (39.0% vs 15.8% Germans vs 24.3% others, p ≤ 0.05). Booster vaccination was reported more by Germans (60.5% vs 43.6% Hungarians vs 36.0% others, p ≤ 0.05). Germans were more likely to report being unvaccinated (3.7% vs 0.9% Hungarians, p ≤ 0.05). More medical students of other nationalities were unaware of their pertussis vaccination status (37.4% vs 20.0% Germans/ 16.5% Hungarians, p ≤ 0.05). 75.2% (n = 1931) rated pertussis vaccinations as absolutely necessary (86.2% Hungarians vs 69.8% Germans/ 66.1% others, p ≤ 0.05).ConclusionsPositive attitudes towards vaccinations were reported but a large group reported insufficient vaccination status and being not aware of their status, especially among international students. Hungarians possibly have a better vaccination status than reported, based on mandatory vaccinations in childhood. The low awareness of vaccination status has implications for future booster vaccinations. All students should be informed about current recommendations and receive vaccination offers in frames of low-threshold medical services.

2155. Elevated Temperature Results in Earlier Diagnosis of Infectious and Inflammatory Postoperative Complications

BackgroundMedical students are taught that wind, water and wound complications occur at specific post-operative times. This may influence the timing of work-up for specific complications. The goal of this study was to investigate the relationship between post-operative temperature curve and time to diagnosis of inflammatory complications.MethodsWe reviewed patients who underwent pancreatectomy at an academic health system from January 2015–February 2018. Clinical data including complications were extracted using definitions set by the National Surgical Quality Improvement Program and temperature was extracted from the Data Warehouse. Time of diagnosis, as determined by labs, microbiologic cultures, radiology and procedures, was extracted for each complication. Group-based trajectory modeling, a technique used to identify distinct clusters of temperature trajectories of patients in the postoperative setting was used to group patients into low- and high-temperature trajectories.ResultsAmong 195 patients who underwent pancreatectomy, 35.5% (69/195) experienced at least one complication within 30 days of surgery. Of the patients who developed complications, 49% (n = 34) and 51% (n = 35) were classified into the low and high temperature trajectory groups based on their temperature trajectory. For most individual inflammatory complications, time to diagnosis was later in the low rather than high temperature groups (Figure 1) and this was significant when averaging all inflammatory complications (12.7d low and 8.6d high; P = 0.002). Time to diagnosis tended to be later in the high rather than low temperature trajectory but this was not statistically significant when averaging all non-inflammatory complications (11.7d low and 11.9d high; P = 0.95).Figure 1.Time to diagnosis by low (L) and high (H) temperature trajectories.ConclusionWe identified earlier diagnosis of inflammatory complications in patients with elevated temperature trajectories. There was no difference in timing of diagnosis for non-inflammatory complications. Temperature trajectory modeling may allow for earlier diagnosis of patients at high risk for inflammatory complications.Disclosures All authors: No reported disclosures.