Cohort Of Medical Students Research Articles

The attitudes towards learning and study habits of Australian medical students

Background/Purpose Medical curricula are designed to provide students with strong foundational biomedical knowledge and the opportunity to develop and practice effective, appropriate, and safe clinical skills. However, instruction on optimal study strategies (i.e. “learning how to learn”) is often overlooked in medical programs. In this paper, we explore the attitudes towards learning and study habits of a large cohort of graduate-entry medical students in Australia. Method Participants in this observational study were invited to complete a questionnaire regarding their attitudes towards study behaviours and strategies, and to complete regular “study diaries” using a custom smartphone application. We collected data for first to fourth-year medical students at various timepoints throughout their academic year. Results We found that these students generally had a high level of literacy regarding the efficacy of evidence-based study techniques, such as practice testing and active participation, but also tended to favour less effective and more convenient and time-efficient study approaches and activities. Students also reported engaging in distracting off-task activities during approximately 61% of their “private study” sessions; however, due to the self-report nature of the data, this is likely an underestimate. Conclusion In conclusion, we found that there appears to be a disconnect between medical students’ knowledge and practice of effective study techniques. Given this apparent dissonance—and the significant demands placed on student time and attention—we encourage educators to consider how they might best support students to engage in effective study techniques.

Perceived effectiveness of the person–environment–occupation innovative teaching model in rehabilitation therapy students

BackgroundGiven the characteristics of the rehabilitation therapy specialty and the drawback of the traditional didactic teaching approach, we developed the innovative teaching approach from the students’ perspective using the person–environment–occupation (PEO) model. The new model was developed from the original PEO model to be applied in pedagogical contexts and tailored to the characteristics of an application-oriented specialty, such as rehabilitation therapy. The present study aimed to examine the perceived effectiveness of the PEO innovative teaching model applied to rehabilitation therapy students.MethodsA pre–post descriptive study was conducted to compare the perceived effectiveness of the PEO innovative teaching model for two consecutive student cohorts. A purposive sampling method was used to recruit students from two cohorts of junior medical students majoring in rehabilitation therapy in the spring semesters of 2020 and 2021. A questionnaire was developed to evaluate the perceived effectiveness of the PEO innovative teaching model. SPSS version 26.0 was used to perform data analysis.ResultsA total of 112 students were included in the study and completed both pre- and post-tests. Of 112 received questionnaires, 101 were considered as valid questionnaires after the quality check (effective rate 90.18%). In the 2020 and 2021 cohorts, students rated the PEO innovative teaching model significantly higher than the didactic teaching approach in the following aspects: the teaching content is highly professional and valuable; the course is extensively expounded; the clinical reasoning is strengthened; problem-solving ability is developed; communication skills are improved; and teamwork skills are developed.ConclusionThe PEO innovative teaching model was perceived to be an effective teaching strategy to enhance students’ academic performance. In addition, three core skills including clinical reasoning, problem-solving ability, and communication skills were improved by the PEO innovative teaching model.

Validity and reliability of Brier scoring for assessment of probabilistic diagnostic reasoning.

Educators need tools for the assessment of clinical reasoning that reflect the ambiguity of real-world practice and measure learners' ability to determine diagnostic likelihood. In this study, the authors describe the use of the Brier score to assess and provide feedback on the quality of probabilistic diagnostic reasoning. The authors describe a novel format called Diagnostic Forecasting (DxF), in which participants read a brief clinical case and assign a probability to each item on a differential diagnosis, order tests and select a final diagnosis. DxF was piloted in a cohort of senior medical students. DxF evaluated students' answers with Brier scores, which compare probabilistic forecasts with case outcomes. The validity of Brier scores in DxF was assessed by comparison to subsequent decision-making in the game environment of DxF, as well as external criteria including medical knowledge tests and performance on clinical rotations. Brier scores were statistically significantly correlated with diagnostic accuracy (95 % CI-4.4 to-0.44) and with mean scores on the National Board of Medical Examiners (NBME) shelf exams (95 % CI-474.6 to-225.1). Brier scores did not correlate with clerkship grades or performance on a structured clinical skills exam. Reliability as measured by within-student correlation was low. Brier scoring showed evidence for validity as a measurement of medical knowledge and predictor of clinical decision-making. Further work must evaluated the ability of Brier scores to predict clinical and workplace-based outcomes, and develop reliable approaches to measuring probabilistic reasoning.

Interprofessional education among musculoskeletal healthcare professions: A scoping review.

To examine peer-reviewed literature involving undergraduate interprofessional education (IPE) focusing on musculoskeletal (MSK) healthcare professions. Methodological searches were conducted on electronic databases PubMed, Scopus, ERIC, and ProQuest. No date restrictions were applied. English sources (qualitative and quantitative methodological studies, conference papers and proceedings, systematic reviews, grey literature, unpublished materials, theses, and dissertations) were included. A researcher, independent reviewer, and research librarian completed the search and data extraction from June to October 2023. Disagreements were resolved by discussion. ATLAS.ti was used to analyze data by generating codes linked to the text. Findings were reported in a narrative format and by using tables. Initially, 2894 articles were retrieved and screened for relevance. After rigorous screening procedures, 18 articles from various countries were deemed eligible for inclusion. The included studies were conducted within the date range of 2010 to 2024. The included studies employed mixed methods (n = 9), quantitative (n = 5), and qualitative (n = 4) approaches. Combined medical and physiotherapy student cohorts were prominently featured in 67% (n = 12) of the reviewed studies. All 18 studies incorporated the implementation and/or evaluation of an IPE intervention. Thematic analysis revealed 5 overarching themes, encompassing the benefits, barriers, interventions, strategies, evaluation, and general findings related to IPE. The reviewed literature emphasizes a significant gap in IPE initiatives concerning various MSK health providers, including chiropractors, podiatrists, biokineticists, and osteopaths. This paucity accentuates the need for further exploration and evaluation of IPE within MSK-specific contexts, crucial for addressing and mitigating the escalating global burden of MSK diseases.

Investigating feelings of imposterism in first-year medical student narratives.

Imposter phenomenon (IP), feeling as if a person does not belong, has been reported in medical students at various rates. In medical literature, this phenomenon has often been defined as a 'syndrome', but other studies have described it as a dynamic experience that can have various impacts on different people at different time points. Although studies have linked IP with other phenomena such as burnout in residents and physicians, no studies have examined its aetiology nor how these feelings are experienced by medical students. With the use of social identity theory as a framework, the authors analysed 233 reflective essays for elements of IP across eight cohorts of medical students from two institutions. Students responded to a prompt that asked: 'What was one part of your identity that you thought you would have to change in order to become a physician?' Included reflections were analysed using the framework method. Elements of IP were identified in 121 reflections (52%) and were categorised into three major themes: (1) Comparing oneself to an idealised image of a medical student, (2) Comparing oneself to an idealised image of a physician and (3) Concerns about presentation of self to others. Each theme contained two or more sub-themes. Commonly, students discussed how their own personality traits, experiences, backgrounds and identities cast doubt on their sense of belonging in medicine. The results of this study were consistent across both institutions, suggesting that imposter feelings are common among all first-year medical students. However, the extent of the impact of these feelings on their identity formation depends on the individual lived experiences of students and the context in which these feelings arise. Encouraging reflective journaling and sharing of stories from all stages of education can normalise imposter feelings during the development of the professional identity as a physician.

The Impact of a Student-Taught Point-of-Care Ultrasound Workshop on Confidence in Medical and Pre-Medical Students

Background: The vast utilization of Point-of-Care Ultrasound (POCUS) across medical specialties has increased the need for enhanced undergraduate medical education in image acquisition and interpretation among medical students. However, challenges such as the need for a standardized medical school curriculum and limited trained faculty preceptors restrict its implementation. The literature highlights the potential of student-taught POCUS workshops in expanding access and enhancing learning. This study seeks to evaluate the efficacy of a student-run POCUS workshop for medical and pre-medical students. Methods: A prospective, cross-sectional study assessed the efficacy of first and second-year medical students teaching a POCUS workshop on the Focused Assessment with Sonography for Trauma (FAST) exam. Student workshop participants were asked to complete pre- and post-workshop surveys to assess their confidence in utilizing POCUS and identifying relevant organs and landmarks. Surveys employed a standardized five-point Likert Scale. Results: Of the 43 initial participants, 29 completed both surveys. Results showed a significant increase in self-reported ultrasound experience (1.7 to 3.2, p < 0.001) and confidence in performing the FAST exam and organ identification (2.2-fold increase, p < 0.001). Both medical and pre-medical student cohorts exhibited similar confidence improvements in confidence. Conclusion: This study supports the literature that student-taught POCUS programs may be a viable adjunct to an institution's ultrasound curriculum. Implementing medical student-led workshops could help address current training gaps, enhance students' teaching and leadership skills, and improve confidence in utilizing and interpreting ultrasound images.

Immersive medical training: a comprehensive longitudinal study of extended reality in emergency scenarios for large student groups

Young healthcare professionals and medical graduates often fall short in the practical experience necessary for handling medical emergencies. This can not only lead to strained feelings of inadequacy and insecurity among future physicians and less experienced healthcare providers in general, but also to detrimental outcomes for patients as emergency medicine demands rapid decision-making with low tolerance for errors. New didactic modalities and approaches may be needed to effectively address this shortcoming. Immersive technologies are powerful novel educational tools with untapped potential in medical training, and may be particularly suitable for simulation trainings in the high-stakes field of emergency medicine.Herein, we systematically explored the educational potential of extended reality (XR) technology, particularly virtual reality (VR), in the management of patients presenting as medical emergencies, combining the use of the STEP-VR application with an untethered hardware setup.Importantly, we aimed at studying multiple, large cohorts of senior medical students involving a total of 529 participants and collecting data over a period of two years. We assessed students’ acceptance of the training through a modified questionnaire measuring device handling, content complexity, degree of immersion, learning success, and seminar design.Our results show high, sustained acceptance and ease of use across different student cohorts and subgroups, with most students finding XR/VR engaging and beneficial for acquiring emergency medicine skills. Importantly, the prevalence of simulation sickness was minimal. Moreover, no major effect of the head-mounted displays (HMDs) price range was noted with regard to the learning experience. The results underscore the potential of XR/VR capabilities in effectively enhancing medical education, particularly in areas of high-stakes clinical scenarios and emergency care, by providing realistic and reproducible immersive training environments.In summary, our findings suggest that XR/VR-based training approaches could significantly contribute to preparing future physicians for the complexities of emergency medical care, encouraging the integration of such technologies into medical curricula. However, careful consideration must be given to its suitability for all students and the practical challenges of its implementation, highlighting the need for further research to harness its full potential for medical education.

Tumor board simulation improves interdisciplinary decision-making in medical students

IntroductionTraining of interdisciplinary clinical reasoning and decision-making skills, essential in daily clinical practice in oncological specialties, are still underrepresented in medical education. Therefore, at LMU University Hospital Munich, we implemented a didactically modified tumor board simulation with experts from five different disciplines (medical oncology, pathology, radiation oncology, radiology, and surgery) presenting patient cases into a one-week course on the basic principles of oncology. In this survey, we examined the self-assessed impact of our course on the interdisciplinary decision-making skills of medical students.MethodsBetween November-December 2023 and January-February 2024, we surveyed two cohorts of medical students in the third year of medical school in our one-week course before and after participating in the tumor board simulation. The objective was to evaluate the self-assessed knowledge in interdisciplinary clinical decision-making, in integrating ethical considerations into clinical reasoning, and in comprehension of various professional viewpoints in interdisciplinary decision-making. Knowledge was assessed using a five-step Likert scale from 1 (no knowledge) to 5 (complete knowledge).ResultsThe survey was answered by 76 students before and 55 after the simulation, equaling 60–70% of all 100 course participants. Mean knowledge level regarding principles of interdisciplinary clinical decision-making improved significantly in all of the following exemplary aspects: purpose and procedure of tumor boards in clinical practice (from 2.4 ± 1.1 to 4.0 ± 1.0, Spearman’s ρ = 0.6, p < 0.001), principles of dealing with ethical challenges in oncology (from 2.4 ± 1.1 to 3.4 ± 1.0, ρ = 0.4, p < 0.001), and principles of shared decision-making in oncology (2.7 ± 1.1 to 3.7 ± 1.0, ρ = 0.4, p < 0.001). Students reported that their skills in clinical decision-making and ability to discuss oncological patient cases from different professional viewpoints improved due to the teaching course.ConclusionBy employing our interdisciplinary one-week course and a didactically modified tumor board simulation featuring experts from various oncological disciplines, medical students’ comprehension of interdisciplinary clinical decision-making in oncology improved significantly.

When can we identify the students at risk of failure in the national medical licensure examination in Japan using the predictive pass rate?

ContextFailure of students to pass the National Medical Licensure Examination (NMLE) is a major problem for universities and the health system in Japan. To assist students at risk for NMLE failure as early as possible after admission, this study investigated the time points (from the time of admission to graduation) at which predictive pass rate (PPR) can be used to identify students at risk of failing the NMLE.MethodsSeven consecutive cohorts of medical students between 2012 and 2018 (n = 637) at the Gifu University Graduate School of Medicine were investigated. Using 7 variables before admission to medical school and 10 variables after admission, a prediction model to obtain the PPR for the NMLE was developed using logistic regression analysis at five time points, i.e., at admission and the end of the 1st, 2nd, 4th, and 6th grades. All students were divided into high (PPR < 95%) and low (PPR ≥ 95%) risk groups for failing the NMLE at the five time points, respectively, and the movement between the groups during 6 years in school was simulated.ResultsMedical students who passed the NMLE had statistically significant factors at each of the 5 time points, and the number of significant variables increased as their grade in school advanced. In addition, two factors extracted at admission were also selected as significant variables at all other time points. Especially, age at entry had a consistent and significant effect during medical school.ConclusionsRisk analysis based on multiple variables, such as PPR, can inform more effective intervention compared to a single variable, such as performance in the mock exam. A longer prospective study is required to confirm the validity of PPR.

Relationship between Prayer Intensity and Anxiety Levels among Medical Students at Muslim Indonesian University

In the dynamic environment of Indonesian universities, students, particularly those in the medical field, face a crucial juncture of personal growth amid academic rigor. This transition from youth to adulthood brings with it not only academic challenges but also psychological hurdles, notably anxiety. While anxiety is a common human experience, it can impede a student's ability to thrive. However, within the context of Indonesian culture, prayer serves as a powerful tool for mental well-being. Studies have indicated its potential to alleviate anxiety and foster a sense of calmness. Thus, this research endeavors to explore the relationship between prayer intensity and anxiety levels among the 2021 cohort of medical students at the Muslim University of Indonesia, shedding light on the intersection of spirituality and mental health in academic settings. The study revealed that the majority of the 2021 cohort of medical students at Muslim University of Indonesia are 21 years old (54.8%), predominantly female (76.7%), with most exhibiting good prayer intensity (49.3%) and normal anxiety levels (74%). Additionally, Chi-Square analysis indicated a significant relationship between prayer intensity and anxiety levels among these students (p = 0.005&lt;0.05). The study findings indicate that the sampled 2021 medical students at Muslim University of Indonesia exhibit good prayer intensity and normal anxiety levels. Moreover, there's a significant relationship between prayer intensity and anxiety levels among these students.

Validation of the Bangla version of the Communication Skills Attitude Scale with the medical students of Bangladesh.

Effective communication skill of physicians is an important component of high-quality healthcare delivery and safe patient care. Communication is embedded in the social and cultural contexts where it takes place. An understanding of medical students' attitudes and learning communication skills would help to design and deliver culturally appropriate medical education. The Communication Skills Attitude Scale (CSAS) is a widely used and validated tool to measure the attitude of medical students toward learning communication skills in different populations, settings, and countries. However, there is no culturally adapted and validated scale in Bangla in the Bangladesh context. This study aims to culturally adapt the CSAS into Bangla, and validate it in a cohort of medical students in Bangladesh. This study used a cross-sectional survey design to collect data from purposively selected 566 undergraduate medical students from the Rajshahi division. The survey was conducted from January to December 2023. Descriptive statistics like frequency distribution and measures of central tendency were used to measure perception regarding communication skills. The sample adequacy was measured through the Kaiser-Meyer-Olkin test. The internal consistency of the items was identified using Cronbach's alpha (α) coefficients. The results of the study show that the Bangla version of the scale is feasible, valid, and internally consistent in the context of a developing country, Bangladesh. The overall internal consistency of the Bangla version is good since the value of Cronbach's alpha (α) is 0.882. For PAS, the internal consistency is 0.933. While, for NAS, the value is 0.719. The item-wise average scores in the PAS indicate that female medical students are more willing to learn communication skills compared with male students (α = 0.933). While, the scores in the NAS indicate that the male students tend to have more negative attitude toward learning communication skills compared with female students (α = 0.719). The CSAS-Bangla is a valid and reliable tool for assessing communication skill attitudes among Bangla speaking medical students. This scale can be used in future studies to measure the attitude of students, designing and evaluating communication skills training programs in medical colleges.

Developing a Situational Judgement Test to Assess Clinical Judgement in Fourth-Year Medical Students: A Pilot Study.

Introduction Assessing clinical judgement objectively and economically presents a challenge in academic medicine. The authors developed a situational judgement test (SJT) to measure fourth-year medical students' clinical judgement. Methods A knowledge-based, single-best-answer SJT was developed by a panel of subject matter experts (SMEs). The SJT included 30 scenarios, each with five response options ranked ordinally from most to least appropriate. A computer-based format was used, and the SJT was piloted by two cohorts of fourth-year medical students at California University of Science and Medicine in 2022 and 2023 upon completion of an internship preparation course. Subsequently, students completed an optional survey. Evaluated scoring methods included original ordinal ranking, dichotomous, dichotomous with negative correction, distance from SME best answer, and distance from SME best answer squared. Results The SJT was completed by 142 fourth-year medical students. Cronbach's alpha ranged from 0.39 to 0.85, depending on the scoring method used. The distance-from-SME-best-answer-squared method yielded the highest internal consistency, which was considered acceptable. Using this scoring method, the mean score was 72.89 (SD = 48.32, range = 26-417), and the standard error of measurement was 18.41. Item analysis found that seven (23%) scenarios were of average difficulty, 13 (43%) had a good or satisfactory discrimination index, and nine (30%) had a distractor efficiency of at least 66%. Most students preferred the SJT to a traditional multiple-choice exam (16; 62%) and felt it was an appropriate tool to assess clinical judgement (15; 58%). Conclusions The authors developed and piloted an SJT to assess clinical judgement among medical students. Although not achieving validation, subsequent development of the SJT will focus on expanding the SME concordance panel, improving difficulty and discrimination indices, and conducting parallel forms reliability and adverse impact analyses.

Intramuscular Adipose Tissue in the Lumbar Paraspinal Muscles Does Not Correlate With Low Back Pain in Medical Students

Objective: The objective of the study is to identify any intergroup differences or statistically significant correlations between paraspinal intramuscular adipose tissue (IntraMAT) deposition and variables such as low back pain, gender, self-reported activity level, body mass index (BMI), age, and academic class-year, as measured by sonographic intensity analysis. This study is specific to a cohort of first- and second-year medical students. Materials and Methods: The right lumbar paraspinal muscles, at the level of the fifth lumbar vertebrae, were investigated with sonography among a cohort of medical students. Image pixels, within the selected region of interest, were segregated by pixel intensity and analyzed for IntraMAT content. Participants reported on additional study variables by responding to a survey. The cohort responses were analyzed to seek correlations between those variables and IntraMAT. Results: The female participants were found to have more IntraMAT ( P &lt; .001). Most participants reported low back pain. There were no significant correlations between IntraMAT and reported low back pain, academic class year, or BMI. Moderate exercise increased IntraMAT deposition, and each year of increasing age decreased IntraMAT ( P &lt; .05). Second-year students experienced more self-reported low back pain than first-year students. Conclusion: A cohort of medical students who were reportedly sedentary had more low back pain than their peers. Back pain was more prevalent in second-year students, irrespective of age, suggesting that ill effects of a sedentary lifestyle may be cumulative. The validity of the sonographic pixel intensity analysis performed was supported by the highly significant increase in IntraMAT observed in female participants. The relationship between low back pain, exercise, BMI, and IntraMAT was uncertain based on available evidence and the results of this study.

Medical students' perspective on the United States Medical Licensing Examination (USMLE) Step 1 transition to Pass/Fail

Background The transition of the United States Medical Licensing Exam: Step 1 to Pass/Fail (P/F), from scored, caused uncertainty about students’ preparedness and wellbeing related to the exam. Comparison of study behavior and results, before and after the P/F transition can provide insights for the medical curriculum and student support. The aim of this study is to evaluate students’ perceptions of their efforts in Step 1 preparation, as compared to cohort performances to determine the impact of the transition of Step 1 to P/F on medical students. Methods Data from four cohorts of second-year medical students (Class of 2022–25, N = 204) were collected from their dedicated Step 1 self-study block. Student study regiments, aggregate practice test results, Step 1 pass rates and post-block self-reported surveys were analyzed qualitatively to compare student effort and outcomes for scores and P/F cohorts. Results Analysis of practice exam averages across the four student cohorts demonstrates a potentially slower and less rigorous start to Step 1 self-studying during the dedicated preparation block for the cohorts that took the P/F Step 1 exam format as compared to the previous cohorts that prepared for a scored Step 1 exam. Similarly, self-reported study regiments decreased in the median number of hours/day and number of weeks of study for the cohorts with P/F Step 1 exam. There was also a slight shift in the type of study resources used, between the two groups, with the scored group using more traditional board preparation resources. Conclusions The P/F transition of the Step 1 exam may lead to reduced student preparedness and may require adjustments in the resources and support provided by institutions.

Validity evidence for the clinical communication skills assessment tool (CCSAT) from 9 years of implementation in a high stakes medical student OSCE

ObjectivesCommunication and other clinical skills are routinely assessed in medical schools using Objective Structured Clinical Examinations (OSCEs) so routinely that it can be difficult to monitor and maintain validity. We report on the accumulation of validity evidence for the Clinical Communication Skills Assessment Tool (CCSAT) based on its use with 9 cohorts of medical students in a high stakes OSCE. MethodsWe describe the implementation of the CCSAT including information on the underlying model, the tool’s items, domains, scales and scoring, and its role in curriculum. Internal structure is explored through item, internal consistency, and confirmatory factor analyses. Evidence for CCSAT validity is synthesized within prevailing frameworks (Messick12 and Kane13) based on continuous quality improvement and use of the CCSAT for feedback, remediation, curricular design, and research. ResultsImplementation of the CCSAT over time has facilitated our communication skills curriculum and training. Thoughtful case development and investment in standardized patient training has contributed to data quality. Item analysis supports our behaviorally anchored scale (not done, partly and well done) and the skills domains suggested by an a priori evidence-based clinical communication model were confirmed via analysis of actual student data. Evidence synthesized across the frameworks suggests consistent validity of the CCSAT for generalization inferences (that it captures the construct), responsiveness (sensitivity to change/difference), content validity/internal structure, relationships to other variables, and consequences/implications. More evidence is needed to strengthen validity of CCSAT scores for understanding extrapolation inferences and real-world implications. Conclusions and Practice ImplicationsThis pragmatic approach to evaluating validity within a program of assessment serves as a model for medical schools seeking to continuously monitor the quality of clinical skill assessments, a need made particularly relevant since the US NBME no longer requires the Step 2 Clinical Skills exam, leaving individual schools with the responsibility for ensuring graduates have acquired the requisite core clinical skills. We document strong evidence for CCSAT validity over time and across cohorts as well as areas for improvement and further examination.

Ownership of Patient Care: Medical Students’ Expectations, Experiences, and Evolutions Across the Core Clerkship Curriculum

Phenomenon : Ownership of patient care is a key element of professional growth and professional identity formation, but its development among medical students is incompletely understood. Specifically, how attitudes surrounding ownership of patient care develop, what experiences are most influential in shaping them, and how educators can best support this growth are not well known. Therefore, we studied the longitudinal progression of ownership definitions and experiences in medical students across their core clerkship curriculum. Approach : We conducted a series of four longitudinal focus groups with the same cohort of medical students across their core clerkship curriculum. Using workplace learning theory as a sensitizing concept, we conducted semi-structured interviews to explore how definitions, experiences, and influencers of ownership developed and evolved. Results were analyzed inductively using thematic analysis. Findings : Fifteen students participated in four focus groups spanning their core clerkship curriculum. We constructed four themes from responses: (1) students’ definitions of ownership of patient care evolved to include more central roles for themselves and more defined limitations; (2) student conceptions of patient care ownership became more relational and reciprocal over time as they ascribed a more active role to patients; (3) student assessment fostered ownership as an external motivator when it explicitly addressed ownership, but detracted from ownership if it removed students from patient care; and (4) structural and logistical factors impacted students’ ability to display patient care ownership. Insights : Student conceptions of ownership evolved over their core clerkship curriculum to include more patient care responsibility and more meaningful relational connections with patients, including recognizing patients’ agency in this relationship. This progression was contingent on interactions with real patients and students being afforded opportunities to play a meaningful role in their care. Rotation structures and assessment processes are key influencers of care ownership that merit further study, as well as the voice of patients themselves in these relationships.

Correction to "Ensuring incoming cohorts of medical students better represent the diversity of Indigenous communities in Canada".

Correction to "Ensuring incoming cohorts of medical students better represent the diversity of Indigenous communities in Canada".

Ensuring incoming cohorts of medical students better represent the diversity of Canada's Indigenous communities.

Ensuring incoming cohorts of medical students better represent the diversity of Canada's Indigenous communities.

Does Medical Curriculum Impact on Empathy? A Longitudinal Study in a Sample of Undergraduate Medical Students

Empathy in medical students is receiving increasing attention as it is fundamental to build and develop a functional patient-physician relationship. When looking at its determinants, demographic and academic factors seem to concur in shaping empathy in this population. Although data show strong gender differences and changes in empathy throughout medical school, it is not clear the direction of these changes and whether gender and curriculum features modulate them. This longitudinal study examined changes in empathy and explored gender differences throughout the medical school. Four consecutive cohorts of Italian medical students (N = 336) completed the Jefferson Scale of Empathy – Student (JSE-S) and the Interpersonal Reactivity Index (IRI) in their second year of study (before any clinical clerkship and communication skills courses) and fifth year of study (after a 2-year clinical clerkship and communication skills courses). Analysis of variance for repeated-measures revealed that, beyond the effect of gender, JSE-S total score and IRI Perspective Taking increased, whereas IRI Personal Distress and IRI Fantasy significantly decreased throughout medical school. No significant change in IRI Empathic Concern emerged over time. Student’s t-tests showed that female students displayed significantly higher mean scores than their male counterparts for all empathy measures in both their second and fifth years of medical training. The findings suggest that the medical curriculum affects self-reported empathy dimensions among undergraduate medical students. Further research is needed to deepen the understanding of the educational factors that promote the changes in empathy levels during medical training.

Learning Bayesian Networks: A Copula Approach for Mixed-Type Data.

Estimating dependence relationships between variables is a crucial issue in many applied domains and in particular psychology. When several variables are entertained, these can be organized into a network which encodes their set of conditional dependence relations. Typically however, the underlying network structure is completely unknown or can be partially drawn only; accordingly it should be learned from the available data, a process known as structure learning. In addition, data arising from social and psychological studies are often of different types, as they can include categorical, discrete and continuous measurements. In this paper, we develop a novel Bayesian methodology for structure learning of directed networks which applies to mixed data, i.e.,possibly containing continuous, discrete, ordinal and binary variables simultaneously. Whenever available, our method can easily incorporate known dependence structures among variables represented by paths or edge directions that can be postulated in advance based on the specific problem under consideration. We evaluate the proposed method through extensive simulation studies, with appreciable performances in comparison with current state-of-the-art alternative methods. Finally, we apply our methodology to well-being data from a social survey promoted by the United Nations, and mental health data collected from a cohort of medical students. R code implementing the proposed methodology is available at https://github.com/FedeCastelletti/bayes_networks_mixed_data .