MD Program Research Articles

STEERing an IDeA in Undergraduate Research at a Rural Research Intensive University

This study documents outcomes, including student career choices, of the North Dakota Institutional Development Award Networks of Biomedical Research Excellence program that provides 10-week, summer undergraduate research experiences at the University of North Dakota School of Medicine and Health Sciences. Program evaluation initiated in 2008 and, to date, 335 students have completed the program. Of the 335, 214 students have successfully completed their bachelor’s degree, 102 are still undergraduates, and 19 either did not complete a bachelor’s degree or were lost to follow-up. The program was able to track 200 of the 214 students for education and career choices following graduation. Of these 200, 76% continued in postgraduate health-related education; 34.0% and 20.5% are enrolled in or have completed MD or PhD programs, respectively. Other postbaccalaureate pursuits included careers in pharmacy, optometry, dentistry, public health, physical therapy, nurse practitioner, and physician’s assistant, accounting for an additional 21.5%. Most students electing to stop formal education at the bachelor’s degree also entered fields related to health care or science, technology, engineering, and mathematics (19.5%), with only a small number of the 200 students tracked going into service or industries which lacked an association with the health-care workforce (4.5%). These student outcomes support the concept that participation in summer undergraduate research boosts efforts to populate the pipeline of future researchers and health professionals. It is also an indication that future researchers and health professionals will be able to communicate the value of research in their professional and social associations. The report also discusses best practices and issues in summer undergraduate research for students originating from rural environments.

Integrating behavioral and social sciences components into a competency-based MD program curriculum: A qualitative study on opinions of faculty members.

Background: Behavioral, social, psychological and biological factors influence health and disease; and, to achieve professional competency, physicians should be knowledgeable about their society and its inhabitants’ behavior. This knowledge will help physicians to become competent in communication, professional behavior, self-awareness, ethical reasoning, and understanding cultural and social differences. In this regard, this research is an attempt to explore perspectives of medical faculty members on necessity of integrating Behavioral and Social Sciences (BSS) components into the medical curriculum. Methods: In this qualitative study, data were collected by semi-structured interview and observation of participants who were recruited from educational departments of faculty of medicine of Iran University of Medical Sciences. 12 faculty members were interviewed individually and were ask about their experiences and perspectives on integration of BSS subject matters into medical curriculum. Data were analyzed using content analysis. Results: The six following themes were emerged from data analysis: "physician-patient interaction", "medical culture", "facilitating behavior change", "socio-cultural issues", "mind-body medical experience" and "physician interaction with health care system". Conclusion: The results revealed that "physician-patient interaction" was the most prominent among the emerged themes. The participants emphasized communication, professionalism, social accountability, and socio-cultural-psychological aspects

Roadmap for creating an accelerated three-year medical education program

ABSTRACTMedical education is undergoing significant transformation. Many medical schools are moving away from the concept of seat time to competency-based education and introducing flexibility in the curriculum that allows individualization. In response to rising student debt and the anticipated physician shortage, 35% of US medical schools are considering the development of accelerated pathways. The roadmap described in this paper is grounded in the experiences of the Consortium of Accelerated Medical Pathway Programs (CAMPP) members in the development, implementation, and evaluation of one type of accelerated pathway: the three-year MD program. Strategies include developing a mission that guides curricular development – meeting regulatory requirements, attaining institutional buy-in and resources necessary to support the programs, including student assessment and mentoring – and program evaluation. Accelerated programs offer opportunities to innovate and integrate a mission benefitting students and the public.Abbreviations: CAMPP: Consortium of accelerated medical pathway programs; GME: Graduate medical education; LCME: Liaison committee on medical education; NRMP: National residency matching program; UME: Undergraduate medical education

Learning gains in a flipped classroom to teach the principles of envenomation

Diagnosis and management of venomous bites and stings, particularly snakebite, is important for Australian clinicians. In 2015, a flipped classroom was trialled to teach the principles of envenomation to year 1 medical students in a MD program. A bespoke online resource was developed and then used by students to prepare for a face-to-face class tailored to their learning needs. Students reported positively about learning the principles of envenomation with the online resource and found it useful. Responses from students also indicated that the interactive class was beneficial to their learning, particularly the clinical application of envenomation. These findings were supported by comparisons of pre- and post-test scores that showed significant learning gains across eight questions. The study also provided some insights into students' perception of knowledge retention and why some students may prefer to prepare individually for content attainment.

Not the Last Word: Ending The Residency Application Arms Race-Starting with the USMLE.

Not the Last Word: Ending The Residency Application Arms Race-Starting with the USMLE.

Medical Training to Achieve Competency in Lifestyle Counseling: An Essential Foundation for Prevention and Treatment of Cardiovascular Diseases and Other Chronic Medical Conditions: A Scientific Statement From the American Heart Association.

A healthy lifestyle is fundamental for the prevention and treatment of cardiovascular disease and other noncommunicable diseases (NCDs). Investment in primary prevention, including modification of health risk behaviors, could result in a 4-fold improvement in health outcomes compared with secondary prevention based on pharmacological treatment. The American Heart Association (AHA) emphasized the importance of lifestyle in its 2020 goals for cardiovascular health promotion and disease reduction. In addition to defining “cardiovascular health” based on criteria for blood pressure and biochemical markers (lipids and glycemia), the AHA Strategic Planning Committee further identified lifestyle characteristics of central importance: nutrition, physical activity, smoking, and maintenance of a healthy body weight.1 The World Health Organization estimated that ≈80% of NCDs could be prevented if 4 key lifestyle practices were followed: a healthy diet, being physically active, avoidance of tobacco, and alcohol intake in moderation.2 To support healthy lifestyle initiatives, major changes are necessary at the societal level to improve population health. Numerous strategies might help to create a culture that promotes and facilitates healthy behaviors, including creating laws and regulations, mounting large-scale public awareness and education campaigns, implementing local community programs, and providing individual counseling.3 Physicians are uniquely positioned to encourage individuals to adopt healthy lifestyle behaviors: Approximately 80% of Americans visit their primary care physician at least once a year. Physicians directly communicate with their patients during clinical encounters across numerous settings, and research indicates that patients highly value recommendations provided by their physicians.4,5 However, data further indicate that lifestyle counseling does not routinely occur in physicians’ offices, thereby representing a lost opportunity. Physicians report that they perform lifestyle counseling during ≈34% of clinic visits.4 Patients, in turn, report an even lower frequency of physician lifestyle counseling. For example, obese patients reported receiving physical activity and …

Leadership training for undergraduate medical students.

Purpose Physicians play an important leadership role in the management and governance of the healthcare system. Yet, many physicians lack formal management and leadership training to prepare them for this challenging role. This Viewpoint article argues that leadership concepts need to be introduced to undergraduate medical students early and throughout their medical education. Design/methodology/approach Leadership is an integral part of medical practice. The recent inclusion of "Leader" competency in the CanMEDS 2015 represents a subtle but important shift from the previous "manager" competency. Providing medical students with the basics of leadership concepts early in their medical education allows them to integrate leadership principles into their professional practice. Findings The Faculty of Medicine at the Memorial University of Newfoundland (MUN) has developed an eight-module, fully online Physician Leadership Certificate for their undergraduate medical education program. This program is cited as an example of an undergraduate medical curriculum that offers leadership training throughout the 4 years of the MD program. Originality/value There are a number of continuing professional development opportunities for physicians in the area of management and leadership. This Viewpoint article challenges undergraduate medical education programs to develop and integrate leadership training in their curricula.

Readiness for Residency: A Survey to Evaluate Undergraduate Medical Education Programs.

Health professions programs continue to search for meaningful and efficient ways to evaluate the quality of education they provide and support ongoing program improvement. Despite flaws inherent in self-assessment, recent research suggests that aggregated self-assessments reliably rank aspects of competence attained during preclerkship MD training. Given the novelty of those observations, the purpose of this study was to test their generalizability by evaluating an MD program as a whole. The Readiness for Residency Survey (RfR) was developed and aligned with the published Readiness for Clerkship Survey (RfC), but focused on the competencies expected to be achieved at graduation. The RfC and RfR were administered electronically four months after the start of clerkship and six months after the start of residency, respectively. Generalizability and decision studies examined the extent to which specific competencies were achieved relative to one another. The reliability of scores assigned by a single resident was G = 0.32. However, a reliability of G = 0.80 could be obtained by averaging over as few as nine residents. Whereas highly rated competencies in the RfC resided within the CanMEDS domains of professional, communicator, and collaborator, five additional medical expert competencies emerged as strengths when the program was evaluated after completion by residents. Aggregated resident self-assessments obtained using the RfR reliably differentiate aspects of competence attained over four years of undergraduate training. The RfR and RfC together can be used as evaluation tools to identify areas of strength and weakness in an undergraduate medical education program.

Joseph C. Wu: Envisioning Personalized Medicine and Clinical Trials in a Dish.

If he develops heart disease in the future, Joseph Wu envisions his physicians selecting the ideal medication for him by first testing drugs on his “mini-me” surrogates – dishes of beating heart cells created from his own stem cells. Joseph C. Wu Growing up in Southern California, Wu helped his father grow Asian specialty pears. Now, as director of the Stanford Cardiovascular Institute in Palo Alto, California, he grows cardiomyocytes for a wide range of applications – disease modeling, drug discovery, medication safety testing, and possible regenerative therapy. Since coming to Stanford in 2004, Wu has worked with both human embryonic stem (ES) cells and human induced pluripotent stem (iPS) cells. Using ES cells, Dr Wu’s laboratory is addressing several important technical challenges in stem cell technology, including how to improve cardiac differentiation efficiency,1 control potential tumorigenicity,2 and avoid immune rejection.3 For iPS cells, his laboratory has shown that iPS cell-derived cardiomyocytes can be used to elucidate the molecular mechanisms of familial dilated cardiomyopathy and hypertrophic cardiomyopathy.4–6 In a paper designated the best basic science manuscript in Circulation in 2014, Wu used a library of iPS cell-derived cardiomyocytes to show that patterns of drug-induced cardiotoxicity differed among healthy controls and patients with long QT syndrome, hypertrophic cardiomyopathy, and dilated cardiomyopathy, indicating that the system might be a more accurate predictor of adverse drug responses than current assays and screening tests.7 In Circulation Research , he recently described the opportunities to use iPS cell-derived cardiomyocytes to advance the scientific understanding and treatment of sudden cardiac death.8 The Stanford Cardiovascular Institute is currently creating a biobank of patient-specific, deidentified iPS cell lines from healthy controls and patients with a wide range of cardiovascular diseases, which will benefit the research community and patients alike.9 …

Increasing the Utility of AAMC Canadian Graduation Questionnaire Data for Program Evaluation: Subscale Development

Abstract: The AAMC Canadian Graduation Questionnaire (CGQ) is widely used for evaluating undergraduate MD programs; however, the analysis of individual items limits its usefulness. To aid in the management and interpretation of the CGQ for use in program evaluation, this study combined items from the sections on clinical learning experiences, physician competencies, and student services into scales and examined their internal structure and reliability. Factor analyses conducted on data from 517 undergraduate medical students supported combining the items into 15 scales. Two examples illustrate how the scales can be used to evaluate student experiences for different cohorts over time and across sites.

Information-Seeking Behaviors of Medical Students: A Cross-Sectional Web-Based Survey.

BackgroundMedical students face an information-rich environment in which retrieval and appraisal strategies are increasingly important.ObjectiveTo describe medical students’ current pattern of health information resource use and characterize their experience of instruction on information search and appraisal.MethodsWe conducted a cross-sectional web-based survey of students registered in the four-year MD Program at Dalhousie University (Halifax, Nova Scotia, and Saint John, New Brunswick, sites), Canada. We collected self-reported data on information-seeking behavior, instruction, and evaluation of resources in the context of their medical education. Data were analyzed using descriptive statistics.ResultsSurveys were returned by 213 of 462 eligible students (46.1%). Most respondents (165/204, 80.9%) recalled receiving formal instruction regarding information searches, but this seldom included nontraditional tools such as Google (23/107, 11.1%), Wikipedia, or social media. In their daily practice, however, they reported heavy use of these tools, as well as EBM summaries. Accessibility, understandability, and overall usefulness were common features of highly used resources. Students identified challenges managing information and/or resource overload and source accessibility.ConclusionsMedical students receive instruction primarily on searching and assessing primary medical literature. In their daily practice, however, they rely heavily on nontraditional tools as well as EBM summaries. Attention to appropriate use and appraisal of nontraditional sources might enhance the current EBM curriculum.

Investigating Canadian medical school attrition metrics to inform socially accountable admissions planning

Objective: Attrition from Canadian medical degree programs was never described despite differences in admissions requirements at the 17 faculties of medicine. Knowledge on attrition metrics could help the faculties evaluate new avenues for addressing the Association of Faculties of Medicine’s (AFMC) Future of Medical Education in Canada (FMEC MD) recommendation to enhance admissions practices with the goal to improve social accountability and student diversity.Method: AFMC databases were used to track medical degree completion of all Canadian M.D. students who enrolled between 2003 and 2007. Students were followed and assigned an M.D. completion status as of by July 1, 2013. Bivariate statistics were used to evaluate if demographic, admission and degree progression variables were associated with medical school attrition.Results: Of 11,454 students enrolled in Canadian M.D. programs from 2003 to 2007, only 197 (1.7%) did not complete. Québec had significantly higher attrition than other jurisdictions with age, educational attainment at time of enrolment, MCAT completion and struggling academically associated with attrition.Conclusion: Attrition from Canadian MD programs is rare and associated with differences in admission requirements and possibly suggests an optimum life stage for medical studies. Improved knowledge of attrition-related factors may offer an additional level of evidence for improving the alignment between admissions policies and the social accountability objectives of medical schools.

MD PhD programs: Providing basic science education for ophthalmologists

Enrollment in MD PhD programs offers the opportunity of a basic science education for medical students and doctors. These programs originated in the USA where structured programs have been offered for many years, but now German universities also run MD PhD programs. The MD PhD programs provided by German universities were investigated regarding entrance requirements, structure and financing modalities. An internet and telephone-based search was carried out. Out of 34 German universities 22 offered MD PhD programs. At 15 of the 22 universities a successfully completed course of studies in medicine was required for enrollment, 7 programs admitted medical students in training and 7 programs required a medical doctoral thesis, which had to be completed with at least a grade of magna cum laude in 3 cases. Financing required scholarships in many cases. Several German universities currently offer MD PhD programs; however, these differ considerably regarding entrance requirements, structure and financing. A detailed analysis investigating the success rates of these programs (e.g. successful completion and career paths of graduates) would be of benefit.

Validity of the Medical College Admission Test for predicting MD-PhD student outcomes.

The Medical College Admission Test (MCAT) is a quantitative metric used by MD and MD–PhD programs to evaluate applicants for admission. This study assessed the validity of the MCAT in predicting training performance measures and career outcomes for MD–PhD students at a single institution. The study population consisted of 153 graduates of the Vanderbilt Medical Scientist Training Program (combined MD–PhD program) who matriculated between 1963 and 2003 and completed dual-degree training. This population was divided into three cohorts corresponding to the version of the MCAT taken at the time of application. Multivariable regression (logistic for binary outcomes and linear for continuous outcomes) was used to analyze factors associated with outcome measures. The MCAT score and undergraduate GPA (uGPA) were treated as independent variables; medical and graduate school grades, time-to-PhD defense, USMLE scores, publication number, and career outcome were dependent variables. For cohort 1 (1963–1977), MCAT score was not associated with any assessed outcome, although uGPA was associated with medical school preclinical GPA and graduate school GPA (gsGPA). For cohort 2 (1978–1991), MCAT score was associated with USMLE Step II score and inversely correlated with publication number, and uGPA was associated with preclinical GPA (mspGPA) and clinical GPA (mscGPA). For cohort 3 (1992–2003), the MCAT score was associated with mscGPA, and uGPA was associated with gsGPA. Overall, MCAT score and uGPA were inconsistent or weak predictors of training metrics and career outcomes for this population of MD–PhD students.

Who should choose a rural LIC: A qualitative study of perceptions of students who have completed a rural longitudinal integrated clerkship

Purpose: Evidence from many longitudinal integrated clerkships (LICs) has shown that students in LICs do as well as those in rotation-based clerkships (RBCs). Researchers now are turning to questions of how and why LICs work and for whom. This study explores the question: “Who should choose the University of Alberta’s Rural LIC?”Methods: Reflective conversations were held with former LIC students at the end of their fourth year of the MD program. The 5-year study began in a hermeneutic phenomenological frame evolving to an iterative process of collection and analysis in the tradition of grounded theory.Results: Students’ perceptions coalesced around four themes: (1) approach to learning, (2) personality, (3) attitudes and (4) career goals. The ability to adapt one’s own structure for learning, a preference for learning by doing and self-directedness were all important factors.Conclusion: Prospective students should be flexible, adaptable, comfortable being uncomfortable, adventuresome and embrace both the program and rural community life in order to benefit maximally from the experience. Rural LICs can be a choice for anyone, but students who have completed a rural LIC identify reasons why it may or may not be the best choice for everyone.

Faculty And Student Perspectives On Formative Feedback And Its Role In Learning

This study explored educators' and students' understanding of feedback and studied educators' implementation and students' utilization of feedback.This is a retrospective observational study that employed a qualitative, in‐depth, semi‐structured interview method. The study was conducted in the MD program at the University of Central Florida College of Medicine. The participants included 11 full‐time faculty members and 13 students from the Class of 2016. Interview transcripts were subject to coding and thematic analysis. Standard end‐of‐course student evaluations were also analyzed for each of the 14 courses in the pre‐clerkship curriculum to gain insight into satisfaction about feedback.The majority of faculty and all student participants gave only basic definitions of feedback and lacked insight into the components of effective feedback. The most commonly listed form of feedback was weekly online formative quizzes. Online quizzes are a type of formative assessment and represent an opportunity for feedback but are not feedback in itself. The fact that participants identified opportunities for feedback as actual feedback indicated a possible misconception among both faculty and students. Eighty two percent of the faculty felt that they were unable to provide the desired level of feedback while 62% of students felt that they did not receive desired feedback. In end‐of‐course evaluations a summary question about level of feedback satisfaction scored lower than overall module satisfaction in all but one instance. Taking interview responses and end‐of‐course evaluation data, the study has identified a need for faculty and student education about what effective feedback is and how to better incorporate it in the education program.

Accelerated MD Programs Eliminate the Fourth Year of Medical School and May Solve Our Nation’s Physician Shortage

Accelerated MD Programs Eliminate the Fourth Year of Medical School and May Solve Our Nation’s Physician Shortage

Increasing the Utility of AAMC Canadian Graduation Questionnaire Data for Program Evaluation: Subscale Development

The AAMC Canadian Graduation Questionnaire (CGQ) is widely used for evaluating undergraduate MD programs; however, the analysis of individual items limits its usefulness. To aid in the management and interpretation of the CGQ for use in program evaluation, this study combined items from the sections on clinical learning experiences, physician competencies, and student services into scales and examined their internal structure and reliability. Factor analyses conducted on data from 517 undergraduate medical students supported combining the items into 15 scales. Two examples illustrate how the scales can be used to evaluate student experiences for different cohorts over time and across sites.

Is medical education hazardous to your health?

Is medical education hazardous to your health?

The emerging physician-scientist workforce: demographic, experiential, and attitudinal predictors of MD-PhD program enrollment.

MD-PhD scientists are a successful, but small and fairly homogenous group of biomedical researchers. The authors conducted a retrospective cohort study to identify predictors of MD-PhD program enrollment to inform evidence-based strategies to increase the size and diversity of the biomedical research workforce. Using deidentified data from all 2001-2006 Pre-Medical College Admission Test Questionnaire (PMQ) respondents, they developed multivariate logistic regression models to identify demographic, experiential, and attitudinal variables associated with MD-PhD program enrollment at matriculation compared with all other MD program enrollment at matriculation and with not enrolling in medical school by August 2012. Of 207,436 PMQ respondents with complete data for all variables of interest, 2,575 (1.2%) were MD-PhD program enrollees, 80,856 (39.0%) were other MD program enrollees, and 124,005 (59.8%) were non-medical-school matriculants. Respondents who were black (versus white), were high school and college laboratory research apprenticeship participants, and highly endorsed the importance of research/finding cures as reasons to study medicine were more likely to be MD-PhD program enrollees, whereas respondents who highly endorsed the status of medicine as a reason to study medicine were less likely to be MD-PhD program enrollees than either other MD program enrollees or non-medical-school matriculants. MD-PhD program directors succeed in enrolling students whose attitudes and interests align with MD-PhD program goals. Continued efforts are needed to promote MD-PhD workforce diversity and the value of high school and college research apprenticeships for students considering careers as physician-scientists.