Virginia Commonwealth University School Research Articles

Virginia Children’s Center Represents New Wave in Facility Design

Virginia Children’s Center Represents New Wave in Facility Design

The mental health community: An underserved and undertreated population: Students call for increased efforts to reduce mental health stigma

The mental health community: An underserved and undertreated population: Students call for increased efforts to reduce mental health stigma

Lessons Learned From the VCU School of Medicine Latino Medical Student Association: A Roadmap for Increasing Diversity in Medical School

The emphasis on increasing diversity within medical schools is not a new trend. At Virginia Commonwealth University School of Medicine, we made a concerted effort to increase the percentage of Hispanic students in each incoming class. In this article, we highlight the experiences, actions, and lessons learned from key stakeholders. We conclude with a set of recommendations for medical school administrators and students who also seek to increase diversity in their enrollment.

Are Scores From NBME Subject Examinations Valid Measures of Knowledge Acquired During Clinical Clerkships?

The National Board of Medical Examiners' Clinical Science Subject Examinations are a component used by most U.S. medical schools to determine clerkship grades. The purpose of this study was to examine the validity of this practice. This was a retrospective cohort study of medical students at the Virginia Commonwealth University School of Medicine who completed clerkships in 2012 through 2014. Linear regression was used to determine how well United States Medical Licensing Examination Step 1 scores predicted Subject Examination scores in seven clerkships. The authors then substituted each student's Subject Examination standard scores with his or her Step 1 standard score. Clerkship grades based on the Step 1 substitution were compared with actual grades with the Wilcoxon rank test. A total of 2,777 Subject Examination scores from 432 students were included in the analysis. Step 1 scores significantly predicted between 23% and 44% of the variance in Subject Examination scores, P < .001 for all clerkship regression equations. Mean differences between expected and actual Subject Examination scores were small (≤ 0.2 points). There was a match between 73% of Step 1 substituted final clerkship grades and actual final clerkship grades. The results of this study suggest that performance on Step 1 can be used to identify and counsel students at risk for poor performance on the Subject Examinations. In addition, these findings call into the question the validity of using scores from Subject Examinations as a high-stakes assessment of learning in individual clerkships.

Evaluation of medication management programs proves difficult

The most valuable lessons to be learned from the federally funded evaluation of Health Care Innovation Award–winning medication management programs lie not in the statistical information but in the qualitative findings, say two pharmacy researchers. “We have another case of trying to evaluate an innovation but [using a method that] really wasn’t designed to evaluate what the innovation was intended to do,” said Todd D. Sorensen, a professor in the Department of Pharmaceutical Care & Health Systems at the University of Minnesota College of Pharmacy in Minneapolis. Gary R. Matzke, coprincipal investigator for one of the awarding-winning programs, said he would not interpret the results of the evaluation—which found few statistical differences in outcomes with the use of medication management services—as a negative verdict on the value of pharmacy interventions. Rather, the evaluation’s quantitative findings point to “the extreme importance” of analyzing “the entirety of the data,” said Matzke, a professor in the Department of Pharmacotherapy and Outcome Sciences at Virginia Commonwealth University School of Pharmacy in Richmond.

Concordance Between Clinical Practice and Published Evidence: Findings From Virginia Commonwealth University School of Dentistry

ObjectivesTo evaluate the concordance between clinical practice and published evidence by dental faculty and graduating students of the Virginia Commonwealth University School of Dentistry. MethodsA questionnaire previously developed by the National Dental Practice-Based Research Network with 12 clinical scenarios was administered to VCU faculty and graduating students. Responses were scored as either consistent or inconsistent with published evidence and then analyzed for differences between dental faculty, graduating students, and the national results. ResultsThere were 43 dental faculty members with at least half-time student contact who responded to the survey. Faculty concordance ranged from 33% to 100%, and general practice faculty had the highest concordance (82%). Eighty-five of the graduating class of 98 responded to the survey, and student concordance ranged from 18% to 92% and averaged 67%. General practice faculty had higher concordance with published evidence than recently graduated dental students. ConclusionsGraduating students and dental faculty demonstrated higher concordance with evidence-based practice than practitioners in the National Dental Practice-Based Research Network. General practice dental faculty demonstrated adequate concordance, but students demonstrated only a medium-level concordance. Practitioners involved in teaching dental students are better able to keep up with evolving evidence and are better able to demonstrate evidence-based practice.

Student Knowledge, Skills, and Self-Efficacy Gains After Completing an Advanced Pharmacy Practice Experience in Geriatrics

Objective. To assess changes in pharmacy students' knowledge, skills, and self-efficacy after completing an advanced pharmacy practice experience (APPE) in geriatrics. Design. During the 2013-2014 academic year, 30 Virginia Commonwealth University (VCU) School of Pharmacy students were required to complete a 5-week Geriatrics APPE at Plaza Professional Pharmacy in Richmond, Virginia. All students completed a 25-point knowledge-based pre- and post-assessment to measure students' self-efficacy. The average time required to accurately fill one unit dose prescription card before and after completing the APPE was also evaluated. Assessment. Students' average score on the knowledge component improved significantly from 54% to 88% after completing the APPE. The average time required to fill one prescription decreased significantly from 4.0 minutes to 2.5 minutes. Students reported an increase in self-efficacy in the following areas: communication, immunizations, geriatrics-specific pharmacotherapy knowledge, and the ability to fill and check monthly unit dose prescription cards. Conclusion. Requiring fourth-year pharmacy students to complete a geriatrics APPE as a capstone experience to the integrated geriatrics content covered in the first through third years of the doctor of pharmacy (PharmD) curriculum provides an important opportunity to improve students' knowledge, skills, and self-efficacy in providing care to older adults.

Professor Charles E. Geyer: neoadjuvant therapy is becoming standard of care for HER2+ breast cancer

Charles E. Geyer Jr. ( Figure 1 ), MD, FACP, is Professor of Medicine in the Division of Hematology, Oncology and Palliative Care, Department of Internal Medicine, at the Virginia Commonwealth University School of Medicine, and he is also an Associate Director for Clinical Research at Virginia Commonwealth University Massey Cancer Center.

The Effects of Faculty Calibration on Caries Risk Assessment and Quality Assurance

Accurate caries risk assessment (CRA) plays a pivotal role in managing the disease of dental caries. The aim of this quality assurance study was to determine if faculty calibration training using a specific set of guidelines in a single session would improve the faculty members' CRA decision making. A calibration seminar was held in December 2014 at the Virginia Commonwealth University School of Dentistry, during which seven completed CRA forms for simulated patients were used to test 55 faculty members' risk assignment level before and after an instructional lecture was given. The results showed a statistically significant increase in the proportion of faculty members responding correctly for five of the seven cases on the pre- and posttests (p<0.01). One case showed no significant increase in correct responses (p=0.07), and on the seventh case, which presented low caries risk, there was a significant decrease in the percentage responding correctly (p<0.0001) due to an increase in the proportion overestimating caries risk. This study's findings were consistent with those in previous studies that, without calibration, faculty members are not necessarily accurate at CRA diagnosis. Since the calibration training improved these faculty members' caries risk assessment scoring, future studies should extend to evaluations for both faculty and students.

Examination of the Link Between Medication Adherence and Use of Mail-Order Pharmacies in Chronic Disease States.

Higher medication adherence is associated with positive health outcomes, including reduction in hospitalizations and costs, and many interventions have been implemented to increase patient adherence. To determine whether patients experience higher medication adherence by using mail-order or retail pharmacies. Articles pertaining to retail and mail-order pharmacies and medication adherence were collected from 3 literature databases: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and International Pharmaceutical Abstracts (IPA). Searches were created for each database and articles were compiled. Articles were screened for exclusion factors, and final articles (n=15) comparing medication adherence in patients utilizing mail and retail pharmacies were analyzed. For each study, various factors were identified including days supply, patients' out-of-pocket costs, prior adherence behavior, therapeutic class, measure of adherence, limitations, and results. Studies were then categorized by disease state, and relevant information from each study was compared and contrasted. The majority of studies-14 out of the 15 reviewed-supported higher adherence through the mail-order dispensing channel rather than through retail pharmacies. There are a number of reasons for the differences in adherence between the channels. Study patients who used mail-order pharmacies were more likely to have substantially higher prior adherence behavior, socioeconomic status, and days supply of medicines received and were likely to be offered financial incentives to use mail-order. The few studies that attempted to statistically control for these factors also found that patients using mail-order services were more adherent but the size of the differences was smaller. The extent to which these results indicate an inherent adherence advantage of mail-order pharmacy (as distinct from adherence benefits due to greater days supply, lower copays, or more adherent patients selecting mail-order pharmacies) depends on how well the statistical controls adjusted for the substantial differences between the mail and retail samples. While the research strongly indicates that consumers who use mail-order pharmacies are more likely to be adherent, more research is needed before it can be conclusively determined that use of mail-order pharmacies causes higher adherence. No outside funding supported this study. Fernandez was partially funded by a Virginia Commonwealth University School of Pharmacy PharmD/PhD Summer Fellowship for work on this project. The authors declare no other potential conflicts of interest. Study concept and design were contributed by Carroll and Fernandez. Fernandez took the lead in data collection, along with Carroll and McDaniel, and data interpretation was performed by Carroll and Fernandez. The manuscript was written and revised by Carroll and Fernandez, with assistance from McDaniel.

Quality of Impressions and Work Authorizations Submitted by Dental Students Supervised by Prosthodontists and General Dentists

Preclinical fixed prosthodontics is taught by Department of Prosthodontics faculty members at Virginia Commonwealth University School of Dentistry; however, 86% of all clinical cases in academic year 2012 were staffed by faculty members from the Department of General Practice. The aims of this retrospective study were to quantify the quality of impressions, accuracy of laboratory work authorizations, and most common errors and to determine if there were differences between the rate of errors in cases supervised by the prosthodontists and the general dentists. A total of 346 Fixed Prosthodontic Laboratory Tracking Sheets for the 2012 academic year were reviewed. The results showed that, overall, 73% of submitted impressions were acceptable at initial evaluation, 16% had to be poured first and re-evaluated for quality prior to pindexing, 7% had multiple impressions submitted for transfer dies, and 4% were rejected for poor quality. There were higher acceptance rates for impressions and work authorizations for cases staffed by prosthodontists than by general dentists, but the differences were not statistically significant (p=0.0584 and p=0.0666, respectively). Regarding the work authorizations, 43% overall did not provide sufficient information or had technical errors that delayed prosthesis fabrication. The most common errors were incorrect mountings, absence of solid casts, inadequate description of margins for porcelain fused to metal crowns, inaccurate die trimming, and margin marking. The percentages of errors in cases supervised by general dentists and prosthodontists were similar for 17 of the 18 types of errors identified; only for margin description was the percentage of errors statistically significantly higher for general dentist-supervised than prosthodontist-supervised cases. These results highlighted the ongoing need for faculty development and calibration to ensure students receive the highest quality education from all faculty members teaching fixed prosthodontics.

Professor Charles E. Geyer: neoadjuvant therapy is becoming standard of care for HER2+ breast cancer.

Charles E. Geyer Jr. ( Figure 1 ), MD, FACP, is Professor of Medicine in the Division of Hematology, Oncology and Palliative Care, Department of Internal Medicine, at the Virginia Commonwealth University School of Medicine, and he is also an Associate Director for Clinical Research at Virginia Commonwealth University Massey Cancer Center.

Successful intravenous catheterization by medical students

BackgroundIntravenous (IV) catheter placement is one of the most basic and essential medical procedures. However, IV placement can be a source of anxiety for medical students as it is often their first procedural patient care. We sought to investigate the factors that impact the success rate of this skill and to determine at what rate students improve. Materials and methodsA confidential web-based survey was distributed to a total of 367 third and fourth year students at Virginia Commonwealth University School of Medicine. The responses were collected over a 2-wk period in July 2015. ResultsThe response rate was 49.0% (180/367); 65.5% of the M3s and 21.8% of the M4s have never had an opportunity to place an IV. The success rate was higher in students with prior experience as laboratory researchers (86.6%, P = 0.014) as well as emergency medical technicians (81.4%, P = 0.038) when compared to students with no experience. Prior preparation such as reading, watching videos, or even lectures did not increase the success rate. Success rates rapidly improved from 47% for the first attempt to 86% for the fifth attempt. ConclusionsA significant percentage of students did not have opportunities to attempt IV catheter placement. We found prior experience, not only as an emergency medical technician but also as a laboratory researcher, significantly increased the success rate. Prior preparations did not improve success rate, and most of the students were successful after only five attempts.

FDA allows omega-3 medication to be marketed off-label

Amarin’s icosapent ethyl (Vascepa) is FDA approved to treat extremely high triglyceride values of 500 mg/dL or above. Although physicians commonly prescribe the medication for offlabel use, the agreement would allow Amarin to market Vascepa to patients with high triglyceride levels of 200 mg/ dL to 499 mg/dL. “This is concerning to me because ef cacy has not yet been clearly established for this purpose,” said Joseph Saseen, PharmD, BCPS, BCACP, vice chair of the department of clinical pharmacy at University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences in Aurora.

Family-centered rounds and medical student performance on the NBME pediatrics subject (shelf) examination: a retrospective cohort study

ObjectiveTo determine the association between family-centered rounds (FCR) and medical student knowledge acquisition as assessed by the National Board of Medical Examiners (NBME) pediatric subject (shelf) exam.MethodsA retrospective cohort study was conducted of third-year medical students who graduated from Virginia Commonwealth University School of Medicine between 2009 and 2014. This timeframe represented the transition from ‘traditional’ rounds to FCR on the pediatric inpatient unit. Data collected included demographics, United States Medical Licensing Examination (USMLE) Step 1 and 2 scores, and NBME subject examinations in pediatrics (PSE), medicine (MSE), and surgery (SSE).ResultsEight hundred and sixteen participants were included in the analysis. Student performance on the PSE could not be statistically differentiated from performance on the MSE for any year except 2011 (z-score=−0.17, p=0.02). Average scores on PSE for years 2009, 2010, 2013, and 2014 were significantly higher than for SSE, but not significantly different for all other years. The PSE was highly correlated with USMLE Step 1 and Step 2 examinations (correlation range 0.56–0.77) for all years.ConclusionsOur results showed no difference in PSE performance during a time in which our institution transitioned to FCR. These findings should be reassuring for students, attending physicians, and medical educators.

Capitol Hill Health Fair: Showing Congress what pharmacy has to offer

Capitol Hill Health Fair: Showing Congress what pharmacy has to offer

Developing a Health Policy-Ready Practice Workforce: Violence and Health Disparities in Interprofessional Education

s / Journal of Interprofessional Education & Practice 1 (2015) 48e77 52 DEVELOPING A HEALTH POLICY-READY PRACTICE WORKFORCE: VIOLENCE AND HEALTH DISPARITIES IN INTERPROFESSIONAL EDUCATION Candace W. Burton PhD, RN, AFN-BC. Robert Wood Johnson Nurse Faculty Scholar Research Scientist for Intimate Partner Violence & Sexual Assault, VCU Institute for Women's Health Assistant Professor, Department of Family and Community Health Nursing Virginia Commonwealth University School of Nursing Background/Introduction Violence is a significant cause of and factor in health disparities, particularly among vulnerable populations. Developing a health care workforce that is prepared to address violence from a health policy standpoint necessitates integration of educational perspectives on both health disparities and violence.

Bloom's Taxonomy in Action

OPEN ACCESSMarch 12, 2015Bloom's Taxonomy in Action Jeanne Schlesinger, MEd, Adam Persky, PhD, Faculty Learning Community Jeanne Schlesinger, MEd Virginia Commonwealth University School of Medicine Google Scholar More articles by this author , Adam Persky, PhD University of North Carolina Eshelman School of Pharmacy Google Scholar More articles by this author , Faculty Learning Community Virginia Commonwealth University School of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.10031 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractIntroduction: Bloom's Taxonomy has become a gold standard for writing learning objectives. Originally developed in the 1950's by Benjamin Bloom and revised in the 1990's by Lorin Anderson, Bloom's Taxonomy is a hierarchical model for organizing thinking skills to write clear learning objectives. Within the taxonomy's six categories build from the most basic to the most complex kinds of thinking. In order to help faculty who already use Bloom's Taxonomy use it more effectively, this online adaptation of “Bloom's Cognitive Taxonomy Slide Chart” was created at the Virginia Commonwealth University School of Medicine (VCUSOM). Methods: This interactive tool was used during a workshop on instructional strategy alignment. During this 2-hour session, small groups of faculty rotated between multiple tables, each of which focused on a specific strategy. The table that featured the Bloom's Taxonomy in Action tool required a laptop. At this table, a faculty developer spent 15 minutes demonstrating the tool features including: verb lists of measurable objectives for all six categories, outcome verbs, instructional strategies, and sample assessment questions. Results: Feedback from the session indicated that faculty found the tool to be useful and that they planned to reference it during their course planning. Additionally, while this tool was originally implemented behind a password protected VCUSOM site, the popularity soon demanded it be shared more widely and has now been used by faculty and graduate students at multiple institutions. Discussion: This interactive tool assists faculty who are formulating outcomes-based learning objectives and provides guidance for integrating instructional strategies with expected outcomes, and ways to assess student achievement. Educational Objectives By the end of this session, learners will be able to: Write learning objectives and align them with instructional strategies and assessment questions.Compare and contrast between levels of complexity and different ways of expressing ideas in order to gain clarity on desired learning objectives, instructional strategies, and assessment questions.Illustrate to other faculty the process of writing learning objectives tied to relevant instructional strategies and assessment questions. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide.docx Blooms Taxonomy in Action Folder To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationSchlesinger J, Persky A, Learning Community F. Bloom's Taxonomy in Action. MedEdPORTAL. 2015;11:10031. https://doi.org/10.15766/mep_2374-8265.10031 Copyright & Permissions© 2015 Schlesinger et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives license.KeywordsGoalsBloomEducational MeasurementTeaching Disclosures None to report. Funding/Support None to report. tabs.loading

Innovation in a Small State: Qatar and the IBC Cluster Model of Higher Education

Innovation in a Small State: <scp>Q</scp>atar and the <scp>IBC</scp> Cluster Model of Higher Education

Patient Retention at Dental School Clinics: A Marketing Perspective

The purpose of this investigation was to examine the drivers of patient retention at dental school clinics from a services marketing perspective. An analysis of patient characteristics at Virginia Commonwealth University School of Dentistry, screened between August 2010 and July 2011 (N=3604), was performed using descriptive statistics, cross-tabulations, and a binary logistic regression. The main findings were that 42 percent of patients in the study were retained and that no response to communication efforts (36 percent) and financial problems (28 percent) constituted the most common reasons for non-retention. Older age, having insurance, and living within a sixty-mile radius were significant drivers of retention (p<0.05). Patients who had completed disease control treatments had a significantly higher retention rate (62 percent) than those who did not (42 percent). Finally, some groups of dental students had higher retention rates than others (p<0.05), indicating that service providers were a driver of retention. The resulting insights benefit dental schools in recruiting patients with the greatest likelihood of returning for care, providing dental students with skills to better service them, and consequently increasing retention. This will lead to providing a continuum of care and student education and to ensuring the sustainability and quality of the school's educational programs.