Pass/fail grading in medical school and impact on residency placement

Objective: There is a trend toward using pass/fail (P/F) grading in the first 2 years of medical school as it has been noted to improve student well-being and academic performance is not negatively impacted. It is important that medical students are afforded the best medical education possible to prepare them for residency placement. Thus, the purpose of this study was to evaluate the impact of P/F grading in medical school on residency placement. Methods: This study compared archival residency match data from two medical school classes. The Class of 2016 had tiered grading and the Class of 2017 had P/F grading in the first year of medical school. Doximity’s Residency Navigator was used to rank the residency programs and an independent samples t-test was calculated to determine if residency rankings differed by class. Results: The findings showed no statistically significant differences in residency placement when comparing a cohort of medical school graduates with tiered grading to a cohort with P/F grading in the first year of medical school. Conclusion: These findings may be useful to medical education leaders when making decisions about grading systems. Medical education leaders should consider implementing P/F grading into the first year of medical school

Pass/Fail Grading in Medical School and Impact on Residency Placement

There is a trend towards using pass/fail (P/F) grading in the first two years of medical school. Existing literature reveals that P/F grading improves medical student well-being and academic performance is not negatively impacted (Ali et al., 2015; McDuff et al., 2014; Reed et al., 2011; Spring, Robillard, Gehlbach, & Moore Simas, 2011; White & Fantone, 2010). However, there is little existing research regarding the impact of P/F grading in the first or first and second years of medical school residency placement. It is important that medical students are afforded the best medical education possible to prepare them for residency placement. This study compared archival residency match data for two graduating classes at the Medical College of Georgia at Augusta University. The Class of 2016 had tiered grading in the first year of medical school and the Class of 2017 had P/F grading in the first year of medical school. Doximity’s Residency Navigator was used to rank the residency programs for the Class of 2016 and 2017. The results of this study concluded that there are no differences in residency placement when comparing a cohort of medical school graduates with tiered grading in the first year of medical school to a cohort with P/F grading in the first year of medical school. These results are consistent with the results of a seminal literature review conducted by Spring et al. (2011), which concluded that there were no significant differences in residency programs obtained when comparing students with P/F grading in medical school to students with tiered grading

Uncovering Geographic Health Disparities: A Secondary Analysis of the Commonwealth Fund International Health Policy Survey

Background: Healthcare delivery faces a myriad of challenges globally with well-documented health inequities between rural and urban populations. Yet, researchers and policy makers have limited understanding of what factors contribute to these inequities. Methods: We analyzed the 2020 Commonwealth Fund International Health Policy (IHP) Survey—a nationally representative self-reported survey of adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States (US). We compared the association of area type (rural or urban) with ten health indicators across three domains: health status and socioeconomic risk factors, affordability of care, and access to care. Logistic regression was used to determine the associations between countries with area type for each factor, controlling for individual’s age and sex. Results: The mean number of geographic health disparities in the 11 countries was 1.9, although there was a wide variation among the 11 nations. The US had statistically significant geographic health disparities in five of the ten indicators, the most of any country. Canada, Norway, and the Netherlands had no statistically significant geographic health disparities. In the US, living in a rural area was associated with having lower odds of having mental health conditions [OR=.89], experiencing material hardship [OR=.87] and higher odds of difficulty accessing after hours care [OR=1.29], having an avoidable emergency department visit in the past two years [OR=2.15], and having a regular provider or place of care [OR= 1.32]. Conclusions: This study has identified geographic health disparities across ten indicators in 11 developed nations. Public health policy makers in the US should look to Canada, Norway, and the Netherlands to improve geographic-based health equity. Keywords: rural health, geography, health disparities, international healt

Conditions and Dynamics That Impact Maternal Health Literacy among High Risk Prenatal-Interconceptional Women

The purpose of the study was to describe conditions and dynamics in the lives of high-risk, low-income, Southern United States prenatal-interconceptional women (n = 37) in a home visiting program that promoted maternal health literacy progression. In the Life Course Health Development (LCHD) Model, conditions were risk and protective factors that impacted health. Dynamics drove the complex, epigenetic relationships between risk and protective factors. Maternal health literacy promotion helped participants address conditions and dynamics to create positive life changes. This research was a retrospective, mixed methods study of women’s service records documenting care from prenatal admission to 24 months post-delivery. The Life Skills Progression Instrument (LSP) was scored to measure maternal health literacy progression. Ethnographic content analysis of visit notes triangulated with quantitative data enabled specificity of critical data elements. Subsequently, a complementary focus group was conducted with the Registered Nurse Case Managers (RNCM). Severe social conditions included devastating poverty, low educational achievement, transient housing, unstable relationships, incarceration, lack of continuous health insurance, and shortage of health care providers. Dynamics included severe psycho-social stressors, domestic violence, lack of employment, low income, low self-esteem and self-expectations, and social/family restraints upon women’s intended positive changes. An important protective factor was the consistent, stable, evidence-informed relationship with the RNCM. Findings from the focus group discussion supported content analysis results

Measuring psychological flexibility in medical students and residents: a psychometric analysis

Purpose: Psychological flexibility involves mindful awareness of our thoughts and feelings without allowing them to prohibit acting consistently with our values and may have important implications for patient-centered clinical care. Although psychological flexibility appears quite relevant to the training and development of health care providers, prior research has not evaluated measures of psychological flexibility in medical learners. Therefore, we investigated the validity of our learners’ responses to three measures related to psychological flexibility. Methods: Fourth-year medical students and residents (n=275) completed three measures of overlapping aspects of psychological flexibility: (1) Acceptance and Action Questionnaire-II (AAQ-II); (2) Cognitive Fusion Questionnaire (CFQ); and (3) Mindful Attention and Awareness Questionnaire (MAAS). We evaluated five aspects of construct validity: content, response process, internal structure, relationship with other variables, and consequences. Results: We found good internal consistency for responses on the AAQ (α=0.93), MAAS (α=0.92), and CFQ (α=0.95). Factor analyses demonstrated a reasonable fit to previously published factor structures. As expected, scores on all three measures were moderately correlated with one another and with a measure of life satisfaction (p<0.01). Conclusion: Our findings provide preliminary evidence supporting validity of the psychological flexibility construct in a medical education sample. As psychological flexibility is a central concept underlying self-awareness, this work may have important implications for clinical training and practice