The impact of clinical clerkships on medical students’ attitudes toward contraception and abortion: a pilot study

Objective: Investigate the impact of clinical clerkships on medical students’ attitudes toward contraception and abortion. Methods: As part of their required curriculum, second-year medical students at the University of Iowa complete an anonymous survey that presents eight questions involving specific contraception and abortion scenarios. In this pilot study, all 159 members of the Class of 2013 who had previously completed this required anonymous survey were invited to re-take the survey at the conclusion of their fourth year. Additional questions, asking the students if they felt that clinical clerkships had changed their perspectives on contraception and abortion in general, were included. Results: Of the 159 members of the Class of 2013, 42 volunteered to participate, for a response rate of 26%. Twenty students (47.62%) felt that clinical clerkships had changed their perspectives on contraception and thirteen students (39.95%) felt that clinical clerkships had changed their perspectives on abortion. The percentage of students who felt comfortable referring a patient to a colleague for an abortion increased significantly from 71.33% to 90.48% (p=0.024). Responses to the other seven questions included in the survey did not differ significantly pre and post-clerkships. Conclusions: This pilot study, although limited by a low response rate, suggests that clinical clerkships have the ability to impact medical students’ attitudes toward contraception and abortion in general, as well as toward specific scenarios involving abortion

Impact of Treatment Initiation and Engagement on Deliberate Self-Harm Among Individuals With First-Episode Psychosis

OBJECTIVE: Individuals with psychosis are at increased risk for suicide, with the greatest risk being present during the first few months after diagnosis. The authors aimed to examine whether treatment initiation within 14 days of diagnosis and treatment engagement within 90 days of initiation reduce the risk for deliberate self-harm (DSH) among individuals with first-episode psychosis (FEP). METHODS: A retrospective longitudinal cohort design was adopted by using Ohio Medicaid claims for 6,349 adolescents and young adults ages 15-24 years with FEP. Logistic regression was used to examine factors associated with treatment initiation and engagement. Cox proportional hazard models were used to estimate the impact of treatment initiation and engagement on DSH. Propensity score weighting was used to control for sociodemographic and clinical covariates. RESULTS: Approximately 70% of the sample initiated treatment, 55% of whom engaged in treatment. Treatment initiation and engagement were associated with both demographic and clinical variables. Treatment initiation significantly reduced the hazard of DSH (average treatment effect in the entire population: hazard ratio [HR]=0.62, 95% CI=0.47-0.81; average treatment effect among those treated: HR=0.64, 95% CI=0.52-0.80). In contrast, treatment engagement was not significantly associated with DSH. CONCLUSIONS: These results suggest that the initial treatment contact is essential for reducing DSH among adolescents and young adults with FEP. Additionally, the finding that treatment engagement did not reduce DSH suggests that standard clinical care may not be sufficient for reducing DSH in this population. These findings highlight the need for suicide-specific interventions for individuals with FEP