A Career Eulogy Reflective Exercise: A View into Early Professional Identity Formation

Beginning medical students have a very early idea of what their physician identity will be. Providing a brief structured opportunity to reflect on the end of their career can be an important first step in identity formation. A reflective exercise was used in the summer prior to beginning medical school as each class of students at a regional rural medical school began a summer prematriculation program from 2015-2019. Students wrote what they wished to be said about them at the end of their career using a “Career Eulogy.” Identifiers were removed and narratives were coded into recurring text clusters by the authors. The students, on an anonymous evaluation, strongly agreed that the exercise facilitated the accomplishment of the program goals. Reflections from 42 entering medical students indicated a preference to be remembered for compassion, passion, quality, and patient relationships. Men more frequently mentioned family and enjoying life, and women more frequently mentioned patient relationships. Rural students included quality and being a teacher of medical students more frequently, and those with a physician parent included passion and community more frequently. Those who later chose family medicine as a specialty more often included references to enjoying life and family. This reflective exercise provided useful insight into early professional identity formation among these medical students and served to encourage group discussion. It could be used with larger, more diverse groups to determine its value and clarify true differences among the demographic and specialty choice patterns. This exercise could also be used annually for each student, providing a longitudinal view of identity formation

An Investigation of Multitiered Behavioral Interventions on Disruptive Behavior and Academic Engagement of Elementary Students

This study examined the effects of a multitiered system of support using Check-In Check-Out (CICO) as a secondary intervention and function-based self-monitoring (FBSM) as a tertiary intervention on the disruptive behavior and academic engagement of four elementary students identified as being in need of additional behavioral supports. A multiple baseline across participants\u27 design was conducted to evaluate the effects of CICO and a reversal design was used to evaluate the additive effects of FBSM with one participant whose behavior was determined nonresponsive to CICO due to variability and minimal change in disruptive behavior. Results indicate a reduction in disruptive behavior and increased academic engagement for three participants upon introduction of CICO. Evaluations of the FBSM intervention were rendered inconclusive; however, preliminary data revealed a decrease in trend and level of disruptive behavior for the participant receiving tertiary support

Why Medical Students Choose Rural Clinical Campuses For Training: A Report From Two Campuses At Opposite Ends Of The Commonwealth

Introduction Although US medical schools have increased their enrollment by about 30%, most of the increase has occurred in urban areas. The affinity model proposes that rural training of a rural student will more likely result in a rural physician, but the exact role of these rural campuses is unclear. Do they solidify and reinforce a pre-existing career plan, do they create social and marital ties that make the transition to rural medicine easier, or could they be replaced with a briefer and more efficient rural rotation? We administered a questionnaire to students attending two different two year rural clinical campuses in the same state in order to explore their opinions regarding the advantages of a rural campus. Methods Two different rural M3-M4 year clinical campuses, affiliated with different medical schools in the same state, administered surveys to 70 medical students across all four years of medical school. Both schools selectively recruit rural students to the rural campuses, and require a campus decision at admission. Both schools require students to attend their first two years at an urban campus, and transfer to the rural campus for clinical education. Questions addressed student opinions on rural campus location, recommendations from others regarding attendance, campus atmosphere and social life, teaching methods and involvement in patient care. Comparisons were analyzed using the non-parametric Mann Whitney U test. Results The top five reasons students chose a rural campus included three aspects of rural training and two features of being rural. There were small differences between the two campuses regarding the importance of more procedures during training and more outdoor activities, the opportunity to study with friends, and strength of local leadership, reflecting differences in the practice setting and the environment of the two campuses. Differences were also noted between upper-level and lower-level students regarding the importance of studying with friends, and the chances of meeting a future spouse. Finally, very rural students (30 miles from urban area) were less concerned with availability of scholarships, and lack of fine dining, but viewed the opportunity to study with friends more favorably. Conclusions This study adds to the published literature by surveying students at multiple rural campuses by year of training. There were many more similarities than differences, but there were differences between the two campuses, and there were also differences as the students progressed in their training, and differences between very rural students and other students attending the campus. Rural campuses provide both clinical and social support for students contemplating rural practice. Results of the survey indicate both are of importance to the students as well, with quality of training the most important factor

A closer look into empathy among medical students: The career eulogy as a lens

Background Empathy is widely considered to be key to being an effective physician. The measurement of empathy is important to those designing medical education. The majority of the literature on empathy is based on survey scales that ask the learner to express their degree of agreement with a series of statements. We have previously studied and published an entirely projective measure that we term a career eulogy. Methods We had 65 students based at a regional rural medical school campus complete measures of a career eulogy (CE) and the Jefferson Scale of Empathy (JSE) over their four years in medical school. We then calculated weighted correlations between these two instruments. We also asked students to rank 10 factors that they thought affected student responses about empathy. Results We found a significant moderate correlation of JSE score with mentions of compassion on the CE (r = 0.414, p= 0.001). We also found that women scored higher on both instruments. The only factor showing consensus among students was that the general outlook on life was the most likely factor explaining student empathy responses. Conclusions Mentions in the compassion category on the CE appear to be measuring a concept very similar to empathy on the JSE. Students expressed that factors affecting their responses about empathy are very individual and that only interventions to change the general outlook on life may affect these measures of empathy. Having used the CE for the last five years, we find it to be a brief, very useful exercise both for measurement of empathy and as a group facilitation method in our professional identity curriculum. We welcome others to use our CE instrument in larger and more diverse groups to determine its true value in both measuring empathy and facilitating group process

Application of bag sampling technique for particle size distribution measurements

Bag sampling techniques can be used to temporarily store an aerosol and therefore provide sufficient time to utilize sensitive but slow instrumental techniques for recording detailed particle size distributions. Laboratory based assessment of the method were conducted to examine size dependant deposition loss coefficients for aerosols held in VelostatTM bags conforming to a horizontal cylindrical geometry. Deposition losses of NaCl particles in the range of 10 nm to 160 nm were analysed in relation to the bag size, storage time, and sampling flow rate. Results of this study suggest that the bag sampling method is most useful for moderately short sampling periods of about 5 minutes

Pollutant exposures and health symptoms in aircrew and office workers: Is there a link?

AbstractSensory effects in eyes and airways are common symptoms reported by aircraft crew and office workers. Neurological symptoms, such as headache, have also been reported. To assess the commonality and differences in exposures and health symptoms, a literature search of aircraft cabin and office air concentrations of non-reactive volatile organic compounds (VOCs) and ozone-initiated terpene reaction products were compiled and assessed. Data for tricresyl phosphates, in particular tri-ortho-cresyl phosphate (ToCP), were also compiled, as well as information on other risk factors such as low relative humidity.A conservative health risk assessment for eye, airway and neurological effects was undertaken based on a “worst-case scenario” which assumed a simultaneous constant exposure for 8h to identified maximum concentrations in aircraft and offices. This used guidelines and reference values for sensory irritation for eyes and upper airways and airflow limitation; a tolerable daily intake value was used for ToCP. The assessment involved the use of hazard quotients or indexes, defined as the summed ratio(s) (%) of compound concentration(s) divided by their guideline value(s).The concentration data suggest that, under the assumption of a conservative “worst-case scenario”, aircraft air and office concentrations of the compounds in question are not likely to be associated with sensory symptoms in eyes and airways. This is supported by the fact that maximum concentrations are, in general, associated with infrequent incidents and brief exposures. Sensory symptoms, in particular in eyes, appear to be exacerbated by environmental and occupational conditions that differ in aircraft and offices, e.g., ozone incidents, low relative humidity, low cabin pressure, and visual display unit work. The data do not support airflow limitation effects. For ToCP, in view of the conservative approach adopted here and the rareness of reported incidents, the health risk of exposure to this compound in aircraft is considered negligible