Medical Students Cultural Attitudes: The Health Belief Attitudes Survey

Cultural competent care is the ability to deliver effective medical care to people from different cultures. The lack of methodological rigor and paucity of psychometric properties information of the instruments limits the generalizability of cultural competency educational interventions. We examined cultural attitudes of first year medical students and examined psychometric properties of the scale to better define the constructs it intends to measure. In a cross-sectional study, first year medical students completed the Health Belief Attitudes Survey (HBAS) in September of their matriculating year (2011-2013) within the context of Introduction to Clinical Medicine. The survey has15 items scored on a 6-point Likert scale (1-6), higher score indicates higher culturally competent attitudes. We used factor analysis to explore constructs and examine internal consistency (Cronbach’s alpha). The response rate was 98% (536/548), 42.2% students were female (n=231), 73.0% (n=400) white, 14.6% Asian (n=80), and 4.4% African American (n=24)(4.9%, n=27, did not provide race or ethnicity). The HBAS median score was 5.3 (25th percentile [Q1], 4.9; 75th percentile [Q3], 5.7). A two-factor solution explained 97% of the variance with Eigenvalues of 5.6 and 1.2, respectively. We conceptualized the constructs as “Understanding the Patients’ Cultural and Socio-Economic Background” (Factor 1, 11 items; Cronbach’s alpha, 0.89). “Building the Professional Relationship and Quality of Care” (Factor 2, 4 items; Cronbach’s alpha, 0.74). First year medical students have high culturally-relevant attitudes. The HBAS instrument captures two main constructs, understanding the patients’ background and perspective and building the professional relationship

Medical education research and IRB review: an analysis and comparison of the IRB review process at six institutions

To compare how different institutional review boards (IRBs) process and evaluate the same multiinstitutional educational research proposal of medical students' quality of life. Prospective collection in 2005 of key variables regarding the IRB submission and review process of the same educational research proposal involving medical students, which was submitted to six IRBs, each associated with a different medical school. Four IRBs determined the protocol was appropriate for expedited review, and the remaining two required full review. Substantial variation existed in the time to review the protocol by an IRB administrator/IRB member (range 1-101 days) and by the IRB committee (range 6-115 days). One IRB committee approved the study as written. The remaining five IRB committees had a median of 13 requests for additional information/changes to the protocol. Sixty-eight percent of requests (36 of 53) pertained to the informed consent letter; one third (12 of 36) of these requests were unique modifications requested by one IRB but not the others. Although five IRB committees approved the survey after a median of 47 days (range 6-73), one committee had not responded six months after submission (164 days), preventing that school from participating. The findings suggest variability in the timeliness and consistency of IRB review of medical education research across institutions that may hinder multi-institutional research and slow evidence-based medical education reform. The findings demonstrate the difficulties of having medical education research reviewed by IRBs, which are typically designed to review clinical trials, and suggest that the review process for medical education research needs reform

Step Up-Not On-The Step 2 Clinical Skills Exam: Directors of Clinical Skills Courses (DOCS) Oppose Ending Step 2 CS

Recently, a student-initiated movement to end the United States Medical Licensing Examination Step 2 Clinical Skills and the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation has gained momentum. These are the only national licensing examinations designed to assess clinical skills competence in the stepwise process through which physicians gain licensure and certification. Therefore, the movement to end these examinations and the ensuing debate merit careful consideration. The authors, elected representatives of the Directors of Clinical Skills Courses, an organization comprising clinical skills educators in the United States and beyond, believe abolishing the national clinical skills examinations would have a major negative impact on the clinical skills training of medical students, and that forfeiting a national clinical skills competency standard has the potential to diminish the quality of care provided to patients. In this Perspective, the authors offer important additional background information, outline key concerns regarding the consequences of ending these national clinical skills examinations, and provide recommendations for moving forward: reducing the costs for students, exploring alternatives, increasing the value and transparency of the current examinations, recognizing and enhancing the strengths of the current examinations, and engaging in a national dialogue about the issue