Relationships between high-stakes clinical skills exam scores and program director global competency ratings of first-year pediatric residents

Responding to mandates from the Accreditation Council for Graduate Medical Education (ACGME) and American Osteopathic Association (AOA), residency programs have developed competency-based assessment tools. One such tool is the American College of Osteopathic Pediatricians (ACOP) program directors’ annual report. High-stakes clinical skills licensing examinations, such as the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation (COMLEX-USA Level 2-PE), also assess competency in several clinical domains.The purpose of this study is to investigate the relationships between program director competency ratings of first-year osteopathic residents in pediatrics and COMLEX-USA Level 2-PE scores from 2005 to 2009.The sample included all 94 pediatric first-year residents who took COMLEX-USA Level 2-PE and whose training was reviewed by the ACOP for approval of training between 2005 and 2009. Program director competency ratings and COMLEX-USA Level 2-PE scores (domain and component) were merged and analyzed for relationships.Biomedical/biomechanical domain scores were positively correlated with overall program director competency ratings. Humanistic domain scores were not significantly correlated with overall program director competency ratings, but did show moderate correlation with ratings for interpersonal and communication skills. The six ACGME or seven AOA competencies assessed empirically by the ACOP program directors’ annual report could not be recovered by principal component analysis; instead, three factors were identified, accounting for 86% of the variance between competency ratings.A few significant correlations were noted between COMLEX-USA Level 2-PE scores and program director competency ratings. Exploring relationships between different clinical skills assessments is inherently difficult because of the heterogeneity of tools used and overlap of constructs within the AOA and ACGME core competencies

Web-Based Objective Structured Clinical Examination with Remote Standardized Patients and Skype: Resident Experience

OBJECTIVE: Using Skype and remote standardized patients (RSPs), investigators sought to evaluate user acceptance of a web-based objective structured clinical examination (OSCE) among resident physicians. METHODS: After participating in four web-based clinical encounters addressing pain with RSPs, 59 residents from different training programs, disciplines and geographic locations completed a 52-item questionnaire regarding their experience with Skype and RSPs. Open-ended responses were solicited as well. RESULTS: The majority of participants (97%) agreed or strongly agreed the web-based format was convenient and a practical learning exercise, and 90% agreed or strongly agreed the format was effective in teaching communication skills. Although 93% agreed or strongly agreed they could communicate easily with RSPs using Skype, 80% preferred traditional face-to-face clinical encounters, and 58% reported technical difficulties during the encounters. Open-ended written responses supported survey results. CONCLUSION: Findings from this study expose challenges with technology and human factors, but positive experiences support the continued investigation of web-based OSCEs as a synchronous e-learning initiative for teaching and assessing doctor-patient communication. Such educational programs are valuable but unlikely to replace face-to-face encounters with patients. PRACTICE IMPLICATIONS: This web-based OSCE program provides physician learners with additional opportunity to improve doctor-patient communication

Correlation Between An Email Based Board Review Program and American Board of Pediatrics General Pediatrics Certifying Examination Scores

Objective To investigate the impact of a weekly email based board review course on individual resident performance on the American Board of Pediatrics (ABP) General Pediatrics Certifying Examination for pediatric residents and, specifically, residents with low ABP In-training Examination (ITE) scores. Methods Weekly board-type questions were emailed to all pediatric residents from 2004–2007. Responses to board-type questions were tracked, recorded, and correlated with ITE scores and ABP General Pediatrics Certifying Examination Scores. Results With regard to total number of questions answered, only total number of questions answered correctly had a significant positive correlation with standard board scores (n = 71, r = 0.24, p = 0.047). For “at risk” residents with ITE scores ≤ 200 (n = 21), number of questions answered in PL 3 year (r = 0.51, p = 0.018) and number of questions answered correctly for all PL years (r = 0.59, p = 0.005) had significant positive correlations with standard board scores. Conclusions Participating regularly in the email-based board review course, answering board style questions, and answering correctly to board style questions were associated with higher standard board scores. This benefit existed for all but was especially prominent among those with poor in-training examination scores

Perspectives of Dermatology Program Directors on the Impact of Step 1 Pass/Fail.

INTRODUCTION: The shift of Step 1 to Pass/Fail has generated several questions and concerns about obtaining residency positions among allopathic and osteopathic students alike. Determining the perspectives of Dermatology Program Directors in regards to post-Step 1 Pass/Fail is critical for students to better prepare for matching into dermatology. METHODS: After receiving Institutional Review Board (IRB) exemption status, the program directors were chosen from 144 Accreditation Council for Graduate Medical Education (ACGME) and 27 American Osteopathic Association (AOA) Dermatology programs using contact information from their respective online website databases. An eight-item survey was constructed on a three-point Likert scale, one free text response, and four demographic questions. The anonymous survey was sent out over the course of three weeks with weekly individualized reminder requests for participation. RESULTS: A total of 54.54% of responders had Letters of Recommendation in their top 3. Forty-five percent of responders had Completed Audition Rotation at Program in their top 3. And, 38.09% of responders had USMLE Step 2 CK Scores in their top 3. CONCLUSION: Approximately 50% of responders agreed that all medical students will have more difficulty matching dermatology. Based on the survey study, Dermatology program directors want to focus more on letters of recommendation, audition rotations, and Step 2 CK scores. Because each field seems to prioritize different aspects of an application, students should attempt to gain as much exposure to different fields such as through research and shadowing to narrow down their ideal specialties. Consequently, the student will have more time to tailor their applications to what residency admissions are looking for

Survey of Osteopathic Medical Students Regarding Physician Shadowing Experiences Before and During Medical School Training.

Introduction: Shadowing a physician is an observational experience which includes a student observing a licensed healthcare provider caring for patients. Shadowing is commonly done by students before and during medical school, but little is known about the nature or extent of these extra-curricular observational experiences. Objective: We hypothesized that shadowing experiences were common yet variable. We investigated the prevalence, nature, and perceived value of medical student experiences with shadowing physicians (both before and during medical school). Methods: This survey-based study was non-experimental with a cross-sectional convenience sample of osteopathic medical students about their shadowing experiences before and during medical school. The survey was sent to all matriculated osteopathic medical students (OMS1-4) for the 2017 to 2018 academic year from two medical schools: Philadelphia College of Osteopathic Medicine (PCOM) (1084 total students) and PCOM-Georgia (554 total students). The final survey instrument included three sections: demographics (6 questions), pre-medical shadowing experiences (21 questions), and medical student shadowing experiences (24 questions). Results: Respondents (357) identified themselves as OMS1 (96), OMS2 (89), OMS3 (73), OMS4 (95) and other (2, OMS5) with enrollment at PCOM-Philadelphia (242) and PCOM-Georgia (115). Among survey respondents, 339 (95.5%) reported shadowing a physician as a pre-medical student, and 110 (30.8%) reported shadowing (outside of their required clinical rotations) a physician during medical school. Requirements to participate were inconsistent; fewer than 50% of shadowing experiences required Health Insurance Portability and Accountability Act of 1996 (HIPAA) training, proof of vaccination, or purified protein derivative (PPD) documentation. In addition to observation, pre-medical and medical students, respectively, participated in history taking (44 [13%], 47 [42.7%]), physical examinations (45 [13.3%], 44 [40%]) and procedures (13, [3.8%], 20 [18.2%]) during their shadowing experiences. Motivations to participate in shadowing varied between pre-medical and medical student experiences, but both groups mentioned their desire to learn more about a particular discipline, obtain letters of recommendation, and gain patient care experience. Students recommended both pre-medical (273 [80.5%]) and medical school (93 [84.5%]) shadowing to future students. Conclusion: Shadowing remains a common and important tool for students to learn about patient care, medicine and careers. The nature of each shadowing experience and participation requirements are quite variable. Measures to ensure patient safety, confidentiality, liability and supervision are inconsistently applied. Promoting guidelines, as well as codes of conduct, for shadowing could serve as a helpful resource for students, academic advisors and supervising clinicians

Clinical Assessment of 4th Year Osteopathic Medical Students: Outdoor Medicine Rotation

Introduction: Securing clinical training sites remains a challenge for medical educators who often resort to paying preceptors or searching for new clinical training sites which haven’t traditionally taken students. We describe a unique partnership between the Boy Scouts of America and PCOM, providing a clinical training opportunity for OMS4 students at PCOM: Outdoor Clinical rotation the Summit Bechtel Family National Boy Scout Reserve in rural West Virginia at the National Scout jamboree, serving 35,000 scouts. Methods and Curricular Design: By the end of the rotation, each PCOM student was able to (1) provide urgent care for common outdoor injuries: fractures, abrasions, insect bites, gastroenteritis, sprains, heat exhaustion, sunburn, eye injuries, etc; (2) provide basic life support, resuscitation and first aid in an outdoor setting; (3) identify and treat common chronic medical conditions (asthma, ADHD, etc) which are common to all children, not just those in a wilderness setting; (4) explain adolescent development and impact on character development, (5) explain the structure and mission of scouting; and (6) identify characteristics of international scouts with regard to culture, background, experience and perspectives. Outcomes: Clinically-based assessments (direct observation, youth protection training, self-reflection, etc) satisfied all 13 Entrustable Professional Activities (AOA)

Somatic Mutagenesis with a Sleeping Beauty Transposon System Leads to Solid Tumor Formation in Zebrafish

Large-scale sequencing of human cancer genomes and mouse transposon-induced tumors has identified a vast number of genes mutated in different cancers. One of the outstanding challenges in this field is to determine which genes, when mutated, contribute to cellular transformation and tumor progression. To identify new and conserved genes that drive tumorigenesis we have developed a novel cancer model in a distantly related vertebrate species, the zebrafish, Danio rerio. The Sleeping Beauty (SB) T2/Onc transposon system was adapted for somatic mutagenesis in zebrafish. The carp ß-actin promoter was cloned into T2/Onc to create T2/OncZ. Two transgenic zebrafish lines that contain large concatemers of T2/OncZ were isolated by injection of linear DNA into the zebrafish embryo. The T2/OncZ transposons were mobilized throughout the zebrafish genome from the transgene array by injecting SB11 transposase RNA at the 1-cell stage. Alternatively, the T2/OncZ zebrafish were crossed to a transgenic line that constitutively expresses SB11 transposase. T2/OncZ transposon integration sites were cloned by ligation-mediated PCR and sequenced on a Genome Analyzer II. Between 700–6800 unique integration events in individual fish were mapped to the zebrafish genome. The data show that introduction of transposase by transgene expression or RNA injection results in an even distribution of transposon re-integration events across the zebrafish genome. SB11 mRNA injection resulted in neoplasms in 10% of adult fish at ∼10 months of age. T2/OncZ-induced zebrafish tumors contain many mutated genes in common with human and mouse cancer genes. These analyses validate our mutagenesis approach and provide additional support for the involvement of these genes in human cancers. The zebrafish T2/OncZ cancer model will be useful for identifying novel and conserved genetic drivers of human cancers

Systems microscopy approaches to understand cancer cell migration and metastasis

Cell migration is essential in a number of processes, including wound healing, angiogenesis and cancer metastasis. Especially, invasion of cancer cells in the surrounding tissue is a crucial step that requires increased cell motility. Cell migration is a well-orchestrated process that involves the continuous formation and disassembly of matrix adhesions. Those structural anchor points interact with the extra-cellular matrix and also participate in adhesion-dependent signalling. Although these processes are essential for cancer metastasis, little is known about the molecular mechanisms that regulate adhesion dynamics during tumour cell migration. In this review, we provide an overview of recent advanced imaging strategies together with quantitative image analysis that can be implemented to understand the dynamics of matrix adhesions and its molecular components in relation to tumour cell migration. This dynamic cell imaging together with multiparametric image analysis will help in understanding the molecular mechanisms that define cancer cell migration

Blended Learning Educational Format for Third-Year Pediatrics Clinical Rotation.

CONTEXT: Traditional medical education is shifting to incorporate learning technologies and online educational activities with traditional face-to-face clinical instruction to engage students, especially at remote clinical training sites. OBJECTIVE: To describe and evaluate the effectiveness of the blended learning format (combining online and face-to-face instruction) for third-year osteopathic medical students during their pediatric rotation. METHODS: Third-year medical students who completed the 4-week clerkship in pediatrics during the 2014-2015 academic year were divided into a standard learning group and a blended learning group with online activities (discussion boards, blogs, virtual patient encounters, narrated video presentations, and online training modules). Comprehensive Osteopathic Medical Achievement Test scores and final course grades were compared between the standard learning and blended learning groups. Students in the blended learning group completed a postsurvey regarding their experiences. RESULTS: Of 264 third-year students who completed the 4-week clerkship in pediatrics during the 2014-2015 academic year, 78 (29.5%) participated in the blended learning supplement with online activities. Of 53 students who completed the postsurvey in the blended learning group, 44 (83.0%) agreed or strongly agreed that The integration of e-learning and face-to-face learning helped me learn pediatrics. Open-ended comments supported this overall satisfaction with the course format; however, 26 of 100 comments reflected a desire to increase the amount of clinical exposure and face-to-face time with patients. No statistical differences were seen between the standard learning (n=186) and blended learning (n=78) groups with regard to Comprehensive Osteopathic Medical Achievement Test scores (P=.321). Compared with the standard learning group, more students in the blended learning group received a final course grade of honors (P=.015). CONCLUSION: Results of this study support the use of blended learning in a clinical training environment. As more medical educators use blended learning, it is important to investigate the best balance between learning with technology and learning in a face-to-face setting. Online activities may enhance but should never fully replace face-to-face learning with real patients