Danette McKinley

During the COVID-19 pandemic, despite many widespread calls for social distancing, recommendations have not been followed by some people and the high rate of non-compliance has significantly affected lives all around the world. It seems that the rate of non-compliance with the recommendations among medical students has been as high as the rest of the other youth. In the time that students are removed from clinical environments and most physician teachers are strained in providing services to patients, medical students can be trained in interdisciplinary behavior change counseling programs and they can be employed in delivering virtual consultations to the patients referred to medical centers.In this quick review, we provide an argument regarding the importance of integrating the topic of patients’ social history into the undergraduate medical curriculum and the necessity of teaching theories of behavior change to medical students. Hypotheses are proposed that focus on the importance...

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Supplemental Digital Content is available in the text. Purpose International medical graduates (IMGs), approximately 25% of the U.S. physician workforce, have unique needs as they enter residency programs. This study identified wellness barriers and challenges that IMGs encounter as they transition to the United States. Method The authors analyzed results from 3 open-ended questions in a 21-item survey. This survey was administered in December 2019 to 11,504 IMG resident physicians sponsored by the Educational Commission for Foreign Medical Graduates’ J-1 visa program. These questions asked respondents to describe challenges to their wellness, how they maintain wellness, and resources that would have aided their transition. Data were analyzed using a mixed-methods approach, including both qualitative descriptions and category frequencies. Results Of the surveys administered, 7,817 responses (68% response rate) were received. Respondents identified challenges navigating cultural differences (1,314, 17%), health care system (1,108, 14%), distance from family and friends (890, 11%), bureaucratic barriers (724, 9%), and language/communication and finances (575, 7%; 565, 7%, respectively). They also specified that friendships/relationships (2,800, 36%) followed by exercise (2,318, 30%), family (1,822, 23%), socialization (1,001, 13%), and healthy eating (775, 10%) were factors important to their wellness. Respondents requested more information about socialization (741, 9%), bureaucratic support (456, 6%), IMG support networks (427, 5%), financial support (404, 5%), and greater online resources (240, 3%). Conclusions IMGs have needs and concerns specific to their demographic group. Participants’ responses suggested that they wanted additional support in the workplace and their personal lives. Answers also indicated that IMGs experienced a unique set of stressors such as fluctuating immigration laws that U.S. medical graduates do not face. Finally, this study supports a body of research that connects social and physical wellness. By identifying and describing these challenges, the authors seek to inform the development of specific programs and resources to improve IMG resident wellness.

Background An outcome-based curriculum helps to communicate expectations of performance to students and clinical teachers. The Mini Clinical Evaluation Exercise (mini-CEX) is a useful tool for workplace-based formative assessment. The objective of this study was to use workplace-based assessment and student feedback to evaluate an Obstetrics and Gynecology (Ob&Gyn) clerkship curriculum. Methods A cross-sectional study was conducted with faculty members and medical students in an Ob&Gyn clerkship. The Mini-CEX was introduced into the clerkship assessment system, together with multiple choice question (MCQ) tests. This tool evaluates the history collection, physical examination, clinical judgment, professionalism and humanism, and also gives an overall score at the end of the test. At the end of the rotation, questionnaires were used to collect the students’ perceptions about their skills acquisition during the program. The results of the Mini-CEX, the MCQ test, and questionnaire resp...

Background Shortages and maldistribution of healthcare workers persist despite efforts to increase the number of practitioners. Evidence to support policy planning and decisions is essential. The World Health Organization has proposed National Health Workforce Accounts (NHWA) to facilitate human resource information systems for effective health workforce planning and monitoring. In this study, we report on the accreditation practices for accelerated medically trained clinicians in five countries: Ethiopia, Ghana, Kenya, Malaysia, and Mongolia. Method Using open-ended survey responses and document review, information about accreditation practices was classified using NHWA indicators. We examined practices using this framework and further examined the extent to which the indicators were appropriate for this cadre of healthcare providers. We developed a data extraction tool and noted any indicators that were difficult to interpret in the local context. Results Accreditation practices i...

The ECFMG Clinical Skills Assessment (CSA) was developed to evaluate whether graduates of international medical schools are ready to enter graduate training programs in the United States. The performance-based patient note exercise is specifically used to assess an examinee's ability to summarize, synthesize and interpret the data collected in a patient interview. The purpose of this study was to investigate whether choice of composition method (typing or writing) affected the psychometric properties of the scores. Using data for a 1-year period, the validity and reliability of typed and written notes was contrasted. Although the characteristics of individuals who chose whether or not to type were different, the statistical analyses indicated that, controlling for examinee ability, physician examiner ratings of the written summaries were not influenced by composition method. The results of this study suggest that the psychometric properties of the patient note scores are invariant with respect to composition method.

If the sequence of administration of encounters in performance-based examinations has an appreciable impact on examinee performance, the validity of any associated assessment decisions could be compromised. The purpose of this article was to determine if the order in which encounters occurred in a multistation standardized patient assessment had an effect on examinee performance and, if so, could this be explained by examinee experience and familiarity with the assessment. Analysis of the scores of over 11,000 examinees who took a 10-station clinical skills assessment was performed to determine trends across the cases. The results showed that administration sequence does have significant, albeit small, impact on examinee performance. In general, examinees perform slightly better as they proceed through the assessment, especially in the first few encounters. The possible reasons for this effect were difficult to establish, but it is likely that comfort with the examination format plays a significant role. For a given assessment, all examinees saw the same cases in a fixed sequence. Therefore, as long as performance gains are relatively small and consistent, it is unlikely that sequence effects compromised the fairness of the assessment.

Cesarean rates in Brazil have reached over 50 percent of all births. Multiple factors have been studied aiming to explain these rates. Mode of delivery preferences among university students may provide insights into strategies to reduce those numbers. A cross-sectional study was conducted enrolling students who attended Health Sciences and Human Sciences undergraduate programs in 2013. Participants answered a semi-structured questionnaire about which mode of delivery they considered the "best" (less risky and more beneficial) and the "preferred" mode (the one they would choose for themselves or their partners). Pearson chi-square was used to assess association among variables. Multiple regression analysis identified independent factors associated with the outcome measures. Among the 797 students who provided complete responses (76% response rate), the mean age was 22.6 years, 61.6 percent were female, 2.6 percent had previous pregnancies, and 56.7 percent were born by cesarean. Vaginal birth was chosen as the "best" mode of delivery by 91.2 percent, and the "preferred" mode by 75.5 percent of students. Being male, born vaginally, and a Health Sciences student was associated with a preference for vaginal birth. Being a Health Sciences student and born vaginally was associated with considering vaginal birth the "best" mode of delivery. Our findings indicate that the recognition of the benefits of vaginal birth do not always translate into a personal preference for vaginal birth. The student's own mode of birth was a strong predictor of their preferences for mode of delivery.

Due to the high-stakes nature of medical exams it is prudent for test agencies to critically evaluate test data and control for potential threats to validity. For the typical multiple station performance assessments used in medicine, it may take time for examinees to become comfortable with the test format and administrative protocol. Since each examinee in the rotational sequence starts with a different task (e.g., simulated clinical encounter), those who are administered non-scored pretest material on their first station may have an advantage compared to those who are not. The purpose of this study is to investigate whether pass/fail rates are different across the sequence of pretest encounters administered during the testing day. First-time takers were grouped by the sequential order in which they were administered the pretest encounter. No statistically significant difference in fail rates was found between examinees who started with the pretest encounter and those who encountered the pretest encounter later in the sequence. Results indicate that current examination administration protocols do not present a threat to the validity of test score interpretations.

... J Gen Intern Med. 1996;11:490-3. Cited Here... 7. Mangione S, Peitzman S. Revisiting physical diagnosis during the medical residency: it is time for a logbook-and more. Acad Med. ... Chair: Beth Dawson. Editor: M. Brownell Anderson. Foreword by Beth Dawson, PhD. ...

Summary Objective: To evaluate the geographic distribution and career trajectory of medical graduates and the factors associated with their choice of practice location. Method: A cross-sectional study involving graduates from December 2001 to December 2010 was conducted. A self-administered questionnaire collected demographics and geographic information (place of birth, place of residence at the time of medical school admission, place of residency training and practice location), and reason for choosing the current location. Statistical analyses assessed trends in geographic distribution of graduates, and identified factors associated with location choice (through the population density of the location chosen for professional practice). Results: A total of 563 graduates completed the questionnaire. Of those, 4.3% (n=24) reported family medicine as their medical specialty, 19.9% (n=112) reported other primary care specialties (internal medicine, pediatrics, surgery and obstetrics-gyn...

There are many differences in the way health care is funded and provided around the world. For quite some time, countries have struggled with the provision of accessible care to their populations, and health care workers have migrated, in part, to support these needs. 1 Because of the more critical health care needs in donor countries, migration of health workers to receiving countries like the United States and United Kingdom has been criticized. 2 In particular, examination of emigration from sub-Saharan Africa * has been of interest. 3,4 Nigeria has, historically, been considered one of the leading countries in the export of physicians. 5 In this context, we present our first FAIMER Short Report, which focuses on the demographic characteristics, examination performance, and practice profiles of graduates of Nigerian medical schools. In this report, we present information on medical education in Nigeria, including information on accreditation/recognition of medical education progr...

Failing candidates often make multiple attempts on licensure and certification examinations. For performance-based assessments, where available test material is often limited, overlap in examination content is frequently inevitable. The purpose of this study was to investigate the performance of repeat candidates, both on new and exposed material, on a standardized patient clinical skills assessment. Analysis of variance techniques were used to investigate the longitudinal performance of repeat candidates. Score differences for the second test session were analyzed as function of prior exposure to assessment materials. Although the performance of candidates improved between the first and second assessment, score increases could not be attributed to the random exposure of examination material. The exposure of case content on clinical skills examinations does not appear to provide any advantage, or disadvantage, to repeat test takers. This finding, although based on average scores for repeat examinees, suggests that valid assessment scores can be obtained even if there is some overlap in assessment content.

The ECFMG Clinical Skills Assessment (CSA) was developed to evaluate whether graduates of international medical schools are ready to enter graduate training programs in the United States. The performance-based patient note exercise is specifically used to assess an examinee's ability to summarize, synthesize and interpret the data collected in a patient interview. The purpose of this study was to investigate whether choice of composition method (typing or writing) affected the psychometric properties of the scores. Using data for a 1-year period, the validity and reliability of typed and written notes was contrasted. Although the characteristics of individuals who chose whether or not to type were different, the statistical analyses indicated that, controlling for examinee ability, physician examiner ratings of the written summaries were not influenced by composition method. The results of this study suggest that the psychometric properties of the patient note scores are invariant with respect to composition method.

The ECFMG Clinical Skills Assessment (CSA) was developed to evaluate whether graduates of international medical schools (IMGs) are ready to enter graduate training programs in the United States. The patient note (PN) exercise is specifically used to assess a candidate's ability to summarize and synthesize the data collected in a simulated patient interview. In a 1-year period, over 7700 first time takers completed the CSA, resulting in over 77,000 physician-based performance ratings. An initial pilot study indicated that, based solely on handwriting, the raters were able to correctly classify the gender of the candidate approximately 70% of the time. This result, combined with the fact that the notes are holistically scored, suggests that rating bias is possible. The purpose of this study was to investigate whether the gender of the candidate, the gender of the performing standardized patient, and the gender of the rater had any impact on scores. An analysis of covariance (ANCOVA) indicated that there was no significant interaction between candidate and rater gender. Female candidates significantly outperformed males, regardless of rater gender (p < 0.01, effect size = 0.23). The results of this study suggest that, based on rater, SP, and candidate characteristics, the validity of the PN ratings is not compromised.

Performance assessments typically require expert judges to individually rate each performance. This results in a limitation in the use of such assessments because the rating process may be extremely time consuming. This article describes a scoring algorithm that is based ...

Due to the high-stakes nature of medical exams it is prudent for test agencies to critically evaluate test data and control for potential threats to validity. For the typical multiple station performance assessments used in medicine, it may take time for examinees to become comfortable with the test format and administrative protocol. Since each examinee in the rotational sequence starts with a different task (e.g., simulated clinical encounter), those who are administered non-scored pretest material on their first station may have an advantage compared to those who are not. The purpose of this study is to investigate whether pass/fail rates are different across the sequence of pretest encounters administered during the testing day. First-time takers were grouped by the sequential order in which they were administered the pretest encounter. No statistically significant difference in fail rates was found between examinees who started with the pretest encounter and those who encountered the pretest encounter later in the sequence. Results indicate that current examination administration protocols do not present a threat to the validity of test score interpretations.

Changes in certification requirements and examinee characteristics are likely to influence the validity of the evidence associated with interpretations made based on test data. We examined whether changes in Educational Commission for Foreign Medical Graduates (ECFMG) certification requirements over time were associated with changes in internal medicine (IM) residency program director ratings and certification examination scores. Comparisons were made between physicians who were ECFMG-certified before and after the Clinical Skills Assessment (CSA) requirement. A multivariate analysis of covariance was conducted to examine the differences in program director ratings based on CSA cohort and whether the examinees emigrated for undergraduate medical education (national vs. international students). A univariate analysis of covariance was conducted to examine differences in scores from the American Board of Internal Medicine (ABIM) Internal Medicine Certification Examination. For both analyses, United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores were used as covariates. Results indicate that, of those certified by ECFMG between 1993 and 1997, 17 % (n = 1,775) left their country of citizenship for undergraduate medical education. In contrast, 38 % (n = 1,874) of those certified between 1999 and 2003 were international students. After adjustment by covariates, the main effect of cohort membership on the program director ratings was statistically significant (Wilks' λ = 0.99, F 5, 15391 = 19.9, P < 0.001). However, the strength of the relationship between cohort group and the ratings was weak (η = 0.01). The main effect of migration status was statistically significant and weak (Wilks' λ = 0.98, F 5,15391 = 45.3, P < 0.01; η = 0.02). Differences in ABIM Internal Medicine Certification Examination scores based on whether or not CSA were required was statistically significant, although the magnitude of the association between these variables was very small. The findings suggest that the implementation of an additional evaluation of skills (e.g., history-taking, physical examination) as a prerequisite to postgraduate medical education (residency) provides some additional, relevant data to those who select ECFMG-certified residents.

The ability to communicate effectively with patients is an essential element of a physician's clinical expertise. As part of the USMLE Step 2 Clinical Skills exam, standardized patients (SPs) provided ratings of communication and interpersonal skills (CIS) along three dimensions. Assessment data from a one-year (2006) cohort of graduates of international medical schools (IMGs) were analyzed and psychometric characteristics of the CIS measures are described. Female and native English-speaking physicians received slightly higher CIS ratings than did males and examinees of other language backgrounds across all dimensions. However, no significant examinee by SP gender interaction effect was detected. Correlations with other measures support the construct validity of the CIS scale. Results of this preliminary study indicate that properly trained SPs can provide accurate and defensible ratings of IMGs' communication and interpersonal skills.

Graduates of international medical schools (IMGs) make up approximately one-quarter of the physician population and play a key role in the provision of health care in the United States. This study investigated whether they differ from U.S. medical graduates (USMGs) in specialty board certification. The study compared USMGs, U.S. citizen IMGs (USIMGs), and non-U.S. citizen IMGs (non-USIMGs) who graduated from medical school between 1958 and 1994 and were involved in direct patient care in 2003. There is variability among the specialties, but overall USMGs have the highest specialty certification rates followed by non-USIMGs, and USIMGs. Among recent medical school graduates, non-USIMGs have certification rates that are comparable to USMGs. IMGs have lower board-certification rates than USMGs, although a sizeable majority has achieved board certification in the specialty they practice. There are differences between non-USIMGs and USIMGs, with the former more likely to become board certified.

To study possible differences in patient satisfaction ratings as a function of physician and patient ethnicity in a standardized patient (SP) performance-based assessment. Data from 334,397 ECFMG Clinical Skills Assessment (CSA) simulated clinical encounters were analyzed. A between-groups analysis of covariance was conducted, with independent variables consisting of SP and candidate ethnicity. Although a significant interaction between SP and candidate ethnicity was found, averaged over all encounters the SPs were equally satisfied with doctors from all cohorts. In general, SPs provided higher satisfaction ratings for racially concordant pairings. Among the ethnic groups of SPs, Asians were the least satisfied. Satisfaction can vary as a function of the ethnicity of the SP. These results are similar to studies of actual patient encounters that show Asians as less satisfied than patients from other ethnic backgrounds. However, for assessment purposes, provided there is a reasonable mix of SPs, the effect is quite small.

If the sequence of administration of encounters in performance-based examinations has an appreciable impact on examinee performance, the validity of any associated assessment decisions could be compromised. The purpose of this article was to determine if the order in which encounters occurred in a multistation standardized patient assessment had an effect on examinee performance and, if so, could this be explained by examinee experience and familiarity with the assessment. Analysis of the scores of over 11,000 examinees who took a 10-station clinical skills assessment was performed to determine trends across the cases. The results showed that administration sequence does have significant, albeit small, impact on examinee performance. In general, examinees perform slightly better as they proceed through the assessment, especially in the first few encounters. The possible reasons for this effect were difficult to establish, but it is likely that comfort with the examination format plays a significant role. For a given assessment, all examinees saw the same cases in a fixed sequence. Therefore, as long as performance gains are relatively small and consistent, it is unlikely that sequence effects compromised the fairness of the assessment.