Research Interests:
Research Interests:
Background Since the Accreditation Council for Graduate Medical Education (ACGME) introduced the Milestones in 2013, the body of validity evidence supporting their use has grown, but there is a gap with regard to response process.... more
Background Since the Accreditation Council for Graduate Medical Education (ACGME) introduced the Milestones in 2013, the body of validity evidence supporting their use has grown, but there is a gap with regard to response process. Objective The purpose of this study is to qualitatively explore validity evidence pertaining to the response process of individual Clinical Competency Committee (CCC) members when assigning Milestone ratings to a resident. Methods Using a constructivist paradigm, we conducted a thematic analysis of semi-structured interviews with 8 Transitional Year (TY) CCC members from 4 programs immediately following a CCC meeting between November and December 2020. Participants were queried about their response process in their application of Milestone assessment. Analysis was iterative, including coding, constant comparison, and theming. Results Participant interviews identified an absence of formal training and a perception that Milestones are a tool for resident ass...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
PURPOSE The reproducibility and consistency of assessments of entrustable professional activities (EPAs) in undergraduate medical education (UME) have been identified as potential areas of concern. EPAs were designed to facilitate... more
PURPOSE The reproducibility and consistency of assessments of entrustable professional activities (EPAs) in undergraduate medical education (UME) have been identified as potential areas of concern. EPAs were designed to facilitate workplace-based assessments by faculty with a shared mental model of a task who could observe a trainee complete the task multiple times. In UME, trainees are frequently assessed outside the workplace by faculty who only observe a task once. METHOD In November 2019, the authors conducted a generalizability study (G-study) to examine the impact of student, faculty, case, and faculty familiarity with the student on the reliability of 162 entrustment assessments completed in a preclerkship environment. Three faculty were recruited to evaluate 18 students completing 3 standardized patient (SP) cases. Faculty familiarity with each student was determined. Decision studies were also completed. Secondary analysis of the relationship between student performance and entrustment (scoring inference) compared average SP checklist scores and entrustment scores. RESULTS G-study analysis revealed that entrustment assessments struggled to achieve moderate reliability. The student accounted for 30.1% of the variance in entrustment scores with minimal influence from faculty and case, while the relationship between student and faculty accounted for 26.1% of the variance. G-study analysis also revealed a difference in generalizability between assessments by unfamiliar (φ = 0.75) and familiar (φ = 0.27) faculty. Sub-analyses showed that entrustment assessments by familiar faculty were moderately correlated to average SP checklist scores (r = 0.44, P < .001), while those by unfamiliar faculty were weakly correlated (r = 0.16, P = .13). CONCLUSIONS While faculty and case had a limited impact on the generalizability of entrustment assessments made outside the workplace in UME, faculty who were familiar with a student's ability had a notable impact on generalizability and potentially on the scoring validity of entrustment assessments, which warrants further study.
Research Interests:
BACKGROUND: Cancer survivorship care is not ade-quately addressed in current medical school curricula. OBJECTIVES: To develop, implement, and evaluate a modular cancer survivorship curriculum that is portable to other educational settings... more
BACKGROUND: Cancer survivorship care is not ade-quately addressed in current medical school curricula. OBJECTIVES: To develop, implement, and evaluate a modular cancer survivorship curriculum that is portable to other educational settings and is designed to provide medical students with a foundation of knowledge, atti-tudes, and skills related to care for cancer survivors. PROGRAM DESCRIPTION: An expert consensus panel developed a set of learning objectives related to cancer survivorship to guide the development of educational modules, such as computer-based self-instructional modules, problem-based learning cases, videos, and clinical exercises. Course and clerkship chairs were directly involved in the development and implementa-tion of the modules. EVALUATION: A cohort study with a historical control group demonstrated that fourth-year medical students increased their knowledge in survivorship issues and their self-reported level of comfort in care activities compared to similar s...
Research Interests:
As students at the David Geffen School of Medicine at UCLA, the student authors were given the opportunity to develop their own creative projects which would be used to teach future medical students. They chose their own topics, planned... more
As students at the David Geffen School of Medicine at UCLA, the student authors were given the opportunity to develop their own creative projects which would be used to teach future medical students. They chose their own topics, planned and researched their projects, and then implemented the projects in interactive digital Adobe Flash files. In the first project they created interactive case-based radiology teaching files. In the second project they integrated photographic images into the existing illustrative anatomy files. Students in subsequent years have learned from these files on computers both at home and in the school’s anatomy lab. The experience of creating the files served as an opportunity for hands-on learning for the student authors, both of the material and of the practice of teaching. In this paper they describe why they undertook these projects, what exactly they did, and the impact their creation had on them. The projects demonstrate that student-driven educational...
Research Interests:
Recently, the IMS Learning Resource Meta-Data Specification [1] was released, paving the way for efficient repurposing of educational multimedia in a multitude of learning environments. The goal of the current project is the development... more
Recently, the IMS Learning Resource Meta-Data Specification [1] was released, paving the way for efficient repurposing of educational multimedia in a multitude of learning environments. The goal of the current project is the development of a national repository of multimedia that supports all levels of health sciences education and that is in accordance with the IMS specifications. An n-tiered, distributed database system will facilitate the discovery, exchange, and implementation of digital multimedia.
Research Interests:
BACKGROUND AND OBJECTIVES Many medical trainees seek work among underserved communities but may be unprepared to cope with the challenges. Relationship-centered qualities have been shown to promote physician resilience and prevent... more
BACKGROUND AND OBJECTIVES Many medical trainees seek work among underserved communities but may be unprepared to cope with the challenges. Relationship-centered qualities have been shown to promote physician resilience and prevent burnout. The UCLA-PRIME program aims to prepare medical students to work among vulnerable groups and begins with a 3-week leadership course. We describe this course and share lessons with those seeking to foster leadership, advocacy, and resiliency in our future physician workforce. METHODS Twenty students participated in our curriculum that emphasized five competencies: leadership, advocacy, teamwork, mindfulness, and self-care. Course activities complemented the students' work as they developed a community outreach project. They assessed and reflected on their leadership, relationship, and team behaviors, were coached to improve these, learned mindfulness meditation, and participated in community forums. Our evaluation assessed course quality, projec...
Research Interests:
Supplemental Digital Content is available in the text. Purpose To have subject matter experts evaluate the Core Entrustable Professional Activities for Entering Residency (Core EPAs) with the EQual rubric to determine if revisions were... more
Supplemental Digital Content is available in the text. Purpose To have subject matter experts evaluate the Core Entrustable Professional Activities for Entering Residency (Core EPAs) with the EQual rubric to determine if revisions were required and, if applicable, how to focus revision efforts. Method Ten entrustable professional activity (EPA) experts were invited to evaluate the 13 Core EPAs. Experts had a 6-month window (December 2018–May 2019) to complete the evaluation, which contained the complete EQual rubric and 3 additional prompts, one of which—“Do you think this EPA requires revision?”—was limited to a “yes/no” response. Descriptive statistics for overall and domain-specific EQual rubric scores for each of the 13 Core EPAs were calculated. Free-text responses to why and/or how a Core EPA should be revised were summarized for any Core EPA that scored below a cutoff or for which the majority of experts recommended revision. Results Six experts completed the evaluation. Most Core EPAs’ (9/13) overall score was above the cutoff, indicating that they align with the key domains of the EPA construct. The remaining 4 Core EPAs (2, 7, 9, and 13) scored below the overall cutoff, suggesting that they may require revision. A majority of experts felt that Core EPAs 6, 7, 9, and 13 required revision. With regard to domain-specific scores, Core EPAs 2, 3, 7, 9, and 13 were below the discrete units of work cutoff; Core EPAs 7, 9, and 13 were below the entrustable, essential, and important tasks of the profession of medicine cutoff; and Core EPA 9 was below the curricular role cutoff. Conclusions The Core EPAs represent a promising initial framework of EPAs for undergraduate medical education. Some Core EPAs might benefit from revision. The process of improving the Core EPAs must continue if they are to standardize outcomes for medical school graduates.
Research Interests:
Research Interests:
Research Interests:
Research Interests: Psychopharmacology, Depression, Schizophrenia, Neuropsychopharmacology, Electroencephalography, and 15 morePrefrontal Cortex, Humans, Major Depressive Disorder, Female, Male, Middle Aged, Adult, Analysis of Variance, FLUOXETINE, Chi Square Distribution, Brain Function, Clinical Application, Psychology and Cognitive Sciences, Medical and Health Sciences, and Antidepressive agents
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests: Program Evaluation, Medical Education, Cancer, General Internal Medicine, Problem Based Learning, and 15 moreMedicine, Curriculum, Medical Students, Humans, Internal Medicine, Program Development, General, Learning Object, Cohort Study, Clinical Sciences, Survival Rate, Neoplasms, Cancer Survivor, Control Group, and Cohort Studies
Despite widespread implementation of policies to address mistreatment, the proportion of medical students who experience mistreatment during clinical training is significantly higher than the proportion of students who report... more
Despite widespread implementation of policies to address mistreatment, the proportion of medical students who experience mistreatment during clinical training is significantly higher than the proportion of students who report mistreatment. Understanding barriers to reporting mistreatment from students' perspectives is needed before effective interventions can be implemented to improve the clinical learning environment. We explored medical students' reasons for not reporting perceived mistreatment or abuse experienced during clinical clerkships at the David Geffen School of Medicine at UCLA (DGSOM). This was a sequential two-phase qualitative study. In the first phase, we analyzed institutional survey responses to an open-ended questionnaire administered to the DGSOM graduating classes of 2013-2015 asking why students who experienced mistreatment did not seek help or report incidents. In the second phase, we conducted focus group interviews with third- and fourth-year medical...
Research Interests:
OBJECTIVE: This study compared the prevalence of symptoms of posttraumatic stress disorder (PTSD), with functional impairment and/or clinical distress, among very long-term survivors of childhood cancer and a group of healthy siblings.... more
OBJECTIVE: This study compared the prevalence of symptoms of posttraumatic stress disorder (PTSD), with functional impairment and/or clinical distress, among very long-term survivors of childhood cancer and a group of healthy siblings. METHODS: A total of 6542 childhood cancer survivors >18 years of age who received diagnoses between 1970 and 1986 and 368 siblings of cancer survivors completed a comprehensive demographic and health survey. RESULTS: A total of 589 survivors (9%) and 8 siblings (2%) reported functional impairment and/or clinical distress in addition to the set of symptoms consistent with a full diagnosis of PTSD. Survivors had more than fourfold greater risk of PTSD, compared with siblings (odds ratio [OR]: 4.14 [95% confidence interval [CI]: 2.08–8.25]). With controlling for demographic and treatment variables, increased risk of PTSD was associated with educational level of high school or less (OR: 1.51 [95% CI: 1.16–1.98]), being unmarried (OR: 1.99 [95% CI: 1.58–2.50]), having annual income below $20000 (OR: 1.63 [95% CI: 1.21–2.20]), and being unemployed (OR: 2.01 [95% CI: 1.62–2.51]). Intensive treatment also was associated with increased risk of full PTSD (OR: 1.36 [95% CI: 1.06–1.74]). CONCLUSIONS: PTSD was reported significantly more often by survivors of childhood cancer than by sibling control subjects. Although most survivors apparently are faring well, a subset reported significant impairment that may warrant targeted intervention.
Research Interests:
Background. Entrustable Professional Activities (EPAs) assessments measure learners’ competence with an entrustment or supervisory scale. Designed for workplace-based assessment EPA assessments have also been proposed for undergraduate... more
Background. Entrustable Professional Activities (EPAs) assessments measure learners’ competence with an entrustment or supervisory scale. Designed for workplace-based assessment EPA assessments have also been proposed for undergraduate medical education (UME), where assessments frequently occur outside the workplace and may be less intuitive, raising validity concerns. This study explored how assessors make entrustment determinations in UME, to include the impact of longitudinal student-assessor relationships.Methods. A qualitative approach using think-alouds was employed. Assessors assessed two students (familiar and unfamiliar) completing a history and physical exam using a supervisory scale and then thought-aloud after each assessment. We conducted a thematic analysis of assessors’ response processes and compared them based on their familiarity with a student.Results. Four themes and fifteen subthemes were identified. The most prevalent theme related to “student performance.” The...
Research Interests:
Early hands-on experience with surgical procedures may help medical students make better-informed choices if considering a surgical specialty. Here, we evaluate a curricular addition in surgical anatomy, formally exposing second-year... more
Early hands-on experience with surgical procedures may help medical students make better-informed choices if considering a surgical specialty. Here, we evaluate a curricular addition in surgical anatomy, formally exposing second-year students to different surgical subspecialties. Students met with surgeons for 7 weeks (one afternoon per week) and practiced surgical procedures on human cadavers with supervision. About a quarter of the participants reported a change in their top choice of specialty upon completing the course, and about half of the students reported changes in their second and third choices. At the time of graduation, 85% of those surveyed reported participation in the course impacted their final choice of specialty. These results demonstrate such a course helped medical students select a specialty during early training.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
The health professions education (HPE) community is a crossroad of scholars from various disciplines with potentially conflicting views on who qualifies as author. Established HPE scholars are expected to model ethical research conduct... more
The health professions education (HPE) community is a crossroad of scholars from various disciplines with potentially conflicting views on who qualifies as author. Established HPE scholars are expected to model ethical research conduct but no research has investigated the extent to which authorship criteria are understood and applied by leaders in the field. This study investigated what leading scholars consider appropriate criteria for authorship and how often these criteria are ignored. Directors of research and editors of HPE journals completed an anonymous survey between September 2015 and August 2016 with questions about authorship practices they experienced and recommended, common authorship criteria, and how often they had encountered unethical authorship decisions. Out of 82 invited scholars, 46 participated in the survey (response rate = 56.0%). They reported a stark contrast between current and recommended authorship practices. Twenty-two (51.2%) had experienced unethical ...
Research Interests:
Objective To assess patient and provider perspectives on the potential value and use of a bilingual patient portal in a large safety-net health system serving predominantly Spanish-speaking patients. Materials and Methods We captured... more
Objective To assess patient and provider perspectives on the potential value and use of a bilingual patient portal in a large safety-net health system serving predominantly Spanish-speaking patients. Materials and Methods We captured patient and provider perspectives through the administration of surveys to assess Internet access, barriers, and facilitators to patient portal adoption, along with portal preferences. We report on these survey results using descriptive and comparative statistics. Results Four hundred patients (82% response rate) and 59 providers (80% response rate) participated in the study. Although 73% of providers believed that the patient portal would increase patient satisfaction, just 39% planned to recommend portal use to patients, citing concerns related to time and reimbursement. In contrast, 72% of patients believed the patient portal would strengthen the patient-provider relationship and 77% believed it would improve the quality of care. Latino patients in p...
Research Interests:
Research Interests:
Research Interests:
Regional and institutional databases have been created to improve access to educational resources and to avert unnecessary duplication. The growth and success of these databases depend upon the willingness of faculty members to contribute... more
Regional and institutional databases have been created to improve access to educational resources and to avert unnecessary duplication. The growth and success of these databases depend upon the willingness of faculty members to contribute their materials. This qualitative study seeks to identify the barriers that block the free exchange of educational multimedia and the incentives that could be created to overcome educators&amp;amp;#39; concerns. In 2001, 34 faculty members from 13 U.S. medical schools each participated in one of five focus groups. They responded to three hypothetical scenarios depicting opportunities for sharing educational resources. Participants&amp;amp;#39; responses were categorized hierarchically and sent back to them for feedback. Participants strongly supported multimedia databases, particularly those that serve a national audience. Obstacles for contributing materials included the lack of institutional recognition for educational innovation, confusing intellectual property policies, the hassle involved in sharing materials, and the perceived commercial potential of the materials. Peer review of educational materials was seen as an important incentive. Medical schools could benefit from the free exchange of high-quality educational multimedia but need to address the concerns of faculty by clarifying institutional copyright rules, streamlining the donation process, and providing assistance with cataloging assets. Removing departmental pressures to commercialize materials and recognizing peer-reviewed donations as academic achievement could foster a culture of sharing.
Research Interests:
Research Interests:
Writing an educational research grant in health profession education is challenging, not only for those doing it for the first time but also for more experienced scholars. The intensity of the competition, the peculiarities of the grant... more
Writing an educational research grant in health profession education is challenging, not only for those doing it for the first time but also for more experienced scholars. The intensity of the competition, the peculiarities of the grant format, the risk of rejection, and the time required are among the many obstacles that can prevent educational researchers with interesting and important ideas from writing a grant, that could provide the funding needed to turn their scholarly ideas into reality. The aim of this AMEE Guide is to clarify the grant-writing process by (a) explaining the mechanics and structure of a typical educational research grant proposal, and (b) sharing tips and strategies for making the process more manageable.
Research Interests:
... Sebastian Uijtdehaage, Ph.D., Anju Relan, Ph.D. Instructional Design & Technology Unit, UCLA School of Medicine, Los Angeles, CA, USA. Email: bas@ucla.edu ... Jonassen, DH, Dyer, D., Peters, K., Robinson, T., Harvey, D., King, M.... more
... Sebastian Uijtdehaage, Ph.D., Anju Relan, Ph.D. Instructional Design & Technology Unit, UCLA School of Medicine, Los Angeles, CA, USA. Email: bas@ucla.edu ... Jonassen, DH, Dyer, D., Peters, K., Robinson, T., Harvey, D., King, M. & Loughner, P (1997). ...
Research Interests:
There is considerable heterogeneity in treatment response among depressed patients. Although most patients respond to the first antidepressant administered, as many as 45% may require treatment with a second or third agent. Pretreatment... more
There is considerable heterogeneity in treatment response among depressed patients. Although most patients respond to the first antidepressant administered, as many as 45% may require treatment with a second or third agent. Pretreatment clinical characteristics of patients can ...
Research Interests:
ABSTRACT Background Simulation-based training and assessment have gained traction in medical education, though their usefulness to preclinical students remains unclear. Our objectives were to determine (1) the feasibility of a simulation... more
ABSTRACT Background Simulation-based training and assessment have gained traction in medical education, though their usefulness to preclinical students remains unclear. Our objectives were to determine (1) the feasibility of a simulation module for teaching students with little or no previous experience in managing undifferentiated, acutely ill patients and (2) its impact on students’ knowledge and attitudes about critical care. Methods Participants at two medical schools served as their own controls in a pre- and post-intervention design. Students were asked to independently manage an acutely ill patient, and after which, they received teaching on basic life support principles. We evaluated performance with a critical actions checklist, and knowledge and attitudes with a written test before intervention, immediately after, and 6 weeks later. Results A total of 41 students participated, of which 34 (83 %) were in their first year of medical school. Mean knowledge scores improved from 45.3 to 76.4 %, and retention remained higher than pre-test levels. Only 17 (41 %) students performed the majority of the critical actions in simulation, yet there was a significant improvement in students’ comfort level and self-reported understanding of critical care after the experience and upon retesting. Conclusion Teaching preclinical students acute care skills with a high-fidelity simulator is feasible and promotes interest in critical care.
The impedance cardiograph has been widely used to examine cardiac sympathetic inotropic activity. Recently evidence was presented indicating that left ventricular ejection time (LVET) may be a useful index of sympathetic chronotropic... more
The impedance cardiograph has been widely used to examine cardiac sympathetic inotropic activity. Recently evidence was presented indicating that left ventricular ejection time (LVET) may be a useful index of sympathetic chronotropic influences derivable from the impedance cardiograph. The goal of the present research was to derive an index of parasympathetic chronotropic influences. In addition, further support for LVET as a sympathetic chronotropic index was sought. Eight healthy college-age subjects participated in a within-subjects design experiment. Tasks were chosen to elicit a wide range of cardiovascular responses resulting from differing combinations of sympathetic and parasympathetic activity. Results indicated that heart rate corrected for LVET (HR-LVET) correlated highly with respiratory sinus arrhythmia (RSA), an index of vagal cardiac chronotropic activity. In addition, principal components analysis indicated that heart rate, RSA, LVET, HR-LVET, and HR corrected for RS...
Research Interests:
Many medical trainees seek work among underserved communities but may be unprepared to cope with the challenges. Relationship-centered qualities have been shown to promote physician resilience and prevent burnout. The UCLA-PRIME program... more
Many medical trainees seek work among underserved communities but may be unprepared to cope with the challenges. Relationship-centered qualities have been shown to promote physician resilience and prevent burnout. The UCLA-PRIME program aims to prepare medical students to work among vulnerable groups and begins with a 3-week leadership course. We describe this course and share lessons with those seeking to foster leadership, advocacy, and resiliency in our future physician workforce. Twenty students participated in our curriculum that emphasized five competencies: leadership, advocacy, teamwork, mindfulness, and self-care. Course activities complemented the students' work as they developed a community outreach project. They assessed and reflected on their leadership, relationship, and team behaviors, were coached to improve these, learned mindfulness meditation, and participated in community forums. Our evaluation assessed course quality, project completion, leadership, mindfuln...