Effect of a required online graded curriculum in the clerkship years on medical student national standardized examination performance

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Kelli Glaser ◽  
Vanessa Pazdernik ◽  
Denise Sackett ◽  
Valerie Sheridan
Keyword(s):  
Clinical Education ◽  
Interprofessional Education ◽  
The United States ◽  
Distributed Model ◽  
Linear Regression Models ◽  
Online Curriculum ◽  
Early Predictors ◽  
Clerkship Education ◽  
Standardized Examinations ◽  
Level 2

Abstract Context Many medical schools have a distributed model for clinical clerkship education, challenging our ability to determine student gaps during clinical education. With the graduating class of 2017, A.T. Still University’s School of Osteopathic Medicine in Arizona (ATSU-SOMA) began requiring additional online curricula for all clerkship courses. Objectives To determine whether third year and fourth year students receiving ATSU-SOMA’s online curricula during core clerkships performed better overall on national standardized examinations than students from previous years who had not received the curricula, and whether scores from online coursework correlated with outcomes on standardized examinations as possible early predictors of success. Methods This retrospective cohort study analyzed existing data (demographics and assessments) from ATSU-SOMA classes of 2017–2020 (curriculum group) and 2014–2016 (precurriculum group). The effect of the curriculum on national standardized examinations (Comprehensive Osteopathic Medical Achievement Test [COMAT] and Comprehensive Osteopathic Medical Licensing Examination of the United States [COMLEX-USA]) was estimated using augmented inverse probability weighting (AIPW). Correlations between assignment scores and national standardized examinations were estimated using linear regression models. Results The curriculum group had 405 students with a mean (standard deviation [SD]) age of 25.7 (±3.1) years. Two hundred and fifteen (53.1%) students in the curriculum group were female and 190 (46.9%) were male. The precurriculum group had 308 students (mean ± SD age, 26.4 ± 4.2 years; 157 [51.0%] male; 151 [49.0%] female). The online curriculum group had higher COMAT clinical subject exam scores in obstetrics and gynecology, osteopathic principles and practice (OPP), psychiatry, and surgery (all p≤0.04), as well as higher COMLEX-USA Level 2-Cognitive Evaluation (CE) family medicine and OPP subscores (both p≤0.03). The curriculum group had a 9.4 point increase in mean total COMLEX-USA Level 2-CE score (p=0.08). No effect was found for the curriculum overall on COMAT mean or COMLEX-USA Level 2-Performance Evaluation scores (all p≥0.11). Total coursework scores in each core clerkship, excluding pediatrics, were correlated with COMAT mean score (all adjusted p≤0.03). Mean scores for five of the seven assignment types in core clerkships, excluding evidence based medicine types, were positively correlated with COMAT mean scores (all adjusted p≤0.049). All assignment types correlated with COMLEX-USA Level 2-CE total score (all adjusted p≤0.04), except interprofessional education (IPE). Conclusions Results from this study of 713 students from ATSU-SOMA suggested that our online curriculum supplemented clinic based learning during clerkship courses and improved student outcomes on national standardized examinations.

scholarly journals Examining concurrent validity between COMLEX-USA Level 2-Cognitive Evaluation and COMLEX-USA Level 2-Performance Evaluation

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Brandon Craig ◽  
Xiaolin Wang ◽  
Jeanne Sandella ◽  
Tsung-Hsun Tsai ◽  
David Kuo ◽  
...  
Keyword(s):  
Performance Evaluation ◽  
Concurrent Validity ◽  
Pearson Correlation ◽  
The United States ◽  
National Board ◽  
Cognitive Evaluation ◽  
Competency Domain ◽  
Medical Examiners ◽  
Pearson Correlations ◽  
Level 2

Abstract Context The Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) is a three level examination used as a pathway to licensure for students in osteopathic medical education programs. COMLEX-USA Level 2 includes a written assessment of Fundamental Clinical Sciences for Osteopathic Medical Practice (Level 2-Cognitive Evaluation [L2-CE]) delivered in a computer based format and separate performance evaluation (Level 2-Performance Evaluation [L2-PE]) administered through live encounters with standardized patients. L2-PE was designed to augment L2-CE. It is expected that the two examinations measure related yet distinct constructs. Objectives To explore the concurrent validity of L2-CE with L2-PE. Methods First attempt test scores were obtained from the National Board of Osteopathic Medical Examiners database for 6,639 candidates who took L2-CE between June 2019 and May 2020 and matched to the students’ L2-PE scores. The sample represented all colleges of osteopathic medicine and 97.5% of candidates who took L2-CE during the complete 2019–2020 test cycle. We calculated disattenuated correlations between the total score for L2-CE, the L2-CE scores for the seven competency domains (CD1 through CD7), and the L2-PE scores for the Humanistic Domain (HM) and Biomedical/Biomechanical Domain (BM). All scores were on continuous scales. Results Pearson correlations ranged from 0.10 to 0.88 and were all statically significant (p<0.01). L2-CE total score was most strongly correlated with CD2 (0.88) and CD3 (0.85). Pearson correlations between the L2-CE competency domain subscores ranged from 0.17 to 0.70, and correlations which included either HM or BM ranged from 0.10 to 0.34 with the strongest of those correlations being between BM and L2-CE total score (0.34) as well as between HM and BM (0.28).The largest increase between corresponding Pearson and disattenuated correlations was for pairs of scores with lower reliabilities such as CD5 and CD6, which had a Pearson correlation of 0.17 and a disattenuated correlation of 0.68. The smallest increase in correlations was observed in pairs of scores with larger reliabilities such as L2-CE total score and HM, which had a Pearson correlation of 0.23 and a disattenuated correlation of 0.28. The reliability of L2-CE was 0.87, 0.81 for HM, and 0.73 for BM. The reliabilities for the L2-CE competency domain scores ranged from 0.22 to 0.74. The small to moderate correlations between the L2-CE total score and the two L2-PE support the expectation that these examinations measure related but distinct constructs. The correlations between L2-PE and L2-CE competency domain subscores reflect the distribution of items defined by the L2-PE blueprint, providing evidence that the examinations are performing as designed. Conclusions This study provides evidence supporting the validity of the blueprints for constructing COMLEX-USA Levels 2-CE and 2-PE examinations in concert with the purpose and nature of the examinations.

scholarly journals Telepsychiatry adoption across hospitals in the United States: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhong Li ◽  
Sayward E. Harrison ◽  
Xiaoming Li ◽  
Peiyin Hung
Keyword(s):  
Continuity Of Care ◽  
Psychiatric Care ◽  
The United States ◽  
Psychiatric Services ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Promising Alternative ◽  
American Hospital ◽  
American Hospital Association ◽  
Inpatient Psychiatric Care

Abstract Background Access to psychiatric care is critical for patients discharged from hospital psychiatric units to ensure continuity of care. When face-to-face follow-up is unavailable or undesirable, telepsychiatry becomes a promising alternative. This study aimed to investigate hospital- and county-level characteristics associated with telepsychiatry adoption. Methods Cross-sectional national data of 3475 acute care hospitals were derived from the 2017 American Hospital Association Annual Survey. Generalized linear regression models were used to identify characteristics associated with telepsychiatry adoption. Results About one-sixth (548 [15.8%]) of hospitals reported having telepsychiatry with a wide variation across states. Rural noncore hospitals were less likely to adopt telepsychiatry (8.3%) than hospitals in rural micropolitan (13.6%) and urban counties (19.4%). Hospitals with both outpatient and inpatient psychiatric care services (marginal difference [95% CI]: 16.0% [12.1% to 19.9%]) and hospitals only with outpatient psychiatric services (6.5% [3.7% to 9.4%]) were more likely to have telepsychiatry than hospitals with neither psychiatric services. Federal hospitals (48.9% [32.5 to 65.3%]), system-affiliated hospitals (3.9% [1.2% to 6.6%]), hospitals with larger bed size (Quartile IV vs. I: 6.2% [0.7% to 11.6%]), and hospitals with greater ratio of Medicaid inpatient days to total inpatient days (Quartile IV vs. I: 4.9% [0.3% to 9.4%]) were more likely to have telepsychiatry than their counterparts. Private non-profit hospitals (− 6.9% [− 11.7% to − 2.0%]) and hospitals in counties designated as whole mental health professional shortage areas (− 6.6% [− 12.7% to − 0.5%]) were less likely to have telepsychiatry. Conclusions Prior to the Covid-19 pandemic, telepsychiatry adoption in US hospitals was low with substantial variations by urban and rural status and by state in 2017. This raises concerns about access to psychiatric services and continuity of care for patients discharged from hospitals.

scholarly journals Social stress and risk of declining cognition: a longitudinal study of men and women in the United States

2021 ◽  
Author(s):  
Jutta Lindert ◽  
Kimberley C. Paul ◽  
E. Lachman Margie ◽  
Beate Ritz ◽  
Teresa Seeman
Keyword(s):  
United States ◽  
Adverse Effects ◽  
Executive Functioning ◽  
Episodic Memory ◽  
Social Status ◽  
Social Stress ◽  
The United States ◽  
Subjective Social Status ◽  
Linear Regression Models ◽  
Men And Women

AbstractLimited research is available on the relationship between social stress and risk of declining cognition. We sought to examine whether social stress has adverse effects on risk of declining episodic memory and executive functioning in aging individuals. We used data from the MIDUS study, a national probability sample of non-institutionalized, English speaking respondents aged 25–74 living in the 48 contiguous states of the United States. The initial wave (1995) included 4963 non-institutionalized adults aged 32–84 (M = 55, SD = 12.4). We used an analytic sample from MIDUS-II (1996/1997) and MIDUS-III (2013) (n = 1821). The dependent variables are episodic memory and executive functioning, which were assessed with the Brief Test for Cognition (BTACT). The independent variables were social stress variables (subjective social status, family and marital stress, work stress and discrimination). To evaluate episodic memory and executive functioning changes over a time period of 10 years, we estimated adjusted linear regression models. Women report significantly lower subjective social status and more discrimination stress than men across all age groups. Controlling for education and income, age, and baseline episodic memory and executive functioning, lower subjective social status had additional adverse effects on declines in episodic memory in men and women. Marital risk had adverse effects on episodic memory in men but not in women. Daily discrimination had adverse effects on executive functioning on all individuals. Public health strategies should focus on reducing social stress in a socio-ecological perspective. Especially, subjective social status and discrimination stress might be a target for prevention efforts.

scholarly journals Is the Association of Diabetes With Uncontrolled Blood Pressure Stronger in Mexican Americans and Blacks Than in Whites Among Diagnosed Hypertensive Patients?

2013 ◽  
Vol 26 (11) ◽  
pp. 1328-1334 ◽  
Author(s):  
Xuefeng Liu ◽  
Ping Song
Keyword(s):  
Blood Pressure ◽  
Racial Differences ◽  
Mexican Americans ◽  
The United States ◽  
Linear Regression Models ◽  
Uncontrolled Blood Pressure ◽  
Hypertensive Patients ◽  
Health And Nutrition ◽  
Multistage Design ◽  
Hispanic White

Abstract BACKGROUND Clinical evidence shows that diabetes may provoke uncontrolled blood pressure (BP) in hypertensive patients. However, racial differences in the associations of diabetes with uncontrolled BP outcomes among diagnosed hypertensive patients have not been evaluated. METHODS A total of 6,134 diagnosed hypertensive subjects aged ≥20 years were collected from the National Health and Nutrition Examination Survey 1999–2008 with a stratified multistage design. Odds ratios (ORs) and relative ORs of uncontrolled BP and effect differences in continuous BP for diabetes over race/ethnicity were derived using weighted logistic regression and linear regression models. RESULTS Compared with participants who did not have diabetes, non-Hispanic black participants with diabetes had a 138% higher chance of having uncontrolled BP, Mexican participants with diabetes had a 60% higher chance of having uncontrolled BP, and non-Hispanic white participants with diabetes had a 161% higher chances of having uncontrolled BP. The association of diabetes with uncontrolled BP was lower in Mexican Americans than in non-Hispanic blacks and whites (Mexican Americans vs. non-Hispanic blacks: relative OR = 0.55, 95% confidence interval (CI) = 0.37–0.82; Mexican Americans vs. non-Hispanic whites: relative OR = 0.53, 95% CI = 0.35–0.80) and the association of diabetes with isolated uncontrolled systolic BP was lower in Mexican Americans than in non-Hispanic whites (Mexican Americans vs. non-Hispanic whites: relative OR = 0.62, 95% CI = 0.40–0.96). Mexican Americans have a stronger associaton of diabetes with decreased systolic BP and diastolic BP than non-Hispanic whites, and a stronger association of diabetes with decreased diastolic BP than non-Hispanic blacks. CONCLUSIONS The association of diabetes with uncontrolled BP outcomes is lower despite higher prevalence of diabetes in Mexican Americans than in non-Hispanic whites. The stronger association of diabetes with BP outcomes in whites should be of clinical concern, considering they account for the majority of the hypertensive population in the United States.

A Preliminary Study of Nursing Practice Patterns Concerning Dysphagia Diet Modification: Implications for Interprofessional Education With SLPs

2021 ◽  
pp. 1-15
Author(s):  
Naomi Gurevich ◽  
Danielle R. Osmelak ◽  
Sydney Osentoski
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Interprofessional Education ◽  
Practice Patterns ◽  
Improve Patient Care ◽  
Treatment Method ◽  
The United States ◽  
Diet Modification ◽  
Work Settings ◽  
Swallowing Dysfunction

Purpose Speech-language pathologists (SLPs) are trained to evaluate and treat dysphagia. One treatment method is to modify diet consistency or viscosity to compensate for swallowing dysfunction and promote a safer intake; this typically involves softening solids and thickening liquids. Thickening liquids is not safer for all patients, and modification of dysphagia diets without adequate training may reduce the quality of dysphagia patient care. Over 90% of SLPs working in health care report exposure to nurses who regularly downgrade dysphagia diets without an SLP consult. This study explores dysphagia diet modification practices of nursing staff with and without dysphagia training. Method Practicing nurses and student nurses ( N = 298) in the United States were surveyed regarding their dysphagia diet modification training and practice patterns. Additionally, a pre-/posttest design was used to determine the efficacy of a short general tutorial on willingness to modify diets without an SLP consult. Results Downgrading diets without an SLP consult is a common practice. Fewer than one third of nurses (31.41%) would avoid it, whereas 73.65% would avoid upgrading without SLP consult. Formal dysphagia training made little difference to this practice. The short general tutorial also had no beneficial effect, in fact slightly reducing the willingness to consult SLPs. Conclusions Dysphagia diet modification practice by nurses is pervasive in U.S. health care. This is a previously unexplored but common issue SLPs face in work settings. This study identifies a need to clarify guidelines and increase interprofessional education between both professions to improve patient care.

Expanding the Happiness Paradox: Ethnoracial Disparities in Life Satisfaction Among Older Immigrants in the United States

2017 ◽  
Vol 31 (2) ◽  
pp. 231-255
Author(s):  
Rocío Calvo ◽  
Dawn C. Carr ◽  
Christina Matz-Costa
Keyword(s):  
United States ◽  
Life Satisfaction ◽  
Regression Models ◽  
The United States ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Older Immigrants ◽  
Happiness Paradox ◽  
Retirement Study ◽  
Lower Life Satisfaction

Objective: This study investigated nativity disparities in life satisfaction among ethnoracial groups of older adults in the United States and the factors associated with such disparities. Method: Cross-sectional data from 7,348 respondents aged 60 and older from the 2012/2014 waves of the Health and Retirement Study (HRS) were used to estimate linear regression models. Results: Older immigrants experienced higher levels of life satisfaction than comparable native-born individuals. This “happiness advantage” was particularly salient for Hispanic immigrants, who reported the highest levels of life satisfaction of all groups included in the study. With increasing education, life satisfaction increased for White and “Other Race” groups, regardless of nativity. However, for both Black groups and native-born Hispanics, higher levels of education were associated with lower life satisfaction. Discussion: Findings suggest that the “happiness paradox” may not only be a matter of Hispanic ethnicity, but that it may also extend to immigrants from other ethnoracial backgrounds.

scholarly journals Empowering Health Care Professionals: An Interprofessional Education Model Implementation and Evaluation

2019 ◽  
Author(s):  
Jessica Shank Coviello
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Interprofessional Education ◽  
Healthcare Professionals ◽  
The United States ◽  
Healthcare Systems ◽  
World Health ◽  
Institute Of Medicine ◽  
Care Needs ◽  
Ensure Patient Safety

In 2016, the Institute of Medicine (IOM) reported medical error as the 3rd leading cause of death in healthcare systems in the United States. Effective communication of patient care needs across healthcare disciplines is critical to ensure patient safety, quality of care, and to improve operational efficiencies in healthcare systems. Ineffective collaboration and communication among healthcare professionals within the procedural areas increases the potential of harm as a patient moves from one healthcare professional to another. Health care systems are thus encouraged to train employees with a focus on interprofessional education (IPE) and collaborative practice. IOM and World Health Organization (WHO) recommend the use of IPE to help improve communication and collaboration. However the current educational structure in many institutions does not include IPE. As such, healthcare professionals work in silos, with little or no collaboration with one another, which may result in service duplication, increased service cost, and poor health outcomes for patients.

scholarly journals COVID-19 Incidence and Hospitalization Rates are Inversely Related to Vaccination Coverage Among the 112 Most Populous Counties in the United States

2021 ◽  
Author(s):  
Jeffrey E. Harris
Keyword(s):  
United States ◽  
Vaccination Coverage ◽  
Hospital Admissions ◽  
The United States ◽  
Lower Half ◽  
Linear Regression Models ◽  
Percentage Point Increase ◽  
Hospitalization Rates ◽  
Point Increase ◽  
Log Linear

AbstractWe tested whether COVID-19 incidence and hospitalization rates were inversely related to vaccination coverage among the 112 most populous counties in the United States, each with a population exceeding 600,000. We measured vaccination coverage as the percent of the total population fully vaccinated as of July 15, 2021, with the exception of 11 Texas counties, where the cutoff date was July 14, 2021. We measured COVID-19 incidence as the number of confirmed cases per 100,000 population during the 14-day period ending August 12, 2021. We measured hospitalization rates as the number of confirmed COVID-19 admissions per 100,000 population during the same 14-day period. COVID-19 incidence was significantly higher among counties in the lower half of the distribution of vaccination coverage (incidence 543.8 per 100,000 among 56 counties with mean coverage 42.61%) than among counties in the lower half of the distribution of coverage (incidence 280.7 per 100,000 among 56 counties with mean coverage 57.37%, p < 0.0001). Hospital admissions were also significantly higher among counties in the lower half of the distribution (55.37 per 100,000) than in the upper half of the distribution (20.48 per 100,000, p < 0.0001). In log-linear regression models, a 10-percentage-point increase in vaccination coverage was associated with a 28.3% decrease in COVID-19 incidence (95% confidence interval, 16.8 – 39.7%), a 44.9 percent increase in the rate of COVID-19 hospitalization (95% CI, 28.8 – 61.0%), and a 16.6% decrease in COVID-19 hospitalizations per 100 cases (95% CI, 8.4 – 24.8%). Higher vaccination coverage is associated not only with significantly lower COVID-19 incidence, but also significantly less severe cases of the disease.

Sign in / Sign up

Export Citation Format

Share Document