Applicant Selection to a Regional Medical Training Program: A Structural Analysis of Interviewer Assessments

Introduction: For regional campuses with specific program foci, assessing applicant fit necessarily extends beyond academic and professional factors. Based on assessments of applicants to a regional Rural Physician Leadership Program (RPLP), this study explores the relationship of academic and socio-demographic factors with interviewers’ ratings of: (1) likelihood of eventually practicing in a rural area of the state; and (2) overall acceptability to medical school. Methods: The study population consisted of 163 first-time RPLP applicants interviewed independently from 2009-2016 by two faculty members at both main and regional medical campuses. Path analysis was used to calculate direct, indirect, and total effects of applicants’ socio-demographic and academic characteristics on interviewers’ composite ratings. This study protocol (#17-0198-X3B) was approved as exempt by the governing Institutional Review Board; the authors report no conflicts of interest. Results: The combined influence of being an in-state resident with rural Appalachian origins, combined with undergraduate GPA, explained 40.7% of the variance in applicants’ predicted likelihood of practicing in rural Kentucky. In terms of applicant acceptability, the strongest direct effects were exerted by academic factors, GPA and total MCAT score, and the sole preceding endogenous variable: likelihood of rural in-state practice. However, two other background factors were modestly but significantly directly associated with overall acceptability: (1) age; and (2) residence. Specifying likelihood of rural practice as an intervening variable explained 42.5% of the variance in applicant acceptability and provided a good fit to the sample data (X2 = 3.19, df = 4 , p = .526, CFI = 1.000, RLI = 1.018, RMSEA = .000). Conclusions: Interviewers appear to be assessing programmatic, mission-specific “fit” within the broader context of applicants’ abilities to navigate a demanding professional training curriculum. Future research should examine graduates’ eventual practice locations and intermediate academic performance as empirical validity of faculty interviewers’ assessments. Similarly, pre-professional pipeline efforts should better coordinate with training programs to provide consistent opportunities to nurture interest in mission-specific outcomes.

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Influence of distributed medical education on pre-clerkship elective use and utility

Journal of Regional Medical Campuses ◽

10.24926/jrmc.v4i1.3447 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Joshua Yu ◽

Andrew P. Costa ◽

Aaron Jones

Keyword(s):

Conflicts Of Interest ◽

Study Data ◽

Sensitivity Analyses ◽

Preparation Methods ◽

Regional Campuses ◽

Significant Difference ◽

Regional Medical ◽

Regional Campus ◽

Ease Of Access ◽

Mcmaster University

Purpose To explore differences in pre-clerkship elective (PCE) use and utility between main and regional campuses at McMaster University’s Michael G. DeGroote School of Medicine, in four main areas: ease of access to PCEs, volume and breadth of PCEs, helpfulness in choosing future specialties, and utility for clerkship preparation. Methods An anonymous and voluntary survey was distributed in early 2020 to McMaster University Michael G. DeGroote School of Medicine’s medical students across all three years of study. Data were analyzed for any significant differences between main and regional campuses, and post-hoc sensitivity analyses were used to account for non-response and self-selection bias. Results Regional campus students felt significantly less frustration around PCE availability (2.88 vs 4.16, p<0.001, scale 1(least) – 5(most)) and significantly greater ease of PCE scheduling than students at the main campus (3.50 vs 2.24, p<0.001, scale 1(least) – 5(most)). Regional campus students explored significantly fewer specialties (5.19 vs 6.19, p = 0.049) and there was no significant difference in the total number of PCE hours undertaken, nor hours spent with a single specialty. Overall, students in both campuses endorsed pressure to take PCEs and mixed benefits of PCEs for clerkship preparation. Students also found PCEs to be an important part of choosing a specialty independent of campus. Conclusion Regional medical campuses at McMaster University offer generally equal opportunities for PCE volume and breadth as main campuses, but with significantly lower barriers and frustrations around scheduling and availabilities. Conflicts of interest There are no conflicts of interest to report.

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The impact of patient narratives on medical students’ perceptions of shared decision making: A randomized controlled trial

10.31234/osf.io/f84cq ◽

2020 ◽

Author(s):

Martina Bientzle ◽

Marie Eggeling ◽

Simone Korger ◽

Joachim Kimmerle

Keyword(s):

Decision Making ◽

Medical Students ◽

Shared Decision Making ◽

Medical Training ◽

Controlled Trial ◽

Future Research ◽

Shared Decision ◽

Randomized Controlled ◽

Information Text ◽

The Impact

BACKGROUND: Successful shared decision making (SDM) in clinical practice requires that future clinicians learn to appreciate the value of patient participation as early as in their medical training. Narratives, such as patient testimonials, have been successfully used to support patients’ decision-making process. Previous research suggests that narratives may also be used for increasing clinicians’ empathy and responsiveness in medical consultations. However, so far, no studies have investigated the benefits of narratives for conveying the relevance of SDM to medical students.METHODS: In this randomized controlled experiment, N = 167 medical students were put into a scenario where they prepared for medical consultation with a patient having Parkinson disease. After receiving general information, participants read either a narrative patient testimonial or a fact-based information text. We measured their perceptions of SDM, their control preferences (i.e., their priorities as to who should make the decision), and the time they intended to spend for the consultation.RESULTS: Participants in the narrative patient testimonial condition referred more strongly to the patient as the one who should make decisions than participants who read the information text. Participants who read the patient narrative also considered SDM in situations with more than one treatment option to be more important than participants in the information text condition. There were no group differences regarding their control preferences. Participants who read the patient testimonial indicated that they would schedule more time for the consultation.CONCLUSIONS: These findings show that narratives can potentially be useful for imparting the relevance of SDM and patient-centered values to medical students. We discuss possible causes of this effect and implications for training and future research.

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An Examination of Individualism within Employee Help-Seeking Networks

International Journal of Human Resource Studies ◽

10.5296/ijhrs.v8i4.13490 ◽

2018 ◽

Vol 8 (4) ◽

pp. 1

Author(s):

Randall P. Settoon ◽

Sang H. Lee

Keyword(s):

Help Seeking ◽

Medical Center ◽

Future Research ◽

Dense Networks ◽

Helping Others ◽

Regional Medical ◽

Regional Medical Center ◽

The Impact ◽

The Relationship

Prior research focusing on the impact of individualistic orientations on the performance of cooperative behaviors has produced mixed results. Researchers have concluded that the self-focused orientation of individualists will lead them to be less cooperative than others. On the other hand, some scholars have argued that helping others is core to individualists’ self-concept and that competently assuming the role of help-giver is a source of intrinsic satisfaction. In this study, we test this proposition by examining individualistic orientations within employee help-seeking networks. Results from a sample of 107 employees within a regional medical center indicate that the level of individualism in helping-seeking networks is positively associated with help-seekers’ perceptions of support. Further, the results suggest that the relationship is stronger in dense networks. Implications of this work and directions for future research are discussed.

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Exploring the global impact of the COVID-19 pandemic on medical education: an international cross-sectional study of medical learners

Canadian Medical Education Journal ◽

10.36834/cmej.71149 ◽

2021 ◽

Author(s):

Allison Brown ◽

Aliya Kassam ◽

Mike Paget ◽

Kenneth Blades ◽

Megan Mercia ◽

...

Keyword(s):

Medical Education ◽

Medical Training ◽

Well Being ◽

World Health ◽

Future Research ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The World ◽

Geographic Regions ◽

The Impact

Background: The evidence surrounding the impact of COVID-19 on medical learners remains anecdotal and highly speculative despite the anticipated impact and potential consequences of the current pandemic on medical training. The purpose of this study was to explore the extent that COVID-19 initially impacted medical learners around the world and examine global trends and patterns across geographic regions and levels of training. Methods: A cross-sectional survey of medical learners was conducted between March 25–June 14, 2020, shortly after the World Health Organization declared COVID-19 a pandemic. Results: 6492 learners completed the survey from 140 countries. Most medical schools removed learners from the clinical environment and adopted online learning, but students reported concerns about the quality of their learning, training progression, and milestone fulfillment. Residents reported they could be better utilized and expressed concerns about their career timeline. Trainees generally felt under-utilized and wanted to be engaged clinically in meaningful ways; however, some felt that contributing to healthcare during a pandemic was beyond the scope of a learner. Significant differences were detected between levels of training and geographic regions for satisfaction with organizational responses as well as the impact of COVID-19 learner wellness and state-trait anxiety. Conclusions: The disruption to the status quo of medical education is perceived by learners across all levels and geographic regions to have negatively affected their training and well-being, particularly amongst postgraduate trainees. These results provide initial empirical insights into the areas that warrant future research as well as consideration for current and future policy planning.

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Targeted Next Generation Sequencing Reveals a Third Breakpoint Cluster Region and New Partner Genes in the KMT2A Recombinome

Blood ◽

10.1182/blood-2021-146172 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 3327-3327

Author(s):

Claus Meyer ◽

Patrizia Larghero ◽

Bruno Lopes ◽

Aurélie Caye-Eude ◽

Hélène Cavé ◽

...

Keyword(s):

Transcription Factors ◽

Multiplex Pcr ◽

Conflicts Of Interest ◽

Future Research ◽

Striking Difference ◽

Elongation Complex ◽

Long Distance ◽

Acute Leukemias ◽

Breakpoint Cluster Region ◽

Cluster Region

Abstract Chromosomal rearrangements of the KMT2A gene are associated with acute leukemias and myelodysplastic syndromes. The large number of known KMT2A fusions (>100) renders a precise diagnosis a demanding task. More than 50% of all KMT2A partner genes have been analyzed at the DCAL, including the novel partner genes BCAS4, FAM13A, RANBP3, and STK4. Even though all KMT2A rearrangements are associated with high-risk acute leukemia, the outcome (poor or very poor) is influenced by the partner gene. So far, we have analyzed more than 3,200 patients positive for a KMT2A rearrangement. The breakpoints of these cases are located mainly in the major breakpoint cluster region (bcr1) and to a small extent in the recently described minor bcr (bcr2). A small number of breakpoints were also found outside of these two bcrs. Most of these patients were analyzed by long distance inverse (LDI)- or multiplex-PCR which only cover bcr1. More recently, we used targeted KMT2A-NGS with whole gene coverage in over 450 patients, which was initially applied selectively in patients negative by LDI- and multiplex-PCR and then used more widely. Within the KMT2A-NGS group, 410 patients had bcr1 breakpoints mainly between the KMT2A exons 7 and 13, while 46 patients bcr2 breakpoints mainly between exons 20 and 24. Of note, five patients had their breakpoint outside of these two bcrs: three of them within intron 2 and no functional KMT2A rearrangement; the other two within intron 35 and intron 36, fusing almost the whole KMT2A gene in frame to the respective partner genes ARHGEF12 and MLLT4. These two breakpoints may define a third and rare bcr (bcr3), although further cases are needed to support this hypothesis. Interestingly, 70 patients displayed a 3'-KMT2A deletion, indicating that the number of terminal deletions is higher than described previously. Two patients had a 5'-KMT2A deletion. All deletions started or ended in bcr1 and bcr2. We also observed a striking difference in the distribution of partner genes between bcr1 and bcr2. The most frequent translocation partners fused to bcr1 sites are transcription factors, while the partner genes linked to bcr2 sites generally code for cytosolic proteins. In bcr1, the 4 most frequent partner genes AFF1, MLLT3, MLLT1, and MLLT10, found in 80% of cases, all code for transcription factors that are part of the super elongation complex (SEC). These fusions therefore all lead to disruption of the hematopoietic lineage commitment. In contrast in bcr2, 3 partner genes USP2, MLLT4, and USP8 account for 85% of the cases. USP2 and USP8 are ubiquitin specific peptidases involved in cell signaling and exclusively fused to bcr2 in KMT2A. While MLLT4 is found as a partner in bcr1, bcr2 and bcr3 fusions; unlike other recurrent KMT2A partners linked to bcr1, it is not a transcription factor and it exerts oncogenic potential via dimerization like other cytosolic partners. We hypothesize that the oncogenic properties of USP2 and USP8 are dependent on dimerization like MLLT4 and that the most frequent fusions involving at different bcrs favor different oncogenic mechanisms: bcr1 transactivation and bcr2 dimerization. Further studies are needed to explain why USP2 and USP8 are exclusively associated with bcr2, and why the most frequent partner genes AFF1 and MLLT3 of the bcr1 are less frequent in bcr2. In conclusion, targeted NGS combined with bioinformatic analysis has expanded our knowledge of the KMT2A recombinome to include more fusion partners and has generated new hypotheses for future research on oncogenic mechanisms. Disclosures No relevant conflicts of interest to declare.

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Medical Specialties With Highest Percentages Of Complaints In The State Of Acre, Brazil

International Archives of Medicine ◽

10.3823/2510 ◽

2017 ◽

Vol 10 ◽

Author(s):

Dilza Teresinha Ambros Ribeiro ◽

José Hiran Gallo ◽

Guilhermina Rego

Keyword(s):

General Practice ◽

Medical Errors ◽

Professional Training ◽

Health Department ◽

The State ◽

Medical Council ◽

State Health ◽

Medical Specialties ◽

Deductive Method ◽

Regional Medical

Background: The present study had the objective of surveying the medical specialties most commonly involved in complaints reported to the Regional Medical Council (CRM) of the state of Acre, between the years 1993 and 2009. Method: Data were gathered from the CRM by means of a questionnaire. This yielded 121 complaints. A deductive method was applied, with quantitative analysis. The results indicated that the specialties most susceptible to “medical errors” were general practice and gynecology. Findings: The results indicated that the specialties most susceptible to “medical errors” were general practice and gynecology. Conclusion: It is hoped that these data will be useful to the State Health Department for justifying greater investments in these fields of scientific knowledge and for better professional training. Keywords: Acre; complaints; specialties; ethics.

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Middle East Respiratory Syndrome (MERS) Infection in Hematological and Oncological Patients: A Case Series from a Tertiary Care Center in Saudi Arabia

Blood ◽

10.1182/blood-2019-123253 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5871-5871 ◽

Cited By ~ 1

Author(s):

Ahmed Alaskar ◽

Mohammed Bosaeed ◽

Hina Rehan ◽

May Anne Mendoza ◽

Bader Alahmari ◽

...

Keyword(s):

Saudi Arabia ◽

Middle East ◽

Clinical Presentation ◽

Conflicts Of Interest ◽

Tertiary Care ◽

Case Series ◽

Case Fatality ◽

Middle East Respiratory Syndrome ◽

Future Research ◽

Fatality Rate

We present the largest to date of a case series of nine patients with hematological and oncological malignancies who were infected with Middle East Respiratory Syndrome Coronavirus (MERS-CoV). MERS-CoV is a novel beta-coronavirus with a high fatality rate in comorbid patients. The majority of MERS cases globally were reported from Saudi Arabia (1983 cases, including 745 related deaths with a case-fatality rate of 37.5%) according to the WHO update of February 2019. All were clinically stable before acquiring the virus. Most of the cases had an active disease as relapse or refractory with three cases being neutropenic. The clinical presentation and radiological features of the patients were variable and inconsistent (Table 1). Diagnosis was confirmed with RT-PCR assays targeting upstream of the E gene and the open-reading frame gene 1a which had to be done repeatedly and required an average of 3 (with max. of 7) samples for a test to be positive (Table 2). All the patients developed respiratory failure, were admitted to the critical care unit (ICU) and required mechanical ventilation. The length of hospital stay ranged from 15 - 48, with an average of 24 days. Unfortunately, all nine patients died within days after admission to the ICU. In addition, the time from diagnosis to death has an average of 9 days ranging from 2-24 days, respectively. In conclusion, MERS CoV infection in hematology/oncology patients has a very poor prognosis regardless of the status of the underlying disease. The clinical presentation is not distinctive and confirming the diagnosis requires numerous respiratory samples. Measures to prevent nosocomial outbreaks should include proper compliance with personal protection equipment by health-care workers when managing patients with suspected and confirmed MERS-CoV infection and prompt isolation of infected patients. Future research is required to enhance our understanding of the disease and to evaluate superior diagnostic and therapeutic options. Disclosures No relevant conflicts of interest to declare.

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Credit Rating Agencies in Capital Markets: A Review of Research Evidence on Selected Criticisms of the Agencies

Journal of Accounting Auditing & Finance ◽

10.1177/0148558x0702200306 ◽

2007 ◽

Vol 22 (3) ◽

pp. 469-492 ◽

Cited By ~ 82

Author(s):

Carol Ann Frost

Keyword(s):

Credit Rating ◽

Conflicts Of Interest ◽

Securities And Exchange Commission ◽

Future Research ◽

Minor Role ◽

Credit Rating Agencies ◽

Regulatory Oversight ◽

Rating Agencies ◽

Accounting Scandals ◽

A Minor

This study assesses the validity of widespread criticisms of the large, “nationally recognized” credit rating agencies (CRAs). The accounting scandals of 2000-02, in particular the highly publicized failure of Enron in December 2001, led many to question their competence and the value of their ratings. This paper evaluates important criticisms of the CRAs discussed in a recent Securities and Exchange Commission (SEC) staff report by using evidence from empirical research studies, and suggests many promising subjects for future research. The analysis given in this paper, and the results of the suggested research (when available), should be of particular interest to lawmakers and regulators who are responsible for determining whether and to what extent the credit rating industry should be subject to statutory and regulatory oversight. Although little rigorously gathered empirical evidence supports the criticisms, many issues remain unresolved. Powerful tests related to potential conflicts of interest and alleged unfair practices are exceptionally difficult to design, and the alleged deficiencies of rating agencies' disclosure practices have yet to be analyzed. Finally, many criticisms are based on subjective benchmarks that are difficult to quantify and open to question. To date, however, accounting researchers have played only a minor role in the debate. Because they are well-versed in such areas as disclosure analysis, capital market tests, and the operation of financial intermediaries and external auditors, these researchers potentially have much to add in this regard.

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Health Tourism in Iran

Medical Tourism ◽

10.4018/978-1-5225-3920-9.ch019 ◽

2017 ◽

pp. 352-374

Author(s):

A. Ayoubian

Keyword(s):

Health Services ◽

Medical Tourism ◽

Medical Training ◽

Medical Center ◽

Geographical Location ◽

Health Tourism ◽

Operational Conditions ◽

Medical Centers ◽

Regional Medical ◽

Quality Health

This chapter shows that Iran has similar advantages to countries with a more developed brand of health tourism, including low costs, quality health services, competent doctors, and abundant natural and cultural attractions. The Health and Medical Ministry has developed 6 mandatory guidelines for medical centers receiving health tourists: these include the general condition of the facility, the workforce, medical facilities, geographical location, operational conditions, and the content of medical center websites. The Ministry offers facilities to hospitals and organizations applying to join the medical tourism program. In particular, the progressive provision of medical procedures, the distribution and marketing of health services, medical training, medical products, and equipment, is within a standardized framework of guidelines and development priorities. The chapter concludes that these interventions are designed to establish an effective presence in world and regional medical tourism markets.

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Increasing Rural Recruitment and Retention through Rural Exposure during Undergraduate Training: An Integrative Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176423 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6423

Author(s):

Jens Holst

Keyword(s):

Urban Areas ◽

Medical Training ◽

Rural Practice ◽

Integrative Review ◽

High Quality Research ◽

Cross Sectional ◽

Recruitment And Retention ◽

Hand Search ◽

Access To Medical Care ◽

Practice Methods

Objectives: Ensuring nationwide access to medical care challenges health systems worldwide. Rural exposure during undergraduate medical training is promising as a means for overcoming the shortage of physicians outside urban areas, but the effectiveness is widely unknown. This integrative review assesses the effects of rural placements during undergraduate medical training on graduates’ likelihood to take up rural practice. Methods: The paper presents the results of a longitudinal review of the literature published in PubMed, Embase, Google Scholar and elsewhere on the measurable effects of rural placements and internships during medical training on the number of graduates in rural practice. Results: The combined database and hand search identified 38 suitable primary studies with rather heterogeneous interventions, endpoints and results, mostly cross-sectional and control studies. The analysis of the existing evidence exhibited predominantly positive but rather weak correlations between rural placements during undergraduate medical training and later rural practice. Beyond the initial scope, the review underpinned rural upbringing to be the strongest predictor for rural practice. Conclusions: This review confirms that rural exposure during undergraduate medical training to contributes to recruitment and retention in nonurban settings. It can play a role within a broader strategy for overcoming the shortage of rural practitioners. Rural placements during medical education turned out to be particularly effective for rural-entry students. Given the increasing funding being directed towards medical schools to produce graduates that will work rurally, more robust high-quality research is needed.

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