Enhancing Competency in Professionalism: Targeting Resident Advance Directive Education

Abstract Background Education about advance directives typically is incorporated into medical school curricula and is not commonly offered in residency. Residents' experiences with advance directives are generally random, nonstandardized, and difficult to assess. In 2008, an advance directive curriculum was developed by the Scott & White/Texas A&M University System Health Science Center College of Medicine (S&W/Texas A&M) internal medicine residency program and the hospital's legal department. A pilot study examining residents' attitudes and experiences regarding advance directives was carried out at 2 medical schools. Methods In 2009, 59 internal medicine and family medicine residents (postgraduate year 2–3 [PGY-2, 3]) completed questionnaires at S&W/Texas A&M (n = 32) and The University of Texas Medical School at Houston (n = 27) during a validation study of knowledge about advance directives. The questionnaire contained Likert-response items assessing attitudes and practices surrounding advance directives. Our analysis included descriptive statistics and analysis of variance (ANOVA) to compare responses across categories. Results While 53% of residents agreed/strongly agreed they had “sufficient knowledge of advance directives, given my years of training,” 47% disagreed/strongly disagreed with that statement. Most (93%) agreed/strongly agreed that “didactic sessions on advance directives should be offered by my hospital, residency program, or medical school.” A test of responses across residency years with ANOVA showed a significant difference between ratings by PGY-2 and PGY-3 residents on 3 items: “Advance directives should only be discussed with patients over 60,” “I have sufficient knowledge of advance directives, given my years of training,” and “I believe my experience with advance directives is adequate for the situations I routinely encounter.” Conclusion Our study highlighted the continuing need for advance directive resident curricula. Medical school curricula alone do not appear to be sufficient for residents' needs in this area.

Download Full-text

PATH-19. MOLECULAR, HISTOLOGIC AND CLINICAL CHARACTERISTICS OF OLIGODENDROGLIOMAS: A MULTI-INSTITUTIONAL RETROSPECTIVE STUDY

Neuro-Oncology ◽

10.1093/neuonc/noaa215.701 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii168-ii168

Author(s):

Antonio Dono ◽

Kristin Alfaro-Munoz ◽

Yuanqing Yan ◽

Carlos Lopez-Garcia ◽

Zaid Soomro ◽

...

Keyword(s):

Health Science ◽

Cancer Center ◽

Subtotal Resection ◽

Adjuvant Radiation ◽

Science Center ◽

Who Grade ◽

Pik3ca Mutations ◽

Increased Risk ◽

Significant Difference ◽

Grade 3

Abstract In the 2016 WHO classification of CNS tumors, oligodendrogliomas are molecularly defined by IDH1 or IDH2 mutations and 1p/19q co-deletion. Some reports suggest that PI3K pathway alterations may confer increased risk of progression and poor prognosis in oligodendroglioma. However, factors that influence prognosis in molecularly defined oligodendroglioma (mOGD) have not been thoroughly studied. Also, the benefits of adjuvant radiation and temozolomide in mOGDs remain to be determined. 107 mOGDs diagnosed between 2008-2018 at the University of Texas Health Science Center at Houston (n= 39) and MD Anderson Cancer Center (n= 68) were included. A retrospective review of the demographic, clinical, histologic, molecular, and outcomes were performed. Median age at diagnosis was 37 years and 61 (57%) patients were male. There were 64 (60%) WHO Grade 2 and 43 (40%) WHO Grade 3 tumors. Ninety-five (88.8%) tumors were IDH1-mutant and 12 (11.2%) were IDH2-mutant. Eighty-two (77%) patients were stratified as high-risk: older than 40-years and/or subtotal resection (RTOG 9802). Gross-total resection was achieved in 47 (45%) patients. Treatment strategies included observation (n= 15), temozolomide (n= 11), radiation (n= 13), radiation with temozolomide (n= 62) and other (n= 6). Our results show a benefit of temozolomide vs. observation in progression-free survival (PFS). However, no benefit in PFS or overall survival (OS) was observed when comparing radiation vs. radiation with temozolomide. PIK3CA mutations were detected in 15 (14%) cases, and patients with PIK3CA-mutant mOGDs showed worse OS (10.7-years vs 15.1-years, p= 0.009). Patients with WHO Grade 3 tumors had shorter PFS but no significant difference in OS was observed compared to grade 2. Our findings suggest that mOGDs harboring PIK3CA mutations have worse OS. Except for an advantage in PFS in temozolomide treated patients, adjuvant treatment with radiation or the combination of both, showed no significant advantage in terms of OS.

Download Full-text

Fabricio B. Teixeira, DDS, MSC, PHD, Associate Professor and Director, Residency Program in Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA

Endodontic Topics ◽

10.1111/etp.12040_4 ◽

2013 ◽

Vol 28 (1) ◽

pp. 138-138

Author(s):

Fabricio B. Teixeira

Keyword(s):

Residency Program ◽

San Antonio ◽

Associate Professor ◽

Health Science ◽

Science Center ◽

University Of Texas ◽

Texas Health ◽

Health Science Center

Download Full-text

Perceptions of Internal Medicine Residency Program Candidates on the Use of Simulation in the Selection Process

Journal of Graduate Medical Education ◽

10.4300/jgme-d-13-00276.1 ◽

2014 ◽

Vol 6 (2) ◽

pp. 338-340 ◽

Cited By ~ 1

Author(s):

Keith Cannon ◽

Zachary Hartsell ◽

Ilko Ivanov ◽

Joseph Charles ◽

Harshad Joshi ◽

...

Keyword(s):

Internal Medicine ◽

Medical School ◽

Residency Program ◽

Situational Awareness ◽

Clinical Skills ◽

Selection Process ◽

Internal Medicine Residency ◽

Medical Simulation ◽

Internal Medicine Residency Program ◽

Interview Process

Abstract Background The recruitment of skilled candidates into internal medicine residency programs has relied on traditional interviewing techniques with varying degrees of success. The development of simulated medical technology has provided a new arena in which to assess candidates' clinical skills, knowledge base, situational awareness, and problem-solving dexterities within a standardized environment for educational and assessment purposes. Objective The purpose of this study was to investigate the interest of program candidates in incorporating simulation medicine into the internal medicine residency interview process. Methods As a prospective, survey-based analysis, potential candidates who completed an interview between October 2012 and January 2013 with an accredited internal medicine residency program were sent a postmatch survey that incorporated 3 additional questions relating to their prior experience with medical simulation and their views on incorporating the technology into the interview format. Results Of the 88 candidates who completed an interview, 92% (n = 81) were scheduled to graduate medical school in 2013 and were graduates of a US medical school. All survey responders described previous experience with medical simulation. Fifty-eight percent (n = 51) of responders described being “less likely” to interview with or join a residency program if they were required to participate in a 10-minute medical simulation during the interview process. Conclusions The results of this study suggest that despite the increasing role of technology in medical education, its role in high-stakes evaluations (such as residency interviews) requires further maturation before general acceptance by residency candidates can be expected.

Download Full-text

The Post-Baccalaureate Premedical Certification Program at the University of North Texas Health Science Center Strengthens Admission Qualifications for Entrance into Medical School

Academic Medicine ◽

10.1097/acm.0b013e31815c641c ◽

2008 ◽

Vol 83 (1) ◽

pp. 45-51 ◽

Cited By ~ 10

Author(s):

Rustin E. Reeves ◽

Jamboor K. Vishwanatha ◽

Thomas Yorio ◽

Michael Budd ◽

Harold J. Sheedlo

Keyword(s):

Medical School ◽

Health Science ◽

Certification Program ◽

Science Center ◽

North Texas ◽

University Of North Texas ◽

Texas Health ◽

Health Science Center ◽

The University ◽

Post Baccalaureate

Download Full-text

Systematic review of medical student willingness to volunteer and preparedness for pandemics and disasters

Emergency Medicine Journal ◽

10.1136/emermed-2020-211052 ◽

2021 ◽

pp. emermed-2020-211052

Author(s):

Matthew Henry Vincent Byrne ◽

James Ashcroft ◽

Laith Alexander ◽

Jonathan C M Wan ◽

Anna Harvey

Keyword(s):

Systematic Review ◽

Medical Students ◽

Medical School ◽

Medical Schools ◽

School Curriculum ◽

Inclusion Criteria ◽

Weighted Mean ◽

Significant Difference ◽

And Training ◽

School Curricula

ObjectiveThis systematic review aimed to estimate the willingness of students to volunteer during a disaster, and how well-prepared medical students are for volunteering by assessing their knowledge and medical school curriculum of disaster and pandemic medicine.ResultsA total of 37 studies met inclusion criteria including 11 168 medical students and 91 medical schools. 24 studies evaluated knowledge (64.9%), 16 evaluated volunteering (43.2%) and 5 evaluated medical school curricula (13.5%). Weighted mean willingness to volunteer during a disaster was 68.4% (SD=21.7%, range=26.7%–87.8%, n=2911), and there was a significant difference between those planning to volunteer and those who actually volunteered (p<0.0001). We identified a number of modifiable barriers which may contribute to this heterogeneity. Overall, knowledge of disasters was poor with a weighted mean of 48.9% (SD=15.1%, range=37.1%–87.0%, n=2985). 36.8% of 76 medical schools curricula included teaching on disasters. However, students only received minimal teaching (2–6 hours).ConclusionsThis study demonstrates that there is a large number of students who are willing to volunteer during pandemics. However, they are unlikely to be prepared for these roles as overall knowledge is poor, and this is likely due to minimal teaching on disasters at medical school. During the current COVID-19 pandemic and in future disasters, medical students may be required to volunteer as auxiliary staff. There is a need to develop infrastructure to facilitate this process as well as providing education and training to ensure students are adequately prepared to perform these roles safely.

Download Full-text

986 A Systematic Review of Medical Student Willingness to Volunteer and Preparedness for Pandemics and Disasters

British Journal of Surgery ◽

10.1093/bjs/znab134.185 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Byrne ◽

J Ashcroft ◽

L Alexander ◽

J Wan ◽

A Harvey

Keyword(s):

Systematic Review ◽

Medical Students ◽

Medical School ◽

Medical Schools ◽

School Curriculum ◽

Inclusion Criteria ◽

Weighted Mean ◽

Significant Difference ◽

And Training ◽

School Curricula

Abstract Introduction We aimed to identify motivators and barriers to volunteering during a disaster and knowledge and medical school curriculum of disaster and pandemic medicine. Method We systematically searched the literature on 28/6/2020, following PRISMA guidelines. Results A total of 37 studies met inclusion criteria including 11,168 medical students and 91 medical schools. 24 studies evaluated knowledge (64.9%), 16 evaluated volunteering (43.2%), and five evaluated medical school curricula (13.5%). Weighted mean willingness to volunteer during a disaster was 68.4% (SD = 21.7%, n = 2911), and there was a significant difference between those planning to volunteer and those who actually volunteered (P<.001). We identified a number of modifiable barriers which may contribute to this difference. Overall, knowledge of disasters was poor with a weighted mean of 48.9% (SD = 15.1%, n = 2985). Conclusions There is a large number of students who are willing to volunteer during pandemics. However, they are likely to be under-prepared for these roles due to poor overall knowledge and limited teaching. During the current COVID-19 pandemic and in future disasters, medical students may be required to volunteer as auxiliary staff. Medical schools need to develop infrastructure to facilitate this process as well as providing education and training to ensure students are adequately prepared for these roles.

Download Full-text

Billingham, Prof. Rupert Everett, (15 Oct. 1921–16 Nov. 2002), Professor and Chairman, Department of Cell Biology and Anatomy, Southwestern Medical School, University of Texas Health Science Center at Dallas, 1971–86, Professor Emeritus, 1990

10.1093/ww/9780199540884.013.u7528 ◽

2007 ◽

Keyword(s):

Medical School ◽

Cell Biology ◽

Health Science ◽

Professor Emeritus ◽

Science Center ◽

University Of Texas ◽

Texas Health ◽

Health Science Center

Download Full-text

Questions Remain about Whether EBM Competencies Learned in Medical School are Retained in Residency

Evidence Based Library and Information Practice ◽

10.18438/b8gk5v ◽

2007 ◽

Vol 2 (3) ◽

pp. 111

Author(s):

Suzanne Lewis

Keyword(s):

Internal Medicine ◽

Medical School ◽

Residency Program ◽

Program Directors ◽

Convenience Sample ◽

Medicine Clerkship ◽

The Third ◽

Journal Clubs ◽

Residency Program Directors ◽

The Impact

Objective – To assess medical graduates’ use of evidence based medicine (EBM) in residency, self-perception of EBM skills, attitudes toward EBM, and the impact of a formal EBM curriculum in their third undergraduate year. Design – A longitudinal follow-up study by self-administered questionnaire. Setting – Internal medicine residency programs in US hospitals. Subjects – A convenience sample of 2001 and 2002 graduates of the University of Illinois College of Medicine at Peoria (UICOM-P) (n=78), and their respective residency program directors (n=72). Methods – A student graduate questionnaire (SGQ) was sent to all members of UICOM-P’s 2001 and 2002 graduating classes who had completed the EBM course during their M-3 Internal Medicine clerkship. A program director questionnaire (PDQ), similar to the SGQ, was sent to the graduates’ residency program directors. The research instrument was tested with a pilot group prior to use, but not validated. The questionnaires consisted of 4 main sections. The first section examined formal and informal EBM programs in the graduates’ residency curriculum. The second section consisted of a self-assessment of EBM skills by the residents and an assessment of those skills by their program directors. The third section asked graduates to compare their EBM skills to those of their fellow residents who had not been students at UICOM-P. Similarly, in the third section of the PDQ, program directors were asked to compare the EBM skills of UICOM-P graduates and non-UICOM-P graduates participating in the residency program. The last section concerned professional and demographic characteristics. Copies of the surveys were mailed out to non-responders after 6 weeks. Results were collated but statistical analysis was not applied. Main results – The response rate was 32% for residents and 35% for program directors. The number of incomplete surveys was not reported. Forty-four percent of all respondents reported having a formal EBM curriculum for residents, and 76% reported an informal curriculum. For both formal and informal programs, the most common teaching formats were journal clubs, followed by lectures, teaching rounds, morning reports, bedside consultations, ambulatory clinics and seminars. In section two of the questionnaires, both residents and program directors rated the residents’ EBM skills similarly. However, the residents rated their skills in searching the literature and application of findings to clinical practice higher than the program directors. Program directors also rated the residents’ skills in understanding statistics and tests higher than the residents themselves. Twenty-four percent of both residents and program directors rated the UICOM-P graduates as “very competent” or “extremely competent” in EBM skills (50). Only 35% of program directors and 27% of residents rated the UICOM-P graduates’ EBM skills as “usually better” or “always better” than their peers who were not UICOM-P graduates (50). Conclusion - The authors of this study conclude that, for UICOM-P graduates, “it might be implied from these results that the EBM skills gained during medical school were retained through their medical school graduation and into their residency training” (51). However, this study has methodological weaknesses which make it difficult to draw any definite conclusions from the results.

Download Full-text