Rachel Levine - Academia.edu (original) (raw)

Papers by Rachel Levine

The American Journal of Medicine, Jun 1, 2006

A New York Times Magazine article from 2003 speculated about a growing trend among American worki... more A New York Times Magazine article from 2003 speculated about a growing trend among American working women. The "opt-out revolution" suggests that many career women do not make it to the "top" not because they can't, but because they choose not to. The article claims that these highly educated and accomplished women are choosing playgroups in place of the boardroom, consciously opting to devote their time and energies to raising a family in lieu of pursuing a career. Although the main premise of the opt-out revolution is vastly oversimplified, it is clear that many women experience the tension inherent in having a family and career and, when provided with feasible options, may choose to shift between full-time, part-time, and unpaid work over the course of their lives. Current trends suggest that although more women are entering medical school than ever, academic medicine as a career is unappealing for women physicians. 3,4 Is academic medicine headed for its own "optout revolution?" This article highlights the reasons why women physicians may opt out of careers in academic medicine and describes one way that academic medical centers may prevent this by promoting part-time work options. Readers also may appreciate that as the number of dual physician couples increases and generational differences that emphasize greater work-family balance become more apparent, workplace flexibility and part-time work will become important issues for physicians of both sexes. 5-7

The American journal of medicine, Jan 8, 2016

Education For Primary Care an Official Publication of the Association of Course Organisers National Association of Gp Tutors World Organisation of Family Doctors, Feb 1, 2013

BACKGROUND: Effective patient-centred communication requires physicians to respond 'in the moment... more BACKGROUND: Effective patient-centred communication requires physicians to respond 'in the moment' to comments and questions. It is a valuable skill to be able to react to unexpected patient utterances with empathy and support, and these surprises may be most common in general practice where patients are encouraged to speak to their doctor about anything. We developed an elective for medical students to learn and practise improvisational skills that would optimise their communications with patients during medical encounters.METHODS: Nineteen second-year medical students during two consecutive years (n =38) participated in a four-session elective that introduced and allowed them to practise the principles and skills of improvisation, and reflect on the role of those skills in their communication with patients. Specific skills that were practised and emphasised included listening, affirmation, vocal tone modulation, nonverbal communication, agreement, collaboration, acceptance and validation. In addition to previously developed 'Improv' exercises, students created their own improvisation exercises targeted at specific communication skills.RESULTS: Twenty-seven (71%) of all participating students completed the post-curriculum assessment survey. Twenty-two (81%) rated their enjoyment as 'tremendous'. The desire to experience something new and different from the standard medical curriculum served as the motivation for many of the students (67%) to sign up for the course. Most students (23/27; 85%) thought that the concepts that were addressed were either 'very much' or 'tremendously' relevant to the care of patients.CONCLUSION: We have found that an improvisational workshop geared towards enhancing medical student communication skills has the potential to impart valuable skills that are essential to providing empathic, supportive patient-centred care. Communication skills training programmes have become a cornerstone in medical student and postgraduate medical education over the past 20 years. Both national accreditation and expert panel consensus guidelines have stressed the importance and framed the structure for best communication practices. Exemplary curricula for teaching medical trainees in core communication strategies to use with patients have been published; many emphasise patient-centred and/or relationshipcentred strategies. Simulated patient technologies with video review can allow learners to practise their skills through both self-assessment and feedback from others. However, despite these newer learning resources, frameworks and behavioural checklists, learners naïve to clinical patient encounters must still learn how to function and adapt within the interpersonal communicative space that is created by the learner and patient. At its core, this is an iterative, spontaneous process created by the dyad and yielding, from moment to moment, to unique and unanticipated outcomes. Thus, repetitive practice will improve confidence but may miss the mark in learning the essential skills of intuitive and improvised interpersonal responsiveness. One could argue that existing approaches in teaching medical learners communication skills may promote rigid and stereotyped responses. Haidet proposes that there are significant parallels between the patient-physician dialogue (when a physician attempts to learn details about a patient and their illness) and improvisational jazz. 11 He contends that effective clinicians who are committed to relationship-centred practice depart from overarching principles of biomedical inquiry when necessary to respond spontaneously and without script to the particular circumstances of each encounter. It is believed that successful doctor-patient relationships are founded upon trusting and open communication, as well as genuine respect that can be shown by a willingness to listen or respond to the issues raised by patients. 12 The nature of the comprehensive care in family medicine makes it likely that GPs will regularly be surprised by concerns raised by patients such that they must be adept at improvising. Because of the gap that currently exists in interview skills training programmes, we hypothesised that the field of improvisational theatre would effectively supplement the traditional curriculum. Improvisation relies on listening, confidence and responding instinctively and spontaneously. 13,14 In this paper, we describe our efforts to develop a brief curriculum for medical students providing training in the art of theatre improvisation, with the goal of enhancing students' confidence and performance in clinical encounters. We hoped that this innovative curricular experience would establish a venue where secondyear medical students could learn and practise improvisational skills that might prove helpful in their communications with patients during medical encounters.

Http Dx Doi Org 10 1207 S15328015tlm1704_3, Jun 15, 2010

The Accreditation Council for Graduate Medical Education requires that residents demonstrate scho... more The Accreditation Council for Graduate Medical Education requires that residents demonstrate scholarly activity prior to completion of training. To determine which factors are associated with program citation for failure to comply with the Residency Review Committee (RRC) scholarly activity requirement for internal medicine residencies. All 391 internal medicine residency program directors were surveyed in March 2002. Data were collected on program characteristics and factors (research curriculum, research director, faculty mentors, protected time for research, funding, and presence of a mandatory research requirement) that have been associated with successful resident research. Multiple logistic regression analysis identified factors associated with citation. The response rate was 78%. Ten percent of respondents report having been cited for lack of demonstration of scholarly activity. Factors that reduced the odds of citation were being a university-based program, odds ratio (OR) 0.13, 95% confidence interval (CI) 0.03-0.54, p = .005; having a greater number of residents, OR 0.95, 95% CI 0.93-0.98, p = .001; and having funding to support resident scholarship, OR 0.39, 95% CI 0.17-0.91, p = .03. Using multiple logistic regression analysis, having designated funding for resident scholarship was the only factor independently associated with a decreased odds of citation, OR 0.27, 95% CI 0.10-0.72, p = .009. To improve compliance with the RRC requirement for scholarly activity and avoid citation, residency programs may wish to consider devoting more resources, particularly money, to support resident scholarly activity.

Journal of General Internal Medicine, May 1, 2008

BACKGROUND: As more physicians work part-time (PT), the faculty, institutions, and organizations ... more BACKGROUND: As more physicians work part-time (PT), the faculty, institutions, and organizations that represent them should understand the factors that motivate and satisfy these physicians. OBJECTIVE: Compare factors associated with job satisfaction among PT and full-time (FT) academic physicians. DESIGN: Cross-sectional survey. PARTICIPANTS: Members of the Society of General Internal Medicine (SGIM), a national, academic Internal Medicine organization.

Journal of religion and health, Jan 17, 2015

Improved collaboration between physicians and chaplains has the potential to improve patient expe... more Improved collaboration between physicians and chaplains has the potential to improve patient experiences. To better understand the benefits and challenges of learning together, the authors conducted several focus groups with participants in an interprofessional curriculum that partnered internal medicine residents with chaplain interns in the clinical setting. The authors derived four major qualitative themes from the transcripts: (1) physician learners became aware of effective communication skills for addressing spirituality. (2) Chaplain interns enhanced the delivery of team-based patient-centered care. (3) Chaplains were seen as a source of emotional support to the medical team. (4) The partnership has three keys to success: adequate introductions for team members, clear expectations for participants, and opportunities for feedback. The themes presented indicate several benefits of pairing physicians and chaplains in the setting of direct patient care and suggest that this is an...

Education for primary care : an official publication of the Association of Course Organisers, National Association of GP Tutors, World Organisation of Family Doctors, 2013

Effective patient-centred communication requires physicians to respond 'in the moment' to... more Effective patient-centred communication requires physicians to respond 'in the moment' to comments and questions. It is a valuable skill to be able to react to unexpected patient utterances with empathy and support, and these surprises may be most common in general practice where patients are encouraged to speak to their doctor about anything. We developed an elective for medical students to learn and practise improvisational skills that would optimise their communications with patients during medical encounters. Nineteen second-year medical students during two consecutive years (n =38) participated in a four-session elective that introduced and allowed them to practise the principles and skills of improvisation, and reflect on the role of those skills in their communication with patients. Specific skills that were practised and emphasised included listening, affirmation, vocal tone modulation, nonverbal communication, agreement, collaboration, acceptance and validation. In ...

International Journal of Medical Education, 2011

The purpose of this study was to assess changes in students' perceptions of the medical school se... more The purpose of this study was to assess changes in students' perceptions of the medical school sense of community and their satisfaction with advising following the initiation of a structured advising program at the Johns Hopkins University School of Medicine. Methods: Participants included School of Medicine graduates from 2006 to 2009. Total sample size was 471. The response rate was 367/471 (81%). A cross-sectional survey design was utilized to assess students' perceived differences in advising and sense of community. Scales were developed to assess these constructs. Scale scores and responses to individual items were compared by graduation year. Results: Statistically significant increases over time were noted on the Advising Satisfaction (F (3,363) = 6.54; p≤0.001) and the Relational Community (F(3,363) = 2.76; p=0.042) scales. Using simple logistic regression, unadjusted Odds Ratios show that students graduating in 2009 report higher quality of advising during their clinical years (OR 2.87, 95% CI=1.56-5.28), around academics (OR 2.54, 95% CI=1.41-4.60), career planning (OR 1.87, 95% CI=1.03-3.38), stress management (OR 2.88, 95% CI=1.56-5.30), and an enhanced sense of community (OR 2.55, 95% CI=1.40-4.64), and social integration (OR 2.07, 95% CI=1.15-3.71) compared to 2006 graduates. Conclusions: We found, that students were more satisfied with advising and the medical school environment over the four years of maturation of the Program. A structured advising program that fosters meaningful, longitudinal relationships between students and advisors may enhance students' experiences during medical school.

Teaching and Learning in Medicine, 2005

The Accreditation Council for Graduate Medical Education requires that residents demonstrate scho... more The Accreditation Council for Graduate Medical Education requires that residents demonstrate scholarly activity prior to completion of training. To determine which factors are associated with program citation for failure to comply with the Residency Review Committee (RRC) scholarly activity requirement for internal medicine residencies. All 391 internal medicine residency program directors were surveyed in March 2002. Data were collected on program characteristics and factors (research curriculum, research director, faculty mentors, protected time for research, funding, and presence of a mandatory research requirement) that have been associated with successful resident research. Multiple logistic regression analysis identified factors associated with citation. The response rate was 78%. Ten percent of respondents report having been cited for lack of demonstration of scholarly activity. Factors that reduced the odds of citation were being a university-based program, odds ratio (OR) 0.13, 95% confidence interval (CI) 0.03-0.54, p = .005; having a greater number of residents, OR 0.95, 95% CI 0.93-0.98, p = .001; and having funding to support resident scholarship, OR 0.39, 95% CI 0.17-0.91, p = .03. Using multiple logistic regression analysis, having designated funding for resident scholarship was the only factor independently associated with a decreased odds of citation, OR 0.27, 95% CI 0.10-0.72, p = .009. To improve compliance with the RRC requirement for scholarly activity and avoid citation, residency programs may wish to consider devoting more resources, particularly money, to support resident scholarly activity.

Southern Medical Journal, 2006

We sought to determine the willingness of academic physicians to accept strategies to contain ins... more We sought to determine the willingness of academic physicians to accept strategies to contain institutional malpractice costs. We surveyed all 270 Department of Medicine physicians at a large academic center. Respondents were asked about their knowledge regarding malpractice premiums, willingness to reduce patient-care activities and accept decreases in compensation. The response rate was 80%. Respondents estimated the annual increase in malpractice premiums from 2004 to 2005 to be 29%. The true increase was 28% (P = 0.55). Almost all opposed eliminating patient care (95%) or providing patient care every other year at double effort and withdrawing from patient care on alternate years (97%). Seventy percent would limit their clinical procedures. Most physicians opposed salary reduction (97%) or decreases in fringe benefits (99%). Few academic physicians are willing to limit patient care or accept decreases in compensation to recoup institutional malpractice costs.

Journal of the American Geriatrics Society, 2014

Because safe transitions of care are critical to patient safety, it is important to prepare physi... more Because safe transitions of care are critical to patient safety, it is important to prepare physician trainees to assist in patient transitions from the hospital. As part of a discharge skills workshop for medical students, a brief reflective exercise was used to understand student perceptions of discharge problems and encourage application of classroom learning. Written reflections completed before and after the workshop were analyzed qualitatively to identify barriers to discharge observed on clinical clerkships and evaluate how the discharge skills workshop influenced student understanding of safe discharges. Students also completed a quantitative evaluation of the workshop. Seventy-eight of the 96 students (81%) at the Johns Hopkins University School of Medicine who participated in the discharge skills workshop volunteered to submit their written reflections. Eighteen themes were identified within two domains (barriers to safe discharges and solutions to improve discharges). The most commonly cited barrier was the sense that the discharge was rushed or premature. Three of the barrier themes and six of the solution themes were related to the importance of communication and collaboration in safe discharges. Students reported that the reflective exercise personalized the learning experience (mean 3.27 ± 0.86 on a scale of 1 (not at all) to 4 (a lot)). Students observed barriers to safe discharges on their clerkships related to poor communication, insufficient time spent planning discharges, and lack of patient education. Brief reflection encouraged students to apply lessons learned in a didactic session to consider solutions for providing safer patient care.

Journal of General Internal Medicine, 2008

BACKGROUND: As more physicians work part-time (PT), the faculty, institutions, and organizations ... more BACKGROUND: As more physicians work part-time (PT), the faculty, institutions, and organizations that represent them should understand the factors that motivate and satisfy these physicians. OBJECTIVE: Compare factors associated with job satisfaction among PT and full-time (FT) academic physicians. DESIGN: Cross-sectional survey. PARTICIPANTS: Members of the Society of General Internal Medicine (SGIM), a national, academic Internal Medicine organization.

Journal of General Internal Medicine, 2014

JAMA, 2005

The Institute of Medicine has called for increased rigor of education research and funding to sup... more The Institute of Medicine has called for increased rigor of education research and funding to support educational innovation. However, funding for medical education research is scarce. The costs of conducting studies in medical education and how such research is currently funded have not been systematically evaluated. To determine how medical education research studies that were recently published were funded and to approximate the costs of conducting these studies. We conducted a cross-sectional survey of first authors of medical education studies published from September 1, 2002, to December 31, 2003. Original medical education research studies conducted at US institutions and published in 13 prominent peer-reviewed journals were included. For each study we measured duration, percentage of the authors' total work commitment ("percentage effort") devoted to the study, resources used and their costs, attainment of funding, and the first author's estimated cost of conducting the study. The cost of each study was calculated by multiplying the percentage effort of each author for the duration of the study by the national median salary for each author, according to specialty and academic rank, and then adding the costs of resources used. Responses were received from authors of 243 (84%) of 290 identified medical education studies. The median calculated cost of conducting the 243 studies was 24,471 dollars (interquartile range [IQR], 11,531 dollars-63 808 dollars). The median authors' estimate of study cost was 10,000 dollars (IQR, 4000 dollars-25 000 dollars). Some funding was obtained for 72 (29.6%) of the studies. Of studies that were funded, the median amount of funding was 15,000 dollars (IQR, 5000 dollars-66,500 dollars). The median calculated cost of funded studies was 37,315 dollars (IQR, 18,731 dollars-82,393 dollars). Private foundation grants were the most common funding source (n = 30 [41.7%]). Factors independently associated with attaining funding were training in grant writing (odds ratio, 2.05; 95% confidence interval, 1.11-3.79) and number of medical education studies published by the first author (odds ratio, 2.4; 95% confidence interval, 1.24-4.63). The majority of published medical education research is not formally funded, and the studies that do receive support are substantially underfunded. To realize the Institute of Medicine's directive and to improve the quality of medical research, policy reform that increases funding for medical education scholarship will likely be required.

International Journal of Clinical Practice, 2005

Case reports are valued components of the medical literature. The assessment of case reports by e... more Case reports are valued components of the medical literature. The assessment of case reports by editors of medical journals and peer reviewers is largely subjective. The purpose of this study was to develop a reliable instrument to evaluate the quality of written case reports. Instrument development involved review of the literature and the materials provided to peer reviewers who review manuscripts, communications with journal editors and discussions of the study team. After multiple amendments, the instrument was pilot tested on both published and unpublished case reports. Further revisions resulted in the final 11-item tool. Four independent reviewers evaluated 28 case reports in their original submission format that had been submitted to five medical journals. The reviewers were blinded to the specific journal that the manuscripts had been submitted and to whether the case reports had been accepted for publication. Inter-rater reliability was assessed using multirater kappa. Inter-rater reliability ranged from 0.03 to 0.90. The four variables with the highest agreement between raters were (i) rationale for writing the case report; (ii) implications of the case report; (iii) adequacy of the literature review; and (iv) overall impression about whether to accept or reject the manuscript (kappas of 0.67, 0.67, 0.90 and 0.67, respectively). Six of the instrument's first 10 variables were highly correlated with the reviewers' decision about whether to accept or reject the case report for publication (item 11) (all p < 0.001). No correlation existed between the reviewers' decision to accept or reject the manuscript and the actual decision that had been made by the various journals. The case report review instrument is the first such tool for objectively evaluating case reports and appears to have reasonable reliability. Medical journals may wish to incorporate the use of this instrument into the decision making about a case report's suitability for publication.

Academic Medicine, 2013

The learning environment (LE) in medical schools and at academic health centers holds significant... more The learning environment (LE) in medical schools and at academic health centers holds significant influence on medical students' professional development, affecting how students form their identities and moral constructs and pattern their behaviors. 1-3 The LE encompasses the physical, social, and psychological context in which students learn; all interactions with faculty, staff, and peers; and the formal, informal, and hidden curricula. 4,5 Supportive medical school LEs are associated with enhanced student learning, achievement, and humanism, 6,7 although undercurrent messages conveyed through the hidden curriculum may erode the values and behaviors taught in more formal settings. In a recently acclaimed text on the future of medical education, Cooke and colleagues 10 advocate for a more intentional shaping of the medical school LE as a means to enhance students' professional formation, creating a greater sense of coherence between espoused and enacted values.

Academic Medicine, 2011

The number of women in academic medicine has steadily increased, although gender parity still doe... more The number of women in academic medicine has steadily increased, although gender parity still does not exist and women leave academics at somewhat higher rates than men. The authors investigated the reasons why women leave careers in academic medicine.

Academic Medicine, 2013

The career decisions, practice patterns, and approach to patient care of current female students,... more The career decisions, practice patterns, and approach to patient care of current female students, who make up close to 50% of medical school classes, will have a profound impact on the profession. This study explores the role gender plays in the mentoring experiences of female medical students. In 2011, the authors conducted focus groups with 48 third- and fourth-year female medical students at four U.S. medical schools. Using a template organizing style, they derived themes in an iterative process to explore female medical students' mentoring relationships and the impact of gender on those relationships. The authors identified four major themes: (1) Optimal mentoring relationships are highly relational. Students emphasized shared values, trust, and a personal connection in describing ideal mentoring relationships. (2) Relational mentoring is more important than gender concordance. Students identified a desire for access to female mentors but stated that when a mentor and mentee developed a personal connection, the gender of the mentor was less important. (3) Gender-based assumptions and stereotypes affect mentoring relationships. Students described gender-based assumptions and expectations for themselves and their mentors. (4) Gender-based power dynamics influence students' thinking about mentoring. Students stated that they were concerned about how their mentors might perceive their professional decisions because of their gender, which influenced what they disclosed to male mentors and mentors in positions of power. Gender appears to play a role in female medical students' expectations and experience with mentoring relationships and may influence their decision making around career planning.

Academic Medicine, 2010

Advising medical students is a challenging task. Faculty who serve as advisors for students requi... more Advising medical students is a challenging task. Faculty who serve as advisors for students require specific skills and knowledge to do their jobs effectively. Career choice is one of the many complex issues about which medical students often seek assistance from a faculty advisor. The authors present a case of a third-year medical student with career indecision, with a focus on the various factors that may be influencing her thinking about career choice.

Academic Medicine, 2010

The case presentation is a time-honored tradition in clinical medicine, and medical journals and ... more The case presentation is a time-honored tradition in clinical medicine, and medical journals and national conferences have provided a forum for this type of scholarship for more than a century.

The American Journal of Medicine, Jun 1, 2006

A New York Times Magazine article from 2003 speculated about a growing trend among American worki... more A New York Times Magazine article from 2003 speculated about a growing trend among American working women. The "opt-out revolution" suggests that many career women do not make it to the "top" not because they can't, but because they choose not to. The article claims that these highly educated and accomplished women are choosing playgroups in place of the boardroom, consciously opting to devote their time and energies to raising a family in lieu of pursuing a career. Although the main premise of the opt-out revolution is vastly oversimplified, it is clear that many women experience the tension inherent in having a family and career and, when provided with feasible options, may choose to shift between full-time, part-time, and unpaid work over the course of their lives. Current trends suggest that although more women are entering medical school than ever, academic medicine as a career is unappealing for women physicians. 3,4 Is academic medicine headed for its own "optout revolution?" This article highlights the reasons why women physicians may opt out of careers in academic medicine and describes one way that academic medical centers may prevent this by promoting part-time work options. Readers also may appreciate that as the number of dual physician couples increases and generational differences that emphasize greater work-family balance become more apparent, workplace flexibility and part-time work will become important issues for physicians of both sexes. 5-7

The American journal of medicine, Jan 8, 2016

Education For Primary Care an Official Publication of the Association of Course Organisers National Association of Gp Tutors World Organisation of Family Doctors, Feb 1, 2013

BACKGROUND: Effective patient-centred communication requires physicians to respond 'in the moment... more BACKGROUND: Effective patient-centred communication requires physicians to respond 'in the moment' to comments and questions. It is a valuable skill to be able to react to unexpected patient utterances with empathy and support, and these surprises may be most common in general practice where patients are encouraged to speak to their doctor about anything. We developed an elective for medical students to learn and practise improvisational skills that would optimise their communications with patients during medical encounters.METHODS: Nineteen second-year medical students during two consecutive years (n =38) participated in a four-session elective that introduced and allowed them to practise the principles and skills of improvisation, and reflect on the role of those skills in their communication with patients. Specific skills that were practised and emphasised included listening, affirmation, vocal tone modulation, nonverbal communication, agreement, collaboration, acceptance and validation. In addition to previously developed 'Improv' exercises, students created their own improvisation exercises targeted at specific communication skills.RESULTS: Twenty-seven (71%) of all participating students completed the post-curriculum assessment survey. Twenty-two (81%) rated their enjoyment as 'tremendous'. The desire to experience something new and different from the standard medical curriculum served as the motivation for many of the students (67%) to sign up for the course. Most students (23/27; 85%) thought that the concepts that were addressed were either 'very much' or 'tremendously' relevant to the care of patients.CONCLUSION: We have found that an improvisational workshop geared towards enhancing medical student communication skills has the potential to impart valuable skills that are essential to providing empathic, supportive patient-centred care. Communication skills training programmes have become a cornerstone in medical student and postgraduate medical education over the past 20 years. Both national accreditation and expert panel consensus guidelines have stressed the importance and framed the structure for best communication practices. Exemplary curricula for teaching medical trainees in core communication strategies to use with patients have been published; many emphasise patient-centred and/or relationshipcentred strategies. Simulated patient technologies with video review can allow learners to practise their skills through both self-assessment and feedback from others. However, despite these newer learning resources, frameworks and behavioural checklists, learners naïve to clinical patient encounters must still learn how to function and adapt within the interpersonal communicative space that is created by the learner and patient. At its core, this is an iterative, spontaneous process created by the dyad and yielding, from moment to moment, to unique and unanticipated outcomes. Thus, repetitive practice will improve confidence but may miss the mark in learning the essential skills of intuitive and improvised interpersonal responsiveness. One could argue that existing approaches in teaching medical learners communication skills may promote rigid and stereotyped responses. Haidet proposes that there are significant parallels between the patient-physician dialogue (when a physician attempts to learn details about a patient and their illness) and improvisational jazz. 11 He contends that effective clinicians who are committed to relationship-centred practice depart from overarching principles of biomedical inquiry when necessary to respond spontaneously and without script to the particular circumstances of each encounter. It is believed that successful doctor-patient relationships are founded upon trusting and open communication, as well as genuine respect that can be shown by a willingness to listen or respond to the issues raised by patients. 12 The nature of the comprehensive care in family medicine makes it likely that GPs will regularly be surprised by concerns raised by patients such that they must be adept at improvising. Because of the gap that currently exists in interview skills training programmes, we hypothesised that the field of improvisational theatre would effectively supplement the traditional curriculum. Improvisation relies on listening, confidence and responding instinctively and spontaneously. 13,14 In this paper, we describe our efforts to develop a brief curriculum for medical students providing training in the art of theatre improvisation, with the goal of enhancing students' confidence and performance in clinical encounters. We hoped that this innovative curricular experience would establish a venue where secondyear medical students could learn and practise improvisational skills that might prove helpful in their communications with patients during medical encounters.

Http Dx Doi Org 10 1207 S15328015tlm1704_3, Jun 15, 2010

The Accreditation Council for Graduate Medical Education requires that residents demonstrate scho... more The Accreditation Council for Graduate Medical Education requires that residents demonstrate scholarly activity prior to completion of training. To determine which factors are associated with program citation for failure to comply with the Residency Review Committee (RRC) scholarly activity requirement for internal medicine residencies. All 391 internal medicine residency program directors were surveyed in March 2002. Data were collected on program characteristics and factors (research curriculum, research director, faculty mentors, protected time for research, funding, and presence of a mandatory research requirement) that have been associated with successful resident research. Multiple logistic regression analysis identified factors associated with citation. The response rate was 78%. Ten percent of respondents report having been cited for lack of demonstration of scholarly activity. Factors that reduced the odds of citation were being a university-based program, odds ratio (OR) 0.13, 95% confidence interval (CI) 0.03-0.54, p = .005; having a greater number of residents, OR 0.95, 95% CI 0.93-0.98, p = .001; and having funding to support resident scholarship, OR 0.39, 95% CI 0.17-0.91, p = .03. Using multiple logistic regression analysis, having designated funding for resident scholarship was the only factor independently associated with a decreased odds of citation, OR 0.27, 95% CI 0.10-0.72, p = .009. To improve compliance with the RRC requirement for scholarly activity and avoid citation, residency programs may wish to consider devoting more resources, particularly money, to support resident scholarly activity.

Journal of General Internal Medicine, May 1, 2008

BACKGROUND: As more physicians work part-time (PT), the faculty, institutions, and organizations ... more BACKGROUND: As more physicians work part-time (PT), the faculty, institutions, and organizations that represent them should understand the factors that motivate and satisfy these physicians. OBJECTIVE: Compare factors associated with job satisfaction among PT and full-time (FT) academic physicians. DESIGN: Cross-sectional survey. PARTICIPANTS: Members of the Society of General Internal Medicine (SGIM), a national, academic Internal Medicine organization.

Journal of religion and health, Jan 17, 2015

Improved collaboration between physicians and chaplains has the potential to improve patient expe... more Improved collaboration between physicians and chaplains has the potential to improve patient experiences. To better understand the benefits and challenges of learning together, the authors conducted several focus groups with participants in an interprofessional curriculum that partnered internal medicine residents with chaplain interns in the clinical setting. The authors derived four major qualitative themes from the transcripts: (1) physician learners became aware of effective communication skills for addressing spirituality. (2) Chaplain interns enhanced the delivery of team-based patient-centered care. (3) Chaplains were seen as a source of emotional support to the medical team. (4) The partnership has three keys to success: adequate introductions for team members, clear expectations for participants, and opportunities for feedback. The themes presented indicate several benefits of pairing physicians and chaplains in the setting of direct patient care and suggest that this is an...

Education for primary care : an official publication of the Association of Course Organisers, National Association of GP Tutors, World Organisation of Family Doctors, 2013

Effective patient-centred communication requires physicians to respond 'in the moment' to... more Effective patient-centred communication requires physicians to respond 'in the moment' to comments and questions. It is a valuable skill to be able to react to unexpected patient utterances with empathy and support, and these surprises may be most common in general practice where patients are encouraged to speak to their doctor about anything. We developed an elective for medical students to learn and practise improvisational skills that would optimise their communications with patients during medical encounters. Nineteen second-year medical students during two consecutive years (n =38) participated in a four-session elective that introduced and allowed them to practise the principles and skills of improvisation, and reflect on the role of those skills in their communication with patients. Specific skills that were practised and emphasised included listening, affirmation, vocal tone modulation, nonverbal communication, agreement, collaboration, acceptance and validation. In ...

International Journal of Medical Education, 2011

The purpose of this study was to assess changes in students' perceptions of the medical school se... more The purpose of this study was to assess changes in students' perceptions of the medical school sense of community and their satisfaction with advising following the initiation of a structured advising program at the Johns Hopkins University School of Medicine. Methods: Participants included School of Medicine graduates from 2006 to 2009. Total sample size was 471. The response rate was 367/471 (81%). A cross-sectional survey design was utilized to assess students' perceived differences in advising and sense of community. Scales were developed to assess these constructs. Scale scores and responses to individual items were compared by graduation year. Results: Statistically significant increases over time were noted on the Advising Satisfaction (F (3,363) = 6.54; p≤0.001) and the Relational Community (F(3,363) = 2.76; p=0.042) scales. Using simple logistic regression, unadjusted Odds Ratios show that students graduating in 2009 report higher quality of advising during their clinical years (OR 2.87, 95% CI=1.56-5.28), around academics (OR 2.54, 95% CI=1.41-4.60), career planning (OR 1.87, 95% CI=1.03-3.38), stress management (OR 2.88, 95% CI=1.56-5.30), and an enhanced sense of community (OR 2.55, 95% CI=1.40-4.64), and social integration (OR 2.07, 95% CI=1.15-3.71) compared to 2006 graduates. Conclusions: We found, that students were more satisfied with advising and the medical school environment over the four years of maturation of the Program. A structured advising program that fosters meaningful, longitudinal relationships between students and advisors may enhance students' experiences during medical school.

Teaching and Learning in Medicine, 2005

The Accreditation Council for Graduate Medical Education requires that residents demonstrate scho... more The Accreditation Council for Graduate Medical Education requires that residents demonstrate scholarly activity prior to completion of training. To determine which factors are associated with program citation for failure to comply with the Residency Review Committee (RRC) scholarly activity requirement for internal medicine residencies. All 391 internal medicine residency program directors were surveyed in March 2002. Data were collected on program characteristics and factors (research curriculum, research director, faculty mentors, protected time for research, funding, and presence of a mandatory research requirement) that have been associated with successful resident research. Multiple logistic regression analysis identified factors associated with citation. The response rate was 78%. Ten percent of respondents report having been cited for lack of demonstration of scholarly activity. Factors that reduced the odds of citation were being a university-based program, odds ratio (OR) 0.13, 95% confidence interval (CI) 0.03-0.54, p = .005; having a greater number of residents, OR 0.95, 95% CI 0.93-0.98, p = .001; and having funding to support resident scholarship, OR 0.39, 95% CI 0.17-0.91, p = .03. Using multiple logistic regression analysis, having designated funding for resident scholarship was the only factor independently associated with a decreased odds of citation, OR 0.27, 95% CI 0.10-0.72, p = .009. To improve compliance with the RRC requirement for scholarly activity and avoid citation, residency programs may wish to consider devoting more resources, particularly money, to support resident scholarly activity.

Southern Medical Journal, 2006

We sought to determine the willingness of academic physicians to accept strategies to contain ins... more We sought to determine the willingness of academic physicians to accept strategies to contain institutional malpractice costs. We surveyed all 270 Department of Medicine physicians at a large academic center. Respondents were asked about their knowledge regarding malpractice premiums, willingness to reduce patient-care activities and accept decreases in compensation. The response rate was 80%. Respondents estimated the annual increase in malpractice premiums from 2004 to 2005 to be 29%. The true increase was 28% (P = 0.55). Almost all opposed eliminating patient care (95%) or providing patient care every other year at double effort and withdrawing from patient care on alternate years (97%). Seventy percent would limit their clinical procedures. Most physicians opposed salary reduction (97%) or decreases in fringe benefits (99%). Few academic physicians are willing to limit patient care or accept decreases in compensation to recoup institutional malpractice costs.

Journal of the American Geriatrics Society, 2014

Because safe transitions of care are critical to patient safety, it is important to prepare physi... more Because safe transitions of care are critical to patient safety, it is important to prepare physician trainees to assist in patient transitions from the hospital. As part of a discharge skills workshop for medical students, a brief reflective exercise was used to understand student perceptions of discharge problems and encourage application of classroom learning. Written reflections completed before and after the workshop were analyzed qualitatively to identify barriers to discharge observed on clinical clerkships and evaluate how the discharge skills workshop influenced student understanding of safe discharges. Students also completed a quantitative evaluation of the workshop. Seventy-eight of the 96 students (81%) at the Johns Hopkins University School of Medicine who participated in the discharge skills workshop volunteered to submit their written reflections. Eighteen themes were identified within two domains (barriers to safe discharges and solutions to improve discharges). The most commonly cited barrier was the sense that the discharge was rushed or premature. Three of the barrier themes and six of the solution themes were related to the importance of communication and collaboration in safe discharges. Students reported that the reflective exercise personalized the learning experience (mean 3.27 ± 0.86 on a scale of 1 (not at all) to 4 (a lot)). Students observed barriers to safe discharges on their clerkships related to poor communication, insufficient time spent planning discharges, and lack of patient education. Brief reflection encouraged students to apply lessons learned in a didactic session to consider solutions for providing safer patient care.

Journal of General Internal Medicine, 2008

BACKGROUND: As more physicians work part-time (PT), the faculty, institutions, and organizations ... more BACKGROUND: As more physicians work part-time (PT), the faculty, institutions, and organizations that represent them should understand the factors that motivate and satisfy these physicians. OBJECTIVE: Compare factors associated with job satisfaction among PT and full-time (FT) academic physicians. DESIGN: Cross-sectional survey. PARTICIPANTS: Members of the Society of General Internal Medicine (SGIM), a national, academic Internal Medicine organization.

Journal of General Internal Medicine, 2014

JAMA, 2005

The Institute of Medicine has called for increased rigor of education research and funding to sup... more The Institute of Medicine has called for increased rigor of education research and funding to support educational innovation. However, funding for medical education research is scarce. The costs of conducting studies in medical education and how such research is currently funded have not been systematically evaluated. To determine how medical education research studies that were recently published were funded and to approximate the costs of conducting these studies. We conducted a cross-sectional survey of first authors of medical education studies published from September 1, 2002, to December 31, 2003. Original medical education research studies conducted at US institutions and published in 13 prominent peer-reviewed journals were included. For each study we measured duration, percentage of the authors' total work commitment ("percentage effort") devoted to the study, resources used and their costs, attainment of funding, and the first author's estimated cost of conducting the study. The cost of each study was calculated by multiplying the percentage effort of each author for the duration of the study by the national median salary for each author, according to specialty and academic rank, and then adding the costs of resources used. Responses were received from authors of 243 (84%) of 290 identified medical education studies. The median calculated cost of conducting the 243 studies was 24,471 dollars (interquartile range [IQR], 11,531 dollars-63 808 dollars). The median authors' estimate of study cost was 10,000 dollars (IQR, 4000 dollars-25 000 dollars). Some funding was obtained for 72 (29.6%) of the studies. Of studies that were funded, the median amount of funding was 15,000 dollars (IQR, 5000 dollars-66,500 dollars). The median calculated cost of funded studies was 37,315 dollars (IQR, 18,731 dollars-82,393 dollars). Private foundation grants were the most common funding source (n = 30 [41.7%]). Factors independently associated with attaining funding were training in grant writing (odds ratio, 2.05; 95% confidence interval, 1.11-3.79) and number of medical education studies published by the first author (odds ratio, 2.4; 95% confidence interval, 1.24-4.63). The majority of published medical education research is not formally funded, and the studies that do receive support are substantially underfunded. To realize the Institute of Medicine's directive and to improve the quality of medical research, policy reform that increases funding for medical education scholarship will likely be required.

International Journal of Clinical Practice, 2005

Case reports are valued components of the medical literature. The assessment of case reports by e... more Case reports are valued components of the medical literature. The assessment of case reports by editors of medical journals and peer reviewers is largely subjective. The purpose of this study was to develop a reliable instrument to evaluate the quality of written case reports. Instrument development involved review of the literature and the materials provided to peer reviewers who review manuscripts, communications with journal editors and discussions of the study team. After multiple amendments, the instrument was pilot tested on both published and unpublished case reports. Further revisions resulted in the final 11-item tool. Four independent reviewers evaluated 28 case reports in their original submission format that had been submitted to five medical journals. The reviewers were blinded to the specific journal that the manuscripts had been submitted and to whether the case reports had been accepted for publication. Inter-rater reliability was assessed using multirater kappa. Inter-rater reliability ranged from 0.03 to 0.90. The four variables with the highest agreement between raters were (i) rationale for writing the case report; (ii) implications of the case report; (iii) adequacy of the literature review; and (iv) overall impression about whether to accept or reject the manuscript (kappas of 0.67, 0.67, 0.90 and 0.67, respectively). Six of the instrument's first 10 variables were highly correlated with the reviewers' decision about whether to accept or reject the case report for publication (item 11) (all p < 0.001). No correlation existed between the reviewers' decision to accept or reject the manuscript and the actual decision that had been made by the various journals. The case report review instrument is the first such tool for objectively evaluating case reports and appears to have reasonable reliability. Medical journals may wish to incorporate the use of this instrument into the decision making about a case report's suitability for publication.

Academic Medicine, 2013

The learning environment (LE) in medical schools and at academic health centers holds significant... more The learning environment (LE) in medical schools and at academic health centers holds significant influence on medical students' professional development, affecting how students form their identities and moral constructs and pattern their behaviors. 1-3 The LE encompasses the physical, social, and psychological context in which students learn; all interactions with faculty, staff, and peers; and the formal, informal, and hidden curricula. 4,5 Supportive medical school LEs are associated with enhanced student learning, achievement, and humanism, 6,7 although undercurrent messages conveyed through the hidden curriculum may erode the values and behaviors taught in more formal settings. In a recently acclaimed text on the future of medical education, Cooke and colleagues 10 advocate for a more intentional shaping of the medical school LE as a means to enhance students' professional formation, creating a greater sense of coherence between espoused and enacted values.

Academic Medicine, 2011

The number of women in academic medicine has steadily increased, although gender parity still doe... more The number of women in academic medicine has steadily increased, although gender parity still does not exist and women leave academics at somewhat higher rates than men. The authors investigated the reasons why women leave careers in academic medicine.

Academic Medicine, 2013

The career decisions, practice patterns, and approach to patient care of current female students,... more The career decisions, practice patterns, and approach to patient care of current female students, who make up close to 50% of medical school classes, will have a profound impact on the profession. This study explores the role gender plays in the mentoring experiences of female medical students. In 2011, the authors conducted focus groups with 48 third- and fourth-year female medical students at four U.S. medical schools. Using a template organizing style, they derived themes in an iterative process to explore female medical students' mentoring relationships and the impact of gender on those relationships. The authors identified four major themes: (1) Optimal mentoring relationships are highly relational. Students emphasized shared values, trust, and a personal connection in describing ideal mentoring relationships. (2) Relational mentoring is more important than gender concordance. Students identified a desire for access to female mentors but stated that when a mentor and mentee developed a personal connection, the gender of the mentor was less important. (3) Gender-based assumptions and stereotypes affect mentoring relationships. Students described gender-based assumptions and expectations for themselves and their mentors. (4) Gender-based power dynamics influence students' thinking about mentoring. Students stated that they were concerned about how their mentors might perceive their professional decisions because of their gender, which influenced what they disclosed to male mentors and mentors in positions of power. Gender appears to play a role in female medical students' expectations and experience with mentoring relationships and may influence their decision making around career planning.

Academic Medicine, 2010

Advising medical students is a challenging task. Faculty who serve as advisors for students requi... more Advising medical students is a challenging task. Faculty who serve as advisors for students require specific skills and knowledge to do their jobs effectively. Career choice is one of the many complex issues about which medical students often seek assistance from a faculty advisor. The authors present a case of a third-year medical student with career indecision, with a focus on the various factors that may be influencing her thinking about career choice.

Academic Medicine, 2010

The case presentation is a time-honored tradition in clinical medicine, and medical journals and ... more The case presentation is a time-honored tradition in clinical medicine, and medical journals and national conferences have provided a forum for this type of scholarship for more than a century.