Challenges to assessing professional identity in medical students: a tale of two measures.

: Professional identity formation (PIF), a foundational process in becoming a physician, includes establishment of values, moral principles, and self-awareness. The purpose of this report is to examine challenges in establishing the validity of measures of identity fusion as one facet of PIF. : Utilizing the modern approach of validity as a unitary concept, the authors generated six hypotheses to examine the evidence for the construct validity of the scores of Physician Professional Identity (PPI) and Identity Integration (IdIn), considering relationships of these measures with each other, year of training and data from a larger survey.

Program evaluation models and related theories: AMEE guide no. 67.

This Guide reviews theories of science that have influenced the development of common educational evaluation models. Educators can be more confident when choosing an appropriate evaluation model if they first consider the model's theoretical basis against their program's complexity and their own evaluation needs. Reductionism, system theory, and (most recently) complexity theory have inspired the development of models commonly applied in evaluation studies today.

Supporting medical education research quality: the Association of American Medical Colleges' Medical Education Research Certificate program.

The quality of the medical education research (MER) reported in the literature has been frequently criticized. Numerous reasons have been provided for these shortcomings, including the level of research training and experience of many medical school faculty. The faculty development required to improve MER can take various forms.

Effects of comprehensive educational reforms on academic success in a diverse student body.

Context: Calls for medical curriculum reform and increased student diversity in the USA have seen mixed success: performance outcomes following curriculum revisions have been inconsistent and national matriculation of under-represented minority (URM) students has not met aspirations. Published innovations in curricula, academic support and pipeline programmes usually describe isolated interventions that fail to affect curriculum-level outcomes.

Methods: United States Medical Licensing Examination (USMLE) Step 1 performance and graduation rates were analysed for three classes of medical students before (matriculated 1995-1997, n=517) and after (matriculated 2003-2005, n=597) implementing broad-based reforms in our education system.

Comprehensive changes in the learning environment: subsequent step 1 scores of academically at-risk students.

Background: During the past 10 years at our institution, a number of changes have been instituted in the learning environment, including instructional techniques, assessment methods, academic support, and explicit board preparation.

Method: The authors studied the Step 1 performance of students with MCAT scores of 20 to 25 in our former and current curricula. Effect sizes were calculated for score improvement using adjusted means from ANCOVA with covariates of MCAT and age.

Creating sustainable curricular change: lessons learned from an alternative therapies educational initiative.

The authors describe the process by which a curriculum was developed to introduce complementary and alternative medicine topics at multiple levels from health professional students to faculty, as part of a five-year project, funded by a grant from the National Institutes of Health, at the University of Texas Medical Branch in Galveston, Texas, from 2001 to 2005. The curriculum was based on four educational goals that embrace effective communication with patients, application of sound evidence, creation of patient-centered therapeutic relationships, and development of positive perspectives on wellness. The authors analyze the complex and challenging process of gaining acceptance for the curriculum and implementing it in the context of existing courses and programs.

Lessons learned from complementary and integrative medicine curriculum change in a medical school.

Objectives: This paper describes a pilot study that examined lessons learned from the introduction of complementary and alternative medicine (CAM) elements into a medical school curriculum.

Methods: A qualitative approach was selected as a first step in evaluating the phenomenological experience of introducing the CAM Educational Project in 2000-05. In 2005, semi-structured interviews were conducted with faculty staff and graduating students who had participated in all 4 years of the CAM Project.

An evaluation of depressed mood in two classes of medical students.

Objective: To assess depression rates in contemporary medical students.

Method: The Beck Depression Inventory (BDI) was administered anonymously to two medical school classes at matriculation, the end of first year, and the end of second year.

Results: Median scores for both classes were low at all points.

Measuring what medical students think about complementary and alternative medicine (CAM): a pilot study of the complementary and alternative medicine survey.

With increasing national and international support for the development of Complementary and Alternative Medicine (CAM) curricula in American medical schools, it is essential to measure what learners know and believe about CAM in order to assess outcomes of new teaching efforts. This paper describes the development and initial results of a survey designed for those purposes. The survey is constructed so that earlier single-institution studies of students' attitudes toward CAM topics, preferred ways of learning about CAM, and students' use of CAM therapies for self-care might be replicated and extended.

Investigating the use of negatively phrased survey items in medical education settings: common wisdom or common mistake?

Background: Attitude surveys in medical education often combine negative items with positive items, a "common wisdom" strategy to counteract response sets. A body of research in other fields has demonstrated that negatively phrased items affect reliability and validity by introducing measurement artifact into scores. The authors investigated the effect of negatively phrased items in the Medical School Learning Environment Survey (MSLES) with data from six medical student cohorts at the University of Texas Medical Branch, Galveston, Texas.

Introduction of patient video clips into computer-based testing: effects on item statistics and reliability estimates.

Purpose: Using patient video clips to evaluate examinees' skills in interpreting physical examination findings is possible with computer-based testing, but the psychometric properties of video-based questions are unknown.

Method: We developed parallel test questions incorporating video clips or text descriptions of abnormal neurologic findings and administered them to 106 fourth-year medical students finishing their Neurology Clerkship.

Results: Overall, video-based questions had comparable difficulty and discrimination compared to analogous text-based questions.

Incorporating simulators in a standardized patient exam.

Objective: Using simulated patients during a clinical skills exam that involves many students has the advantage of standardizing the delivery of historical data. One major disadvantage is the inability to standardize the physical exam findings. We designed a simulated patient exam that incorporates simulated abnormal physical exam findings.

Teaching and testing physical examination skills without the use of patients.

Objective: To design a cardiopulmonary physical exam curriculum that does not involve the use of patients. Bedside teaching is becoming a lost art, and the use of alternative methods of instruction such as simulation has become increasingly important. Simulators have been shown to enhance physical examination skills of students and physicians in training.

Clinical performance assessment and interactive video teleconferencing: an iterative exploration.

Background: The direct observation of students in authentic settings by faculty provides valuable feedback on performance and helps ensure mastery of clinical skills.

Description: We explored the use of interactive video technology (IVT) as a way of involving community preceptors as raters on a clinical performance exam for 3rd-year students after their family medicine clerkship. Family medicine preceptors, from locations in their communities, observed students on campus conduct interviews and physical exams of standardized patients and then interacted with them during their case presentations.