Feasibility of implementing a standardized multisource feedback program in the graduate medical education environment.

Background: Multisource feedback (MSF) is emerging as a central assessment method for several medical education competencies. Planning and resource requirements for a successful implementation can be significant. Our goal is to examine barriers and challenges to a successful multisite MSF implementation, and identify the benefits of MSF as perceived by participants.

The relationship between direct observation, knowledge, and feedback: results of a national survey.

Background: Multisource feedback can provide a comprehensive picture of a medical trainee's performance. The utility of a multisource feedback system could be undermined by lack of direct observation and accurate knowledge.

Method: The National Board of Medical Examiners conducted a national survey of medical students, interns, residents, chief residents, and fellows to learn the extent to which certain behaviors were observed, to examine beliefs about knowledge of each other's performance, and to assess feedback.

Lost in transition: the experience and impact of frequent changes in the inpatient learning environment.

Purpose: The traditional "rotating" model of inpatient training remains the gold standard of residency, moving residents through different systems every two to four weeks. The authors studied the experience and impact of frequent transitions on residents.

Method: This was a qualitative study.

Which experiences in the hidden curriculum teach students about professionalism?

Purpose: To examine the relationship between learner experience in the "hidden curriculum" and student attribution of such experiences to professionalism categories.

Method: Using the output of a thematic analysis of 272 consecutive narratives recorded by 135 students on a medical clerkship from June through November 2007, the authors describe the frequency of these experiences within and across student-designated Association of American Medical Colleges-National Board of Medical Examiners professionalism categories and employ logistic regression to link varieties of experience to specific professionalism categories.

Results: Thematic analysis uncovered two main domains of student experience: medical-clinical interaction and teaching-and-learning experiences.

The quality of written comments on professional behaviors in a developmental multisource feedback program.

Background: Written feedback on professional behaviors is an important part of medical training, but little attention has been paid to the quality of written feedback and its expected impact on learning. A large body of research on feedback suggests that feedback is most beneficial when it is specific, clear, and behavioral. Analysis of feedback comments may reveal opportunities to improve the value of feedback.

Validity considerations in the assessment of professionalism.

During the last decade, interest in assessing professionalism in medical education has increased exponentially and has led to the development of many new assessment tools. Efforts to validate the scores produced by tools designed to assess professionalism have lagged well behind the development of these tools. This paper provides a structured framework for collecting evidence to support the validity of assessments of professionalism.

Medical students' professionalism narratives: a window on the informal and hidden curriculum.

Purpose: The aim of this study was to use medical students' critical incident narratives to deepen understanding of the informal and hidden curricula.

Method: The authors conducted a thematic analysis of 272 stories of events recorded by 135 third-year medical students that "taught them something about professionalism and professional values." Students wrote these narratives in a "professionalism journal" during their internal medicine clerkships at Indiana University School of Medicine, June through November 2007.

Paradoxes of professionalism and error in complex systems.

Professionalism is at the heart of risk management in complex, dangerous work such as medicine, aviation, and military operations. Professionalism is closely connected to expertise and is therefore closely connected to the ability to prevent and mitigate errors. But there are two paradoxes in this connection.

Assessment of medical professionalism: who, what, when, where, how, and ... why?

Medical professionalism is increasingly recognized as a core competence of medical trainees and practitioners. Although the general and specific domains of professionalism are thoroughly characterized, procedures for assessing them are not well-developed. This article outlines an approach to designing and implementing an assessment program for medical professionalism that begins and ends with asking and answering a series of critical questions about the purpose and nature of the program.

A theoretical sketch of medical professionalism as a normative complex.

Validity arguments for assessment tools intended to measure medical professionalism suffer for lack of a clear theoretical statement of what professionalism is and how it should behave. Drawing on several decades of field research addressing deviance and informal social control among physicians, a theoretical sketch of professionalism is presented that can be used to predict how individual adjustment to professional norms should co-vary with other social and psychological phenomena. Physicians may understand and value professional norms but fail to enact them in practice because of conflicting normative demands.

Disciplinary careers of drug-impaired physicians.

Alcohol and drug abuse are among the leading reasons for disciplinary action against physicians by state licensing authorities in the United States. I use event history models to describe the longitudinal patterns in disciplinary actions taken against physicians' licenses by state medical boards in the United States, 1990-2000. Adverse licensure action episodes that included discipline for drug or alcohol abuse were more likely to be followed by license restoration than episodes that did not.

A multilevel analysis of the relationships between selected examinee characteristics and United States Medical Licensing Examination Step 2 Clinical Knowledge performance: revisiting old findings and asking new questions.

Background: This study examines: (1) the relationships between examinee characteristics and United States Medical Licensing Examination Step 2 Clinical Knowledge (CK) performance; (2) the effect of gender and examination timing (time per item) on the relationship between Steps 1 and 2 CK; and (3) the effect of school characteristics on the relationships between examinee characteristics and Step 2 CK performance.

Method: A series of hierarchical linear models (examinees-nested-in-schools) predicting Step 2 CK scores was fit to the data set. The sample included 54,487 examinees from 114 U.

Analysis of count data using poisson regression.

Nurses and other health researchers are often concerned with infrequently occurring, repeatable, health-related events such as number of hospitalizations, pregnancies, or visits to a health care provider. Reports on the occurrence of such discrete events take the form of non-negative integer or count data. Because the counts of infrequently occurring events tend to be non-normally distributed and highly positively skewed, the use of ordinary least squares (OLS) regression with non-transformed data has several shortcomings.