Journal of Regional Medical Campuses

Entrustable Professional Activities in Medical Education: SELECT Leadership, Values-Based Patient-Centered Care, Health Systems, and Scholarly Excellence

Joann Farrell Quinn — 2024-10-03

Entrustable Professional Activities (EPAs) represent a concept in medical education that has gained significant traction over the last few years, particularly in the context of competency-based medical education. An EPA refers to a specific task or responsibility that can be entrusted to a trainee once they have demonstrated the necessary competence. EPAs provide concrete tasks that a trainee should be able to complete at various stages of training in order to clarify expectations and responsibilities they should master.

The University of South Florida Morsani College of Medicine (USFMCOM), Scholarly Excellence, Leadership Experiences, Collaborative Training (SELECT) MD program pairs a unique four-year longitudinal leadership program including the domains of leadership, values-based patient-centered care, health systems, and scholarly excellence with an innovative medical degree program. Students in the SELECT program spend the first two years on the campus in Tampa, Florida, and the clinical years on the regional campus in Allentown, Pennsylvania. These additional threads of curriculum call for a unique set of EPAs. A working group of faculty, students, and administrators within the college from both the main and regional campus developed EPAs for each of the above listed areas of focus within the curriculum.

In this paper, the authors describe how Entrustable Professional Activities were developed at MCOM to assess the SELECT curriculum in the areas of leadership, values-based patient-centered care, health systems, and scholarly excellence.

Self-Stigma vs. Perceived Public Stigma Toward Mental Illness in Rural Adults

Brent McCreary — 2024-10-03

Introduction:

Mental illness is a clinically significant disturbance in an individual's cognition, emotion regulation, or behavior. Stigma toward mental health comes in two primary forms: Self-stigma and perceived public stigma.

Purpose: The objective of this study is to quantify the amount of stigma toward mental illness in rural adults and analyze differences in stigma across demographic groups.

Methods: Adults were offered a 14-item questionnaire at five different sites from January 2023 to April 2023. Rural distinctions were made based on participants' reported county of residence following the Indiana Office of Community and Rural Affairs (OCRA) definition of rurality. Demographic information such as age, gender, marital status, total household income, and highest level of education were also obtained.

Results: Rural adults experience mild amounts of self-stigma (14.52 +/- 5.0) and moderate amounts of perceived public stigma (18.4 +/- 4.3). Adults aged 46-65 experience more significant levels of perceived public stigma when compared to those of younger participants. An inverse relationship exists between the highest level of education and self-stigma towards mental illness. Seventy two percent of respondents agreed or strongly agreed with the statement, “In general, others believe that having a mental illness is a sign of personal weakness or inadequacy.”

Conclusions: This study demonstrates that perceived public stigma toward mental illness presents a significant barrier to care for mental illness. Adults aged 46-65 are especially vulnerable to the perceived public stigma toward mental illness. To provide the largest benefit to rural populations, anti-stigma campaigns should focus on perceived public stigma among adults aged 46-65.

Promoting Patient Care Ownership in Medical Students through Standardized Simulations

Disha Patel — 2024-10-03

Background:Professional identity formation (PIF) has been demonstrated to play an important role in medical students' transition from a peripheral role into becoming a physician that bears primary responsibility for the care of their patients^1,2. Multiple factors influence this development, including clinical experiences as well as sociocultural, familial, academic, moral, religious, and gender-based roles, values, beliefs, and obligations. Many of these factors can be emulated in simulations to encourage this merging of identities; the most critical of which is patient care ownership (PCO)⁶. This study was conducted on the 4th year medical students at the Medical College of Georgia (MCG) and compares a self-reported PCO index score amongst the various subsets. These include main vs regional campus assignment for clinical years, gender identity, ethnicity, and prior healthcare experience before medical school.

Methods:For this study, we distributed a questionnaire developed by Avey et al. (2009) and adapted by Wyatt et al.¹¹ (2023) to evaluate the feelings and opinions of medical students regarding their level of patient care ownership^11,16,17. To evaluate the effects of the longitudinal simulation curriculum on PCO as measured with the survey instrument index scores, independent sample t-tests and ANOVA between different groups with a Tukey HSD multiple-comparison post-hoc were done. Groups analyzed for differences included campus, gender identity, race, ethnicity, and prior experience in the healthcare field.

Results: A total of 201 students were invited to participate in this study. There was no statistically significant difference between students from main and regional campuses in PCO index scores. When comparing between gender identities of male, female, and nonbinary, there was no significant difference (p = 0.248). Comparing ethnicities did not show any significant differences (p = 0.936). Finally, there was no significant difference in PCO index scores between students in regard to their prior healthcare experiences (p = 0.155).

Conclusion:This study highlights the importance of a comprehensive and intentionally-designed simulation curriculum to prompt PCO in order to facilitate PIF prior to residency, for the purpose of producing more confident and competent intern physicians².

Conflict of interest: none

Treatment of human and animal subjects: not applicable

Development of a mobile application to increase motivation, engagement & teaching activity of clinical faculty using gamification principles

Aazad Abbas — 2024-10-03

Background:

Clinician teachers (CT) have historically felt undervalued and underappreciated. One technology used to increase motivation is gamification: the process of inserting elements of game-playing into activities that are not usually associated with games. We developed a mobile application that rewards CTs using in-app gamification techniques to increase CTs motivation. This program was implemented specifically in a regional campus setting, Mississauga, Ontario.

Methods:

A cross-platform application that rewards physicians for their clinical teaching hours was created. This consisted of a star grading criteria where each physician was awarded depending on the number of hours completed. End-user perceptions of the application were evaluated using a survey with a Likert scale and open-ended questions. Survey results were collated with descriptive statistics and thematic analysis.

Results:

The TutorTracker application was developed implementing a live gamification algorithm. It allows physicians to view their hours completed, rewards obtained, and add additional hours. The majority of CTs agreed or strongly agreed that the application was user-friendly, easy to navigate and enjoyed the rewards provided. Major themes that emerged were regarding additional features and full integration of such an application for rewarding teaching efforts.

Conclusions:

Gamification principles have been implemented in a cross-platform application allowing CTs to be rewarded for their teaching. The next steps would be to formally quantify the effects and advantages of using the application to increase the motivation of tutors.

Gender Differences in Planned Retirement Age Among Medical Students: Are Changes on the Horizon?

William J. Crump — 2024-10-03

ABSTRACT

Gender Differences in Planned Retirement Age Among Medical Students: Are Changes On the Horizon?

Purpose

Planned age of retirement has an important effect on the physician workforce. Earlier studies of practicing physicians have reported that the planned as well as actual retirement age was significantly younger for women. Also, previous reports had shown that rural physicians tended to retire earlier. This paper offers a view earlier in the physician pipeline and reports surveys of medical students and pre-medical college students concerning their retirement plans.

Methods

During 2015-2019, 70 college students and 41 medical students at a regional rural medical campus completed a career eulogy that included their planned retirement age.

Results

Combining both groups of students, women planned to retire at a mean age of 61.9 and men at 59.1, P=0.048. A longitudinal comparison of just medical students showed that prematriculation students just before starting medical school had the oldest planned age of 66.9, compared to college students (57.4 to 58.9) and medical students (64.0 to 64.6), P=0.049. There was no difference in planned retirement age in rural vs urban upbringing.

Conclusions

In this group of pathways students, women planned to retire almost 3 years later than men, which differs from earlier reports of physicians in practice. The men planned retirement almost 5 years earlier than in previous reports of planned retirement age. There was no difference in rural vs urban upbringing. Whether this is a generalizable finding will require similar studies in different student populations on other campuses, and our survey instrument is available for others to look deeper into the process of professional identity formation that may explain any differences in planned retirement age.