Best Oral Presentation Award Nominee

Robert Treat

Medical College of Wisconsin

PURPOSE: Medical students are amazingly resilient in the face of academic challenges, studying relentlessly enormous volumes of course materials, and having scant time for personal endeavors. Perseverance is a major element of resilience that requires persistence in pursuing something despite the difficulty in achieving success. Resilient individuals must therefore value the outcomes they strive to achieve.  The purpose of this study is to analyze the relationship of medical student perseverance and values as impacted by gender.  METHODS: In 2017/18, 205 of 500 M-1/M-2 medical students (106 males/99 females) voluntarily completed these self-reported surveys: RS-25 Resilience Scale and Human Values Inventory. Inter-item reliability determined with Cronbach's alpha. Pearson correlations (r) and stepwise multivariate linear regressions used for predicting perseverance scores from ten value domains and 56 facets. IBM  SPSS  24.0 generated statistical analysis. This research approved by institution's IRB.  RESULTS: Perseverance (alpha=0.7) scores were significantly (p<.050) and negatively correlated to all ten human value domains: universalism (r= -0.5), benevolence (-0.4), conformity (-0.3), tradition (-0.3), security (-0.4), power (-0.4), achievement (-0.4), hedonism (-0.3), stimulation (-0.3), and self-direction (-0.4). The remaining four factors of resilience (authenticity, equanimity, purpose, self-reliance) had positive correlations with the ten values.  Linear regression results for male perseverance (R=0.43, p<.001) was predicted by four values facets: excitement (beta=0.3), obedience (0.3), wisdom (-0.4), and safety (-0.5). Linear regression results for female perseverance (R=0.54, p<.001) was predicted by creativity (0.5), self-discipline (0.3), meaning in life (-0.3), broad-mindedness (-0.3), enjoyment (-0.3), and wisdom (-0.4).  CONCLUSIONS: Medical student perseverance increased as their self-enhancement values such as hedonism and power decreased, but also as their self-transcendent values such as benevolence did. Predictive modelling revealed greater complexity as resilient female students valued creativity and self-discipline and male students valued excitement, but both devalued wisdom while persisting towards goals. Values must be prioritized when in conflict.
 

Presentation 2 - Student perspectives about readiness to perform EPA tasks: Does a year of experience affect self-assessed need for supervision?
Victor Soukoulis

University of Virginia

 

PURPOSE The AAMC's 13 Core Entrustable Professional Activities (EPAs) identify tasks that students should be prepared to do with indirect supervision on day one of residency. A key consideration in entrustment decision-making is a learner's trustworthiness, including ability to self-evaluate, discern limitations, and ask for help/supervision. We have reported the discrepancy between student and clerkship director perceptions about the level of supervision learners require for EPAs at the beginning of the clerkship year. In this study, we sought to evaluate how, with reflection on their experiences during the clerkships and in doing EPA assessments, these same students retrospectively and prospectively assessed their abilities and need for supervision. METHODS After the end of the clerkship year, students were asked to retrospectively rate the level of supervision they needed to perform each EPA, and to prospectively rate their supervision needs going into the post-clerkship phase. They were asked how confident they were in these determinations. Retrospective assessments were compared to pre-clerkship assessments and confidence. RESULTS Students (n=33) reported that, in retrospect, they needed higher levels of supervision at the start of their clerkship year than they originally determined (2.93 vs 2.69; p<0.015). The difference was statistically significant for a specific subset of EPAs related to commonly performed tasks. Looking forward, students reported low need for supervision for all EPAs as they entered the post-clerkship phase, with high levels of confidence in their self-assessment. CONCLUSION For activities students commonly participated in and received feedback about during the clerkship year, students reported needing higher levels of supervision on retrospective self-assessment. Students' high confidence in their supervision needs moving forward raises concern, however, about how to integrate learners' abilities to self-assess in determinations about trustworthiness.

 

Presentation 3 - Faculty Resilience, Reflexivity, and Well-Being: Requisite Elements of Success
Robert Treat

Medical College of Wisconsin

 

PURPOSE Academic faculty in the health sciences face many professional challenges from competing demands of teaching, scholarship, and clinical duties. Successful achievement of these ongoing demands requires the capacity to persevere when stress levels rise.  The ability to manage challenging workloads and endure stress requires resilience. Research indicates that those who engage in reflexivity or self-evaluation of actions, can persevere and be resilient due to an acute awareness and ability to problem-solve when challenges arise. The purpose of this study is to analyze differences in medical school faculty resilience as impacted by perceived levels of stress and determine how mindful development of reflexivity has the capacity to foster resilience and grit among faculty. METHODS In March 2018, twenty faculty were interviewed in person or on the phone by one of the authors at a private Midwestern medical college for approximately thirty minutes each about sources of stress that impacted their resilience. Qualitative analysis reported themes that were used for follow-up focus groups. RESULTS Major sources of faculty stress included systemic sources as the electronic health record (65%) and physician scheduling (45%) and individual sources as work/life imbalance (30%) and little/no protected time for academic pursuits (25%). Reported mediators of perceived faculty stress included access to physical, psychological, and temporal resources; leadership, mentorship, and staff support; and use of positive psychology such as mindfulness training, use of nudge theory and PERMA. CONCLUSIONS Maintaining well-being and resilience include having shared values with leaders and obtaining support for electronic health record and non-patient care responsibilities. Flexibility on scheduling and planned redundancy in time will help with work/life balance.

 

Presentation 4 - Formative Assessment and Self-directed Learning: Undergraduate Medical Students' Needs
Youn Seon Lim

Donald and Barbara Zucker School of Medicine 
 

OBJECTIVE: In self-directed learning environments, students must monitor and assess their learning progress themselves.  Formative assessments (FAs) play a central role as instructional tools to train students in these self-assessment skills.  Previous studies show that the effectiveness of FAs as a training instrument is highly correlated with the degree to which students participate in the design and implementation of their FAs. Nonetheless, in present day undergraduate medical education (UME), FAs are typically devised and administered with minimal student involvement.  This study seeks to identify UME students' needs and expectations towards FAs believed to improve their self-directed learning. METHOD: A total of 140 volunteer UME students participated in an online survey that used open-ended questions about students' general preferences concerning FAs, and which specific characteristics of FAs students believed were most supportive in facilitating self-directed learning.  The responses to the open-ended questions were quantified using thematic analysis. Mean comparison tests and relation tests were conducted to identify primary characteristics of FAs described as helpful by students.  Of particular interest was how students perceived the role of feedback that FAs provide to them and which features students thought were especially helpful in learning self-directed learning. RESULTS: Results showed that 67.9% of UME students appreciated the use of FAs to teach them self-directed learning skills.  Gender, race and years-in-school were related to significant differences: female students, Caucasian students, and students in their first years were more satisfied with current FAs practices.  Overall, students pointed out that to help with self-directed learning, FAs should possess the following characteristics: transparency, accuracy, relevance, timeliness, and specific (study) directions. CONCLUSIONS: The majority of UME students were positive about the use of FAs to teach them self-directed learning skills; but the results also showed that there is still room for improvement especially, in regard to the involvement of minority students.