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   Table of Contents - Current issue
May-August 2022
Volume 35 | Issue 2
Page Nos. 39-76

Online since Thursday, January 12, 2023

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Co-Editors' Notes p. 39
Danette McKinley, Payal Bansal, Michael Glasser
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Medical student anxiety and depression in the COVID-19 Era: Unique needs of underrepresented students p. 41
Sheryl Lin, Albert C Chong, Erin H Su, Sabrina L Chen, Won Jong Chwa, Chantal Young, Jacob Schreiber, Stephanie K Zia
DOI:10.4103/efh.efh_112_22  PMID:36647931
Background: The COVID-19 pandemic has caused significant morbidity, mortality, and mental health consequences. Few studies have examined the mental toll of COVID-19 on United States (US) medical students, who experience greater rates of depression and anxiety than the general population. Students who identify as underrepresented in medicine (URM) may experience even greater mental health adversities than non-URM peers. This study examines COVID-19's impact on preclinical medical student anxiety and depression and unique challenges disproportionately affecting URM students during the initial phase of the pandemic. Methods: Medical students at four US institutions completed an anonymous survey including the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires for depression and anxiety. Participants provided information on demographics, past mental health difficulties, and concerns during the pandemic. Chi-square and Mann–Whitney U tests were performed using SPSS. Results: During the initial phase of the pandemic, URMs were 3.71 times more likely to be in the at-risk category on GAD-7 than non-URM peers. Before COVID-19, there was no significant difference between self-reported feelings or diagnoses of anxiety between groups. During the COVID-19 pandemic, there were significant differences in feelings of increased anxiety between URM (Mdn = 76) and non-URM (Mdn = 49) students, U = 702.5, P < 0.001, feelings of increased sadness between URM (Mdn = 49) and non-URM (Mdn = 34) students, U = 1036.5, P = 0.042, concern for new financial difficulty between URM (Mdn = 50) and non-URM students (Mdn = 7), U = 950.5, P = 0.012, and concern about lack of mental health support from their academic institution between URM (Mdn = 18) and non-URM students (Mdn = 9), U = 1083, P = 0.036 (one-tailed). Discussion: Large-scale crises such as COVID-19 may exacerbate mental health disparities between URM and non-URM students. Medical schools should consider increasing financial and mental health support for URM students in response to these significant adverse events.
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A rasch analysis of three socialization and communication measures in 4th-year doctor of pharmacy students p. 48
Aryn C Karpinski, Joseph M LaRochelle, Kelli Qua, Riza Memis
The impact of communication and anxiety on Doctor of Pharmacy students across three measures was examined. Data were collected (N = 120) from 4th-year Doctor of Pharmacy students at a historically black college/university using the Interprofessional Socialization and Valuing Scale, the Personal Report of Communication Apprehension, and the Social Phobia Inventory. Results of Rasch Differential Item Functioning Analysis indicated statistically significant differences between each ethnic group on subcomponents of anxiety in each measure (20% Caucasian, 43% African American, 31.7% Asian, and 4.2% others). Evidence from this study shows that racial demographics affect different subscales of anxiety across doctoral pharmacy students. While some pedagogical implications exist, issues within the measures and their items must also be addressed.
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Perspectives of internal medicine residency clinics: A national survey of US medical directors p. 58
Robert J Fortuna, Daniel G Tobin, Halle G Sobel, Ernie-Paul Barrette, Craig Noronha, Larry Laufman, Xiaofan Huang, Kristen A Staggers, Mohan Nadkarni, Lee B Lu
DOI:10.4103/efh.efh_75_22  PMID:36647933
Background: Ambulatory training is an integral component of internal medicine residency programs, yet details regarding operational processes in resident continuity clinics remain limited. Methods: We surveyed a convenience sample of medical directors of residency practices between 2015 and 2019 (n = 222) to describe and share operational and scheduling processes in internal medicine resident continuity clinics in the US. Results: Among residency practices, support for the medical director role ranged substantially, but was most commonly reported at 11%–20% full-time-equivalent support. By the end of the survey period, the majority of programs (65.1%) reported obtaining patient-centered medical home (PCMH) certification (level 1–3). For new patient appointments, 34.9% of programs reported a 1–7 day wait and 25.8% reported an 8–14 day wait. Wait times for new appointments were generally shorter for PCMH certified practices (P = 0.029). No-show rates were most commonly 26%–50% for new patients and 11%–25% for established patients. Most programs reported that interns see 3–4 patients per ½-day and senior residents see 5–6 patients per ½-day. Most interns and residents maintain a panel size of 51–120 patients. Discussion: Creating high-performing residency clinics requires a focus on core building blocks and operational processes. Based on the survey results and consensus opinion, we provide five summary recommendations related to (1) support for the medical director leadership role, (2) patient-centered and coordinated models of care, (3) support for patient scheduling, (4) recommended visit lengths, and (5) ancillary support, such as social work.
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The “new normal” for medical education during and post-COVID-19 p. 67
Fady Andraous, Ghada Essam Al-Din Amin, Mohamed Farouk Allam
After outbreaks in more than 110 countries, the World Health Organization declared COVID-19 a global pandemic on the March 11, 2020, heralding unprecedented challenges in medical education. Our aim is to provide a descriptive overview of the impact of COVID-19 on medical education worldwide and to assess its future repercussions. Worldwide, medical students were removed from clerkship training. Clinical skills and practical procedure training transitioned to being online, and in some cases, postponed. Medical educators scrambled to convert the curriculum into online formats. Access to Internet, technology, and computer education posed resource allocation challenges in developing countries and further widened the disparities in medical education. Even in countries where the framework and funding were available to support the online transition, debatably, this arrangement can lead to disparities in clinical skills, bedside manner, and field experience among pre- and post-COVID-19 medical graduates. Challenges extend beyond undergraduate medical education to include the medical licensing process of international and national postgraduates. The international community of medical educators needs to collaborate to drive the future of medical education, as the world adapts to the “new normal.”
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Flipped classroom as a learner-centered approach to teach pharmacology p. 69
Ambili Remesh
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Blueprinting process in biochemistry: A strategic step in written assessment in undergraduate medical education p. 71
Yogesh Ramkrishna Pawade, Anita Shivaji Chalak, Dipti Yogesh Pawade
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Disruptive innovation in Japanese medical education: Positive transformation to blended online and on-site clinical clerkship after coronavirus disease 2019 p. 73
Ayaka Takahara, Kiyoshi Shikino
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Community-based education in rural Rwanda p. 75
Lotta Velin, Jacquelyn Corley, Alyssa Corley, Eden Gatesi, Olivier Mbarushimana Nshuti, Genereuse Irakoze Iradukunda, Zahirah Z McNatt, Akiiki Bitalabeho, Denys Ndangurura, Abebe Bekele
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