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Does a measure of Medical Professional Identity Formation predict communication skills performance?

Kalet, Adina; Ark, Tavinder K; Monson, Verna; Song, Hyuksoon S; Buckvar-Keltz, Lynn; Harnik, Victoria; Yingling, Sandra; Rivera, Rafael; Tewksbury, Linda; Lusk, Penelope; Crowe, Ruth
OBJECTIVE:To validate an approach to measuring professional identity formation (PIF), we explore if the Professional Identity Essay (PIE), a stage score measure of medical professional identity (PI), predicts clinical communication skills. METHODS:Students completed the PIE during medical school orientation and a 3-case Objective Structured Clinical Exam (OSCE) where standardized patients reliably assessed communication skills in 5 domains. Using mediation analyses, relationships between PIE stage scores and communication skills were explored. RESULTS:For the 351 (89%) consenting students, controlling for individual characteristics, there were increases in patient counseling (6.5%, p<0.01), information gathering (4.3%, p = 0.01), organization and management (4.1%, p = 0.02), patient assessment (3.6%, p = 0.04), and relationship development (3.5%, p = 0.03) skills for every half stage increase in PIE score. The communication skills of lower socio-economic status (SES) students are indirectly impacted by their slightly higher PIE stage scores. CONCLUSION/CONCLUSIONS:Higher PIE stage scores are associated with higher communication skills and lower SES. PRACTICE IMPLICATIONS/CONCLUSIONS:PIE predicts critical clinical skills and identifies how SES and other characteristics indirectly impact future clinical performance, providing validity evidence for using PIE as a tool in longitudinal formative academic coaching, program and curriculum evaluation, and research.
PMID: 33896685
ISSN: 1873-5134
CID: 4889222

Breaking Tradition to Bridge Bench and Bedside: Accelerating the MD-PhD-Residency Pathway

Modrek, Aram S; Tanese, Naoko; Placantonakis, Dimitris G; Sulman, Erik P; Rivera, Rafael; Du, Kevin L; Gerber, Naamit K; David, Gregory; Chesler, Mitchell; Philips, Mark R; Cangiarella, Joan
PROBLEM/OBJECTIVE:Physician-scientists are individuals trained in both clinical practice and scientific research. Often, the goal of physician-scientist training is to address pressing questions in biomedical research. The established pathways to formally train such individuals are, mainly, MD-PhD programs and physician-scientist track residencies. Although graduates of these pathways are well equipped to be physician-scientists, numerous factors, including funding and length of training, discourage application to such programs and impede success rates. APPROACH/METHODS:To address some of the pressing challenges in training and retaining burgeoning physician-scientists, New York University Grossman School of Medicine formed the Accelerated MD-PhD-Residency Pathway in 2016. This pathway builds on the previously established accelerated three-year MD pathway to residency at the same institution. The Accelerated MD-PhD-Residency Pathway conditionally accepts MD-PhD trainees to a residency position at the same institution through the National Resident Matching Program. OUTCOMES/RESULTS:Since its inception, 2 students have joined the Accelerated MD-PhD-Residency Pathway, which provides protected research time in their chosen residency. The pathway reduces the time to earn an MD and PhD by one year and reduces the MD training phase to three years, reducing the cost and lowering socioeconomic barriers. Remaining at the same institution for residency allows for the growth of strong research collaborations and mentoring opportunities, which foster success. NEXT STEPS/UNASSIGNED:The authors and institutional leaders plan to increase the number of trainees that are accepted into the Accelerated MD-PhD-Residency Pathway and track the success of these students through residency and into practice to determine if the pathway is meeting its goal of increasing the number of practicing physician-scientists. The authors hope this model can serve as an example to leaders at other institutions who may wish to adopt this pathway for the training of their MD-PhD students.
PMID: 33464738
ISSN: 1938-808x
CID: 4760452

Describing faculty exemplars of medical professionalism [Meeting Abstract]

Lusk, P; Altshuler, L; Monson, V; Buckvar-Keltz, L; Crowe, R; Tewksbury, L; Poag, M; Harnik, V; Rivera, R; Kalet, A
BACKGROUND: Internalizing a strong medical professional identity (PI) is a critical part of medical education. Recent studies of medical students have documented that students' PI, measured by the Professional Identity Essay (PIE), a reflective writing assessment of PI based on Kegan's theory of adult development and Bebeau's developmental model of PI, vary and are impacted by education. Little is known about the PI of exemplary professional physicians. We sought to: 1) describe the PI of physicians who exemplify the highest principles of the medical profession, and 2) evaluate NYU faculty identified as professional exemplars by peers to provide data and demonstrate clear role models for learners METHODS: We elicited nominations for professional exemplar physicians from NYU faculty, chief residents, and 4th-year students, using the definition of professionalism developed by Colby and Damon (1992). Participants were recruited after receiving at least 3 nominations; select participants who received 1 or 2 nominations were also recruited to diversify the participants in terms of specialty, years of practice, gender and race.We also used snowball techniques to get nominations fromstudy participants. After consenting, faculty received the 11-question PIE. We analyzed demographic data of nominated faculty and completed a content analysis of the PIE.
RESULT(S): 206 individual faculty were nominated at least one time by 70 community members. 32 individuals were recruited to the study; to date 22 have completed the PIE. The 206 nominees/22 participants represent: 34/12 specialties, average years in practice 17.6/23.8, range of years in practice 62 for nominees/44 for participants. We identified 3 primary themes through the content analysis: (1) Response to Expectations, "Everything. The profession demands everything.As much as this profession takes fromme, it is dwarfed by what I have received in return." (2) Response to Failure: "I fail to live up to expectations every day. Some days thismotivatesme, other days I disappoint myself." (3) Learning from Others: "I view teaching as integral to medical professionalism." There was a range of developmental levels in the responses with some focusing more on external rather than internal motivations: "I can say that the [malpractice] process for me was very threatening, emotionally consuming and had the potential to alter professional behavior in the wrong way."
CONCLUSION(S): Nominated faculty represented a diverse group with respect to PI. Many participants demonstrated great professionalism and a sense of internal PI in responses to the PIE questions, while others focused onmore externalmotivations to drive their professional behaviors. Further analysis is needed to define the qualities of a true exemplary professional. The range of responses of the exemplars can both serve as role models for learners and provide multiple pathways for learners and faculty to strengthen their own professional identities
ISSN: 1525-1497
CID: 4803412

Evolution of an Accelerated 3-Year Pathway to the MD Degree: The Experience of New York University School of Medicine

Cangiarella, Joan; Cohen, Elisabeth; Rivera, Rafael; Gillespie, Colleen; Abramson, Steven
The revision of the curriculum at New York University School of Medicine in 2010, with a reduction of the preclerkship curriculum to 18 months, made it possible to offer an accelerated 3-year pathway in 2013 for students who know their career path. The goals of the program include individualizing education, reducing student debt, and integrating undergraduate and graduate medical education. This accelerated 3-year doctor of medicine (3YMD) pathway is the first program of its kind in the United States to offer conditional acceptance to residency programs in all specialties through the National Resident Matching Program. Since inception of the pathway 6 years ago, 81 students have graduated. Critical components to successfully launch and implement the program are described.Unwavering commitment to the program as a high institutional priority by the dean and vice dean for education facilitated the support required by department chairs and residency program directors and the flexibility needed for success. Alignment between the 3- and 4-year pathways has made it possible to add points of entry into the 3-year pathway during the second and third years and to shift back into the 4-year pathway, as warranted. Modifications to how 3YMD students are mentored included changing the role of the departmental advisor and adding a dedicated 3YMD pathway advisor who serves as an advocate for both the students and the program. Having a relatively large number of 3YMD students has contributed to the success of the program and facilitated acceptance by the residencies.
PMID: 31577593
ISSN: 1938-808x
CID: 4116272

Signatures of medical student applicants and academic success

Baron, Tal; Grossman, Robert I; Abramson, Steven B; Pusic, Martin V; Rivera, Rafael; Triola, Marc M; Yanai, Itai
The acceptance of students to a medical school places a considerable emphasis on performance in standardized tests and undergraduate grade point average (uGPA). Traditionally, applicants may be judged as a homogeneous population according to simple quantitative thresholds that implicitly assume a linear relationship between scores and academic success. This 'one-size-fits-all' approach ignores the notion that individuals may show distinct patterns of achievement and follow diverse paths to success. In this study, we examined a dataset composed of 53 variables extracted from the admissions application records of 1,088 students matriculating to NYU School of Medicine between the years 2006-2014. We defined training and test groups and applied K-means clustering to search for distinct groups of applicants. Building an optimized logistic regression model, we then tested the predictive value of this clustering for estimating the success of applicants in medical school, aggregating eight performance measures during the subsequent medical school training as a success factor. We found evidence for four distinct clusters of students-we termed 'signatures'-which differ most substantially according to the absolute level of the applicant's uGPA and its trajectory over the course of undergraduate education. The 'risers' signature showed a relatively higher uGPA and also steeper trajectory; the other signatures showed each remaining combination of these two main factors: 'improvers' relatively lower uGPA, steeper trajectory; 'solids' higher uGPA, flatter trajectory; 'statics' both lower uGPA and flatter trajectory. Examining the success index across signatures, we found that the risers and the statics have significantly higher and lower likelihood of quantifiable success in medical school, respectively. We also found that each signature has a unique set of features that correlate with its success in medical school. The big data approach presented here can more sensitively uncover success potential since it takes into account the inherent heterogeneity within the student population.
PMID: 31940377
ISSN: 1932-6203
CID: 4263442

Measuring professional identity formation early in medical school: Validity evidence [Meeting Abstract]

Kalet, A; Song, H; Buckvar-Keltz, L; Monson, V; Hubbard, S; Crowe, R; Rivera, R; Yingling, S
BACKGROUND: An evidence-based approach to understand ethical medical professional identity formation (PIF) is needed. Scored by an expert, the Professional Identity Essay (PIE) produces a developmental stage (8 potential levels) based on a constructivist-developmental methodology developed in dental, law students and military officer trainees. We assessed the validity and utility of measuring baseline PIF in a professionalism curriculum and hypothesized that PIE stage would correlate with undergraduate humanities majors, subscores on admissions Multiple Mini Interviews (MMI), and DIT2 score, but would not correlate with gender, SES, URM status, age, MCAT scores, or GPA. METHODS: During medical school orientation, all 132 entering medical students completed 1) the Professional Identity Essay (PIE) and 2) the Defining Issues Test (DIT2), a validated measure of moral reasoning. A trained expert (VM) scored narrative responses to seven prompts (Inter-rater ICC .83, 95% CI [.57 - .96], intra-rater ICC .85, 95% CI [.50 - .93]). The DIT2 N2 score reflects the proportion of the time students used universal ethical principles to justify a response to six moral dilemma cases. Students' reflections following a debriefing were content-analyzed. Admissions data was obtained for consenting students. RESULTS: 129 students consented (57% women, mean age 23 (range 18-34, SD 1.7). Distribution of PIF stage scores was along 4 stages (2-3: 16 (12%), 3: 59 (45%), 3-4: 49 (37%) 4: 6 (4%)). DIT2 scores indicated a strong preference for post-conventional moral reasoning (N2) relative to moral justifications based on personal interest or maintaining norms, with a mean DIT2 N2 score of 54% (range 9.7%-76.5%). PIF stage as measured by the PIE was correlated with DIT N2, rho = .19 (p < .05), MMI-Conflict Resolution, rho = .26 (p < .05) and MMI-Team Work, rho = .22 (p < .05), but no other admission variable. DIT N2 score and MMI-Responsibility were correlated rho = .18 (p < .05). Content analysis of 130 students' reflective writing on PIE stage and DIT score report revealed mostly positive reactions to the PIF curriculum (117/130, 90%). Students with mixed negative reactions (28/130, 21%) reported confusion, concern about future training, or dissatisfaction with the gap between their self-perception and the results. Students who demonstrated an analytic approach to evaluating their feedback tended not to report negative reactions, even when they were surprised by the feedback. CONCLUSIONS: A developmental evidence grounded measure of PIF is a feasible and acceptable part of a medical professionalism curriculum for entering medical students, distributes similarly to groups in other professional training programs and correlates with a validated measure of moral reasoning and admissions MMI stations that assess relevant constructs. This approach is acceptable and intriguing to our students and may be useful as an approach to competency-based professionalism curricula
ISSN: 0884-8734
CID: 2554132


Kalet, Adina; Song, Hyuksoon; Buckvar-Keltz, Lynn; Monson, Verna; Hubbard, Steven; Crowe, Ruth; Rivera, Rafael; Yingling, Sandra
ISSN: 0884-8734
CID: 5327732

A 3-year M.D.--accelerating careers, diminishing debt

Abramson, Steven B; Jacob, Dianna; Rosenfeld, Melvin; Buckvar-Keltz, Lynn; Harnik, Victoria; Francois, Fritz; Rivera, Rafael; Hopkins, Mary Ann; Triola, Marc; Grossman, Robert I
PMID: 24047055
ISSN: 0028-4793
CID: 541902

Epidural Air in Child with Spontaneous Pneumomediastinum

Tomita, Sandra; Rivera, Rafael; Kuenzler, Keith; Ginsburg, Howard
PMID: 22648190
ISSN: 0939-7248
CID: 180159

Incarcerated Amyand's hernia in a premature infant associated with circumcision: a case report and literature review

Park, J; Hemani, M; Milla, S S; Rivera, R; Nadler, E; Alukal, J P
Amyand's hernia is a rare presentation of an appendix within an inguinal hernia sac. It is commonly mistaken for an incarcerated or strangulated hernia. Prompt diagnosis requires awareness of this entity, as well as associated radiologic findings on computed tomography (CT) and ultrasound. Treatment includes antibiotics and surgical intervention involving appendectomy and hernia repair. We present a case of a premature infant who developed systemic symptoms after a circumcision and was eventually diagnosed with an Amyand's hernia with concurrent appendicitis
PMID: 20012455
ISSN: 1248-9204
CID: 149913