Medical Education Online™ Open Peer Review Section

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Medical Education Online is implementing an open review process on an experimental basis. A number of journals including Nature and the Public Library of Science's new journal PLoS One have or are in the process of experimenting with open review systems. Although they have been implemented in many forms, they essentially allow some form of public comment as part of the manuscript review process.

How it works - MEO uses a two-stage review process. Submitted manuscripts are reviewed by one of the managing editors. If they feel the manuscript fits within the scope of the Journal and is appropriate for peer review, it is assigned to one of our review editors and sent out for external peer review. If not, the managing editor sends an e-mail to the author explaining why the manuscript was not selected for peer review.

If the author agrees to participate in the process, their manuscript is made available via this page as a "preprint." As a reader, you will have the option of providing comments and constructive feedback concerning the manuscript via a link to a Web-based form just below the link to the manuscript. If you choose to do so, you must provide your name and e-mail address. The comments are then reviewed by one of the MEO editors. Comments that do not contain what is felt to be legitimate commentary or constructive feedback concerning the manuscript will be rejected. Comments that are felt to be appropriate by the editor will be posted on the Web site with the manuscript and sent to the author. The author will have the opportunity to submit a reply to the comment which will be posted with the comment on the Web site.

We encourage you to read the preprint papers that are of interest to you and encourage you to provide constructive feedback that will help the authors improve their manuscripts and provide additional feedback for the peer-review process. We also welcome your comments on the open peer review process.

Personality Profiles of Incoming Male and Female Medical Students:   Results of a Multi-Site 9-year Study

(The preprint version of this article is no longer available. It has been published in its final form in Volume 12 of the peer-reviewed portion of the Journal.)

Abstract
Purpose: This study conveys findings of a 9-year multi-site medical school study of personality traits among incoming medical students.  The purpose of the study was twofold. First, it assessed gender differences by exploring personality traits of incoming male and female medical students. Second, it sought to illuminate personality factors associated with those who choose a career in medicine by comparing personality of medical students to the general population. 
Methods: The Sixteen Personality Factor Questionnaire (16PF) was administered at four medical schools.  Two thousand one hundred and seventy seven first-year medical students (1021 females; 1156 males) completed the 16PF.
Results: Study findings reveal significant personality differences between male and female medical students on 11 of 16 personality factors as well as substantial differences in personality functioning between medical students and the general population.  Findings are described and future directions for analyses are presented.

Nutrition Resources developed through the Nutrition Academic Award Program for Medical Schools

(The preprint version of this article is no longer available. It was not accepted for publication)

Abstract: One of the goals of the Nutrition Academic Award (NAA) program is to enhance and integrate nutrition into the medical school curriculum. This goal requires that resources be available for a wide range of nutrition topics and in a variety of formats that can be incorporated into existing courses and clinical clerkships. This paper describes the resources developed by multidisciplinary teams of physicians, nutritionists, and medical school educators through the NAA program, and provides a comprehensive list of educational materials that have been produced over the past five years by 21 U.S. medical schools. These materials include nutrition assessment and counseling tools, knowledge and attitude surveys, nutrition and wellness newsletters, Power Point slides, videos, books, clinical cases, and web-based products. These resources are available through the national NAA Web site at http://www.nhlbi.nih.gov/funding/training/naa/ Medical institutions and faculty members who are responsible for teaching nutrition in medical schools will find the resources for training medical students and residents in nutrition.

Key words:: medical nutrition education, nutrition resources, web-based nutrition tools  

A study of two clinical performance scores: The generalizability of a combined score derived from clinical evaluation forms and OSCEs

(The preprint version of this article is no longer available. It has been published in its final form in Volume 12 of the peer-reviewed portion of the Journal.)

Abstract:
Context/Objective: Improved within school clinical skills assessment, combined with remediation could assure the public regarding the competency of graduating students. In addition to using the OSCE, the clinical skills of medical students are also routinely assessed with clinical evaluation forms (CEFs). It is reasonable to assume that the OSCE and the CEF each measure a somewhat different aspect of a student’s clinical competence. The OSCE provides information about a student’s communication and data collection skills. The CEF provides information about a student’s clinical reasoning, relevant knowledge, and ability to interpret clinical data. The purpose of this study is to examine and relationship between the OSCE and the CEF and to consider the psychometric characteristics and the validity of a composite that combines these two measures to generate a final score for summarizing students’ clinical skills.
Design/Setting: This study included two medical student classes from a large Midwestern medical school. On average, students completed approximately 12 standardized patient encounters (OSCEs) and were rated over 33 times on a standard CEF. The reliability of the CEF and OSCE were estimated using generalizability analyses. A correlation between the mean OSCE score and the mean CEF was calculated, tested for significance, and corrected for attenuation due to the unreliability of both the CEF score and the OSCE score. Classical test theory (CTT) methods were used to calculate a composite score reliability using various weightings on the two measures.
Results: For both classes there was a statistically significant correlation between the CEF and OSCE (r = .27 & .42, p = .003 & .0001). The disattenuated correlations were .44 and .68. In both years the reliability of the composite tended to decrease as the weight on the OSCE increased above .2. However, increasing the weighting on the OSCE of up to .4 was associated with only a small decrease in composite reliability.
Conclusion: These results demonstrate that assessment information based on simulated clinical encounters and actual patient encounters can be combined into a composite measure of performance. Consistent with previous reports in the literature, there was moderate correlation between the CEF score and OSCE score. The OSCE and CEF focus on different aspects of clinical competency and combining the two scores produces a more reliable score for assigning final grades. Since a composite score may provide a more valid measure of clinical performance, this study supports using a combined CEF and OSCE measure for the calculation of clinical grades and for making competency decisions.

Keywords: Clinical science education, Standardized patients, psychometrics, generalizability, validity

Pre-Clinical Medical Students’ Exposure to and Attitudes Toward Pharmaceutical Industry Marketing

(The preprint version of this article is no longer available. It has been published in its final form in Volume 12 of the peer-reviewed portion of the Journal.)

Abstract
Background: Recent studies have examined the exposures and attitudes toward pharmaceutical industry marketing of physicians and future physicians in clinical training, but fewer studies have addressed these topics amongst pre-clinical medical students. Thus, the purpose of this study was to assess pre-clinical students’ level of exposure to the pharmaceutical industry and their attitudes toward marketing.
Method: First and second-year medical students at UCLA completed a 40-item survey based on previous studies.
Results: 78.5% of pre-clinical students responded to the survey. Exposure to pharmaceutical industry marketing started very early in medical school.  Most second-year students (77%) had received gifts including drug samples after three semesters. Most felt that this would not affect their future prescribing behavior.  
Conclusions: These findings and findings from related studies, coupled with the students’ desire to learn more about the issue, suggest that an early educational intervention addressing this topic may be warranted in American medical schools.

Keywords: Basic science education, Clinical science education, Ethics/professionalism

New Internet-Based Learning Resource for Internal Medicine Residents

(The preprint version of this article is no longer available. You can contact the lead author Roger Y. Wong MD, FRCPC, FACP at atrymwong@interchange.ubc.ca )

Abstract
Purpose: To describe the development and resident utilization of a new Internet-based learning resource for internal medicine residents (e-Res).
Methods: We developed a password-protected website with 5 content modules containing internal medicine specific resources, and evaluated usage overall and relative use of each module. 
Results: The median logins per resident per training year were 93 for first-year residents, 66 for second-year, and 42 for third-year.  There were 3088 hits registered over 2 years.  The section containing subspecialty reference articles had the greatest usage (32% of all hits), with disproportionately high usage of articles pertaining to physical examination skills.  The cardiac auscultation section received 11.4% of all hits.  The section outlining important dates and subspecialty fellowship match process had the lowest overall usage (1.9% of all hits), however it had the highest number of hits per item. 
Conclusions: We developed an Internet-based multimedia learning resource that was used regularly by internal medicine residents.  The heaviest usage was among junior residents, particularly in the section on reference articles.

A Focus Group Study of Medical Students’ Views of an Integrated Complementary and Alternative Medicine (CAM) Ccurriculum: Students Teaching Teachers

Abstract
Background - Student views of new curricula can shape training outcomes. This qualitative study elicited student opinions of CAM instruction to examine and distill best strategies.
Methods - 42 second, third and fourth year students participated in focus groups using a predefined question route. Interviews were audiotaped and transcribed. Transcripts were independently interpreted/analyzed by 3 faculty using a grounded theory approach, then discussed and integrated. Student responses across groups and by training year were compared.
Results - Students successfully differentiated CAM curricula from other academic content and were supportive of a longitudinal integrated approach. They had positive attitudes toward CAM use for themselves but this did not necessarily translate into patient recommendations. They agreed that goals of the CAM curriculum should center on awareness of patient use, evidence and information relevant to clinical practice. They advocated a case-based, hands-on, experiential strategy vs lectures. Students proposed greater institutional commitment to strengthen curricular effectiveness. The majority did not intend to practice CAM modalities but valued skills to assess them. Patient-centeredness was recognized.
Conclusions - In-depth student input allowed examination of the effectiveness of a CAM curriculum, permitting improvement and assessment of program effectiveness. The findings support continuation of an integrated CAM curriculum.

Keywords: Curriculum assessment, Complementary and Alternative Medicine (CAM), focus groups, medical students, qualitative.

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