Steven Eagle
Israel
The cost of health care is unquestionably out of control. While the solution requires a multipronged approach, most interventions have targeted residents and attendings. This study took a qualitative approach to evaluating an interactive “Money in Medicine” curriculum for medical students. Students expressed that they had little exposure to the concepts of “Choosing Wisely” and the cost of individual tests. In addition, they recognized that knowing the costs of healthcare could affect their management decisions.
Friday, December 18, 2020
Tuesday, December 15, 2020
Utility of Item Response Theory in medical students’ general procedural skill assessment
Hirotaka Kato
University of Kentucky / Albert B. Chandler
Background: Though Item Response Theory (IRT) is a well-established method to analyze response data, the utility of IRT in clinical skill assessment is not well-described. Using the procedure simulation test data whose standards were determined by the Angoff method, we explored (1) the psychometric properties of the test and (2) how different passing scores change the interpretations of the test.
Methods: Our study was conducted at a single US medical school where 3rd-year medical students are required to pass 10 procedural skill simulations. The unidimensional partial credit model was applied to the data of 131 students whose total scores for each procedure were recorded. We mapped person locations and thresholds on the same continuum (i.e., the item-person map) which allowed us to assess how the test performance would change by different passing scores (i.e., Angoff, +1, +2, and perfect scores).
Results: The item-person map elucidated a gap between student abilities and item difficulties (thresholds). The Angoff scores were too easy to differentiate high- from low-performers. Adding 1 point to the Angoff scores resulted in the largest variance, that would allow the test to assess a wider range of skills. This procedural skill test however was not suited to assess a wide range of skills unless we make some items more difficult and appropriate for the target populations.
Conclusions: This study illustrates the application of IRT in clinical skill assessment. The results showed that IRT was useful to refine the test itself and the passing scores.
University of Kentucky / Albert B. Chandler
Background: Though Item Response Theory (IRT) is a well-established method to analyze response data, the utility of IRT in clinical skill assessment is not well-described. Using the procedure simulation test data whose standards were determined by the Angoff method, we explored (1) the psychometric properties of the test and (2) how different passing scores change the interpretations of the test.
Methods: Our study was conducted at a single US medical school where 3rd-year medical students are required to pass 10 procedural skill simulations. The unidimensional partial credit model was applied to the data of 131 students whose total scores for each procedure were recorded. We mapped person locations and thresholds on the same continuum (i.e., the item-person map) which allowed us to assess how the test performance would change by different passing scores (i.e., Angoff, +1, +2, and perfect scores).
Results: The item-person map elucidated a gap between student abilities and item difficulties (thresholds). The Angoff scores were too easy to differentiate high- from low-performers. Adding 1 point to the Angoff scores resulted in the largest variance, that would allow the test to assess a wider range of skills. This procedural skill test however was not suited to assess a wide range of skills unless we make some items more difficult and appropriate for the target populations.
Conclusions: This study illustrates the application of IRT in clinical skill assessment. The results showed that IRT was useful to refine the test itself and the passing scores.
Friday, December 4, 2020
Employing Strategies to Address Implicit Racial Bias in the Home Visit Setting: A Phenomenological Study of Family Medicine Residents
Anna Goroncy
The Christ Hospital / University of Cincinnati
Background: Implicit racial bias (IB) in physicians contributes to racial health inequities. Residents are not consistently trained to address IB. Few curricula addressing IB in graduate medical education have been evaluated, especially in the clinical setting.
Objectives: The purpose of this phenomenological study is to characterize Family Medicine (FM) residents’ experience of employing strategies to mitigate IB during primary care home visits (HVs) to urban, predominately African-American, homebound older adults. The outcomes of this qualitative study will inform future curriculum development.
Methods: FM residents completed pre-work, including taking the Implicit Association Test and evaluating strategies to address IB. Residents applied these strategies during HVs to homebound older adults. Residents completed written reflections about their experiences and commitments-to-change (CTC). A survey two months later assessed completion of targeted actions and barriers faced. Resident focus groups were utilized to enhance themes drawn from reflections. Researchers completed a thematic analysis of this data January-July 2020.
Results: Thematic analysis identified five themes: Response to IAT, barriers, strategies, value of HVs and mindfulness definition. In follow-up surveys, all residents’ stated level of CTC remained the same (9/9, 100%) and 8/9 residents (89%) had partially or fully implemented their intended change at 2 months.
Conclusions: Residents utilized the opportunity to learn and apply strategies to address IB. Residents continued to implement newly-learned strategies in the clinical setting two months after training and applied skills to settings outside of HVs and other bias types. These findings can facilitate development of meaningful, clinically-based IB curricula with lasting impacts.
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