This Week in JAMA FREE

A JAMA THEME ISSUE
Edited by Robert M. Golub, MD

Distress and depression among medical students are addressed in 2 articles in this issue. Dyrbye and colleagues surveyed students at 7 medical schools and found that distress (“burnout”) was associated with self-reports of unprofessional conduct related to patient care and less altruistic professional values. Schwenk and colleagues surveyed students at 1 medical school and found that depressed students were more likely than nondepressed students to endorse depression stigma attitudes. In an editorial, Roberts discusses the responsibility of medical educators to address the well-being of medical students.

Identifying individual patient circumstances that require variation from standard care (“contextualization”) is an important aspect of clinical decision making. In a quasi-randomized controlled trial, Schwartz and colleagues found that fourth-year medical student internal medicine subinterns who participated in an educational intervention designed to increase skills in incorporating the patient's context in assessment and management of care were more likely than students in the control group to seek contextual clues and to contextualize care of individual standardized patients.

In an experimental study that involved first- and second-year internal medicine residents, Mamede and colleagues found that recent experience with a clinical problem resulted in an overestimation of the likelihood of a similar diagnosis in a subsequent case, presumably based on the ease with which the diagnosis comes to mind (“availability bias”). When the residents engaged in structured reanalysis of the case findings using reflective reasoning, availability bias was counteracted and diagnostic accuracy improved.

In a study that randomly assigned resident physicians to receive 1 of 3 different online surveys presented as evaluating quality of life and values, Sah and Loewenstein found that reminding early-career physicians of personal sacrifices made during their training increased the perceived acceptability of industry-sponsored gifts. When a potential rationalization was provided—that low salaries and education-related debt might justify gift acceptance—perceived gift acceptability increased.

Andriole and Jeffe analyzed 10-year follow-up data from the 1994-1999 national cohort of medical school matriculants to identify demographic and prematriculation factors associated with medical school outcomes. They found that lower scores on the Medical College Admission Test, nonwhite race/ethnicity, and premedical debt of more than $50 000 were independently associated with a greater likelihood of academic withdrawal or dismissal and graduating without achieving a passing score on first attempt on both the US Medical Licensing Examination Step 1 and Step 2.

To assess whether the order in which third-year core clerkships are completed affects student performance, Kies and colleagues examined 2000-2008 performance records for medical students at a US medical school and found that clerkship order was associated with performance on clerkship subject examinations and grades but not clinical performance or US Medical Licensing Examination Step 2 scores.

“A person recounting his or her history necessarily presents an account of events from his or her perspective—this is the first introduction to subjectivity.” From “’Taking’ a History.”

Biomedical informatics for physicians

Economic reality and medical education

How physicians (should) think

Insights into how trainees act, feel and reason

Data on US medical schools and graduate medical education

Join Ralph Gonzales, MD, MSPH, Wednesday, October 20, 2010, from 2 to 3 PM eastern time to discuss whether adolescent or adult coughing may be a symptom of pertussis. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

For your patients: Information about medical licensure.