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PubMed2002

Should medical school faculty see assessments of students made by previous teachers?

Whether medical school faculty should be provided with assessments of students made by previous teachers remains controversial. To document which schools have implemented policies that address this issue and to characterize the specific features of these policies, in 1998 the authors conducted a direct mail survey of deans of student affairs and medical education at 144 medical schools in the United States, Canada, and Puerto Rico. Replies were received from 129 (90%) of the 144 medical schools. Of those schools, 72 (56%) reported having policies that address this issue. The policies permit the sharing of information in 38 (53%) of the 72 schools that had policies; therefore, at the time of this study, 29% of the 129 medical schools that responded to the survey had a policy that permits the sharing of assessment information. The policies permit the sharing of information related to problems with academic performance (35%), professional conduct (35%), physical health (25%), and miscellaneous circumstances, such as learning disability (5%). Information may be shared with clerkship coordinators (44%), course directors (35%), faculty mentors (11%), clinical faculty supervisors (8%), and resident supervisors (3%). The findings show that there is considerable diversity in the format and content of policies that address the issue of whether medical school faculty should be provided with information about students' assessments made by previous teachers. The authors explain why policies that require the provision of such information are helpful to medical school faculty, and offer recommendations based on the survey findings.

Confidentiality↗

PubMed2003

A pilot randomized, controlled trial of a longitudinal residents-as-teachers curriculum.

PURPOSE: To determine whether a longitudinal residents-as-teachers curriculum improves generalist residents' teaching skills. METHOD: From May 2001 to February 2002, 23 second-year generalist residents in four residencies affiliated with the University of California, Irvine, College of Medicine, completed a randomized, controlled trial of a longitudinal residents-as-teachers program. Thirteen intervention residents underwent a 13-hour curriculum during one-hour noon conferences twice monthly for six months, practicing teaching skills and receiving checklist-guided feedback. In a 3.5-hour, eight-station objective structured teaching examination (OSTE) enacted and rated by 15 senior medical students before and after the curriculum, two trained, blinded raters independently assessed each station with detailed, case-specific rating scales (rating scale reliability = 0.96, inter-rater reliability = 0.78). RESULTS: The intervention and control groups were similar in academic performance, specialty distribution, and gender (chi(2) = 0.434, p =.81). On a five-point Likert scale (5 = best teaching skills), intervention and control residents showed similar mean pretest OSTE scores (2.83 vs. 2.88, p =.736). The intervention group improved their mean overall OSTE scores 22.3% (more than two standard deviations) from 2.83 (pretest) to 3.46 (post-test; p <.0005; 95% CI 0.53 to 0.72). Intervention residents also improved significantly on six of eight OSTE stations. Within the control group, no pretest-to-post-test change achieved statistical significance. Mann-Whitney and Wilcoxon signed-rank tests confirmed these results. CONCLUSIONS: Generalist residents randomly assigned to receive a 13-hour longitudinal residents-as-teachers curriculum consistently showed improved OSTE scores. Future research should clarify which aspects of residents-as-teachers curricula most effectively improve educational outcomes.

California↗

PubMed2006

Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students.

PURPOSE: To systematically review articles reporting on depression, anxiety, and burnout among U.S. and Canadian medical students. METHOD: Medline and PubMed were searched to identify peer-reviewed English-language studies published between January 1980 and May 2005 reporting on depression, anxiety, and burnout among U.S. and Canadian medical students. Searches used combinations of the Medical Subject Heading terms medical student and depression, depressive disorder major, depressive disorder, professional burnout, mental health, depersonalization, distress, anxiety, or emotional exhaustion. Reference lists of retrieved articles were inspected to identify relevant additional articles. Demographic information, instruments used, prevalence data on student distress, and statistically significant associations were abstracted. RESULTS: The search identified 40 articles on medical student psychological distress (i.e., depression, anxiety, burnout, and related mental health problems) that met the authors' criteria. No studies of burnout among medical students were identified. The studies suggest a high prevalence of depression and anxiety among medical students, with levels of overall psychological distress consistently higher than in the general population and age-matched peers by the later years of training. Overall, the studies suggest psychological distress may be higher among female students. Limited data were available regarding the causes of student distress and its impact on academic performance, dropout rates, and professional development. CONCLUSIONS: Medical school is a time of significant psychological distress for physicians-in-training. Currently available information is insufficient to draw firm conclusions on the causes and consequences of student distress. Large, prospective, multicenter studies are needed to identify personal and training-related features that influence depression, anxiety, and burnout among students and explore relationships between distress and competency.

Anxiety Disorders↗

PubMed1993

Mismatch negativity in the neurophysiologic/behavioral evaluation of auditory processing deficits: a case study.

The subject of this case report is an 18-year-old woman with grossly abnormal auditory brain stem response (ABR), normal peripheral hearing, and specific behavioral auditory processing deficits. Auditory middle latency responses (MLRs) and cortical potentials N1, P2, and P300 were intact. The mismatch negativity (MMN) was normal in response to certain synthesized speech stimuli and impaired to others--consistent with her behavioral discrimination of these stimuli. Behavioral tests of auditory processing were consistent with auditory brain stem dysfunction. A neuropsychological evaluation revealed normal intellectual and academic performance. The subject was in her first year of college at the time of the evaluation. This case study is important because: (1) Although there have been several reports of absent/abnormal ABR with preserved peripheral hearing and deficits in auditory processing, little is known about the specific nature of the auditory deficits experienced by these individuals. Such information may be valuable to the clinical management of patients with this constellation of findings. (2) Of interest is the information that the mismatch negativity (MMN) cortical event-related potential can bring to the evaluation of patients with auditory processing deficits. The MMN reflects central auditory processing of small acoustic differences and may provide an objective measure of auditory discrimination. (3) From a theorectical standpoint, a patient with neural deficits affecting specific components of the auditory pathway provides insight into the relationship between evoked potentials and physiological mechanisms of auditory processing. How do various components of the auditory pathway contribute to speech discrimination? How might evoked potentials reflect the processes underlying the neural coding of specific features of speech stimuli such as timing and spectral cues?

Achievement↗

PubMed1989

The trajectory of cognitive development in males with fragile X syndrome.

The trajectory of cognitive development in males with fragile X syndrome was identified in a cross-sectional study of 56 males and in a smaller, longitudinal study of 10 fragile X males. Results from both studies indicated steady cognitive growth until late childhood and early adolescence (10 to 15 years of age), at which point mental age plateaued and IQ declined. Males with higher initial IQ scores manifested more IQ decline than those with initial lower levels of intelligence. The trajectories of IQ differ from those in other etiological groups and mixed groups of retarded individuals. Results have direct implications for intervention strategies with fragile X males. Parents and teachers should be informed about the possibility of an early plateau in mental age, the impact this may have on the child's academic performance, and that the plateau and IQ decline may not be apparent in the child's adaptive behaviors.

Adolescent↗

PubMed1990

Problem behavior in international adoptees: I. An epidemiological study.

Behavioral/emotional problems and competencies in 2,148 international adoptees aged 10 to 15 years were compared with those in a same-aged sample of 933 children from the general population using the Achenbach Child Behavior Checklist. Parents reported more externalizing problem behavior for adopted than nonadopted children. More than twice as many 12- to 15-year-old adopted boys were scored above the cutoff criterion for problem behavior than nonadopted boys of the same age. For adopted boys in this age range especially high scores were obtained on the Delinquent and Hyperactive syndromes. Adopted children were scored less competent than nonadopted children in their social and academic functioning, whereas adopted children were found to be more active in nonsports activities and to function somewhat better than nonadopted children in sports and nonsports activities. In contrast to the effect of parental occupational level on competent scores for normative American and Dutch samples, adopted children from lower SES showed better academic performance, were less often referred to special classes, and had less other school problems than adopted children from higher SES.

Adolescent↗

PubMed1995

Pemoline effects on children with ADHD: a time-response by dose-response analysis on classroom measures.

OBJECTIVE: To evaluate the dose-response by time-response characteristics of pemoline (Cylert) on dependent measures of behavior and academic performance in a laboratory classroom. METHOD: After a 2-week baseline, a double-blind crossover design was used to compare placebo, 18.75 mg, 37.5 mg, 75 mg, and 112.5 mg of pemoline, q.a.m., with each dose administered for 1 week. Medication was given at 9:00 A.M., and performance was measured beginning immediately and beginning 2, 4, and 6 hours after ingestion. The dependent measures included number of math problems completed correctly, teacher-recorded rates of on-task behavior and noncompliance, and teacher ratings on an Abbreviated Conners Teacher Rating Scale. RESULTS: There were linear effects of medication, with pemoline doses greater than 18.75 mg having an effect beginning 2 hours after ingestion and lasting through the seventh hour after ingestion. CONCLUSIONS: Results are contrasted with widespread misbeliefs regarding pemoline's time course and efficacy.

Attention Deficit Disorder with Hyperactivity↗

PubMed1997

Educational and occupational outcome of hyperactive boys grown up.

OBJECTIVE: Little is known about the adult outcome of attention-deficit hyperactivity disorder (ADHD), a very prevalent childhood disorder that is known to affect deleteriously academic performance and other areas of child functioning. This study represents a third wave of evaluations that examine the long-term educational achievement and occupational rank of children with ADHD. METHOD: This is a prospective follow-up of white boys of average intelligence whose ADHD was clinically diagnosed according to systematic criteria at an average age of 7 years. Follow-up intervals range from 15 to 21 years (mean, 17 years). At average age 24 years, 85 probands (representing 82% of the childhood cohort) and 73 controls (84%) were directly interviewed by trained clinicians who were blind to group membership. RESULTS: First, probands completed significantly less formal schooling than controls (about 2 years less, on average). Second, probands had lower-ranking occupational positions than controls. Finally, these disadvantages were not accounted for by adult mental status. CONCLUSIONS: The present study suggests that childhood ADHD predisposes to specific disadvantages and continues to affect important functional domains unrelated to current psychiatric diagnosis.

Adult↗

PubMed1998

Equivalent effects of stimulant treatment for attention-deficit hyperactivity disorder during childhood and adolescence.

OBJECTIVE: To compare the therapeutic effect size of methylphenidate on attention-deficit hyperactivity disorder (ADHD) during childhood versus adolescence. METHOD: A retrospective follow-up study of 16 individuals with diagnosed ADHD who completed double-blind, placebo-controlled, crossover studies of methylphenidate 0.3 mg/kg during two separate summer treatment programs. The programs were completed when the subjects were children (aged 8 to 11 years) and adolescents (aged 12 to 14.5 years). Dependent variables include objective measures of academic performance and social behavior and ratings completed by counselors and teachers. RESULTS: Effect sizes ranged from very large to small, with most effects in the moderate to large range. Across the 12 dependent variables, t tests found that only 3 showed statistically significant changes in effect size from childhood to adolescence. Putative changes in effect sizes can be dismissed for methodological reasons. CONCLUSION: Stimulant medication is equally effective with children and adolescents with ADHD if they are engaged in similar activities. Treatment providers should rigorously examine environmental causes to problems before prescribing higher doses of stimulants to adolescents with ADHD who exhibit a worsening in functioning.

Achievement↗

PubMed1998

Social role functioning by adolescents with psychiatric disorders.

OBJECTIVE: To identify aspects of social role functioning that are impaired in adolescents with specific psychiatric disorders in order to improve the psychiatric taxonomy and clinical knowledge base. METHOD: Adolescents in four urban public schools were screened for mental health problems. Structured psychiatric interviews (National Institute of Mental Health Diagnostic Interview Schedule for Children Version 2.2) with 288 adolescents and their mothers were used to identify youths with psychiatric disorders, and 10 aspects of social role functioning were assessed. Aspects of social role functioning that discriminated between youths with and without psychiatric disorders and between those with emotional disorders and those with disruptive disorders were identified for boys and for girls. RESULTS: Boys with any type of disorder and all youths with disruptive disorders had significant, consistent impairment in academic performance and several other areas of functioning. Youths with emotional disorders, especially girls, demonstrated impairment in social activity participation and peer acceptance, but girls with disorders were not as consistently different from those without as were the boys with emotional disorders. CONCLUSIONS: Role functioning differs in important ways between youths with and without psychiatric disorders and between girls and boys with disorders. The results underscore the importance of investigating observable aspects of role behavior in order to improve the timely detection and effective management of psychiatric disorders in youth.

Adolescent↗

PubMed1999

The third factor of the WISC-III: it's (probably) not freedom from distractibility.

OBJECTIVE: This study examined the ecological validity, construct validity, and diagnostic utility of the third factor of the WISC-III, heuristically labeled "Freedom From Distractibility" (FFD). METHOD: A sample of 200 children, aged 6 to 11 years, with attention-deficit hyperactivity disorder (ADHD) completed the WISC-III, the Wide Range Achievement Test-Revised, and the Test of Variables of Attention. Objective parent and teacher report measures of attention and hyperactivity were completed. RESULTS: Mean FFD scores were significantly lower than other WISC-III factor scores. The diagnostic utility of FFD is limited, however, as the majority of these children did not show a significant relative weakness on this index. Correlational analyses failed to support the concurrent, ecological, or construct validity of the FFD. FFD scores were not correlated with a measure of sustained visual attention. Findings suggest that among children with ADHD, a low FFD score may be associated with the presence of a learning disability or poor academic performance. This finding was maintained after level of general intelligence was statistically controlled. CONCLUSIONS: Clinicians and researchers should not view FFD as a reliable or valid index of attention or as a diagnostic screening measure for identifying children with ADHD.

Achievement↗

PubMed1999

Predicting methylphenidate response in children with ADHD: theoretical, empirical, and conceptual models.

OBJECTIVE: To evaluate the theoretical merit and empirical validity of models designed to predict response to methylphenidate (MPH) among children with attention-deficit/hyperactivity disorder (ADHD). METHOD: Seventy-six children with ADHD received each of 4 counterbalanced doses of MPH (5, 10, 15, and 20 mg) in the context of a double-blind, placebo-controlled, within-subject (crossover) experimental design. Logical and conceptual foundations of 3 models of MPH response were subjected to critical scrutiny, and patterns of relationship anticipated on the basis of these models were subjected to empirical analysis. RESULTS: The conceptual foundations of all reviewed models were found to be substantially flawed, and none provided an adequate empirical basis for predicting response to MPH among children with ADHD. CONCLUSIONS: The observed pattern of relationships suggests that magnitudes of response to MPH in domains of classroom attention and behavioral disinhibition are correlated and differentially predictive of response on measures of academic performance and teacher-rated behavior.

Attention Deficit Disorder with Hyperactivity↗

PubMed1999

Psychopathology and achievement in children at high risk for developing alcoholism.

OBJECTIVE: To compare rates of psychopathology and academic achievement in children who were either at high or low risk for developing alcoholism and to determine whether academic deficits would predict prospectively the presence of psychopathology occurring within the next year. METHOD: Children and adolescents, aged 8 to 18 years, were evaluated as part of a longitudinal follow-up. Diagnoses obtained by using the Schedule for Affective Disorders and Schizophrenia for School-Age Children and grade-equivalent scores from the reading, spelling, and arithmetic sections of the Wide Range Achievement Test were determined at yearly intervals. RESULTS: High-risk offspring were more likely to have a diagnosable disorder. In addition, analyses using the mother's and father's diagnosis of alcoholism as a covariate showed higher hazard ratios for selected disorders (depression, affective disorder, attention-deficit/hyperactivity disorder, and conduct disorder), some of which were gender-dependent. Logistic regression analysis of achievement test scores demonstrated that reading and math scores predicted the presence of childhood psychopathology at the following annual evaluation. CONCLUSIONS: Children from pedigrees with a high density of alcoholism are at greater risk for developing psychopathology. Furthermore, observed deficits in academic performance may be considered an indicator of a developing diagnosable illness.

Adolescent↗

PubMedDate not supplied

Return to school as an outcome measure after a burn injury.

Outcome measures have become an important tool to assist with monitoring the efficacy of burn care. One such measurement for children is the time required for them to return to school, as well as their behavior and academic performance in school after a burn injury. The purpose of this study was to relate demographic data with return-to-school time and school performance. Through medical record review and interviews with patients, parents, and school teachers, information was obtained regarding the patient's burn injury, as well as home and school status before and after the burn injury. School information before the burn injury was obtained after patient admission. Schools were contacted 6 months after hospital discharge for data after the burn injury. Thirty-four patients aged 6 to 16 years had their outcomes evaluated from September 1993 to June 1995. Average total body surface area burned was 25.9%; the mean area of full-thickness burn was 17.5%. Length of stay averaged 30.8 days. Sixty-five percent of patients were discharged with splints, and all were discharged with a pressure program. Children returned to school an average of 7.4 days after discharge, and the average number of missed school days was 22. Thirty-four percent of the children had a school reentry visit, and either a phone call, written material, or both were provided in lieu of a visit to the other schools. For this population, burn injury did not appear to impact outcome negatively as it related to a child's return or function in school. These children returned to school rather rapidly after discharge and functioned as well or better after injury. Little loss of grade was noted, and only those children with problems in school before the burn injury had problems after the burn injury. Contact with the child's school before reentry might have assisted with the smooth transition.

Adolescent↗

PubMed1999

Persistent cough in an adolescent.

Jessica, a 14-year-old girl with a history of asthma, went to her pediatrician's office because of a persistent cough. She had been coughing for at least 3 months with occasional cough-free periods of less than a few days. The cough was nonproductive and was not accompanied by fever, rhinorrhea, or facial or chest pain. Jessica and her mother observed that the cough increased with exercise and typically was not present during sleep. She has used two metered-dose inhalers--albuterol and cromolyn--without any change in the cough pattern. For the past 5 years, Jessica has had mild asthma responsive to albuterol. She enjoys running on the cross-country team, soccer, and dancing. She is an average student and denies any change in academic performance. She has never been hospitalized or had an emergency department visit for asthma or pneumonia. There has been no recent travel or exposure to a person with a chronic productive cough, tobacco smoke, or a live-in pet. Jessica lives with her mother and younger sister in a 10-year-old, carpeted apartment without any evidence of mold or recent renovation. In the process of taking the history, the pediatrician noticed that Jessica coughed intermittently, with two or three coughs during each episode. At times, the cough was harsh; at other times, it was a quiet cough, as if she were clearing her throat. She was cooperative, without overt anxiety or respiratory distress. After a complete physical examination with normal findings, the pediatrician interviewed Jessica and her mother alone. Jessica's parents had been divorced for the past 6 years. She lived with her mother but visited her father, and his new family with two young children, every weekend. She spoke about this arrangement comfortably and said that she loved her father and mother but didn't like the tension she experienced at her father's home. "I don't like adults arguing when kids are around." When asked why she thought the cough persisted so long, she commented in a neutral tone, "I don't know. It's never been like this before." Jessica's pediatrician prescribed an inhaled steroid with the albuterol. When the cough did not respond after 1 week, he ordered a chest radiograph (normal) and a tuberculin skin test (purified protein derivative-negative), and he added montelukast (a leukotriene inhibitor) and monitored airway resistance with a peak flow meter. The cough persisted, and the peak flow recording showed normal airway resistance. At this time, Jessica's pediatrician suspected a conversion reaction and contemplated the next best therapeutic strategy.

Adolescent↗

PubMed2004

Agreement between parent and teacher reports on behavioral problems among chinese children.

Research has consistently shown low to moderate correlations between parent and teacher reports on children's behavioral problems in Western samples. Little is known about the agreement between parent and teacher reports on behavioral problems among Chinese children. The authors examined the agreement on behavioral and emotional problems in a community sample of 2836 Chinese children aged 6 to 11 years from Mainland China. Children's behavioral problems were assessed by the Child Behavior Checklist (CBCL) and Teacher Report Form (TRF). Consistent with most previous studies in Western samples, our results indicated that parent-teacher agreement was low to moderate for attention, externalizing, and internalizing problems. Parent-teacher agreement was higher for attention and externalizing problems than for internalizing problems and decreased with increased behavioral problems. Child's gender, age, and academic performance and father's age were correlated with parent-teacher agreement on ratings of behavioral problems.

Achievement↗

PubMed1992

The physical, psychological, and socioeconomic costs of pediatric trauma.

This prospective study examined the physical, psychological, and socioeconomic effects of injuries on children and their immediate families. Ninety-two injured children admitted with minor (ISS less than 16) or major (ISS greater than or equal to 16) injuries were compared with a control group of 59 children admitted during the same period with acute appendicitis. The two populations were similar in mean age, sex ratio, parental age and work status, and number of siblings. The parents of the injured children had a lower level of education than those of the controls. Fifty-four percent of the minor injury patients and 71% of the major injury patients had persistent physical limitations at 12 months in contrast to none of the controls. Thirty-eight percent of minor injury patients had pre-existing behavioral disturbances compared with 14% of major injury patients and 10% of controls. Behavioral disturbances among major trauma patients showed a sharp rise to 41% at 12 months and tended to persist in cases with continuing physical limitations. The major injury patients and those with significant head injuries exhibited a decrease in academic performance; minor injury patients and those without head injury showed no change. Maternal malaise rose sharply to about 40% in both injury groups in contrast to 7% in the controls and was more common in the presence of persistent physical limitations. Only 73% of families in the major injury group had returned to normal family life compared with 87% of the minor injury group and 100% of controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Achievement↗

PubMedDate not supplied

A nurse-managed universal newborn hearing screen program.

Hearing loss is one of the most common major birth defects, yet the average age for identifying significant hearing loss in children in the United States is 30 months. Hearing loss directly affects a child's ability to develop normal language skills, impairs his or her ability to communicate with others in the environment, and has been shown to correlate with poor academic performance. However, if hearing loss is detected early and interventions are begun before 6 months of age, children with hearing loss develop language, cognitive, and speech skills comparable to their non-hearing-impaired peers. Only 38 states mandate universal newborn hearing screening before discharge from the hospital. This article describes an institutional universal hearing screening program developed by nursing, which collaborated with physicians, audiologists, and otolaryngologists. Careful planning, including a thorough literature review, networking with area hospitals, and dialoging with experts in the field led to a successful program.The outcomes from this program compare favorably to nationally published data.

Developmental Disabilities↗