BackgroundPhysicians’ tolerance of uncertainty (TU) is a trait potentially associated with desirable outcomes, and emerging evidence suggests it may change over time. Past studies of TU, however, have been cross-sectional and have not measured tolerance of the different, specific types of uncertainty that physicians confront. We addressed these limitations in a longitudinal exploratory study of medical students.MethodsAt the end of medical school (Doctor of Medicine degree) Years 1 and 4, a cohort of 26 students at a US medical school completed measures assessing tolerance of different types of uncertainty: 1) complexity (uncertainty arising from features of information that make it difficult to comprehend); 2) risk (uncertainty arising from the indeterminacy of future outcomes); and 3) ambiguity (uncertainty arising from limitations in the reliability, credibility, or adequacy of information). Change in uncertainty-specific TU was assessed using paired t-tests.ResultsBetween Years 1 and 4, there was a significant decrease in tolerance of ambiguity (t=3.22, p=0.004), but no change in students’ tolerance of complexity or risk.ConclusionsTolerance of ambiguity – but not other types of uncertainty – decreases during medical school, suggesting that TU is a multidimensional, partially mutable state. Future studies should measure tolerance of different uncertainties and examine how TU might be improved.

To identify barriers to outdoor physical activity in winter among Somali youth in Maine. Despite the many proven health benefits of physical activity among children, such as cardiovascular fitness and health status as an adult, there has been a decrease in physical activity among children in recent years. Specifically, children who are of low socio-economic status or are from communities where many immigrants are at increased risk for developing obesity. Immigrants are also less likely to be physically active. There are many potential barriers to wintertime physical activity among Somali youth in Maine, such as lack of financial resources, transportation, proper winter clothing, and appropriate knowledge of winter safety, and language and cultural barriers. For females, different attire required for outdoor activity may be a barrier. Somali parents and children were recruited from Portland, Maine to participate in focus groups led by a trained facilitator with a Somali translator and cultural broker. Transcripts were coded using NVIVO software to identify barriers to physical activity among Somali youth outside in winter. Eight focus groups were conducted. Sixty-one Somali community members were recruited. Participants felt outdoor physical activity is important, but note that it is decreased in winter. Barriers to outdoor activity in winter cited by focus group participants were lack of resources, health concerns, gender barriers for females, and knowledge barriers. Concern over lack of supervision while children play outside was also cited. This study revealed many of the underlying beliefs, barriers and cultural issues that impact Somali families' intention to be active and ability to be active outdoors in winter. These findings can be used to generate research hypotheses and public health interventions regarding outdoor physical activity among Somali youth.

ObjectivesThe purpose of this study was to evaluate Family Medicine Clerkship students’ writing skills using an anchored scoring rubric. In this study, we report on the assessment of a current scoring rubric (SR) used to grade written case description papers (CDP) for medical students, describe the development of a revised SR with examination of scoring consistency among faculty raters, and report on feedback from students regarding SR revisions and written CDP.MethodsFive faculty members scored a total of eighty-three written CDP using both the Original SR (OSR) and the Revised SR1 (RSR1) during the 2009-2010 academic years.ResultsOverall increased faculty inter-rater reliability was obtained using the RSR1. Additionally, this subset analysis revealed that the five faculty using the Revised SR2 (RSR2) had a high measure of inter-rater reliability on their scoring of this subset of papers (as measured by intra-class correlation (ICC) with ICC = 0.93, p < 0.001.ConclusionsFindings from this research have implications for medical education, by highlighting the importance of the assessment and development of reliable evaluation tools for medical student writing projects.

The majority (76%) of persons arrested for prescription drug trafficking did not have PMP records and did not directly obtain the diverted medication from a licensed pharmacy. Traditional red flags, like cash payment and using multiple prescribers or pharmacies, were uncommon. Therefore, arrest records for diversion and PMPs are distinct and complementary tools for identifying individuals at risk for substance misuse.

Public libraries and health appear to intersect around substance abuse and depression-anxiety disorders. Moderate or higher use of public libraries is strongly associated with tobacco cessation.