ObjectiveTo investigate the association between cigarette use during pregnancy and pregnancy-induced hypertension/preeclampsia/eclampsia (PIH) by maternal race/ethnicity and age.MethodsThis retrospective cohort study was based on the U.S. 2010 natality data. Our study sample included U.S. women who delivered singleton pregnancies between 20 and 44 weeks of gestation without major fetal anomalies in 2010 (n = 3,113,164). Multivariate logistic regression models were fit to estimate crude and adjusted odds ratios and the corresponding 95% confidence intervals.ResultsWe observed that the association between maternal smoking and PIH varied by maternal race/ethnicity and age. Compared with non-smokers, reduced odds of PIH among pregnant smokers was only evident for non-Hispanic white and non-Hispanic American Indian women aged less than 35 years. Non-Hispanic Asian/Pacific Islander women who smoked during pregnancy had increased odds of PIH regardless of maternal age. Non-Hispanic white and non-Hispanic black women 35 years or older who smoked during pregnancy also had increased odds of PIH.ConclusionOur study findings suggest important differences by maternal race/ethnicity and age in the association between cigarette use during pregnancy and PIH. More research is needed to establish the biologic and social mechanisms that might explain the variations with maternal age and race/ethnicity that were observed in our study.

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The results of this study suggest that performance on Step 1 can be used to identify and counsel students at risk for poor performance on the Subject Examinations. In addition, these findings call into the question the validity of using scores from Subject Examinations as a high-stakes assessment of learning in individual clerkships.

Purpose The ability of medical schools to accurately and reliably assess medical student clinical performance is paramount. The RIME (reporter–interpreter–manager–educator) schema was originally developed as a synthetic and intuitive assessment framework for internal medicine clerkships. Validity evidence of this framework has not been rigorously evaluated outside of internal medicine. This study examined factors contributing to variability in RIME assessment scores using generalizability theory and decision studies across multiple clerkships, thereby contributing to its internal structure validity evidence. Method Data were collected from RIME-based summative clerkship assessments during 2018–2019 at Virginia Commonwealth University. Generalizability theory was used to explore variance attributed to different facets through a series of unbalanced random-effects models by clerkship. For all analyses, decision (D-) studies were conducted to estimate the effects of increasing the number of assessments. Results From 231 students, 6,915 observations were analyzed. Interpreter was the most common RIME designation (44.5%–46.8%) across all clerkships. Variability attributable to students ranged from 16.7% in neurology to 25.4% in surgery. D-studies showed the number of assessments needed to achieve an acceptable reliability (0.7) ranged from 7 in pediatrics and surgery to 11 in internal medicine and 12 in neurology. However, depending on the clerkship each student received between 3 and 8 assessments. Conclusions This study conducted generalizability- and D-studies to examine the internal structure validity evidence of RIME clinical performance assessments across clinical clerkships. Substantial proportion of variance in RIME assessment scores was attributable to the rater, with less attributed to the student. However, the proportion of variance attributed to the student was greater than what has been demonstrated in other generalizability studies of summative clinical assessments. Overall, these findings support the use of RIME as a framework for assessment across clerkships and demonstrate the number of assessments required to obtain sufficient reliability.

Instructions: Check the box that most nearly approximates the student's performance. This evaluation form is to be used to assess student performance and will be the basis for the resident and attending physician portion of the final grade. Evaluate the student at the M-3 Level, taking into account their degree of experience from previous M-3 clerkships.

PURPOSE: We aimed to test whether measures of resident well-being correlated with perceptions of program support and psychological safety. BACKGROUND: Trainee well-being is a crucial component of developing competent and skilled OB/GYN physicians. While there are several measures of well-being collected at the national-level, there is little insight in the role of individual programs to foster trainee well-being. Perceived organizational and psychological safety are two constructs that can help identify cultural aspects of the clinical learning environment that may relate to trainee well-being. METHODS: OBGYN residents in a training program were recruited to complete an IRB-approved survey through paper and electronic methods between May-June 2018. Measures included the Survey of Perceived Organizational Support (POS), Psychological Safety Scale (PS), Perceived Stress Scale (PSS), Wayne State Wellness Scale (RWS) and Physician Well-Being Index (PWBI); all demonstrate validity and reliability evidence to assess factors of well-being and cultural aspects of the training program. Results: 20 OBGYN residents completed our survey. Results indicated a strong relationship between perceived organizational support and wellness (r=.62, P<.01 for RWS, r=.50, P<.05 for PWB)., suggesting greater perceptions of support relate to better wellness. Similarly, psychological safety also had a strong relationship with wellness (r=.56, p<.05 for RWS; r=-.72, p<.01 for PWB). DISCUSSION: Our findings suggest that there is a strong relationship between trainee wellness and the cultural measures of support and safety, especially between psychological safety and negative indicators of well-being (e.g., feeling burnt out from work, feelings of irritation). Further research should include interventions to improve perceptions of support and safety.

The purpose of medical school is to train students to become excellent physicians. An excellent physician is one who possesses diverse skills including a strong clinical knowledge base, interpersonal communication skills, and professionalism. 1 While some of these skills may be introduced in the classroom, dedicated clinical teaching and learning at the bedside is critical. 2 Unfortunately, competition for the residency match in the United States motivates learners to perform well. 3 This pressure to perform may lead increase focus on clinical grades, and a disproportionate emphasis on preparation for knowledge-based assessments rather than time spent developing diverse doctoring skills at the bedside. 4

In this article we address the concept of burnout, first in the medical student setting, and then in the residency setting. We will review the prevalence followed by a discussion of risk factors, consequences, and finally thoughts on prevention and intervention.