BACKGROUND: Despite substantial research on medical student mistreatment, there is scant quantitative data on microaggressions in US medical education. OBJECTIVE: To assess US medical students' experiences of microaggressions and how these experiences influenced students' mental health and medical school satisfaction. DESIGN AND PARTICIPANTS: We conducted a crosssectional, online survey of US medical students' experiences of microaggressions. MAIN MEASURES: The primary outcome was a positive depression screen on the 2-item Patient Health Questionnaire (PHQ-2). Medical school satisfaction was a secondary outcome. We used logistic regression to model the association between respondents' reported microaggression frequency and the likelihood of a positive PHQ-2 screen. For secondary outcomes, we used the chi-squared statistic to test associations between microaggression exposure and medical school satisfaction. KEY RESULTS: Out of 759 respondents, 61% experienced at least one microaggression weekly. Gender (64.4%), race/ethnicity (60.5%), and age (40.9%) were the most commonly cited reasons for experiencing microaggressions. Increased microaggression frequency was associated with a positive depression screen in a dose-response relationship, with second, third, and fourth (highest) quartiles of microaggression frequency having odds ratios of 2.71 (95% CI: 1-7.9), 3.87 (95% CI: 1. , relative to the first quartile. Medical students who experienced at least one microaggression weekly were more likely to consider medical school transfer (14.5% vs 4.7%, p<0.001) and withdrawal (18.2% vs 5.7%, p<0.001) and more likely to believe microaggressions were a normal part of medical school culture (62.3% vs 32.1%) compared to students who experienced microaggressions less frequently. CONCLUSIONS: To our knowledge, this is the largest study on the experiences and influences of microaggressions among a national sample of US medical students. Our major findings were that microaggressions are frequent occurrences and that the experience of microaggressions was associated with a positive depression screening and decreased medical school satisfaction.

ABSTRACTObjectives: To assess and compare the prevalence of psychological morbidity among survivors of the 2005 northern Pakistan earthquake from Azad Kashmir and the Northwest Frontier Province (NWFP).Methods: We conducted a cross-sectional study among randomly sampled survivors (N = 361) of the earthquake living in camps at the time of the interview, approximately 6 months after the earthquake.Results: The prevalence of posttraumatic stress disorder (PTSD) symptoms in the total sample was 51.5% and the prevalence of individuals who received positive scores on the Hopkins Symptom Checklist (HSCL) was 75%. The prevalence rates for anxiety and depression symptoms were 77.3% and 70.9%, respectively. The prevalence in Azad Kashmir was 57.9% for PTSD and 79.8% for positive HSCL, and NWFP had 41.3% PTSD and 67.4% positive HSCL. Study subjects from Azad Kashmir were approximately 2 times as likely to have PTSD or a positive HSCL when compared to subjects from NWFP (odds ratio 1.95, confidence interval 1.27-3.0; P = .0024) and (odds ratio 1.91, confidence interval 1.18-3.1; P = .0085), respectively.Conclusions: Nearly half of the northern Pakistan earthquake survivors had symptoms of PTSD. Six months after the incident, more than three-fourths exhibited symptoms of an anxiety disorder.(Disaster Med Public Health Preparedness. 2011;5:293–299)

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Transfers of care have been associated with adverse events. High quality sign-out may help mitigate this risk. The authors sought to characterize the clinical questions asked of physicians covering patients overnight and to determine the adequacy of current sign-out practice to anticipate inquiries. The authors conducted a prospective, self-report study of interns’ overnight experience at two hospitals. We collected data from novice interns (July 7–August 3, 2010) and experienced interns (March 2–March 29, 2011) in an Internal Medicine residency program. Interns recorded information about overnight inquiries regarding cross-covered patients. For each inquiry about a patient, the intern was asked to record what the situation was about, who initiated the contact, where the intern found the desired information, whether all required data was located, whether the call could have been anticipated by the primary team, if so, whether the call was anticipated, whether the sign-out was sufficient, the time required to address the question, and whether the patient was physically visited. Twenty-one interns (13 novice, 8 experienced) reported 167 overnight inquiries. Most were from nursing staff (87 %) about a wide range of topics, with orders (25 %) and plan of care (20 %) being most common. Trainees used the oral or written sign-out to answer 56 % of inquiries. The proportion of inquiries successfully anticipated (47 % overall) significantly decreased as the academic year progressed (AOR = 0.4, 95 % CI 0.2, 0.8). Trainees rely on sign-out to answer nearly half of overnight inquiries, but the quality of sign-out may decrease over the course of the academic year. The deterioration of sign-out quality from novice to experienced interns and the common use of sign-out as a reference by covering interns suggest continued education, support and oversight by supervising physicians may be beneficial.

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