Adina L Kalet, M.D.

Assessment of medical student clinical reasoning by "lay" vs physician raters: inter-rater reliability using a scoring guide in a multidisciplinary objective structured clinical examination
Berger, Alexandra J; Gillespie, Colleen C; Tewksbury, Linda R; Overstreet, Ivey M; Tsai, Ming C; Kalet, Adina L; Ogilvie, Jennifer B
2012 Jan;203(1):81-86, American journal of surgery
BACKGROUND: To determine whether a 'lay' rater could assess clinical reasoning, interrater reliability was measured between physician and lay raters of patient notes written by medical students as part of an 8-station objective structured clinical examination. METHODS: Seventy-five notes were rated on core elements of clinical reasoning by physician and lay raters independently, using a scoring guide developed by physician consensus. Twenty-five notes were rerated by a 2nd physician rater as an expert control. Kappa statistics and simple percentage agreement were calculated in 3 areas: evidence for and against each diagnosis and diagnostic workup. RESULTS: Agreement between physician and lay raters for the top diagnosis was as follows: supporting evidence, 89% (kappa = .72); evidence against, 89% (kappa = .81); and diagnostic workup, 79% (kappa = .58). Physician rater agreement was 83% (kappa = .59), 92% (kappa = .87), and 96% (kappa = .87), respectively. CONCLUSIONS: Using a comprehensive scoring guide, interrater reliability for physician and lay raters was comparable with reliability between 2 expert physician raters
— id: 147696, year: 2012, vol: 203, page: 81, stat: Journal Article,

The professionalism curriculum as a cultural change agent in surgical residency education
Hochberg MS; Berman RS; Kalet AL; Zabar SR; Gillespie C; Pachter HL
2011 Jan;203(1):14-20, American journal of surgery
BACKGROUND: Teaching professionalism effectively to fully engaged residents is a significant challenge. A key question is whether the integration of professionalism into residency education leads to a change in resident culture. METHODS: The goal of this study was to assess whether professionalism has taken root in the surgical resident culture 3 years after implementing our professionalism curriculum. Evidence was derived from 3 studies: (1) annual self-assessments of the residents' perceived professionalism abilities to perform 20 defined tasks representing core Accrediting Council on Graduate Medical Education professionalism domains, (2) objective metrics of their demonstrated professionalism skills as rated by standardized patients annually using the objective structure clinical examination tool, and (3) a national survey of the Surgical Professionalism and Interpersonal Communications Education Study Group. RESULTS: Study 1: aggregate perceived professionalism among surgical residents shows a statistically significant positive trend over time (P = .016). Improvements were seen in all 6 domains: accountability, ethics, altruism, excellence, patient sensitivity, and respect. Study 2: the cohort of residents followed up over 3 years showed a marked improvement in their professionalism skills as rated by standardized patients using the objective structure clinical examination tool. Study 3: 41 members of the national Surgical Professionalism and Interpersonal Communications Education Study Group rated their residents' skills in admitting mistakes, delivering bad news, communication, interdisciplinary respect, cultural competence, and handling stress. Twenty-nine of the 41 responses rated their residents as 'slightly better' or 'much better' compared with 5 years ago (P = .001). Thirty-four of the 41 programs characterized their department's leadership view toward professionalism as 'much better' compared with 5 years ago. CONCLUSIONS: All 3 assessment methods suggest that residents feel increasingly prepared to effectively deal with the professionalism challenges they face. Although professionalism seminars may have seemed like an oddity several years ago, residents today recognize their importance and value their professionalism skills. As importantly, department chairpersons report that formal professionalism education for residents is viewed more favorably compared with 5 years ago
— id: 141463, year: 2011, vol: 203, page: 14, stat: Journal Article,

More thoughts about residents' professionalism education in malpractice
Hochberg, Mark S; Kalet, Adina L; Zabar, Sondra R
2011 Oct;86(10):1192-1193, Academic medicine
— id: 137896, year: 2011, vol: 86, page: 1192, stat: Journal Article,

Perspective: Malpractice in an academic medical center: a frequently overlooked aspect of professionalism education
Hochberg, Mark S; Seib, Carolyn D; Berman, Russell S; Kalet, Adina L; Zabar, Sondra R; Pachter, H Leon
2011 Mar;86(3):365-368, Academic medicine
Understanding how medical malpractice occurs and is resolved is important to improving patient safety and preserving the viability of a physician's career in academic medicine. Every physician is likely to be sued by a patient, and how the physician responds can change his or her professional life. However, the principles of medical malpractice are rarely taught or addressed during residency training. In fact, many faculty at academic medical centers know little about malpractice.In this article, the authors propose that information about the inciting causes of malpractice claims and their resolution should be incorporated into residency professionalism curricula both to improve patient safety and to decrease physician anxiety about a crucial aspect of medicine that is not well understood. The authors provide information on national trends in malpractice litigation and residents' understanding of malpractice, then share the results of their in-depth review of surgical malpractice claims filed during 2001-2008 against their academic medical center. The authors incorporated those data into an evidence-driven curriculum for residents, which they propose as a model for helping residents better understand the events that lead to malpractice litigation, as well as its process and prevention
— id: 129319, year: 2011, vol: 86, page: 365, stat: Journal Article,

Undergraduate medical education in substance abuse: a review of the quality of the literature
Kothari, Devyani; Gourevitch, Marc N; Lee, Joshua D; Grossman, Ellie; Truncali, Andrea; Ark, Tavinder K; Kalet, Adina L
2011 Jan;86(1):98-112, Academic medicine
PURPOSE: To prepare to develop a medical school curriculum on substance abuse disorders (SADs), the authors conducted a review of the quality of the sparse published literature. METHOD: The authors searched MEDLINE (1950 through December 2008) using OVID, PsycINFO, and PubMed to identify all studies of SAD interventions targeted toward undergraduate medical students. Of the 1,084 studies identified initially, 31 reported sufficient data to allow the authors to evaluate quality using Medical Education Research Study Quality Instrument (MERSQI) scores. The authors also determined the impact of the studies by considering three-year citation rate and journal impact factor. A detailed review of the literature provided data on contact hours and intervention content. RESULTS: The three-rater intraclass correlation coefficient for total MERSQI score was 0.82 (95% confidence interval: 0.70-0.90). The mean MERSQI score was 10.42 of a possible 18 (SD 2.59; range: 6.33-14.83). MERSQI scores were higher for more recently published studies and correlated with three-year citation rate but not impact factor. The mean contact time for 26 studies was 29.25 hours (range: 0.83-200 hours). CONCLUSIONS: The literature provides a variety of educational methods to train medical students in SAD detection and intervention skills. This literature is of variable quality and provides limited guidance for development of curricula and medical education policy. Better methods of curriculum evaluation and publication guidelines would help ensure that this literature has a positive impact on educational practice and public health
— id: 119230, year: 2011, vol: 86, page: 98, stat: Journal Article,

Assessing medical students' self-regulation as aptitude in computer-based learning
Song, Hyuksoon S; Kalet, Adina L; Plass, Jan L
2011 Mar;16(1):97-107, Advances in health sciences education
We developed a Self-Regulation Measure for Computer-based learning (SRMC) tailored toward medical students, by modifying Zimmerman's Self-Regulated Learning Interview Schedule (SRLIS) for K-12 learners. The SRMC's reliability and validity were examined in 2 studies. In Study 1, 109 first-year medical students were asked to complete the SRMC. Bivariate correlation analysis results indicated that the SRMC scores had a moderate degree of correlation with student achievement in a teacher-developed test. In Study 2, 58 third-year clerkship students completed the SRMC. Regression analysis results indicated that the frequency of medical students' usage of self-regulation strategies was associated with their general clinical knowledge measured by a nationally standardized licensing exam. These two studies provided evidence for the reliability and concurrent validity of the SRMC to assess medical students' self-regulation as aptitude. Future work should provide evidence to guide and improve instructional design as well as inform educational policy
— id: 130961, year: 2011, vol: 16, page: 97, stat: Journal Article,

A Web-Based Module on Neurobiology to Engage Students in Substance Abuse Research
Truncali, A.; Lee, J. D.; Gillespie, C.; Ross, S.; Kerr, D.; Huben, L.; Kalet, A. L.; Moore, F.; Naegle, M.; Gourevitch, M. N.
2011 ;32(1):53-54, Substance abuse
— id: 128810, year: 2011, vol: 32, page: 53, stat: Journal Article,

Teaching physicians to address unhealthy alcohol use: a randomized controlled trial assessing the effect of a Web-based module on medical student performance
Truncali, Andrea; Lee, Joshua D; Ark, Tavinder K; Gillespie, Colleen; Triola, Marc; Hanley, Kathleen; Gourevitch, Marc N; Kalet, Adina L
2011 Mar;40(2):203-213, Journal of substance abuse treatment
BACKGROUND: The authors developed and evaluated an interactive, Web-based module to train medical students in screening and brief intervention (SBI) for unhealthy alcohol use. METHODS: First-year students were randomized to module versus lecture. Change in knowledge, attitudes, and confidence were compared. Performance was assessed by objective structured clinical examination (OSCE) and analyzed by intention to treat and treatment received. RESULTS: Of 141 consenting students, 64% (n = 90) completed an intervention (54% lecture vs. 70% Web assigned). Knowledge, confidence, and attitudes improved in both groups, with more improvement in Advise-Assist knowledge for Web students (14% vs. -3%, p = .003). Web students outperformed their lecture peers in both general communication (65% vs. 51% items well done, p = .004) and alcohol-specific tasks (54% vs. 41%, p = .021) on OSCE. Analysis by treatment received enhanced between-group differences. CONCLUSION: Use of a Web-based module to teach SBI is associated with greater knowledge gain and skills performance compared with a lecture covering similar content. The module provides an efficient means for training in this area
— id: 138090, year: 2011, vol: 40, page: 203, stat: Journal Article,

BASELINE ASSESSMENT OF INCOMING MEDICAL STUDENTS COMMUNICATION SKILLS: THE NYU CURRICULUM FOR THE 21ST CENTURY BASELINE OSCE
Gillespie, C; Hanley, K; Adams, J; Zabar, S; Kalet, A
2010 JUN ;25(9):232-232, Journal of general internal medicine
— id: 111908, year: 2010, vol: 25, page: 232, stat: Journal Article,

PATIENT ACTIVATION: HOW ARE PATIENT ACTIVATING SKILLS RELATED TO OTHER CORE CLINICAL SKILLS?
Gillespie, C; Hanley, K; Kalet, A; Zabar, S; Porter, B
2010 JUN ;25(9):340-341, Journal of general internal medicine
— id: 111914, year: 2010, vol: 25, page: 340, stat: Journal Article,

STUDENTS WHO DEVELOP SELF-ASSESSMENT SKILLS IN A STRUCTURED VIDEOTAPE REVIEW IMPROVE THEIR INTERVIEWING SKILLS WITH STANDARDIZED PATIENTS
Hanley, K; Zabar, S; Disney, L; Kalet, A; Gillespie, C
2010 JUN ;25(9):393-394, Journal of general internal medicine
— id: 111917, year: 2010, vol: 25, page: 393, stat: Journal Article,

Can professionalism be taught? Encouraging evidence
Hochberg, Mark S; Kalet, Adina; Zabar, Sondra; Kachur, Elizabeth; Gillespie, Colleen; Berman, Russell S
2010 Jan;199(1):86-93, American journal of surgery
BACKGROUND: Teaching and assessing the Accreditation Council for Graduate Medical Education (ACGME) competencies of Professionalism and Communication have proven to be a challenge for surgical residency training programs. This study used innovative pedagogic approaches and tools in teaching these two competencies. The purpose of this study was to determine whether the learners actually are assimilating and using the concepts and values communicated through this curriculum. METHODS: A six-station Objective Structured Clinical Examination (OSCE) was designed using standardized patients to create varying Professionalism and Communication scenarios. The surgical resident learners were evaluated using these OSCEs as a baseline. The faculty then facilitated a specially designed curriculum consisting of six interactive sessions focusing on information gathering, rapport building, patient education, delivering bad news, responding to emotion, and interdisciplinary respect. At the conclusion of this curriculum, the surgical resident learners took the same six-station OSCE to determine if their professionalism and communication skills had improved. RESULTS: The surgical resident learners were rated by the standardized patients according to a strict task checklist of criteria at both the precurricular and postcurricular OSCEs. Improvement in the competencies of Professionalism and Communication did achieve statistical significance (P = .029 and P = .011, respectively). CONCLUSIONS: This study suggests that the Communication and Professionalism ACGME competencies can be taught to surgical resident learners through a carefully crafted curriculum. Furthermore, these newly learned competencies can affect surgical resident interactions with their patients positively
— id: 106382, year: 2010, vol: 199, page: 86, stat: Journal Article,

Physicians' use of the 5As in counseling obese patients: is the quality of counseling associated with patients' motivation and intention to lose weight?
Jay, Melanie; Gillespie, Colleen; Schlair, Sheira; Sherman, Scott; Kalet, Adina
2010 ;10:159-159, BMC health services research
ABSTRACT: BACKGROUND: Physicians are encouraged to counsel obese patients to lose weight, but studies measuring the quality of physicians' counseling are rare. We sought to describe the quality of physicians' obesity counseling and to determine associations between the quality of counseling and obese patients' motivation and intentions to lose weight, key predictors of behavior change. METHODS: We conducted post-visit surveys with obese patients to assess physician's use of 5As counseling techniques and the overall patient-centeredness of the physician.. Patients also reported on their motivation to lose weight and their intentions to eat healthier and exercise. One-way ANOVAs were used to describe mean differences in number of counseling practices across levels of self-rated intention and motivation. Logistic regression analyses were conducted to assess associations between number of 5As counseling practices used and patient intention and motivation. RESULTS: 137 patients of 23 physicians were included in the analysis. While 85% of the patients were counseled about obesity, physicians used only a mean of 5.3 (SD = 4.6) of 18 possible 5As counseling practices. Patients with higher levels of motivation and intentions reported receiving more 5As counseling techniques than those with lower levels. Each additional counseling practice was associated with higher odds of being motivated to lose weight (OR 1.31, CI 1.11-1.55), intending to eat better (OR 1.23, CI 1.06-1.44), and intending to exercise regularly (OR 1.14, CI 1.00-1.31). Patient centeredness of the physician was also positively associated with intentions to eat better (OR 2.96, CI 1.03-8.47) and exercise (OR 26.07, CI 3.70-83.93). CONCLUSIONS: Quality of physician counseling (as measured using the 5As counseling framework and patient-centeredness scales) was associated with motivation to lose weight and intentions to change behavior. Future studies should determine whether higher quality obesity counseling leads to improved behavioral and weight outcomes
— id: 110871, year: 2010, vol: 10, page: 159, stat: Journal Article,

From the patient's perspective: the impact of training on resident physician's obesity counseling
Jay, Melanie; Schlair, Sheira; Caldwell, Rob; Kalet, Adina; Sherman, Scott; Gillespie, Colleen
2010 May;25(5):415-422, Journal of general internal medicine
BACKGROUND: It is uncertain whether training improves physicians' obesity counseling. OBJECTIVE: To assess the impact of an obesity counseling curriculum for residents. DESIGN: A non-randomized, wait-list/control design. PARTICIPANTS: Twenty-three primary care internal medicine residents; 12 were assigned to the curriculum group, and 11 were assigned to the no-curriculum group. Over a 7-month period (1-8 months post-intervention) 163 of the residents' obese patients were interviewed after their medical visits. INTERVENTION: A 5-hour, multi-modal obesity counseling curriculum based on the 5As (Assess, Advise, Agree, Assist, Arrange) using didactics, role-playing, and standardized patients. MAIN MEASURES: Patient-report of physicians' use of the 5As was assessed using a structured interview survey. Main outcomes were whether obese patients were counseled about diet, exercise, or weight loss (rate of counseling) and the quality of counseling provided (percentage of 5As skills performed during the visit). Univariate statistics (t-tests) were used to compare the rate and quality of counseling in the two resident groups. Logistic and linear regression was used to isolate the impact of the curriculum after controlling for patient, physician, and visit characteristics. KEY RESULTS: A large percentage of patients seen by both groups of residents received counseling about their weight, diet, and/or exercise (over 70%), but the quality of counseling was low in both the curriculum and no curriculum groups (mean 36.6% vs. 31.2% of 19 possible 5As counseling strategies, p = 0.21). This difference was not significant. However, after controlling for patient, physician and visit characteristics, residents in the curriculum group appeared to provide significantly higher quality counseling than those in the control group (std beta = 0.18; R(2) change = 2.9%, P < 0.05). CONCLUSIONS: Residents who received an obesity counseling curriculum were not more likely to counsel obese patients than residents who did not. Training, however, is associated with higher quality of counseling when patient, physician, and visit characteristics are taken into account
— id: 130962, year: 2010, vol: 25, page: 415, stat: Journal Article,

SHE FELL OFF THE CLIFF AND SURVIVED! STEREOTYPE THREAT AS A TREATABLE CAUSE FOR CLINICAL INCOMPETENCE IN NON-TRADITIONAL MEDICAL STUDENTS
Kalet, A; Taffel, L; Bruno, JH; Tewksbury, L
2010 JUN ;25(9):547-547, Journal of general internal medicine
— id: 111925, year: 2010, vol: 25, page: 547, stat: Journal Article,

WHO FAILS CLINICAL SKILLS EXAMS? DESCRIPTIVE EPIDEMIOLOGY TO INFORM CLINICAL SKILLS REMEDIATION
Kalet, A; Tewksbury, L; Bruno, JH; Taffel, L
2010 JUN ;25(9):454-454, Journal of general internal medicine
— id: 111921, year: 2010, vol: 25, page: 454, stat: Journal Article,

New measures to establish the evidence base for medical education: identifying educationally sensitive patient outcomes
Kalet, Adina L; Gillespie, Colleen C; Schwartz, Mark D; Holmboe, Eric S; Ark, Tavinder K; Jay, Melanie; Paik, Steve; Truncali, Andrea; Hyland Bruno, Julia; Zabar, Sondra R; Gourevitch, Marc N
2010 May;85(5):844-851, Academic medicine
Researchers lack the rich evidence base and benchmark patient outcomes needed to evaluate the effectiveness of medical education practice and guide policy. The authors offer a framework for medical education research that focuses on physician-influenced patient outcomes that are potentially sensitive to medical education. Adapting the concept of ambulatory care sensitive conditions, which provided traction to health services research by defining benchmark patient outcomes to measure health system performance, the authors introduce the concept and propose the adoption of educationally sensitive patient outcomes and suggest two measures: patient activation and clinical microsystem activation. They assert that the ultimate goal of medical education is to ensure that measurement of future physicians' competence and skills is based not only on biomedical knowledge and critical clinical skills but also on the ability to translate these competencies into effective patient- and systems-level outcomes. The authors consider methodological approaches and challenges to measuring such outcomes and argue for large, multiinstitutional, prospective cohort studies and the development of a national Database for Research in Education in Academic Medicine to provide the needed infrastructure. They advocate taking the next steps to establish an educational evidence base to guide the academic medical centers of the 21st century in aligning medical education practice with health care delivery that meets the needs of individuals and populations
— id: 110111, year: 2010, vol: 85, page: 844, stat: Journal Article,

WHAT THEY BRING WITH THEM TO MEDICAL SCHO
Mercuri, J; Gillespie, C; Hanley, K; Zabar, S; Kalet, A
2010 JUN ;25(9):431-431, Journal of general internal medicine
— id: 111920, year: 2010, vol: 25, page: 431, stat: Journal Article,

Immediate and follow-up effects of a brief disability curriculum on disability knowledge and attitudes of PM&R residents: a comparison group trial
Moroz, Alex; Gonzalez-Ramos, Gladys; Festinger, Trudy; Langer, Karen; Zefferino, Stephanie; Kalet, Adina
2010 ;32(8):e360-e364, Medical teacher
BACKGROUND: Humanistic attitudes are essential in physicians and therefore supporting them is a key component in graduate medical education (GME). The importance of a physician's attitude toward people with disability is especially relevant within the rehabilitation discipline, as prevailing attitudes and misconceptions can be potential barriers to successful diagnosis and treatment. AIM: This study was designed to examine the relationship between participation in a brief disability sensitivity training and knowledge of disability and attitudes of physical medicine and rehabilitation (PM&R) residents toward people with disability. METHODS: A daylong training for residents consisted of lectures and a panel presentation that covered (1) disability facts, (2) personal stories of people with disabilities, and (3) medical evaluation of disability. The presentations were followed by a simulation experience where resident pairs (one assigned to a wheel chair, the other a 'caretaker') performed various tasks. This was followed by a group discussion of their experience. Three instruments were administered prior to the training: (1) a brief demographic questionnaire, (2) 30 multiple choice questions measuring various aspects of knowledge about disability, and (3) the Scale of Attitudes toward Disabled Persons, Form R (SADP). After the training experience, the knowledge instrument and the SADP were re-administered along with a series of items to measure various aspects of students' satisfaction with the training. The three instruments described were re-administered 3 months post-training. RESULTS: There was significant immediate gain in both the disability knowledge and the attitude scores among trainees as compared to a control group of physiatry residents in standard medical training. Knowledge gains of the disability sensitivity training group did not persist, but attitude toward disability gains remained at the 3 months follow up. CONCLUSION: After a brief curriculum in disability knowledge and sensitivity for PM&R physicians in training, there was a short-term improvement in disability knowledge and an improvement in disability attitudes sustained at 3 months
— id: 111614, year: 2010, vol: 32, page: e360, stat: Journal Article,

ASSESSING RESIDENTS COMPETENCE IN TWO CONTEXTS: STANDARDIZED PATIENT EXAMS AND UNANNOUNCED STANDARDIZED PATIENT VISITS
Zabar, S; Lipkin, M; Hanley, K; Burgess, A; Bruno, JH; Adams, J; Kalet, A; Gillespie, C
2010 JUN ;25(9):227-227, Journal of general internal medicine
— id: 111907, year: 2010, vol: 25, page: 227, stat: Journal Article,

UNANNOUNCED STANDARDIZED PATIENTS: A NOVEL METHOD OF ASSESSING THE CLINICAL CARE TEAM
Zabar, S; Murphy, J; Hanley, K; Stevens, D; Burgess, A; Bruno, JH; Kalet, A; Gillespie, C
2010 JUN ;25(9):472-473, Journal of general internal medicine
— id: 111922, year: 2010, vol: 25, page: 472, stat: Journal Article,

Can interactive skills-based seminars with standardized patients enhance clinicians' prevention skills? Measuring the impact of a CME program
Zabar, Sondra; Hanley, Kathleen; Stevens, David L; Ciotoli, Carlo; Hsieh, Amy; Griesser, Cecily; Anderson, Marian; Kalet, Adina
2010 Aug;80(2):248-252, Patient education & counseling
OBJECTIVE: Communication skills are crucial for high-risk behavior screening and counseling. Practicing physicians have limited opportunities to improve these skills. This paper assesses the impact of a continuing medical education (CME) program for Student Health Center clinicians that targeted communication skills, screening practices and patient satisfaction. METHODS: Program evaluation included pre- and post-objective structured clinical examinations (OSCE's), chart review, and provider and patient satisfaction surveys. Data were analyzed using paired t-tests and ranked sum tests. RESULTS: OSCE scores (n=15) revealed significant improvements in communication skills overall (p=0.004) and within specific domains (data gathering: p=0.003; rapport building: p=0.01; patient education: p=0.02), but no change in case-specific knowledge (p=0.1). Participants (n=14) reported high satisfaction with program methods (mean=4.6/5) and content (mean=4.7/5), 70% planning to alter their clinical practice. Chart audits (pre=96, post=103) showed increased screening for smoking (RR 1.65, p=0.03), depressed mood (RR 1.40, p=0.04), anhedonia (RR 1.47, p=0.01), sexual activity (RR 1.73, p=0.002) and drinking (RR 1.77, p=0.04). Sampling of satisfaction among participants' patients (pre n=689, post n=383) detected no increase in already high baseline satisfaction. CONCLUSION: This curriculum improved clinicians' relevant skills and screening behavior. PRACTICE IMPLICATIONS: Skills-oriented CME can improve clinicians' communication skills and screening and counseling practices
— id: 111340, year: 2010, vol: 80, page: 248, stat: Journal Article,

What standardised patients tell us about 'activating' patients
Gillespie, Colleen; Bruno, Julia Hyland; Kalet, Adina
2009 Nov;43(11):1112-1113, Medical education
— id: 105176, year: 2009, vol: 43, page: 1112, stat: Journal Article,

Residents' perceptions of their own professionalism and the professionalism of their learning environment
Gillespie, Colleen; Paik, Steve; Ark, Tavinder; Zabar, Sondra; Kalet, Adina
2009 Dec;1(2):208-215, Journal of graduate medical education
BACKGROUND: The competency of professionalism encompasses a range of behaviors in multiple domains. Residency programs are struggling to integrate and effectively assess professionalism. We report results from a survey assessing residents' perceptions of their professional competence and the professionalism of their learning environment. METHODS: A survey was developed to assess specific behaviors reflecting professionalism based on the conceptualizations of key accrediting bodies. Residents rated their ability to perform the behaviors and reported the frequency with which they observed their fellow residents failing to perform the behaviors. Eighty-five senior residents in emergency medicine, internal medicine, pediatrics, psychiatry, and surgery specialties completed the survey (response rate = 77%). Differences among domains (and among items within domains) were assessed. Correlations between perceived professionalism and the professionalism of the learning environment were described. RESULTS: Cronbach alpha for professionalism competence was .93 and for professionalism in the learning environment it was .86. Residents reported feeling most competent in being accountable (mean score = 51.4%; F = 10.3, p<.001) and in demonstrating respect. Some residents reported having trouble being sensitive to patients (n = 5 to 23). Disrespectful behaviors were the most frequently witnessed professionalism lapse in the learning environment (mean = 41.1%; F = 8.1, p<.001). While serious lapses in professionalism were not witnessed with great frequency in the learning environment, instances of over-representing qualifications were reported. Problems in accountability in the learning environment were negatively associated with residents' perceived competence. CONCLUSIONS: Residents reported being able to perform professionally most of the time, especially in terms of accountability and respect. However, disrespect was a feature of the learning environment for many residents and several serious lapses were witnessed by a small number of residents. Accountability in the learning environment may be an important indicator of or influence on residents' professionalism
— id: 149733, year: 2009, vol: 1, page: 208, stat: Journal Article,

Defining Medical Basic Science: General Internists' Special Role in the Reformation of Medical School Education
Jacobs, Elizabeth A; Kalet, Adina
2009 Nov;24(11):1261-1262, Journal of general internal medicine
— id: 105641, year: 2009, vol: 24, page: 1261, stat: Journal Article,

IS THERE AN ASSOCIATION BETWEEN QUALITY OF OBESITY COUNSELING AND PATIENTS' MOTIVATION AND INTENTION TO CHANGE THEIR BEHAVIORS?
Jay, M; Schlair, S; Gillespie, C; Zabar, S; Ark, T; Sherman, S; Axtmayer, A; Von Erck, D; Stevens, DL; Kalet, AL
2009 APR ;24(10):111-111, Journal of general internal medicine
— id: 99166, year: 2009, vol: 24, page: 111, stat: Journal Article,

A randomized trial of a brief multimedia intervention to improve comprehension of food labels
Jay, Melanie; Adams, Jennifer; Herring, Sharon J; Gillespie, Colleen; Ark, Tavinder; Feldman, Henry; Jones, Vicky; Zabar, Sondra; Stevens, David; Kalet, Adina
2009 Jan;48(1):25-31, Preventive medicine
OBJECTIVE: Food label use is associated with better food choices, an essential part of the management of many chronic diseases. Previous studies suggest lack of comprehension of food labels. We studied a multimedia intervention to improve food label comprehension in a sample of low income patients in New York City. METHODS: This randomized study took place at Gouverneur Healthcare Services from 2005 until 2007. The intervention group (n=29) received a Nutrition Facts Label pocket card and viewed a video explaining card use. The control group (n=27) received written materials. Participants completed a 12-item pre- and post-intervention nutrition food label quiz. Quiz scores were analyzed using repeated measures analysis of variance. RESULTS: The intervention group had greater improvement on the quiz than the control group (p<0.001). There was a three way interaction by time with health literacy and treatment group where the greatest improvement occurred in patients with adequate health literacy in the intervention group (p<0.05). There was no improvement in patients with limited health literacy. CONCLUSION: A multimedia intervention is an effective way to improve short-term food label comprehension in patients with adequate health literacy. Further research is necessary to improve understanding of food labels in patients with limited health literacy
— id: 97782, year: 2009, vol: 48, page: 25, stat: Journal Article,

Physicians' attitudes about obesity and their associations with competency and specialty: a cross-sectional study
Jay, Melanie; Kalet, Adina; Ark, Tavinder; McMacken, Michelle; Messito, Mary Jo; Richter, Regina; Schlair, Sheira; Sherman, Scott; Zabar, Sondra; Gillespie, Colleen
2009 ;9:106-106, BMC health services research
BACKGROUND: Physicians frequently report negative attitudes about obesity which is thought to affect patient care. However, little is known about how attitudes toward treating obese patients are formed. We conducted a cross-sectional survey of physicians in order to better characterize their attitudes and explore the relationships among attitudes, perceived competency in obesity care, including report of weight loss in patients, and other key physician, training, and practice characteristics. METHODS: We surveyed all 399 physicians from internal medicine, pediatrics, and psychiatry specialties at one institution regarding obesity care attitudes, competency, including physician report of percent of their patients who lose weight. We performed a factor analysis on the attitude items and used hierarchical regression analysis to explore the degree to which competency, reported weight loss, physician, training and practice characteristics explained the variance in each attitude factor. RESULTS: The overall response rate was 63%. More than 40% of physicians had a negative reaction towards obese patients, 56% felt qualified to treat obesity, and 46% felt successful in this realm. The factor analysis revealed 4 factors-Physician Discomfort/Bias, Physician Success/Self Efficacy, Positive Outcome Expectancy, and Negative Outcome Expectancy. Competency and reported percent of patients who lose weight were most strongly associated with the Physician Success/Self Efficacy attitude factor. Greater skill in patient assessment was associated with less Physician Discomfort/Bias. Training characteristics were associated with outcome expectancies with newer physicians reporting more positive treatment expectancies. Pediatric faculty was more positive and psychiatry faculty less negative in their treatment expectancies than internal medicine faculty. CONCLUSION: Physician attitudes towards obesity are associated with competency, specialty, and years since postgraduate training. Further study is necessary to determine the direction of influence and to explore the impact of these attitudes on patient care
— id: 100613, year: 2009, vol: 9, page: 106, stat: Journal Article,

Attracting health professional students to substance abuse research
Kalet, Adina; Gillespie, Colleen; Naegle, Madeline A; More, Frederick
2009 Nov;43(11):1094-1094, Medical education
— id: 105175, year: 2009, vol: 43, page: 1094, stat: Journal Article,

Impact of a Web-Based Alcohol Screening and Brief Intervention Module
Lee, J.; Gillespie, C.; Gourevitch, M. N.; Hanley, K.; Jay, M.; Paik, S.; Richter, R.; Triola, M.; Zabar, S.; Kalet, A.
2009 OCT ;30(2):204-204, Substance abuse
— id: 114207, year: 2009, vol: 30, page: 204, stat: Journal Article,

Learning Outcomes of a Web Module for Teaching Interpreter Interaction Skills to Pre-clerkship Students
Lie, Desiree; Bereknyei, Sylvia; Kalet, Adina; Braddock, Clarence 3rd
2009 Apr;41(4):234-235, Family medicine
— id: 97796, year: 2009, vol: 41, page: 234, stat: Journal Article,

Medical students retain pain assessment and management skills long after an experiential curriculum: A controlled study
Stevens, David L; King, Danielle; Laponis, Ryan; Hanley, Kathleen; Zabar, Sondra; Kalet, Adina L; Gillespie, Colleen
2009 Oct;145(3):319-324, Pain
We implemented a pain assessment and management (PAM) curriculum for second year medical students and evaluated long-term skills retention compared to the prior year's class which did not receive the curriculum. The curriculum included pain pathophysiology, assessment and treatment instruction plus feedback on PAM practice with standardized patients. Both cohorts underwent a required end-of-third-year clinical skills examination. Intervention and control group performance on three pain cases (acute, chronic and terminal) was compared. The PAM curriculum was implemented 1.5years before the intervention cohort participated in the clinical skills exam. More intervention students (134/159, 84.3% response rate) obtained basic (87.2% vs. 76.0%, p=.028) and comprehensive (75.2% vs. 60.9%, p=.051) descriptions of acute pain than control students (n=129/174, 74.1% response rate). Intervention students demonstrated superior skills for terminal pain, including: more often asking about impact on functioning (40.7% vs. 25.8%, p=.027), advising change of medication (97.3% vs. 38.7%, p<.001), and providing additional medication counseling (55.0% vs. 27.0%, p<.001). Virtually all students obtained basic descriptions of chronic (intervention vs. control, 98.1% vs. 96.1%, p=.367) and terminal (92.9% vs. 91.7%, p=.736) pain. Surprisingly, more control than intervention students obtained a comprehensive description of chronic pain (94.6% vs. 77.8%, p<.001) and asked about current pain medication in the terminal case (75.6% vs. 55.0%, p=.004). Exposure to the curriculum resulted in durable increases in students' ability to perform PAM skills in patients with acute and terminal pain
— id: 101565, year: 2009, vol: 145, page: 319, stat: Journal Article,

UNANNOUNCED STANDARDIZED PATIENTS (USP) CAN ASSESS PROFESSIONALISM AND COMMUNICATION SKILLS IN THE EMERGENCY ROOM
Zabar, S; Ark, TK; Gillespie, C; Kachur, EK; Hsieh, A; Kalet, AL; Manko, JA; Regan, LA
2009 APR ;24(10):203-203, Journal of general internal medicine
— id: 99169, year: 2009, vol: 24, page: 203, stat: Journal Article,

Can Unannounced Standardized Patients Assess Professionalism and Communication Skills in the Emergency Department?
Zabar, Sondra; Ark, Tavinder; Gillespie, Colleen; Hsieh, Amy; Kalet, Adina; Kachur, Elizabeth; Manko, Jeffrey; Regan, Linda
2009 Sep;16(9):915-918, Academic emergency medicine
Abstract Objectives: The authors piloted unannounced standardized patients (USPs) in an emergency medicine (EM) residency to test feasibility, acceptability, and performance assessment of professionalism and communication skills. Methods: Fifteen postgraduate year (PGY)-2 EM residents were scheduled to be visited by two USPs while working in the emergency department (ED). Multidisciplinary support was utilized to ensure successful USP introduction. Scores (% well done) were calculated for communication and professionalism skills using a 26-item, behaviorally anchored checklist. Residents' attitudes toward USPs and USP detection were also surveyed. Results: Of 27 USP encounters attempted, 17 (62%) were successfully completed. The detection rate was 44%. Eighty-three percent of residents who encountered a USP felt that the encounter did not hinder daily practice and did not make them uncomfortable (86%) or suspicious of patients (71%). Overall, residents received a mean score of 60% for communication items rated 'well done' (SD +/- 28%, range = 23%-100%) and 53% of professionalism items 'well done' (SD +/- 20%, range = 23%-85%). Residents' communication skills were weakest for patient education and counseling (mean = 43%, SD +/- 31%), compared with information gathering (68%, SD +/- 36% and relationship development (62%, SD +/- 32%). Scores of residents who detected USPs did not differ from those who had not. Conclusions: Implementing USPs in the ED is feasible and acceptable to staff. The unpredictability of the ED, specifically resident schedules, accounted for most incomplete encounters. USPs may represent a new way to assess real-time resident physician performance without the need for faculty resources or the bias introduced by direct observation. ACADEMIC EMERGENCY MEDICINE 2009; 16:1-4 (c) 2009 by the Society for Academic Emergency Medicine
— id: 101564, year: 2009, vol: 16, page: 915, stat: Journal Article,

Navigating the JGIM Special Issue on Medical Education
Bowen, Judith L; Cook, David A; Gerrity, Martha; Kalet, Adina L; Kogan, Jennifer R; Spickard, Anderson; Wayne, Diane B
2008 Jul;23(7):899-902, Journal of general internal medicine
— id: 93860, year: 2008, vol: 23, page: 899, stat: Journal Article,

Proposed standards for medical education submissions to the Journal of General Internal Medicine
Cook, David A; Bowen, Judith L; Gerrity, Martha S; Kalet, Adina L; Kogan, Jennifer R; Spickard, Anderson; Wayne, Diane B
2008 Jul;23(7):908-913, Journal of general internal medicine
To help authors design rigorous studies and prepare clear and informative manuscripts, improve the transparency of editorial decisions, and raise the bar on educational scholarship, the Deputy Editors of the Journal of General Internal Medicine articulate standards for medical education submissions to the Journal. General standards include: (1) quality questions, (2) quality methods to match the questions, (3) insightful interpretation of findings, (4) transparent, unbiased reporting, and (5) attention to human subjects' protection and ethical research conduct. Additional standards for specific study types are described. We hope these proposed standards will generate discussion that will foster their continued evolution
— id: 93859, year: 2008, vol: 23, page: 908, stat: Journal Article,

Do internists, pediatricians, and psychiatrists feel competent in obesity care?: using a needs assessment to drive curriculum design
Jay, Melanie; Gillespie, Colleen; Ark, Tavinder; Richter, Regina; McMacken, Michelle; Zabar, Sondra; Paik, Steven; Messito, Mary Jo; Lee, Joshua; Kalet, Adina
2008 Jul;23(7):1066-1070, Journal of general internal medicine
BACKGROUND: Physicians must effectively evaluate and treat obesity. To design a needs-driven curriculum intended to improve patient outcomes, physicians were surveyed about their self-perceived knowledge and skills. OBJECTIVE: The objective of this study was to determine the expressed needs of residents and faculty regarding obesity care training across three specialties. DESIGN: The study used a survey given to faculty and residents in General Internal Medicine, Pediatrics, and Psychiatry. METHODS: Survey questions were generated from comprehensive nutrition curriculum and clinical recommendations, administered online, and then organized around a validated behavioral health framework-the 5As (assess, advise, agree, assist, arrange). Analyses were conducted to evaluate differences in perceived knowledge and skills between specialties and across training levels. RESULTS: From an overall response rate of 65% (65 residents and 250 faculty members), nearly 20% reported inadequate competency in every item with 48% of respondents reporting an inability to adequately counsel patients about common treatment options. Internists reported the lowest competency in arranging referrals and follow-up. Psychiatrists reported the lowest competency in assessment skills. CONCLUSIONS: This survey demonstrated a critical need for training in specific areas of obesity care. The proposed curriculum targets these areas taking into consideration observed differences across specialties
— id: 82919, year: 2008, vol: 23, page: 1066, stat: Journal Article,

Twenty years of fostering the development of caring, balanced practitioners for the underserved: Major results of an in-depth survey of graduates of a humanistic primary care residency program
Laponis, R; Gillespie, C; Zabar, S; Kalet, AL; Adams, JG; Shah, NR; Anderson, M; Lipkin, M
2008 MAR ;23(2):429-429, Journal of general internal medicine
— id: 78177, year: 2008, vol: 23, page: 429, stat: Journal Article,

Working with patients with alcohol problems: a controlled trial of the impact of a rich media web module on medical student performance
Lee, Joshua D; Triola, Marc; Gillespie, Colleen; Gourevitch, Marc N; Hanley, Kathleen; Truncali, Andrea; Zabar, Sondra; Kalet, Adina
2008 Jul;23(7):1006-1009, Journal of general internal medicine
INTRODUCTION/AIMS: We designed an interactive web module to improve medical student competence in screening and interventions for hazardous drinking. We assessed its impact on performance with a standardized patient (SP) vs. traditional lecture. SETTING: First year medical school curriculum. PROGRAM DESCRIPTION: The web module included pre/posttests, Flash(c), and text didactics. It centered on videos of two alcohol cases, each contrasting a novice with an experienced physician interviewer. The learner free-text critiqued each clip then reviewed expert analysis. PROGRAM EVALUATION: First year medical students conveniently assigned to voluntarily complete a web module (N = 82) or lecture (N = 81) were rated by a SP in a later alcohol case. Participation trended higher (82% vs. 72%, p < .07) among web students, with an additional 4 lecture-assigned students crossing to the web module. The web group had higher mean scores on scales of individual components of brief intervention (assessment and decisional balance) and a brief intervention composite score (1-13 pt.; 9 vs. 7.8, p < .02) and self-reported as better prepared for the SP case. CONCLUSIONS: A web module for alcohol use interview skills reached a greater proportion of voluntary learners and was associated with equivalent overall performance scores and higher brief intervention skills scores on a standardized patient encounter
— id: 82918, year: 2008, vol: 23, page: 1006, stat: Journal Article,

Two decades of Title VII support of a primary care residency: process and outcomes
Lipkin, Mack; Zabar, Sondra R; Kalet, Adina L; Laponis, Ryan; Kachur, Elizabeth; Anderson, Marian; Gillespie, Colleen C
2008 Nov;83(11):1064-1070, Academic medicine
PURPOSE: To assess 23 years of Health Resources and Services Administration (HRSA) Title VII Training in Primary Care Medicine and Dentistry funding to the New York University School of Medicine/Bellevue Primary Care Internal Medicine Residency Program. The program, begun in 1983 within a traditional, inner-city, subspecialty-oriented internal medicine program, evolved into a crucible of systematic innovation, catalyzed and made feasible by initiatives funded by the HRSA. The curriculum stressed three pillars of generalism: psychosocial medicine, clinical epidemiology, and health policy. It developed tight, objectives-driven, effective, nonmedical specialty blocks and five weekly primary care activities that created a paradigm-driven, community-based, role-modeling matrix. Innovation was built in. Every block and activity was evaluated immediately and in an annual, program-wide retreat. Evaluation evolved from behavioral checklists of taped interviews to performance-based, systematic, annual objective structured clinical examinations. METHOD: The authors reviewed eight grant proposals, project reports, and curriculum and program evaluations. They also quantitatively and qualitatively surveyed the 122 reachable graduates from the first 20 graduating classes of the program. RESULTS: Analysis of program documents revealed recurring emphases on the use of proven educational models, strategic innovation, and assessment and evaluation to design and refine the program. There were 104 respondents (85%) to the survey. A total of 87% of the graduates practice as primary care physicians, 83% teach, and 90% work with the underserved; 54% do research, 36% actively advocate on health issues for their patients, programs, and other constituencies, and 30% publish. Graduates cited work in the community and faculty excitement and energy as essential elements of the program's impact; overall, graduates reported high personal and career satisfaction and low burnout. CONCLUSIONS: With HRSA support, a focused, innovative program evolved which has already met each of the six recommendations for future innovation of the Alliance for Academic Internal Medicine Education Redesign Task Force. This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs
— id: 93382, year: 2008, vol: 83, page: 1064, stat: Journal Article,

What do resident physicians know about nutrition? An evaluation of attitudes, self-perceived proficiency and knowledge
Vetter, Marion L; Herring, Sharon J; Sood, Minisha; Shah, Nirav R; Kalet, Adina L
2008 Apr;27(2):287-298, Journal of the American College of Nutrition
OBJECTIVE: Despite the increased emphasis on obesity and diet-related diseases, nutrition education remains lacking in many internal medicine training programs. We evaluated the attitudes, self-perceived proficiency, and knowledge related to clinical nutrition among a cohort of internal medicine interns. METHODS: Nutrition attitudes and self-perceived proficiency were measured using previously validated questionnaires. Knowledge was assessed with a multiple-choice quiz. Subjects were asked whether they had prior nutrition training. RESULTS: Of the 114 participants, 61 (54%) completed the survey. Although 77% agreed that nutrition assessment should be included in routine primary care visits, and 94% agreed that it was their obligation to discuss nutrition with patients, only 14% felt physicians were adequately trained to provide nutrition counseling. There was no correlation among attitudes, self-perceived proficiency, or knowledge. Interns previously exposed to nutrition education reported more negative attitudes toward physician self-efficacy (p = 0.03). CONCLUSIONS: Internal medicine interns' perceive nutrition counseling as a priority, but lack the confidence and knowledge to effectively provide adequate nutrition education
— id: 93346, year: 2008, vol: 27, page: 287, stat: Journal Article,

Competency in System Based Practice: Making the system transparent - A web module with "learner appeal"
Zabar, S; Gillespie, C; Morris, K; Bernstein, CA; Ark, T; Triola, M; Holloway, W; Kalet, A
2008 MAR ;23(2):217-217, Journal of general internal medicine
— id: 78173, year: 2008, vol: 23, page: 217, stat: Journal Article,

Using bedside rounds to teach communication skills in the internal medicine clerkship
Janicik, Regina; Kalet, Adina L; Schwartz, Mark D; Zabar, Sondra; Lipkin, Mack
2007 ;12(2):1-6, Medical Education Online
Background: Physicians' communication skills, which are linked to important patient outcomes, are rarely explicitly taught during the clinical years of medical school. This paper describes the development, implementation, and evaluation of a communication skills curriculum during the third-year Internal Medicine Clerkship. Methods: In four two-hour structured bedside rounds with trained Internal Medicine faculty facilitators, students learned core communication skills in the context of common challenging clinical situations. In an end-of-clerkship survey students evaluated the curriculum's educational effectiveness. Results: Over the course of a year, 160 third-year students and 15 faculty participated. Of the 75/160 (47%) of students who completed the post-clerkship survey, almost all reported improvement in their communication skills and their ability to deal with specific communication challenges. Conclusions: The curriculum appears to be a successful way to reinforce core communication skills and practice common challenging situations students encounter during the Internal Medicine Clerkship. (journal abstract)
— id: 79111, year: 2007, vol: 12, page: 1, stat: Journal Article,

Using bedside rounds to teach communication skills in the internal medicine clerkship
Janicik, Regina; Kalet, Adina L; Schwartz, Mark D; Zabar, Sondra; Lipkin, Mack
2007 ;12(1):?-?, Medical Education Online
Background: Physicians\' communication skills, which are linked to important patient outcomes, are rarely explicitly taught during the clinical years of medical school. This paper describes the development, implementation, and evaluation of a communication skills curriculum during the third-year Internal Medicine Clerkship. Methods: In four two-hour structured bedside rounds with trained Internal Medicine faculty facilitators, students learned core communication skills in the context of common challenging clinical situations. In an end-of-clerkship survey students evaluated the curriculum\'s educational effectiveness. Results: Over the course of a year, 160 third-year students and 15 faculty participated. Of the 75/160 (47%) of students who completed the post-clerkship survey, almost all reported improvement in their communication skills and their ability to deal with specific communication challenges. Conclusions: The curriculum appears to be a successful way to reinforce core communication skills and practice common challenging situations students encounter during the Internal Medicine Clerkship.
— id: 105275, year: 2007, vol: 12, page: ?, stat: Journal Article,

Tackling the obesity epidemic in low literacy populations: A RCT of an intervention to teach patients to understand nutrition food labels
Jay, M; Adams, JG; Herring, SJ; Feldman, HJ; Lee, G; Qin, A; Kalet, AL; Tseng, C; Stevens, DL; Zabar, S
2007 APR ;22(1):110-110, Journal of general internal medicine
— id: 87185, year: 2007, vol: 22, page: 110, stat: Journal Article,

Preliminary evaluation of the Web Initiative for Surgical Education (WISE-MD)
Kalet, Adina L; Coady, Sarah H; Hopkins, Mary Ann; Hochberg, Marc S; Riles, Thomas S
2007 Jul;194(1):89-93, American journal of surgery
BACKGROUND: Major changes in health care delivery and financing have negatively impacted students' experience during the surgery clerkship, particularly their exposure to physicians' decision-making processes and to the continuity of patient care. In response to these dilemmas in surgical education, we have developed the Web Initiative for Surgical Education (WISE-MD), a comprehensive surgery clerkship curriculum delivered through multimedia teaching modules and designed to enhance exposure to surgical disease and clinical reasoning. METHODS: As part of the process of creating WISE-MD, we conducted preliminary studies to assess the impact of this computer-assisted approach on students' knowledge, clinical reasoning, and satisfaction. RESULTS: Compared to students who did not view the modules, early data show a trend toward improved knowledge and an improvement in clinical reasoning for students who used the WISE-MD modules. This effect was specific to the clinical content area addressed in the module seen by the students. Most students felt the module was superior to traditional teaching methods and enhanced their understanding of surgical technique and anatomy. CONCLUSIONS: WISE-MD, a theory-driven example of a concerted technology-based approach to surgical education, has the potential to address the myriad problems of today's clinical learning environment.
— id: 73032, year: 2007, vol: 194, page: 89, stat: Journal Article,

Medical training in school-based health centers: a collaboration among five medical schools
Kalet, Adina L; Juszczak, Linda; Pastore, Doris; Fierman, Arthur H; Soren, Karen; Cohall, Alwyn; Fisher, Martin; Hopkins, Catherine; Hsieh, Amy; Kachur, Elizabeth; Sullivan, Laurie; Techow, Beth; Volel, Caroline
2007 May;82(5):458-464, Academic medicine
School-based health centers (SBHCs) have tremendous untapped potential as models for learning about systems-based care of vulnerable children. SBHCs aim to provide comprehensive, community-based primary health care to primary and secondary schoolchildren who might not otherwise have ready access to that care. The staffing at SBHCs is multidisciplinary, including various combinations of nurse practitioners, physicians, dentists, nutritionists, and mental health providers. Although this unique environment provides obvious advantages to children and their families, medical students and residents receive little or no preparation for this type of practice.To address these deficiencies in medical education, five downstate New York state medical schools, funded by the New York State Department of Health, collaborated to define, develop, implement, and evaluate curricula that expose health professions students and residents to SBHCs. The schools identified core competencies and developed a comprehensive training model for the project, including clinical experiences, didactic sessions, and community service opportunities, and they developed goals, objectives, and learning materials for each competency for all types and levels of learners. Each school has implemented a wide range of learning activities based on the competencies.In this paper, the authors describe the development of the collaboration and illustrate the process undertaken to implement new curricula, including considerations made to address institutional needs, curricula development, and incorporation into existing curricula. In addition, they discuss the lessons learned from conducting this collaborative effort among medical schools, with the goal of providing guidance to establish effective cross-disciplinary curricula that address newly defined competencies.
— id: 72819, year: 2007, vol: 82, page: 458, stat: Journal Article,

Promoting professionalism through an online professional development portfolio: successes, joys, and frustrations
Kalet, Adina L; Sanger, Joseph; Chase, Julie; Keller, Allen; Schwartz, Mark D; Fishman, Miriam L; Garfall, Alfred L; Kitay, Alison
2007 Nov;82(11):1065-1072, Academic medicine
Medical educators strive to promote the development of a sound professional identity in learners, yet it is challenging to design, implement, and sustain fair and meaningful assessments of professionalism to accomplish this goal. The authors developed and implemented a program built around a Web-based Professional Development Portfolio (PDP) to assess and document professional development in medical students at New York University School of Medicine. This program requires students to regularly document their professional development through written reflections on curricular activities spanning preclinical and clinical years. Students post reflections, along with other documents that chronicle their professional growth, to their online PDP. Students meet annually with a faculty mentor to review their portfolios, assess their professional development based on predetermined criteria, and establish goals for the coming year. In this article, the authors describe the development of the PDP and share four years of experience with its implementation. We describe the experiences and attitudes of the first students to participate in this program as reported in an annual student survey. Students' experiences of and satisfaction with the PDP was varied. The PDP has been a catalyst for honest and lively debate concerning the meaning and behavioral manifestations of professionalism. A Web-based PDP promoted self-regulation on an individual level because it facilitated narrative reflection, self-assessment, and goal setting, and it structured mentorship. Therefore, the PDP may prepare students for the self-regulation of the medical profession--a privilege and obligation under the physician's social contract with society
— id: 75401, year: 2007, vol: 82, page: 1065, stat: Journal Article,

Improving journal club presentations, or, I can present that paper in under 10 minutes
Schwartz, Mark D; Dowell, Deborah; Aperi, Jaclyn; Kalet, Adina
2007 Jul-Aug;147(1):A8-A9, ACP journal club
— id: 73384, year: 2007, vol: 147, page: A8, stat: Journal Article,

Improving journal club presentations, or, I can present that paper in under 10 minutes
Schwartz, Mark D; Dowell, Deborah; Aperi, Jaclyn; Kalet, Adina L
2007 Jun;12(3):66-68, Evidence Based Medicine
— id: 72878, year: 2007, vol: 12, page: 66, stat: Journal Article,

Medical students retain pain assesment and management (PAM) skills long after an experiential curriculum: A controlled study
Stevens, DL; King, D; Laponis, R; Hanley, K; Waldman, S; Gillespie, C; Zabar, S; Kalet, AL
2007 APR ;22(1):88-88, Journal of general internal medicine
— id: 87184, year: 2007, vol: 22, page: 88, stat: Journal Article,

General Health Questions- A Virtual OSCE
Triola, Marc M; Feldman, Henry; Kalet, Adina; Zabar, Sondra; Kachur, Elizabeth; Anderson, Marian; Lipkin, Mack
MedEdPORTAL [sl : AAMC],
CHIP Case: 27 Year-old Korean female suffering from normal anxiety and 'worried well.' - We are looking for collaborators to both create and study the impact of Virtual Patients. At this stage of our development, the VP cases are available (after registering with us) to any faculty from an accredited institution. If that faculty wishes to make it available to students in their institution they may do so. The scripts would be available to any faculty/school with whom we are or would be collaborating
— id: 5650, year: 2007, vol: , page: ?, stat: Chapter,

Migraine Follow-up - A Virtual OSCE
Triola, Marc M; Feldman, Henry; Kalet, Adina; Zabar, Sondra; Kachur, Elizabeth; Anderson, Marian; Lipkin, Mack
MedEdPORTAL [sl : AAMC],
CHIP Case: 22 year old Chinese Female and 23-year-old White (Non-Hispanic) female dealing with bereavment. -We are looking for collaborators to both create and study the impact of Virtual Patients. At this stage of our development, the VP cases are available (after registering with us) to any faculty from an accredited institution. If that faculty wishes to make it available to students in their institution they may do so. The scripts would be available to any faculty/school with whom we are or would be collaborating
— id: 5648, year: 2007, vol: , page: ?, stat: Chapter,

Psychosocial Aspects of Terrorism and Disaster Medicine
Triola, Marc M; Feldman, Henry; Kalet, Adina; Zabar, Sondra; Kachur, Elizabeth; Anderson, Marian; Lipkin, Mack
MedEdPORTAL [sl : AAMC],
Web-based online course (Virtual Patient). Users will be required to complete a registration form on the NYU website before gaining access. Registration is free but is restricted to full-time teaching faculty or administrators affiliated with a recognized educational institution. This online course will provide useful information and tools to address patients' psychosocial responses to terrorist threats or attacks, to help focus responses of health care teams in acute situations, and to fulfill leadership roles in communities. The modules emphasize the most common psychosocial stress responses to bio-terrorism and disasters: 1. Acute Stress Disorder 2. Post-Traumatic Stress Disorder (PTSD)
— id: 5647, year: 2007, vol: , page: ?, stat: Chapter,

Surgical PA - A Virtual OSCE
Triola, Marc M; Feldman, Henry; Kalet, Adina; Zabar, Sondra; Kachur, Elizabeth; Anderson, Marian; Lipkin, Mack
MedEdPORTAL [sl : AAMC],
CHIP Case: 31 year-old White male with Acute Stress Disorder. -We are looking for collaborators to both create and study the impact of Virtual Patients. At this stage of our development, the VP cases are available (after registering with us) to any faculty from an accredited institution. If that faculty wishes to make it available to students in their institution they may do so. The scripts would be available to any faculty/school with whom we are or would be collaborating
— id: 5649, year: 2007, vol: , page: ?, stat: Chapter,

Working With Interpreters: Learning To Conduct A Cross-Language Medical Interview With An Online Web-Based Module
Waldman, Sarah; Kalet, Adina
MedEdPORTAL [sl : AAMC],
This is a web-based curriculum to introduce medical students, residents, and practicing healthcare professionals the skills, knowledge and attitudes necessary for working with limited English proficient patients through interpreters
— id: 5646, year: 2007, vol: , page: ?, stat: Chapter,

How to be an outstanding reviewer for the Journal of General Internal Medicine ... and other journals
Estrada, C; Kalet, A; Smith, W; Chin, MH
2006 MAR ;21(3):281-284, Journal of general internal medicine
— id: 63305, year: 2006, vol: 21, page: 281, stat: Journal Article,

Learning skills of professionalism: A student-led professionalism curriculum
Horlick, Margaret; Masterton, Deirdre; Kalet, Adina
2006 ;11(1):1-8 Jan, Medical Education Online
Background: Medical schools must address the fact that students embarking on careers in medicine are idealistic but have a vague understanding of the values and characteristics that define medical professionalism. Traditionally, we have relied primarily on unsystematic role modeling and lectures or seminars on related topics to teach professionalism. Methods: A committee of students and a faculty advisor created a curriculum, based on a needs assessment of the targeted learners, to raise students' awareness of professional tenets and provide them with the skills to recognize and analyze conflicts between the values of professionalism and the daily pressures of medical school training. The student-run professionalism curriculum begins during medical school orientation and is followed by three student-facilitated case-based workshops over the next two years. All of the workshops involve small group discussions led by trained upperclass student facilitators. The workshops address the application of professional values to both the preclinical and clinical situations and prepare students for self-reflection, self-assessment and peer evaluation. We evaluated students' satisfaction following each workshop and pre/post attitudes for the first workshop. Results: Twenty five upper-class student facilitators were trained in the first year. Student attendance ranged from 80-100% of the class (N = 160), the proportion of students who agreed or strongly agreed that the workshops were educationally useful ranged from 60-75% for each workshop. Certain student attitudes improved immediately after the first workshop. These workshops continue annually. Conclusions: Students have been a driving force behind this curriculum, which is a model for professionalism education. It was accepted by students and, although somewhat controversial, created a level of awareness and discussion regarding professional behavior in medical school that had previously been absent. (journal abstract)
— id: 78701, year: 2006, vol: 11, page: 1, stat: Journal Article,

Defining, navigating, and negotiating success: the experiences of mid-career Robert Wood Johnson Clinical Scholar women
Kalet, Adina L; Fletcher, Kathlyn E; Ferdman, Dina J; Bickell, Nina A
2006 Sep;21(9):920-925, Journal of general internal medicine
BACKGROUND: We studied female graduates of the Robert Wood Johnson Clinical Scholars Program (CSP, Class of 1984 to 1989) to explore and describe the complexity of creating balance in the life of mid-career academic woman physicians. METHODS: We conducted and qualitatively analyzed (kappa 0.35 to 1.0 for theme identification among rater pairs) data from a semi-structured survey of 21 women and obtained their curricula vitae to quantify publications and grant support, measures of academic productivity. RESULTS: Sixteen of 21 (76%) women completed the survey. Mean age was 48 (range: 45 to 56). Three were full professors, 10 were associate professors, and 3 had left academic medicine. Eleven women had had children (mean 2.4; range: 1 to 3) and 3 worked part-time. From these data, the conceptual model expands on 3 key themes: (1) defining, navigating, and negotiating success, (2) making life work, and (3) making work work. The women who described themselves as satisfied with their careers (10/16) had clarity of values and goals and a sense of control over their time. Those less satisfied with their careers (6/16) emphasized the personal and professional costs of the struggle to balance their lives and described explicit institutional barriers to fulfillment of their potential. CONCLUSION: For this group of fellowship-prepared academic women physicians satisfaction is achieving professional and personal balance
— id: 67933, year: 2006, vol: 21, page: 920, stat: Journal Article,

Medical students' ability to care for lesbian, gay, bisexual, and transgendered patients
Sanchez, Nelson F; Rabatin, Joseph; Sanchez, John P; Hubbard, Steven; Kalet, Adina
2006 Jan;38(1):21-27, Family medicine
BACKGROUND AND OBJECTIVES: Our objective was to assess medical students' ability to care for lesbian, gay, bisexual, and transgender (LGBT) patients and to identify potential deficiencies in medical school curricula pertaining to this care. METHODS: Between March 1 and April 15, 2004, third- and fourth-year medical students at a metropolitan medical school were sent an e-mail requesting participation in a confidential on-line survey of 64 quantitative questions designed to assess their ability to care for LGBT patients. RESULTS: A total of 248 of 320 (77.5%) students responded. Medical students with greater clinical exposure to LGBT patients reported more frequent sexual history taking with LGBT patients, had more positive attitude scores, and possessed higher knowledge scores than students with little or no clinical exposure. Overall, on the 13-item attitude survey, the mean was 4.15 (5 = most positive, SD = .55, range 1.86-5.00), indicating a desire and willingness to provide health care to LGBT patients. The mean score on the 14-item knowledge test was 60% (SD = .12) correct. CONCLUSIONS: Medical students with increased clinical exposure to LGBT patients tended to perform more comprehensive histories, hold more positive attitudes toward LGBT patients, and possess greater knowledge of LGBT health care concerns than students with little or no clinical exposure
— id: 63735, year: 2006, vol: 38, page: 21, stat: Journal Article,

A randomized trial of teaching clinical skills using virtual and live standardized patients
Triola, M; Feldman, H; Kalet, A L; Zabar, S; Kachur, E K; Gillespie, C; Anderson, M; Griesser, C; Lipkin, M
2006 May;21(5):424-429, Journal of general internal medicine
BACKGROUND: We developed computer-based virtual patient (VP) cases to complement an interactive continuing medical education (CME) course that emphasizes skills practice using standardized patients (SP). Virtual patient simulations have the significant advantages of requiring fewer personnel and resources, being accessible at any time, and being highly standardized. Little is known about the educational effectiveness of these new resources. We conducted a randomized trial to assess the educational effectiveness of VPs and SPs in teaching clinical skills. OBJECTIVE: To determine the effectiveness of VP cases when compared with live SP cases in improving clinical skills and knowledge. DESIGN: Randomized trial. PARTICIPANTS: Fifty-five health care providers (registered nurses 45%, physicians 15%, other provider types 40%) who attended a CME program. INTERVENTIONS: Participants were randomized to receive either 4 live cases (n=32) or 2 live and 2 virtual cases (n=23). Other aspects of the course were identical for both groups. RESULTS: Participants in both groups were equivalent with respect to pre-post workshop improvement in comfort level (P=.66) and preparedness to respond (P=.61), to screen (P=.79), and to care (P=.055) for patients using the skills taught. There was no difference in subjective ratings of effectiveness of the VPs and SPs by participants who experienced both (P=.79). Improvement in diagnostic abilities were equivalent in groups who experienced cases either live or virtually. CONCLUSIONS: Improvements in performance and diagnostic ability were equivalent between the groups and participants rated VP and SP cases equally. Including well-designed VPs has a potentially powerful and efficient place in clinical skills training for practicing health care workers
— id: 67849, year: 2006, vol: 21, page: 424, stat: Journal Article,

Psychosocial Aspects of Terrorism and Disaster Medicine
Triola, Mark; Feldman, Henry; Zabar, Sondra; Anderson, Marian; Kalet, Adina; Kachur, Elizabeth; Lipkin, Mack
2006;:- [Web Site], Nov 9, 2006, MedEdPORTAL
Web-based online course (Virtual Patient). Users will be required to complete a registration form on the NYU website before gaining access. Registration is free but is restricted to full-time teaching faculty or administrators affiliated with a recognized educational institution. This online course will provide useful information and tools to address patients' psychosocial responses to terrorist threats or attacks, to help focus responses of health care teams in acute situations, and to fulfill leadership roles in communities. The modules emphasize the most common psychosocial stress responses to bio-terrorism and disasters: Acute Stress Disorder; Post-Traumatic Stress Disorder (PTSD); Depression / Bereavement; Sub-Diagnostic Distress
— id: 150921, year: 2006, vol: , page: , stat: Web Site,

"Oh! She doesn't speak english!" Assessing resident competence in managing linguistic and cultural barriers
Zabar, Sondra; Hanley, Kathleen; Kachur, Elizabeth; Stevens, David; Schwartz, Mark D; Pearlman, Ellen; Adams, Jennifer; Felix, Karla; Lipkin, Mack Jr; Kalet, Adina
2006 May;21(5):510-513, Journal of general internal medicine
BACKGROUND: Residents must master complex skills to care for culturally and linguistically diverse patients. METHODS: As part of an annual 10-station, standardized patient (SP) examination, medical residents interacted with a 50-year-old reserved, Bengali-speaking woman (SP) with a positive fecal occult blood accompanied by her bilingual brother (standardized interpreter (SI)). While the resident addressed the need for a colonoscopy, the SI did not translate word for word unless directed to, questioned medical terms, and was reluctant to tell the SP frightening information. The SP/SI, faculty observers, and the resident assessed the performance. RESULTS: Seventy-six residents participated. Mean faculty ratings (9-point scale) were as follows: overall 6.0, communication 6.0, knowledge 6.3. Mean SP/SI ratings (3.1, range 1.9 to 3.9) correlated with faculty ratings (overall r=.719, communication r=.639, knowledge r=.457, all P<.01). Internal reliability as measured by Cronbach's alpha coefficients for the 20 item instrument was 0.91. Poor performance on this station was associated with poor performance on other stations. Eighty-nine percent of residents stated that the educational value was moderate to high. CONCLUSION: We reliably assessed residents communication skills conducting a common clinical task across a significant language barrier. This medical education innovation provides the first steps to measuring interpreter facilitated skills in residency training
— id: 66202, year: 2006, vol: 21, page: 510, stat: Journal Article,

Online classrooms enhance clerkship small group teaching
Coady, Sarah; Kalet, Adina; Hopkins, Mary Ann
2005 Nov;39(11):1152-1153, Medical education
— id: 61270, year: 2005, vol: 39, page: 1152, stat: Journal Article,

Can a web-based curriculum improve students' knowledge of, and attitudes about, the interpreted medical interview?
Kalet, Adina L; Mukherjee, Debjani; Felix, Karla; Steinberg, Sarah E; Nachbar, Martin; Lee, Amy; Changrani, Joytsna; Gany, Francesca
2005 Oct;20(10):929-934, Journal of general internal medicine
OBJECTIVES: To develop and evaluate a web-based curriculum to introduce first year medical students to the knowledge and attitudes necessary for working with limited English proficient (LEP) patients through interpreters. METHOD: Six hundred and forty first year medical students over 4 consecutive years took this curriculum as part of their Patient Physician and Society course. They viewed 6 patient-physician-interpreter video vignettes, gave open text analyses of each vignette, and compared their responses to those generated by experts, thereby receiving immediate formative feedback. They listened to video commentaries by a cultural expert, lawyer, and ethicist about working with LEP patients, completed pre- and postmodule questionnaires, which tested relevant knowledge and attitudes, and were provided a summative assessment at the end of the module. Students completed an optional survey assessing the educational value of, and providing open text commentary about, the module. RESULTS: Seventy-one percent (n=456) of first year students who completed the module consented to have their data included in this evaluation. Mean knowledge (19 items) scores improved (46% pre- to 62% postmodule, P<.001), reflecting improvements in knowledge about best interpreter practices and immigration demographics and legal issues. Mean scores on 4 of 5 attitude items improved, reflecting attitudes more consistent with culturally sensitive care of LEP patients. Mean satisfaction with the educational value of the module for 155 students who completed the postmodule survey was 2.9 on a scale of 1 to 4. CONCLUSION: Our web-curriculum resulted in short-term improvement in the knowledge and attitudes necessary to interact with LEP patients and interpreters. The interactive format allowed students to receive immediate formative feedback and be cognizant of the challenges and effective strategies in language discordant medical encounters. This is important because studies suggest that the use of these skills in patient encounters leads to greater patient and provider satisfaction and improved health outcomes
— id: 66677, year: 2005, vol: 20, page: 929, stat: Journal Article,

Encouraging patient adherence: primary care physicians' use of verbal compliance-gaining strategies in medical interviews
Smith, Valerie A; DeVellis, Brenda M; Kalet, Adina; Roberts, Joanne C; DeVellis, Robert F
2005 Apr;57(1):62-76, Patient education & counseling
Compliance-gaining strategies refer to subtle differences in ways people use language when their goal is to influence someone else's behavior. This stands in contrast to other kinds of persuasion aimed only at influencing others beliefs and attitudes. We have developed a new method of coding what physicians say when they are trying to influence patients' behaviors. This method applies theory and methods from the fields of interpersonal influence, linguistics and social psychology. We tested the reliability of this new method by randomly selecting 37 audiotaped medical interviews collected for an unrelated study [J. Gen. Int. Med., 9 (1994) 402] and having three coders independently identify physician compliance-gaining utterances and then independently apply one of 57 codes to each utterance. These codes also were categorized on two underlying dimensions reflecting whether the physician (1) framed the compliance-gaining utterance in a direct or indirect way, and (2) did or did not give a justification for that direct or indirect request. Reliability among coders and coders agreement with the final utterance identification and coding decisions, measured as per cent agreement among coders and/or, where appropriate, by Cohen's kappa were good to excellent. Most physicians' strategies were indirect and incomplete. For female patients, physicians used significantly more strategies, including more indirect strategies, complete strategies, 'prescriptions' and 'demands'. For male patients, physicians used a greater percent of direct strategies, including 'procedural demands'. This method provides a reliable and promising new technique for observing naturally occurring physician compliance-gaining speech
— id: 68812, year: 2005, vol: 57, page: 62, stat: Journal Article,

Assessing residents' competency in care management: report of a consensus conference
Frohna, John G; Kalet, Adina; Kachur, Elizabeth; Zabar, Sondra; Cox, Malcolm; Halpern, Ralph; Hewson, Mariana G; Yedidia, Michael J; Williams, Brent C
2004 Winter;16(1):77-84, Teaching & learning in medicine
BACKGROUND: Residency programs must prepare physicians to practice in the current health care environment. This mandate is reflected in 3 of the 6 competency domains now required by the Accreditation Council for Graduate Medical Education: systems-based practice, interpersonal skills and communication, and practice-based learning and improvement. SUMMARY: An invitational conference was convened, with experts in clinical practice, managed care administration, and education to identify and recommend optimal and promising assessment methods for 4 target areas: physician-patient communication, ethics, teamwork and collaboration, and practice management. Working in small groups, participants considered a range of resident assessment methods and identified current or future methods for each area, based on reliability, validity, use of behaviorally oriented outcomes, feasibility, and cost. Preferred methods of assessment varied by domain and include written examinations, computer-based patient management problems, standardized patients, objective structured clinical examinations, portfolios, 360-degree evaluations, and patient satisfaction surveys. CONCLUSIONS: The use of several practical, scientifically sound, and specific methods for assessing residents' competency in care management are recommended. Assessment instruments will need to be flexible enough to adapt to the rapid changes in the health care delivery system and terminology
— id: 68813, year: 2004, vol: 16, page: 77, stat: Journal Article,

Putting it all together: An effective and efficient videotape seminar for senior residents
Zabar, S; Kalet, A
1999 Apr 29-May 1;14(SUPPL. 2):161-161, Journal of general internal medicine
— id: 15908, year: 1999, vol: 14, page: 161, stat: Journal Article,

Ambulatory versus inpatient rotations in teaching third-year students internal medicine
Kalet A; Schwartz MD; Capponi LJ; Mahon-Salazar C; Bateman WB
1998 May;13(5):327-330, Journal of general internal medicine
We studied 63 randomly selected third-year students who split their 10-week medicine clerkship between ambulatory and inpatient components. Compared with their inpatient experience, during the ambulatory rotation, the 63 students felt more like doctors, more responsible for patients, and more able to know and help their patients. Students reported that ambulatory attending staff appeared happier and less stressed, and did not embarrass them as frequently. Compared with their 619 "inpatient" classmates, these 63 "ambulatory" students scored as well on the medicine examination, and were as likely to receive honors (44% vs 41%), and to choose internal medicine residencies (35% vs 34%). In conclusion, students experienced better relationships with their patients and teachers during the ambulatory rotation, which was academically comparable to the inpatient experience.
— id: 21068, year: 1998, vol: 13, page: 327, stat: Journal Article,

Patients as teachers: an integrated approach to teaching medical students about the ambulatory care of HIV infected patients
Vail R; Mahon-Salazar C; Morrison A; Kalet A
1996 Jan;27(1):95-101, Patient education & counseling
Our experience with medical students in a large inner city hospital left us concerned that students' fears affect their ability to learn about and care for HIV-positive people. Therefore, we decided to create an environment in which the students could feel safe exploring their own attitudes and feelings about HIV. To accomplish the goal, we developed a curriculum in the ambulatory care of HIV-positive people. We recruited and trained patients from an HIV support group at our hospital to work with students in one-on-one sessions to teach interviewing, physical exam, and patient counseling skills. As part of a 4-week ambulatory clerkship for third year students we developed a minicourse which included four sessions with didactic and experiential components. The first week consisted of an orientation and group discussion in which patients told the students about what its like to live with HIV. During each of the following three sessions, students met with a preceptor to learn about HIV in an ambulatory care setting. The didactic session was followed by one-on-one student/patient encounters in which students practised skills discussed that week and patients gave them feedback. At the close of the day, the entire group reconvened to discuss what had happened. As a result of this integrated approach, students are experiencing the relational aspects of providing medical care, often for the first and only time. In the process they are learning to take good social histories and are learning how patients with HIV relate to and sometimes reorganize their family and social support systems. Students have the opportunity to get to know, in depth, a relatively healthy person who is living with a chronic, stigmatizing illness. Both patients and students are talking to each other on a level of intimacy that is rare in the training environment. Patients express a new appreciation of their own role and power in the relationship and a new insight into the struggles of the provider. Faculty experience a renewed commitment to the importance of creating an environment where the students can discover for themselves the joy of the connection between doctor and patient. Students have an opportunity to relate to patients not as pathology, but as people with lives before and beyond the medical system. This model is practical and may be useful in teaching about other chronic diseases in the ambulatory setting
— id: 20089, year: 1996, vol: 27, page: 95, stat: Journal Article,

How do physicians talk with their patients about risks?
Kalet A; Roberts JC; Fletcher R
1994 Jul;9(7):402-404, Journal of general internal medicine
To describe the communication about risk between community-based physicians and their patients, the authors audiotaped 160 physician-patient encounters in the private practices of 19 physicians. Coding was done using a structured scheme to identify the presence of talk about risk of future illness, and to describe its characteristics. Patient understanding and satisfaction were assessed through an interview. Risk discussion occurred in 26% (95% CI 19%-33%) of the visits, quantitatively in two cases and specifically with respect to outcome in 48% (95% CI 40%-56%) of the visits. The patients initiated only 16% of this discussion but were, in general, satisfied with their care and the information they had received, but they had poor recall of the specifics of the discussion
— id: 6654, year: 1994, vol: 9, page: 402, stat: Journal Article,

Diabetic ketoacidosis in prisoners without access to insulin [see comments]
Keller AS; Link RN; Bickell NA; Charap MH; Kalet AL; Schwartz MD
1993 Feb 3;269(5):619-621, JAMA
OBJECTIVE--To assess the cause and clinical severity of diabetic ketoacidosis in male prisoners hospitalized in New York City. DESIGN--Retrospective chart review. SETTING--A municipal hospital in New York City. PATIENTS--Forty-nine adult male prisoners with a total of 54 hospital admissions for diabetic ketoacidosis between January 1, 1989, and June 30, 1991. MAIN OUTCOME MEASURES--Charts were reviewed for diabetic and medical history, time from arrest until hospitalization, cause of diabetic ketoacidosis, admission laboratory data, and hospital course. RESULTS--Thirty-eight (70%) of the 54 admissions for diabetic ketoacidosis among prisoners occurred because prisoners had not received insulin during the period immediately following arrest (mean number of days from arrest until hospitalization was 2.5). All of these individuals had a history of insulin-dependent diabetes and were reportedly compliant with their insulin regimen at the time of arrest. Admission laboratory data for this group of prisoners included a mean serum glucose level of 27.4 mmol/L (495 mg/dL) and a mean serum bicarbonate level of 14.4 mmol/L. Mean number of days in the hospital was 3.4 including a mean of 1 day in an intensive care unit. CONCLUSIONS--Inadequate access to medication results in serious sequelae for recently arrested prisoners in New York City with insulin-dependent diabetes. Access to health care for recently arrested prisoners needs to be improved
— id: 13252, year: 1993, vol: 269, page: 619, stat: Journal Article,

Allergic reactions to MMR vaccine
Kalet A; Berger DK; Bateman WB; Dubitsky J; Covitz K
1992 Jan;89(1):168-169, Pediatrics
— id: 21069, year: 1992, vol: 89, page: 168, stat: Journal Article,