Volume 116, Issue 10

Context: The use of standardized patients (SPs) promotes and enhances interpersonal skill sets of medical students and provides a critical opportunity for students to display their relational competence during simulated patient encounters. Objective: To investigate whether SPs’ ratings of osteopathic medical students’ empathy and interpersonal skills correlate with students’ self-rated empathy. Methods: The study used a cross-sectional quantitative design. After SP encounters, first-, second-, and third-year osteopathic medical students self-rated empathy using the Jefferson Scale of Empathy medical student version. Standardized patients also assessed students’ empathy using the Jefferson Scale of Patient Perceptions of Physician Empathy and interpersonal skills using the Professionalism Assessment Ratings Scale. Results: Of 780 first-, second-, and third-year students, 717 students returned the survey (91.9%). In total, 383 students were women (53.4%) and 334 were men (46.6%). Of 717 SP encounters, SPs returned surveys for 648 encounters (90.3%). Ratings from SPs regarding their perceptions of osteopathic medical students’ empathetic abilities and interpersonal skills did not correlate with students’ self-rated empathy scores. Second- and third-year students were perceived by SPs as having better-developed empathetic and interpersonal skill sets when compared with first-year students. Results of SPs’ ratings indicated that the higher the interpersonal skills, the higher the SP-perceived empathy for students across all years ( r =0.66; P <.001). Conclusion: Students’ self-rated empathy did not correlate with SP-perceived empathy. However, the findings validated that students’ core relational competencies increase as they progress through medical school.

Context: The identification and evaluation of activities capable of dislodging calyceal renal calculi require a patient surrogate or validated functional pyelocalyceal renal model. Objective: To evaluate roller coaster facilitation of calyceal renal calculi passage using a functional pyelocalyceal renal model. Methods: A previously described adult ureteroscopy and renoscopy simulator (Ideal Anatomic) was modified and remolded to function as a patient surrogate. Three renal calculi of different sizes from the patient who provided the original computed tomographic urograph on which the simulator was based were used. The renal calculi were suspended in urine in the model and taken for 20 rides on the Big Thunder Mountain Railroad roller coaster at Walt Disney World in Orlando, Florida. The roller coaster rides were analyzed using variables of renal calculi volume, calyceal location, model position on the roller coaster, and renal calculi passage. Results: Sixty renal calculi rides were analyzed. Independent of renal calculi volume and calyceal location, front seating on the roller coaster resulted in a passage rate of 4 of 24. Independent of renal calculi volume and calyceal location, rear seating on the roller coaster resulted in a passage rate of 23 of 36. Independent of renal calculi volume in rear seating, calyceal location differed in passage rates, with an upper calyceal calculi passage rate of 100%; a middle calyceal passage rate of 55.6%; and a lower calyceal passage rate of 40.0%. Conclusion: The functional pyelocalyceal renal model serves as a functional patient surrogate to evaluate activities that facilitate calyceal renal calculi passage. The rear seating position on the roller coaster led to the most renal calculi passages.

Andrew Taylor Still, MD, DO, coined the original idea of lesion based on the obstruction of flow of body fluids, but primarily referring to bony structures and more precisely to the spine. Throughout the 20th century, this idea was shaped and developed into the concept of somatic dysfunction, a term that is familiar to both US-trained osteopathic physicians and foreign-trained osteopaths and has been an essential cornerstone of osteopathic practice and teaching. The present historical narrative review offers an overview of the evolution of Still’s original lesion concept, major evidence-based models of somatic dysfunction that attempt to explain the clinical findings, and a critique of the concept.

Context: At the author’s institution, patient perspective sessions were added to the preclinical curricula, in which actual patients present their medical stories and experiences to large groups of first- and second-year medical students. This curricular approach was designed to help address concerns about limited patient interaction during these years, which could lead to empathy erosion, academic burnout, and poor memory retention. Objective: To determine whether patient perspective sessions conducted in the first and second years of medical school had an effect on students’ empathy toward patients and perceived retention of material. Methods: In the summer of 2014, an anonymous electronic survey was sent to medical students in the class of 2016 who had completed the mandatory patient perspective curricula. The patient perspective sessions had started in the academic year of 2012-2013, and they involved real patients who presented their medical stories and experiences in the medical setting. Results: Of 135 surveys sent, 43 completed surveys (32%) were returned. Twenty-seven respondents (89%) reported that the patient perspective sessions met the objective of “enhancing empathy toward the patient experience,” and 23 respondents (75%) reported that the sessions made the material easier to remember. Further, 24 respondents (91%) reported enjoying the sessions, and all respondents reported that they wanted the patient perspective sessions to continue. Conclusion: Patient perspective sessions are a unique way to add more clinical exposure to the preclinical curriculum. These sessions have the potential to increase students’ empathy toward patients, to increase their retention of material, and to provide new perspective. Further, students reported enjoying the sessions, which can help decrease the potential for academic burnout.

Context: Empathy is an integral component of the patient-physician relationship and involves a cognitive ability to connect with others in a meaningful fashion. Multiple longitudinal studies have shown that self-reported allopathic medical student empathy declines significantly during year 3. However, to date, only 4 cross-sectional studies have been published on osteopathic medical students’ empathy. Whereas studies of allopathic medical students reported a decline in empathy, similar results were not found in osteopathic studies. Objective: To investigate (1) self-reported empathy through years 1 to 3 of osteopathic medical students and (2) whether empathy declines during year 3. Design: Design included cross-sectional and test-retest data collection. Setting: Private osteopathic medical school in the Northeast region of the United States. Participants: Osteopathic medical students. Main Outcome Measure: The Jefferson Scale of Empathy medical student version. Results: Respondents (N=717) included 383 women (53%) and 334 men (47%). When empathy levels were examined by demographics, the only significant finding was that women reported significantly higher empathy levels than men (112.3 vs 109.3; P <.001). Cross-sectional results indicate that mean empathy levels were significantly lower for third-year students at the end of the year (108.7) compared with first- and second-year students at the beginning of the year (111.3 and 112.4, respectively; P <.05). Test-retest analyses of year 3 indicated significantly lower empathy levels from the beginning to the end of the academic year (111.2 and 108.7, respectively; P <.05). Conclusion: Osteopathic medical students’ empathy declined significantly during year 3, which is consistent with the findings from allopathic samples but differs from findings from osteopathic samples. More research is needed to build the data on osteopathic medical student samples and to achieve a better understanding of changes in empathy in osteopathic and allopathic medical students.

In early 2014, the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, and the American Association of Colleges of Osteopathic Medicine agreed to a memorandum of understanding describing a single accreditation system for graduate medical education in the United States. Although there are many benefits, such as consistent quality of graduate medical education, alignment of competency standards, alignment with policymakers’ expectations, unification of voices on graduate medical education access and funding issues, and visibility of osteopathic medicine, there are also many challenges in creating a uniform system of graduate medical education. The authors review the pathways to initial certification for both the American Board of Surgery and the American Osteopathic Board of Surgery and discuss recertification and maintenance of certification.