Mitigating the Risks of Drinking from a Fire Hose...2017/03/11 · from MS2 peer mentors 37 11 0 0 3.77 Provided me with valuable opportunities to meet and interact with MS1 faculty

3/4/2017

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Mitigating the Risks of

Drinking from a Fire Hose:

Observations from a Prematriculation Experiment

2017 APAHC Annual Conference (Detroit, MI) • 03/11/17

Wm. Scott Slattery, Ph.D.

University of Minnesota Medical School

Objectives

1. Learn about the development and structure of the

Enrichment program;

2. Explore how psychology serves to inform

consideration of elements incorporated into

prematriculation programming;

3. Discussion of similar transitional programming

efforts at other institutions and future

considerations.

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A profile of awesomeness …

• 2 Rhodes Scholars

• 1 Fulbright Scholar

• 1 Competitive Irish dancer (who participated in the World Irish Dance Championships three times)

• 1 professional boxer

• 1 professional hockey player

• 1 professional volleyball player

• 8 members of the military

• Multiple marathon finishers

• 33 different majors; unique subjects include Justice and Peace Studies, Anthropology, African American Studies, Classics, History, Religion, Hispanic Studies, History, Dance, Art, and Latin

• 23 students were born in 16 different countries other than the US.

• 34 languages spoken other than English

• 5 AmeriCorps / Teach for America volunteers

• 33 published at least one paper

Physician well-being (Dyrbye, Thomas, Shanafelt, 2005)

The goal of medical education is to graduate knowledgeable, skillful, and professional physicians. The medical school curriculum has been developed to accomplish these ambitions; however, some aspects of training may have unintended negative effects on medical students’ mental and emotional health that can under- mine these values. Studies suggest that mental health worsens after students begin medical school and remains poor throughout training. On a personal level, this distress can contribute to sub- stance abuse, broken relationships, suicide, and attrition from the profession.

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Physician burnout (Shanafelt, et al., 2012)

‘Compared with a

probability-based sample

of 3442 working US

adults, physicians were

more likely to have

symptoms of burnout

… and to be dissatisfied

with work-life balance ...’ (Shanafelt, et al., 2012)

Physician burnout (Peckham, 2017)

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Physician burnout (Peckham, 2017)

Year 1 Transition

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Year 1 Transition (Challenges)

• Novelty

• Culture

• Process (e.g., streaming lectures)

• Acclimation

• Volume of information

• Firehose effect

• Life … Development contexts

• Identity formation (for younger students)

• Family roles/responsibility

• Parenthood

• $$$ / SES stressors

• Learning / MH conditions

• Others ...

Year 1 Transition (Challenges)

• Psychology says …

A. Self-efficacy

B. Dis-empowerment (helplessness)

C. Acculturation, community,

connections

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A. Self-efficacy (Bandura, 1977)

• Performance accomplishment (experience)

• Vicarious experience (modeling)

• Verbal persuasion (encouragement)

•Mentorship (coaching)

Self-efficacy (The degree of) Confidence that if you have a goal, you will achieve it

“Growth”

Confidence

Competence

Certainty

Comfort

Self-Efficacy = High

Doubt

Incompetence

Uncertainty

Inadequacy

Self-Efficacy = Low

A ‘Recipe’ for Self-efficacy Support

1 Practice, practice, practice

2 Mentorship, tutoring, coaching,

guidance

3 Encouragement, support,

‘normalization’ of experience

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Identity & ‘self ’ as recipient of help

Most medical students have always been the best at everything they have done, and medical school presents an environment that makes even the most talented people question themselves. Because we have never had to ask for help, a significant portion of students have not developed the skill of seeking help.

Eduardo Salazar The University of Arizona College of Medicine

http://humanism-in-medicine.org/medical-students-burnout-prevention/

B. Empowerment

Power = Options

“nouns”

• People

• Places

• Things

• Ideas

Sadan (1997)

From powerlessness to acquiring power for agency/control

• Power over … domination

• Power to ... ability to make decisions

• Assets

• Knowledge and know-how

• Power with ... common purpose

• Capacity

• Power within ... self-awareness, esteem (knowing how to be)

• Will

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C. Community / Networking

Connection

• Connections - being ’part of ’

• Efficiency - consultations

• Celebration of diversity

• Acceptance

Disconnection

• Self-reliance/autonomy

• Isolation

• Marginalization/Unique

• “Minnesota nice” (… isn’t always so)

• ‘The’ student-parent, adult learner, young student, first gen student, low SES background, ‘rusty’ (away from academia), etc.

• Doubt / not belonging

• Negative social comparison / Imposter syndrome (not good enough)

D. Burnout

Maslach & Jackson (1981)

1. Emotional exhaustion

2. Depersonalization

3. Reduced sense of

personal

accomplishment

Medical student experience

• Drink from the fire hose;

• load it up;

• Manage even if lack of structure/intentionality;

• Leave your ‘self ’ at the door – do what’s expected (doing vs. being);

• ‘Streaming’ / plugged-in culture.

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Students can be successful +

satisfied in Medical School

… so, what to do?

Prematriculation (?)

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Process & Considerations

1. Explored many programs / approaches

2. Program had to be of quality (value)

3. Different than Orientation

4. Design elements to address potential threats to:

• Self-efficacy

• Empowerment

• Community / Networking

5. Capture the experience / evaluation

“Enrichment”

• Committee

• Student Affairs

• Admissions

• Curriculum

• Minority Affairs / Diversity

• Assessment / Evaluation

• Faculty / Staff

2014

• 3 weeks of planning

• Pilot – 5 days, 1 group

• 15 students

2015

• Working plan in place (early Spring)

• 4 days, 2 staggered groups

• 41 students

2016

• Repeat of 2015 plan

• 4 days, 2 staggered groups

• 51 students

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Program Components

On-campus component

• Day 1: Welcome / Pre-program assessment

• Peer mentor introductions

• Green Line dinner

• Day 2: Academic approaches / strategies

• Day 3: Fall course introductions

• Sample lectures

• Tools practice

• Day 4: ‘Words from the Wise’ / Closing

• Peer mentors - Resources ‘lab’

• Closing / Post-program assessment

• [Off-time: Campus/Community Exploration]

On-line component

• Module 1

• Module 2

• Module 3

Additional elements

• “Connections” luncheons

• Day 2: MedEd staff

• Day 3: Student groups / student council

• Day 4: Spring/Summer Course Directors & Course Managers

• Longitudinal support

• Ongoing, weekly consultation with peer mentor / tutor

throughout MS1

• Assessment/Evaluation

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Evaluation / Assessment

Pre-Enrichment

• Background

• Academic factor survey

• Learning approaches

A. Self-efficacy (5 items)

B. Empowerment (12 items) • Assets (3)

• Knowledge / Know how (5)

• Will (2)

• Capacity (2)

Post-Enrichment

• Value of program (12 items)

• Rating of program elements (17 items)

• Qualitative items(5 items)

Most helpful? /Least helpful? /Surprising? /Empowering? /Reflections?

A.Self-efficacy (5 items)

B.Empowerment (12 items) • Assets (3)

• Knowledge / Know how (5)

• Will (2)

• Capacity (2)

C.Networking • After 1 month (September) • After 9 months (April)

Participants

Selection (6 touchpoints)

• MCAT ≤ 27

• Age ≥ 25 y.o.

• Last school year ≤ 2011

• Self-identified

disadvantaged

• BCPM gpa ≤ 3.30

• Non-sciences ugrad major

Cohorts

• Round 1:

• 3+ factors

• 2 factors (MCAT + BCPM)

• 2 factors (BCPM + non-science)

• N=22 invites; n=8 participants (36%; 2014)



• Round 2:

• ‘Open’ invitation to MS1 class

• 8 accepted; N=16 total participants (2014)



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Peer Mentors (!)

• 2 per small group

• 1 from tutoring staff + 1 with vested interest in

supporting student transitions

• Voluntary

• Prior Enrichment participants ‘giving back’ (felt accomplishment)

• Longitudinal support

A. Design: Self-efficacy

• Experience:

• Day 3 – experiential lectures;

• Day 4 – practice with often-used tools;

• Modeling:

• Peer mentors

• Peer mentors

• Course Directors

• Encouragement:

• Connections luncheons (MedEd staff; student groups; curricular faculty & staff;

• Coaching:

• Day 2 – academic/cultural skills;

• Day 3 - Peer mentor input on course tips/strategies;

• Day 4 – Peer mentor – time for exploration + FAQs

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B. Design: Empowerment

• People:

• Peers(!);

• Peer mentors(!);

• Course directors, student leaders, deans, staff, etc.;

• Places:

• Day 1 – Greenline outing;

• Campus spaces (for exposure);

• MS2 student availability for community exploration;

• Things:

• Resources;

• Tools

• Ideas:

• Day 2 – stress & time management; test-taking;

• Peer mentors – ‘inside’ scoop on best practices for success;

C. Design: Networking / Community

• Noted before, but the familiarity born of exposure to peers, peer mentors, faculty, deans, staff, etc. is priceless;

• De-mystifies the culture; removes awkwardness;

• Enhances potential during the Orientation experience (… hey, I already know people here!). This has potential for expanding networks further (via body buddies, other peers met and introduced, etc.;

• One peer mentor per group continues to serve as a tutor (if needed)

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D. Design: Burnout

• Emotional exhaustion:

• Preemptive anxiety reduction;

• Tools for efficiency (lightens their load) – knowing the who, what, where …;

• Depersonalization:

• Getting to know peers + peer mentors (outside of competing demands from coursework and other peer obligations)

• Normalizes experiences (others share my experiences, challenges, assets)

• Reduced sense of personal accomplishment:

• Great opportunity for year 2 students to ‘give back’;

• Participants see ways to contribute to success of their peers as well

Outcomes

Value, Evaluations, Assessments

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Value of the Enrichment program

Post-program evaluation

Value of program (4.00 scale)

2014 2015 2016

• Met expectations? 3.73 3.67 3.52

• Would recommend for next year? 3.93 3.81 3.77

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Please indicate your agreement with the following statements

re: the Enrichment program

Question Strongly

Agree

Agree Disagree Strongly

Disagree

Mean

Met my expectations 29 17 0 2 3.52

I would recommend the Enrichment program 41 5 0 2 3.77

Created valuable opportunities to meet other

MS1 peers 39 8 0 1 3.77

Enhanced my overall sense of confidence in

effectively managing the Year 1 academic

demands

32 13 2 1 3.58

Enhanced my overall sense of comfort with

the Medical School learning environment 28 18 1 0 3.57

Provided me with valuable input and insight

from MS2 peer mentors 37 11 0 0 3.77

Provided me with valuable opportunities to

meet and interact with MS1 faculty 18 27 2 1 3.29

Provided me with valuable opportunities to

meet and interact with MedEd staff 17 31 0 0 3.35

I feel better prepared to begin MS1 39 7 1 1 3.75

Enhanced my overall knowledge of relevant

support resources and where to access them 28 17 2 1 3.50

Increased my overall awareness of, and

comfort with, relevant faculty and staff 26 21 0 1 3.50

Please indicate your agreement with the following statements

re: the Enrichment program cont.

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Evaluation of program elements

Post-program evaluation

Please indicate your agreement with the following

statements re: the Enrichment program

Question Strongly

Agree


Disagree

Mean

provided helpful insights into MS1

lecture/course expectations through

the experiential previews (Day 3) 32 15 1 0 3.65

introduced valuable approaches and

management strategies for more

effective and efficient academic

performance efforts (Day 2)

31 15 2 0 3.60

provided helpful opportunities for

'hands-on' experience with learning

tools and resources (e.g. streaming

lectures, ANKI, note-taking tools, etc.)

(Days 3-4)

21 22 5 0 3.33

included valuable suggestions and

recommendations from course

directors (Day 3) 29 16 3 0 3.54

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introduced relevant information and

resources to make informed choices

(Days 2-4) 29 15 3 0 3.55

Provided useful insights and

information about the Essentials of

Clinical Medicine (ECM) curriculum 24 20 2 0 3.48

Provided relevant insights and

information into MS1 experiences

through the 'Words from the Wise'

session with peer mentors (Day 4)

23 22 2 1 3.40

provided time to learn about people

and places involved in my MS1

experience (Day 1) 28 19 1 0 3.56

lunch opportunities (Connections)

were a helpful way to meet relevant

faculty, staff, and students in a more

relaxed, informal way

26 20 2 0 3.50

Question Strongly

Agree


Disagree

Mean

Please indicate your agreement with the following statements re: the Enrichment program cont.

I found the peer mentors to be...

Question Strongly Agree Agree Disagree Strongly Disagree Mean

Approachable 45 3 0 0 3.94

Respectful 45 3 0 0 3.94

Knowledgeable 42 5 0 0 3.89

I found the MedEd staff to be...

I found the Course Directors to be...









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Empowerment & Self-efficacy

Pre- & Post-program assessments

1

1.5

2

2.5

3

3.5

4

1 2 3 4 5 6 7 8 9 10 11 12

Pre-EP Mean Post-EP Mean

7 How connected do you feel to your Medical School peers?

8 How connected do you feel with the Medical School faculty & staff?

9 How aware are you of the effective study skills and strategies available to help support your academic efforts?

10 How confident are you in your desire/motivation to make a successful medical school transition?

11 How confident are you in being able to control/guide your efforts in MS1?

12 How confident are you in your ability to find/create needed opportunities for success in MS1?

1 How prepared do you feel you are to effectively manage the academic demands of MS1?

2 How confident are you in what to expect?

3 How aware are you of the resources in place to support your academic efforts?

4 How prepared are you to anticipate the demands/expectations of MS1?

5 How connected do you feel to the Medical School (in general)?

6 How aware are you of the Academic Health Center and UMN campus?

Means (1-4 scale) of responses on Pre- and Post-Enrichment Questionnaires:

Empowerment

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1

1.5

2

2.5

3

3.5

4

1 2 3 4 5

Pre-EP Mean Post-EP Mean

1 I can do what's needed to successfully maintain work-life balance and satisfaction.

2 I can identify and utilize skills, strategies, and approaches to be academically successful.

3 I can put together a 'team' of peers, staff, and faculty to support my academic efforts.

4 I can rely on myself for perspectives & attitudes needed to effectively manage my experiences and maintain balance.

5 I can maintain connections with family, friends, and others for personal balance and perspective.

Means (1-4 scale) of responses on Pre- and Post-Enrichment Questionnaires:

Self-Efficacy

Qualitative responses

Post-program evaluations

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Most helpful?

• I think that having the peer mentors share their experiences and providing specific input about the classes and the demands of each class was extremely helpful [empowerment - power to]. I still think the material is difficult but after hearing the advice from the peer mentors, at least it feels manageable [self-efficacy];

• I found the specifics of the different technological avenues available for our use was very helpful. I also found talking in small groups about your fears, relationships, culture of medical school, etc. extremely helpful [connections];

• Meeting with course directors was also very helpful, most importantly what to expect for the first day of class [self-efficacy; empowerment – power with];

• Everything to be honest.

Surprises?

• I shouldn't be surprised but the MS2s were extremely helpful and would help me connect with others that may have had similar interests.

• The Friday session about stress and time management. I really didn't think I had anymore to learn/improve in those areas but found out that I actually do;

• I found just having the faculty/staff members of the school be around us for many of the activities and lunches really allowed me to be more comfortable in their presence;

• It was really nice to meet some other students ahead of time!

• I didn't expect that meeting and getting exposed to the Med Ed staff would feel so empowering, but I really feel that I have resources available to me that I'm not sure I would have known existed.

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Empowering?

• While I felt that I would be able to succeed in medical school

prior to the program, Enrichment provided me with a greater

confidence to start my courses off strong. I now feel much

more equipped to tackle the demands [empowerment – power

to];of first year and its infamous "fire hose.”

• Yes, I feel empowered to be successful. Most of this comes from

the connections to second year students. I feel that I can ask

them for advice on how to survive certain aspects of year one

[self-efficacy … reaching out!; empowering – power with];.

Would recommend?

• Yes, I would without a doubt. It was a lot, a lot of information; perhaps a bit overwhelming. Yet I would much rather be a bit overwhelmed but still have all the information, than to not have any of this helpful information at all [empowerment – power to]. That would be even more overwhelming, I am sure [self-efficacy];

• The people were wonderful [connections], and it was a great transition into this new chapter of my life. I feel more comfortable with the UMN campus, I am less anxious about meeting my classmates, and I think I will be able to go at the academic work with a strong plan in place [empowerment – power within / self-efficacy]. It was wonderful.

• All the anxiety that I felt prior to this program has been drastically reduced. I feel confident that I will find my groove and be successful. [empowerment – power within / self-efficacy]

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Would recommend? cont.

• Uh, duh. Totally would recommend this program. It will help me do better academically this year, and in this light was invaluable

• It is hard for me to imagine how this program would not be beneficial to any future participant, as even for someone like me who went to the UMN for undergraduate I have learned a lot from the program. It was definitely a great experience socially and academically to connect with the medical school;

• I would definitely recommend this program to other students. I think it is very beneficial and gives you a sense of relief and empowerment prior to starting school, especially if you have been out of school for a few years.

• Yes! I feel 10 times more comfortable, confident, and less stressed than I had before this program about the transition into medical school and MS1 itself.

Future considerations

• Programming:

• Enrichment for transition to clerkships

(UME); Enrichment for transition to

residency (GME);

• Refine + expand online (Black Bag)

component (revise/clarify materials;

create modules with video components;

• Explore expansion of program to add’l

students (n=80-100);

• Assess value of ongoing peer mentor

support (longitudinal component);

• Assess cost effectiveness (refine as

indicated).

• Assessment:

• Within group comparisons;

• Matched sample comparisons

(formal study of Enrichment

participants vs. controls in MS1

class);

• Refine procedures for networking

analysis;

• Explore potential relationships

between program outcomes and

participant performance in Fall term

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Contact information

Wm. Scott Slattery, Ph.D. Dir. of Learner Development

University of Minnesota

Medical School

612-386-9682

[email protected]

References

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191-215.

Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2005, December). Medical student distress: causes, consequences,

and proposed solutions. In Mayo Clinic Proceedings (Vol. 80, No. 12, pp. 1613-1622).

Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of organizational behavior, 2(2),

99-113.

Peckham, C. Medscape Lifestyle Report 2017: Race and Ethnicity, Bias and Burnout. January 11, 2017

http://www.medscape.com/features/slideshow/lifestyle/2017/overview#page=1

Shanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D., ... & Oreskovich, M. R. (2012). Burnout and

satisfaction with work-life balance among US physicians relative to the general US population. Archives of internal

medicine, 172(18), 1377-1385.

Sadan, E. (1997). Developing a Theory of Empowerment. Empowerment and community planning: Theory and practice of

people-focused social solutions. (pp. 137-169). Tel Aviv: Hakibbutz Hameuchad Publishers.

mailto:[email protected]



Documents

Mitigating the Risks of Drinking from a Fire Hose...2017/03/11 · from MS2 peer mentors 37 11 0 0 3.77 Provided me with valuable opportunities to meet and interact with MS1 faculty