“The role of a journal club in medical education” February 4, 2010

1. “The role of a journal club in medical education”February 4, 2010 Alan G. Robinson M.D. Associate Vice Chancellor, Medical Sciences Executive Associate Dean, David Geffen School of Medicine at UCLA

2. The Imposter Phenomenon • Clance, a barrier to empowerment and achievement in women • High achieving women who nonetheless believe themselves to be less intelligent and less competent than others perceive them to be • Believe they have achieved success by “fooling the others”

3. Residents Family Medicine and the Imposter Phenomenon, Oriel

4. Henning – Perfectionism and the imposter phenomenon in medical, dental, nursing and pharmacy students • 30% of students were clinically positive on Clance Impostor Phenomenon scale (CIP) • 27% were experiencing psychological distress of clinical significance • Perfectionism was scored by: “I expect it of me”, “I expect it of others”, “Others expect it of me” • The strongest predictors of psychological distress were CIP and perfectionism - “Others expect it of me”

5. Stereotype Susceptibility, Shih • African students stereotyped as poor students underperform when they believe they are being compared to white students • Elderly people perform poorly on a memory task when primed with a negative stereotype of the elderly • Most research has focused on one dimension of identity and on negative stereotyping

6. Asian-American women are subject to two common stereotypes • Women have inferior math skills compared to men • Asians have superior math skills compared to other ethnic groups • An experiment was done with Asian-American women, all with excellent math skills, mean SAT 751 (max 800)

7. Harvard Asian-American women were divided into three groups and given a questionnaire about residential life prior to a math test • Female identity questionnaire - single-sex floors, coed dorms, had a roommate, etc. • Asian identity questionnaire - language known, spoken at home, generations in America, etc. • Control identity questionnaire – satisfaction with phone service, subscribe to cable television, etc.

8. A similar study was performed with women in Vancouver Canada where: • The Asian community is recently immigrated • The stereotype is that Asians are less capable

9. Correct Answers on Math test %

10. The effect of international experiences on medical student attitudes, Godkin • Established program at the University of Massachusetts medical school • Students who participated in international programs had higher ratings on cultural competence • However, possible major contributor may have been selection the bias for students who chose international experiences

11. Class of 2002, attitudes of travelers (T) & non-travelers (NT) in 1st and 3rd year

12. Do physicians know when their diagnoses are correct? Friedman • Implications for decision support and error reduction • Exponential growth of biomedical knowledge and shortened half-life of “correct” information suggest need for external support • Will physicians seek external support? • Participants were given a series of cases, ask the DX and whether they would seek help

13. Portion of cases correctly diagnosed at each confidence level – Friedman JGIM, 2004

14. Breakdown of under and over confidence in nonaligned cases

15. 10 rules for successful journal club • Have it in a relaxed location • Be monotonous in cheese and snacks, i.e. don’t let participants try to one up each other with contributions of food • Serve water, wine and soft drinks • Eliminate from participation those who do not attend regularly • A theme for the year encourages session to session continuity

16. 10 rules for successful journal club 6) Look outside the medical literature for ideas 7) Don’t allow handouts or long review articles as background 8) Discuss how the article relates to your present activities 9) Plan an annual social event for participants and guests, e.g. movie and supper 10) Don’t allow nudity at the sessions

17. References Barlow A, et al. Home-visiting intervention to improve child care among American Indian adolescent mothers. Archives of Pediatrics & Adolescent Medicine2006; 160:1101-1107. Beach MC, Rosner M, Cooper LA, Duggan PS, Shatzer J. Can Patient-centered attitudes reduce racial and ethnic disparities in care? Academic Medicine 2007; 82(2): 193-198. Berwick, Donald M. Disseminating Innovations in Health Care. JAMA2003;289(15): 1969-1975. Chen, Pauline W. Final Exam: A Surgeon’s Reflections on Mortality Clance P, Imes S. The impostor phenomenon in high-achieving women: dynamics and therapeutic intervention. Psychotherapy: Theory, Research, and Practice 1978;15:241-247. Dornan T, Boshuizen H, King N, Scherpbjer A. Experience-based learning: A Model Linking the Processes and Outcomes of Medical Students’ Workplace Learning. Medical Education 2007; 41:84-91. Eva K, Cunnington J, reiter H, Keane D, Norman G. How can I know what I don’t Know? Poor self assessment in a well-defined domain. Advances in Health Sciences Education2004;9: 221-224. Friedman, Charles P., Guido G. Gatti, Timothy M. Franz, Gwedolyn C. Murphy et al. Do Physicians Know When Their Diagnoses Are Correct?" . Journal of General Internal Medicine 2005;20: 334-339.

18. References Godkin, Michael, and Judith Savageau. The Effect of Medical Students' International Experience on Attitudes Toward Serving Underserved Multicultural Populations. Family Medicine2003;35(4): 273-278. Henning, Kris, Sydney Ey, and Darlene Shaw. Perfectionism, the imposter phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Medical Education 1998;30:456-464. Ingram, M., et al. The Impact of Promotoras on Social Support and Glycemic Control Among Members of a Farmworker Community on the UC-Mexico border. The Diabetes Educator 2007; 33(6): 172S-178S. Klitzman, R . Improving Education on Doctor-patient Relationships and Communication: lessons from doctors who become patients. Academic Medicine 2006; 81(5): 447-453. Koskinen L, Tossavainen K. Study Abroad as a Process of Learning Intercultural Competence in Nursing. International Journal of Nursing Practice 2004;10:111-120 Oriel, Kathy; Mary Beth Plane, and Marlon Mundt. Family Medicine residents and the Impostor Phenomenon. Family Medicine 2004;36(4): 248-252. Shih, Margaret, Todd L. Pittinsky, and Nalini Ambady. STEREOTYPE SUSCEPTIBILITY: Identity Salience and Shifts in Quantitative Performance. Psychological Science 1999;10(1): 80-83. White C. Smoothing Out Transition: How Pedagogy Influences Medical Students’ Achievement of Self-Regulated Learning Goals. AHSE 2007; 12:279-297.

19. Movies (included in presentation) Connery, Sean, Laurence Mark, Rhonda Tollefsonet al. (Producers), & Van Sant, G. (Director). (2000). Finding Forester [Motion Picture]. United States: Columbia Pictures. Sanders, Tim, John Barnett, Frank Hubneret al. (Producers), & Caro, N. (Director). (2003). Whale Rider [Motion Picture]. New Zealand: Newmarket Films. Brown, Effie, George LaVooet al. (Producers), & Cardoso, P. (Director). (2002). Real Women Have Curves [Motion Picture]. United States: HBO Independent Productions. Loader, Kevin, Nicholas Hytner, Damian Joneset al. (Producers), & Hytner, N. (Director). (2006). The History Boys [Motion Picture]. United Kingdom: Fox Searchlight. Bosanquet, Simon. (Producer), & Nichols, M. (Director). (2001). Wit [Motion Picture]. United States: HBO Independent Productions.

20. Other Movies discussed by journal club Brockway, Jody, Howard Burkons, Tom Cox et al. (Producer), & Haines, R. (Director). (2006). The Ron Clark Story [Motion Picture]. United States: Turner Broadcasting Inc. DeVito, Danny, Michael Shamberg, Stacy Sher et al. (Producers), & LaGravenese, R. (Director). (2007). Freedom Writers [Motion Picture]. United States: Paramount Pictures. Franco, Larry J., Charles Gordon, Marc Sternberg et al. (Producers), & Johnston, J. (Director). (1999). October Sky [Motion Picture]. United States: Universal Studios. Grazer, Brian, Ron Howard. (Producers), & Howard, R. (Director). (2001). A Beautiful Mind [Motion Picture]. United States: Imagine Entertainment. Cort, Robert W. (Producer), & Sargent, J. (Director). (2004). Something the Lord Made [Motion Picture]. United States: HBO Independent Productions. Gladstein, Richard N. (Producer), & Hallstrom, L. (Director). (2000). Cider House Rules [Motion Picture]. Australia: Miramax Films. Farrell, Mike, Barry Kemp, Marvin Minoff, Charles Newwirth et al. (Producers), & Shadyac, T. (Director). (1998). Patch Adams [Motion Picture]. United States: Universal Studios.