Background: Therapeutic misunderstanding (TMU) and its three facets: therapeutic misconception, therapeutic misestimation, and therapeutic optimism have been identified as major challenges to the ethical conduct of clinical research and obtaining informed consent from research participants. However, the prevalence of TMU among clinicians and researchers has not been explored. Since most physicians will be exposed to clinical research over the course of their career, the understanding of clinical research procedures is important. In this study we attempted to determine the prevalence of TMU among medical students: future clinicians. Methods: Twenty-two BUSM undergraduate medical students took part in a two-part, survey evaluating the prevalence of therapeutic misunderstanding using "The Therapeutic Misunderstanding Scale". The attitudes of the students towards increasing the exposure to clinical research topics through the medical school curriculum were also determined. Results: The majority of the medical students exhibited therapeutic misunderstanding, particularly in the area of therapeutic misconception. In particular, the misunderstanding the difference between evidence-based clinical care versus hypothesis driven clinical research was exhibited. Although there was strong agreement that education in clinical research and clinical research ethics was important, the participants though increases of clinical research topics in the curriculum was not needed. Conclusions: The increased prevalence of TMU among future physicians underscores the need to teach clinical research and research ethics. Further research on a larger sample needed to validate the findings.

abstract: Healthy lifestyle behaviors including quality nutrition have been shown to successfully prevent chronic disease or minimize symptoms. However, many physicians lack the knowledge and skills to provide adequate nutrition counseling and education for their patients. A major component of this problem is that medical schools are not required to teach nutrition education. The purpose of this feasibility study was to compare the changes in the perceived importance of nutrition in the medical field in medical students before and after participating in a week-long interactive nutrition course in order to determine if a week-long course can positively influence students’ perceptions of nutrition. Ultimately by changing these perceptions, medical students may be able to better help patients prevent chronic disease. The participants were first year medical students at the Mayo Clinic School of Medicine (Scottsdale, AZ) who chose to participate in this medical school “Selective”. The study included a five-day curriculum of case-studies, lectures from specialized health professionals, and a cooking class led by a chef who trained in France. An anonymous pre- and post-study questionnaire with five-point Likert scale questions was used to measure changes in attitudes. The data suggest that students’ perceptions regarding the importance and relevance of nutrition in the medical shifted slightly more positive after attending this Selective, although these shifts in attitude were not statistically significant. Limitations of this study include a small sample size and selection bias, which may have decreased the potential of having significant results. Both of these factors also make the results of this study less generalizable to all medical students. This study supports the need for a larger experimental study of a similar design to verify that an interactive, evidence-based nutrition class and culinary experience increases medical students’ positive perceptions of nutrition in the medical field. / Dissertation/Thesis / Masters Thesis Nutrition 2020

abstract: Marijuana legalization will likely result in increased marijuana consumption with uncertain social and health impacts. This thesis looks to share user perspectives on marijuana, specifically addressing how users represent marijuana risks, benefits, and uncertain or unknown dangers. Data were collected from an online social-media forum that initiated the discussion by prompting readers to reflect on marijuana risks in a context of growing accolades concerning its benefits. Grounded theory and thematic analysis were both utilized to identify consistent themes or patterns across user comments. It was found that users identified both benefits and risks of marijuana, while some users had disputes about certain known risks (such as impaired driving) or uncertain or unknown dangers (such as reduced dream activity). Despite disagreements about the degree of risk associated with a particular activity (such as driving and dreaming), this thesis found risks and benefits were discussed in relatively narrow ways that suggest more education is needed around the full spectrum of the effects of various strains, including benefits, risks, and uncertainties. / Dissertation/Thesis / Masters Thesis Communication 2019

This applied dissertation was designed to evaluate the business and leadership components of a Registered Nursing (RN) to Bachelor of Science in Nursing (BSN) program at the university. The problem was that an evaluation of the present RN-to-BSN curriculum had not been conducted since 2006 to determine if the best practices in business and leadership were current, applicable, and relevant in the current RN-to-BSN curriculum. The researcher utilized an evaluation methodology to assess the business and leadership components of an RN-to-BSN nursing program. An evaluation tool was developed and used to compare expected outcomes (criteria) of current practices to expected outcomes (criteria) of best practices in the field of nursing. The expected outcomes (criteria) of current best practices were developed from a review of the literature, data collected from RN-to-BSN alumni students, and input from formative and summative committees. Thirteen specific procedures guided the study to assess the value, merit, and worth of the program and to answer six research questions. The final evaluation by the expert panel revealed that the current best practices in business and leadership taught in Nursing 4020 and Nursing 4030 courses were not current with preferred best practices. The final report recommended updating the courses with current best practices collected from the literature, formative and summative committee members, practicing RNs, and experts in the nursing profession.

This work explores the development and use of patient satisfaction evaluation system in a family practice setting. The goal was to develop a system that would minimally interfere with the delivery of care while simultaneously disclosing sources of patient satisfaction and dissatisfaction. The information would then be used to improve aspects of patient care and service delivery.

Indiana University-Purdue University Indianapolis (IUPUI) / Background. Despite widespread criticism of physician-performed evaluations of medical students’ clinical skills, clinical clerkship evaluations (CCEs) remain the foremost means by which to assess trainees’ clinical prowess. Efforts undertaken to improve the quality of feedback students receive have ostensibly led to higher assessment demands on physician faculty; the consequences of which remain unknown. Accordingly, this study investigated the extent to which physicians’ evaluative responsibilities influenced the quality of CCEs and qualitatively explored physicians’ perceptions of these evaluations. Methods. A questionnaire was delivered to physicians (n = 93) at Indiana University School of Medicine to gauge their perceived evaluative responsibilities. Evaluation records of each participant were obtained and were used to calculate one’s measurable quantity of CCEs, the timeliness of CCE submissions, and the quality of the Likert-scale and written feedback data included in each evaluation. A path analysis estimated the extent to which one’s evaluative responsibilities affected the timeliness of CCE submissions and CCE quality. Semi-structured interviews with a subset of participants (n = 8) gathered perceptions of the evaluations and the evaluative process. Results. One’s measurable quantity of evaluations did not influence one’s perceptions of the evaluative task, but did directly influence the quality of the Likert-scale items. Moreover, one’s perceptions of the evaluative task directly influenced the timeliness of CCE submissions and indirectly influenced the quality of the closed-ended CCE items. Tardiness in the submission of CCEs had a positive effect on the amount of score differentiation among the Likert-scale data. Neither evaluative responsibilities nor the timeliness of CCE submissions influenced the quality of written feedback. Qualitative analysis revealed mixed opinions on the utility of CCEs and highlighted the temporal burden and practical limitations of completing CCEs. Conclusions. These findings suggest physicians’ perceptions of CCEs are independent of their assigned evaluative quantity, yet influence both the timeliness of evaluation submissions and evaluative quality. Further elucidation of the mechanisms underlying the positive influence of evaluation quantity and timely CCE submissions on CCE quality are needed to fully rationalize these findings and improve the evaluative process. Continued research is needed to pinpoint which factors influence the quality of written feedback.

Indiana University-Purdue University Indianapolis (IUPUI) / High-fidelity patient simulation (HFPS) recreates clinical scenarios by combining mock patients and realistic environments to prepare learners with practical experience to meet the demands of modern clinical practice while ensuring patient safety. This research investigated the efficacy of HFPS in medical education through a case study of the Indiana University Bloomington Interprofessional Simulation Center. The goal of this research was to understand the role of simulated learning for attaining clinical selfefficacy and how HFPS training impacts performance. Three research questions were addressed to investigate HFPS in medical education using a mixed methods study design. Clinical competence and self-efficacy were quantified among medical students at IUSMBloomington utilizing HFPS compared to two IUSM campuses that did not incorporate this instructional intervention. Clinical competence was measured as performance on the Objective Structured Clinical Examination (OSCE), while self-efficacy of medical students was measured through a validated questionnaire. Although the effect of HFPS on quantitative results was not definitive, general trends allude to the ability of HFPS to recalibrate learners’ perceived and actual performance. Additionally, perceptual data regarding HFPS from both medical students and medical residents was analyzed. Qualitative results discovered the utility of HFPS for obtaining the clinical mental framework of a physician, fundamental psychomotor skills, and essential practice communicating and functioning as a healthcare team during interprofessional education simulations. Continued studies of HFPS are necessary to fully elucidate the value of this instructional adjunct, however positive outcomes of simulated learning on both medical students and medical residents were discovered in this study contributing to the existing HFPS literature.

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Carta al editor / Revisión por pares

The COVID-19 pandemic has disrupted all sectors of society including medical education. Medical schools are faced with an ethical dilemma pitting quality of medical education against student safety and delivering quality patient care. This paper identifies the different participants affected by a medical school’s decision on how to educate their students, discusses the current context of the pandemic, and analyzes the different options medical schools have. This paper defines two phases of the pandemic whereby phase two is defined as the time period the scientific community has an adequate understanding of the risks associated with COVID-19 and hospitals have adequate personal protective equipment. Phase one is simply the time before both of those criteria are met, and is the time when medical students should not be allowed on in-person clinical rotations. During phase two, students should be granted agency to make the decision for themselves. Using the analysis of the current pandemic, the paper outlines how medical schools’ decisions should change for future hypothetical pandemics. / Urban Bioethics