Monica L Lypson

Concordia University–Ann Arbor, Ann Arbor, Michigan, United States

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Publications (80)174.75 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Problem: Competency-based education, including assessment of specialty-specific milestones, has become the dominant medical education paradigm; however, how to determine baseline competency of entering interns is unclear-as is to whom this responsibility falls. Medical schools should take responsibility for providing residency programs with accurate, competency-based assessments of their graduates. Approach: A University of Michigan ad hoc committee developed (spring 2013) a post-Match, milestone-based medical student performance evaluation for seven students matched into emergency medicine (EM) residencies. The committee determined EM milestone levels for each student based on assessments from the EM clerkship, end-of-third-year multistation standardized patient exam, EM boot camp elective, and other medical school data. Outcomes: In this feasibility study, the committee assessed nearly all 23 EM milestones for all seven graduates, shared these performance evaluations with the program director (PD) where each student matched, and subsequently surveyed the PDs regarding this pilot. Of the five responding PDs, none reported using the traditional medical student performance evaluation to customize training, four (80%) indicated that the proposed assessment provided novel information, and 100% answered that the assessment would be useful for all incoming trainees. Next steps: An EM milestone-based, post-Match assessment that uses existing assessment data is feasible and may be effective for communicating competency-based information about medical school graduates to receiving residency programs. Next steps include further aligning assessments with competencies, determining the benefit of such an assessment for other specialties, and articulating the national need for an effective educational handover tool between undergraduate and graduate medical education institutions.
    Academic medicine: journal of the Association of American Medical Colleges 10/2015; DOI:10.1097/ACM.0000000000000953 · 2.93 Impact Factor
  • Monica L Lypson · Kathryn Goldrath · Chiu Yueh Yao · Paula T Ross ·

    Journal of Women's Health 10/2015; DOI:10.1089/jwh.2015.5530 · 2.05 Impact Factor
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    Monica Lypson · Rachel Perlman · Paula Ross ·

    10/2015; 4(1):e111-2.
  • Jennifer N Stojan · Michael A Clay · Monica L Lypson ·

    BMJ quality & safety 10/2015; DOI:10.1136/bmjqs-2015-004584 · 3.99 Impact Factor
  • Scott D Gitlin · Monica L Lypson ·
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    ABSTRACT: Preparing for a laboratory or research-based career in academic medicine involves learning and acquiring a broad set of knowledge, skills, and experiences that facilitate the transition from trainee to faculty member. It also involves identifying and cultivating solid mentor/mentee relationships in the laboratory environment. It is well known that different skill sets and mentoring approaches are necessary for those pursuing laboratory-based research as compared with those needed for clinical practice and patient-oriented research. Here, we discuss several key approaches to help mentees identify fruitful mentor/mentee relationships.
    Journal of Cancer Education 09/2015; DOI:10.1007/s13187-015-0916-y · 1.23 Impact Factor

  • Rachel L Perlman · Paula T Ross · Monica L Lypson ·

    Mayo Clinic Proceedings 06/2015; 90(6):713-715. DOI:10.1016/j.mayocp.2015.03.021 · 6.26 Impact Factor
  • Rachel L Perlman · Paula T Ross · Monica L Lypson ·

    Academic medicine: journal of the Association of American Medical Colleges 05/2015; 90(5):548. DOI:10.1097/ACM.0000000000000697 · 2.93 Impact Factor
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    ABSTRACT: As residency programs move toward measuring milestones for competency based education assessment, medical schools will need to collaborate with residencies to determine competencies for graduating students. The objective of this study is to define the educational milestones for fourth year medical students during an internal medicine sub-internship. Cross-sectional internet based survey (with attention to validity evidence) was developed in early 2013 and administered to Internal medicine attendings and Internal medicine sub-interns working on an inpatient team at three academic medical centers. With the purpose to determine the milestones for sub-interns items asked respondents what responsibilities a sub-intern could be entrusted to perform without direct supervision. Faculty responded that behaviors sub-interns could perform with indirect supervision were mostly at the "reporter" level including completing a history and physical examination and collecting data such as test results. Other skills such as venipuncture and some communication skills such as calling consults, providing patient counseling, responding to pages, and creating discharge instructions were examples of tasks in which the majority of faculty felt that students were progressing toward unsupervised practice. Behaviors where the majority of faculty would always supervise a medical student performance included performance on the "interpreter" level including interpreting electrocardiograms, significant physical examination findings, and laboratory results. Medical students less commonly noted needed supervision on the majority of the items when compared to faculty. Tasks in the reporter domain such as taking a history, collecting medical records, and reporting results can be characterized as medical student milestones. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Medicine 03/2015; 128(7). DOI:10.1016/j.amjmed.2015.02.001 · 5.00 Impact Factor
  • Monica Lypson · Stacie Buckler · Kelly Poszywak ·

  • Paula T Ross · Monica L Lypson ·
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    ABSTRACT: Background: Physician bias toward patients directly impacts patient care and health outcomes. However, too little research has been done investigating avenues to bring about self-awareness in this area to eliminate commonly held stereotypes that fuel physician bias. Purposes: The purpose of this study was to explore the ways in which 2nd-year medical students' reflected on an artistic-narrative presentation given by a woman with sickle cell disease. Methods: A total of 320 2nd-year medical student essays were reviewed for content relevant to the artistic-narrative presentation. A total of 75 essays were identified and served as the data for this study. These 75 essays were analyzed using qualitative interpretive thematic content analysis to identify students' perceptions and reflections on culture in the healthcare environment and the patient-provider relationship. Results: The analysis of the reflective essays revealed that this exercise helped students acknowledge physician bias in pain treatment, foster empathetic views toward patients as individuals, and recognize various ways in which biased beliefs can provide incite in healthcare disparities. Conclusions: These findings suggest that the combination of methods-art, narrative, and written reflection-helped students acknowledge their own bias as well as the ways in which taken-for-granted assumptions and biases can influence patient care.
    Teaching and Learning in Medicine 10/2014; 26(4):344-349. DOI:10.1080/10401334.2014.945032 · 0.66 Impact Factor
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    ABSTRACT: Objectives: Determine postgraduate first-year (PGY-1) trainees ability to perform patient care handoffs and associated medical school training. Methods: About 173 incoming PGY-1 trainees completed an OSCE handoff station and a survey eliciting their training and confidence in conducting handoffs. Independent t-tests compared OSCE performance of trainees who reported receiving handoff training to those who had not. Analysis of variance examined differences in performance based on prior handoff instruction and across levels of self-assessed abilities, with significance set at p<0.05. Results: About 35% of trainees reported receiving instruction and 51% reported receiving feedback about their handoff performance in medical school. Mean handoff performance score was 69.5%. Trainees who received instruction or feedback during medical school had higher total and component handoff performance scores (p<0.05); they were also more confident in their handoff abilities (p<0.001). Trainees with higher self-assessed skills and preparedness performed better on the OSCE (p<0.05). Conclusions: This study provides evidence that incoming trainees are not well prepared to perform handoffs. However, those who received instruction during medical school perform better and are more confident on standardized performance assessments. Given communication failures lead to uncertainty in patient care and increases in medical errors, medical schools should incorporate handoff training as required instruction.
    Medical Teacher 08/2014; 37(3):1-8. DOI:10.3109/0142159X.2014.947939 · 1.68 Impact Factor
  • Rachel L Perlman · Paula T Ross · Monica L Lypson ·
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    ABSTRACT: Purpose: Physicians and their spouses experience challenges to their relationships, some of which are shared with the general population and others of which are unique to the field of medicine. Trainees and junior faculty members remain curious about how they will balance their careers alongside marriage and family obligations. This study explores the challenges and strengths of dual- and single-physician relationships. Method: In 2009, using appreciative inquiry as a theoretical framework, the authors conducted in-depth qualitative interviews with 25 individuals: 12 women and 13 men; 10 from dual-physician and 15 from single-physician relationships. A phenomenological analytic approach was used to arrive at the final themes. Results: Four themes emerged during the interviews: "We rely on mutual support in our relationships," "We recognize the important roles of each family member," "We have shared values," and "We acknowledge the benefit of being a physician to our relationships." Conclusions: These findings illustrate that physicians identify strategies to navigate the difficult aspects of their lives. Learn ing from others' best practices can assist in managing personal relationships and work-life balance. These data can also be useful when counseling physicians on successful relationship strategies. As systems are developed that improve wellness and focus on role models for work-life balance, it will be important for this topic to be integrated into formal curricula across the continuum of medical education.
    Academic medicine: journal of the Association of American Medical Colleges 08/2014; 90(1). DOI:10.1097/ACM.0000000000000449 · 2.93 Impact Factor
  • Mitesh S Patel · Monica L Lypson · D Douglas Miller · Matthew M Davis ·
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    ABSTRACT: Problem: Nearly half of graduating medical students in the United States report that medical school provides inadequate instruction in topics related to health policy. Although most medical schools report some form of policy education, there lacks a standard for teaching core concepts and evaluating student satisfaction. Approach: Responses to the Association of American Medical College's Medical School Graduation Questionnaire were obtained for the years 2007-2008 and 2011-2012 and mapped to domains of training in health policy curricula for four domains: systems and principles; value and equity; quality and safety; and politics and law. Chi-square tests were used to test differences among unadjusted temporal trends. Multiple logistic regression models were fit to the outcome variables and adjusted for student characteristics, student preferences, and medical school characteristics. Outcomes: Compared with 2007-2008, students' perceptions of training in 2011-2012 increased on a relative basis by 11.7% for components within systems and principles, 2.8% for quality and safety, and 6.8% for value and equity. Components within politics and law had a composite decline of 4.8%. Multiple logistic regression models found higher odds of reporting satisfaction with training over time for all components within the domains of systems and principles, quality and safety, and value and equity (P < .01), with the exception of medical economics. Next steps: Medical student perceptions of training in health policy improved over time. Causal factors for these trends require further study. Despite improvement, nearly 40% of graduating medical students still report inadequate instruction in health policy.
    Academic medicine: journal of the Association of American Medical Colleges 07/2014; 89(10). DOI:10.1097/ACM.0000000000000408 · 2.93 Impact Factor
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    ABSTRACT: Rationale and objectives: Despite increasing radiology coverage, nonradiology residents continue to preliminarily interpret basic radiologic studies independently, yet their ability to do so accurately is not routinely assessed. Materials and methods: An online test of basic radiologic image interpretation was developed through an iterative process. Educational objectives were established, then questions and images were gathered to create an assessment. The test was administered online to first-year interns (postgraduate year [PGY] 1) from 14 different specialties, as well as a sample of third- and fourth-year radiology residents (PGY3/R2 and PGY4/R3). Results: Over a 2-year period, 368 residents were assessed, including PGY1 (n = 349), PGY3/R2 (n = 14), and PGY4/R3 (n = 5) residents. Overall, the test discriminated effectively between interns (average score = 66%) and advanced residents (R2 = 86%, R3 = 89%; P < .05). Item analysis indicated discrimination indices ranging from -0.72 to 48.3 (mean = 3.12, median 0.58) for individual questions, including four questions with negative discrimination indices. After removal of the negatively indexed questions, the overall predictive value of the instrument persisted and discrimination indices increased for all but one of the remaining questions (range 0.027-70.8, mean 5.76, median 0.94). Conclusions: Validation of an initial iteration of an assessment of basic image-interpretation skills led to revisions that improved the test. The results offer a specific test of radiologic reading skills with validation evidence for residents. More generally, results demonstrate a principled approach to test development.
    Academic Radiology 07/2014; 21(7):909-15. DOI:10.1016/j.acra.2014.03.010 · 1.75 Impact Factor
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    ABSTRACT: Objectives: With the Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation System, emergency medicine (EM) residency programs will be required to report residents' progress through the EM milestones. The milestones include five progressively advancing skill levels, with Level 1 defining the skill set of a medical school graduate and Level 5, that of an attending physician. The ACGME stresses that multiple forms of assessment should be used to ensure capture of the multifaceted competencies. The objective of this study was to determine the feasibility and results of programmatic assessment of Level 1 milestones using multisource assessments for incoming EM interns in July. Methods: The study population was interns starting in 2012 and 2013. Interns' Level 1 milestone assessment was done with four distinct methods: 1) the postgraduate orientation assessment (POA) by the Graduate Medical Education Office for all incoming interns (this multistation examination covers nine of the EM milestones and includes standardized patient cases, task completion, and computer-based stations); 2) direct observation of patient encounters by core faculty using a milestones-based clinical skills competency checklist; 3) the global monthly assessment at the end of the intern orientation month that was updated to reflect the EM milestones; and 4) faculty assessment during procedural labs. These occurred during the July orientation month that included the POA, clinical shifts, didactic sessions, and procedure labs. Results: In the POA, interns were competent in 48% to 93% of the milestones assessed. Overall, competency was 70% to 80%, with low scores noted in aseptic technique (patient care Milestone 13 [PC13]) and written and verbal hand-off (interpersonal communications skills [ICS]2). In overall communication, 70% of interns demonstrated competency. In excess of 80% demonstrated competency in critical values interpretation (PC3), informed consent (PC9), pain assessment (PC11), and geriatric functional assessment (PC3). On direct observation, almost all Level 1 milestones were achieved (93% to 100%); however, only 78% of interns achieved competency in pharmacotherapy (PC5). On global monthly evaluations, all interns met Level 1 milestones. Conclusions: A multisource assessment of EM milestones is feasible and useful to determine Level 1 milestones achievement for incoming interns. A structured assessment program, used in conjunction with more traditional forms of evaluation such as global monthly evaluations and direct observation, is useful for identifying deficits in new trainees and may be able inform the creation of early intervention programs.
    Academic Emergency Medicine 06/2014; 21(6). DOI:10.1111/acem.12393 · 2.01 Impact Factor
  • Monica Lypson · Divy Ravindranath · Paula Ross ·

  • Monica Lypson · Andrew Campbell · Jennifer Stojan · Paula Ross ·

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    Rachel L Perlman · Jennifer Christner · Paula T Ross · Monica L Lypson ·
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    ABSTRACT: Portfolios are emerging as a tool for documenting learning progression and assessing competency. ePortfolios are appealing as a portable and fluid means of documenting both learning and relevant experiences in a large number of students. Competence and learning can be especially difficult to document in important aspects of education and training, such as patient-centeredness, the cultural context of disease, and social determinants of health that do not lend themselves to fact-based assessment methods. Successful implementation of a method such as an ePortfolio requires explicit faculty development, as many faculty members have limited expertise with modern educational assessment technology. As part of the authors' introduction of a Sociocultural ePortfolio Assessment Tool in the undergraduate medical curriculum, three faculty development workshops were held to expand faculty skills in using this technology. In addition to gaining comfort using a new Web-based technology, faculty members also needed to develop skills with providing mentored feedback and stimulating student reflection. Workshops were modeled after other successful programs reported in the literature and allowed faculty to develop a structured format for evaluating student content. Faculty members were given multiple opportunities to practice their newly developed skills providing mentored reflections using an ePortfolio. The workshop evaluations were positive, suggesting that faculty participation in the workshops were a necessary component for them to develop sufficient assessment skills for providing mentored reflection. Faculty members who participated in this program-whether or not they had content expertise in sociocultural medicine-valued the hands-on faculty development program.
    Academic medicine: journal of the Association of American Medical Colleges 12/2013; 89(2). DOI:10.1097/ACM.0000000000000120 · 2.93 Impact Factor
  • Paul Dougherty · Paula T Ross · Monica L Lypson ·

    12/2013; 5(4):701-2. DOI:10.4300/JGME-D-13-00309.1

Publication Stats

407 Citations
174.75 Total Impact Points


  • 2010-2015
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2004-2015
    • University of Michigan
      • • Department of Internal Medicine
      • • Medical School
      • • Department of Health Behavior and Health Education
      Ann Arbor, Michigan, United States