Monica L Lypson

University of Michigan, Ann Arbor, Michigan, United States

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Publications (62)160.3 Total impact

  • 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 · 3.47 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.
  • 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 · 1.12 Impact Factor
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    ABSTRACT: 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 · 2.05 Impact Factor
  • Rachel L Perlman, Paula T Ross, Monica L Lypson
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    ABSTRACT: 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.
    Academic medicine: journal of the Association of American Medical Colleges 08/2014; DOI:10.1097/ACM.0000000000000449 · 3.47 Impact Factor
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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 · 3.47 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 · 2.08 Impact Factor
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    ABSTRACT: 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. La población de estudio fueron residentes que comenzaron en 2012 y 2013. La evaluación de los hitos de nivel 1 de los residentes se llevó a cabo con cuatro métodos distintos: 1) la evaluación de orientación posgrado (EOP) por la oficina Graduate Medical Education para todos los residentes entrantes. Este examen multiestación abarca nueve de los hitos de la MUE e incluye casos clínicos de pacientes estandarizados, realización de tareas y estaciones basadas en informática; 2) la observación directa de los encuentros con los pacientes por núcleo de profesores utilizando una lista de comprobación de competencia de habilidades clínicas basadas en hitos; 3) la evaluación mensual global al final del mes de orientación del residente que se actualiza para reflejar los hitos de la MUE; y 4) la evaluación del profesorado en los laboratorios de procedimientos. Éstos ocurrieron durante el mes de orientación de julio e incluyeron la EOP, las guardias, las sesiones clínicas y los laboratorios de procedimiento. En la EOP, los residentes fueron competentes en un 48–93% de los hitos evaluados. La competencia global fue de un 70% a un 80%, con puntuaciones bajas observadas en técnicas asépticas (PC13) así como las transferencias verbal y escrita (ICS2). En la comunicación total, un 70% de los residentes demostraron competencia. Se demostró más de un 80% de competencia en interpretación de valores críticos (PC3), consentimiento informado (PC9), valoración del dolor (PC11) y valoración funcional geriátrica (PC3). En la observación directa, se lograron casi todos los hitos de nivel 1 (93% a 100%), sin embargo sólo el 78% de los residentes adquirieron la competencia en farmacoterapia (PC5). En las evaluaciones mensuales globales, todos los residentes alcanzaron los hitos de nivel 1. Una evaluación multifuente de los hitos de la MUE es viable y útil para determinar los hitos de nivel 1 para residentes entrantes. Un programa de evaluación estructurado, usado en conjunción con las formas más tradicionales de evaluación como las evaluaciones mensuales globales y la observación directa, es útil para identificar los déficits en los nuevos residentes y puede ser capaz de informar para la creación de programas de intervención temprana. Spanish Con el próximo sistema de acreditación (PSA) del Accreditation Council for Graduate Medical Education desde, se exigirá a los programas de residencia que documenten los progresos de los residentes a través de hitos. Los hitos incluyen cinco niveles de habilidad que aumentan progresivamente, con el nivel 1 que define el conjunto de habilidades de un licenciado en medicina, hasta el nivel 5 de un médico asistencial. La ACGME subraya que deberían ser utilizadas múltiples formas de evaluación para asegurar la captura de las competencias polifacéticas. El objetivo de este estudio fue determinar la viabilidad y los resultados de la evaluación programática de los hitos de nivel 1 usando evaluaciones de múltiples fuentes para los residentes entrantes de Medicina de Urgencias y Emergencias (MUE) en julio.
    Academic Emergency Medicine 06/2014; 21(6). DOI:10.1111/acem.12393 · 2.20 Impact Factor
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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; DOI:10.1097/ACM.0000000000000120 · 3.47 Impact Factor
  • Paul Dougherty, Paula T Ross, Monica L Lypson
    12/2013; 5(4):701-2. DOI:10.4300/JGME-D-13-00309.1
  • Medical Education 11/2013; 47(11):1126-1127. DOI:10.1111/medu.12321 · 3.62 Impact Factor
  • Monica L Lypson, Ingrid Philibert
    Academic medicine: journal of the Association of American Medical Colleges 10/2013; 88(10):1404. DOI:10.1097/ACM.0b013e3182a368e8 · 3.47 Impact Factor
  • 09/2013; 5(3):515-516. DOI:10.4300/JGME-D-13-00205.1
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    ABSTRACT: Soaring costs of health care, patients living longer with chronic illnesses, and continued attrition of interest in primary care contribute to the urgency of developing an improved model of health care delivery. Out of this need, the concept of the team-based, patient-centered medical home (PCMH) has developed. Amidst implementation in academic settings, clinical teachers face complex challenges not previously encountered: teaching while simultaneously learning about the PCMH model, redesigning clinical delivery systems while simultaneously delivering care within them, and working more closely in expanded interprofessional teams.To address these challenges, the authors reviewed three existing faculty development models and recommended four important adaptations for preparing clinical teachers for their roles as system change agents and facilitators of learning in these new settings. First, many faculty find themselves in the awkward position of teaching concepts they have yet to master themselves. Professional development programs must recognize that, at least initially, health professions learners and faculty will be learning system redesign content and skills together while practicing in the evolving workplace. Second, all care delivery team members influence learning in the workplace. Thus, the definition of faculty must expand to include nurses, pharmacists, social workers, medical assistants, patients, and others. These team members will need to accept their roles as educators. Third, learning to deliver health care in teams will require support of both interprofessional collaboration and intraprofessional identity development. Fourth, learning to manage change and uncertainty should be part of the core content of any faculty development program within the PCMH.
    Academic medicine: journal of the Association of American Medical Colleges 07/2013; 88(9). DOI:10.1097/ACM.0b013e31829ecf89 · 3.47 Impact Factor
  • 06/2013; 5(2):333-334. DOI:10.4300/JGME-D-13-00074.1
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    ABSTRACT: Introduction: The purpose was to evaluate the Bookmark standard-setting method for use on a performance-based assessment in medical education. Methods: We compared cutscores for Aseptic performance assessment using the modified Angoff, Hofstee and modified Bookmark methods. Results: The Angoff produced a cutscore of 62%, SD = 18 and a percent passing (pp) = 64%. The Hofstee cutscore was 71%, SD = 7 and pp = 46%. Bookmark mean cutscores were 65.9% SD = 10.7 and pp = 42% for advanced beginners; 83.6%, SD = 9.2 and pp = 17% for competent and the proficient category resulted in a cutscore of 96.4% SD = 3.9 and pp = 1%. Faculty judges found the Bookmark method to be an easy and acceptable method. Conclusions: The Bookmark method was acceptable to faculty, has reasonable quality metrics when compared to other methods and can be a practical tool for establishing standards in performance-based examinations. The Bookmark method could be useful for establishing multiple levels of competency using the Dreyfus criteria.
    Medical Teacher 04/2013; DOI:10.3109/0142159X.2013.778395 · 2.05 Impact Factor
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    ABSTRACT: OBJECTIVE: To investigate the influence of participation in a health behavior counseling (HBC) case by examining standardized patients' real-life attitudes and behaviors toward nutrition and physical activity habits. METHODS: Focus group sessions were held with 10 standardized patients who regularly participated in the HBC case. Emergent themes were identified using grounded theory data analysis. RESULTS: Standardized patients reported how participation with role playing in the HBC case prompted personal lifestyle changes. Changes occurred through increased awareness and motivation to make adjustments to health habits, such as exercise and improved food choices. CONCLUSIONS AND IMPLICATIONS: The HBC model can be an effective method for helping patients to recognize the need to take action and implement positive lifestyle changes.
    03/2013; 45(5). DOI:10.1016/j.jneb.2013.01.011
  • Preeti N Malani, Monica L Lypson
    12/2012; 4(4):541-542. DOI:10.4300/JGME-D-12-00270.1
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    Monica Lypson, Ingrid Philibert
    06/2012; 4(2):138-9. DOI:10.4300/JGME-04-02-31
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    Steven J Kasten, Mark E P Prince, Monica L Lypson
    06/2012; 4(2):257-60. DOI:10.4300/JGME-D-12-00032.1

Publication Stats

303 Citations
160.30 Total Impact Points

Institutions

  • 2004–2014
    • University of Michigan
      • • Department of Internal Medicine
      • • Department of Health Behavior and Health Education
      Ann Arbor, Michigan, United States
  • 2010–2012
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States