Touro University College of Osteopathic Medicine-CA (TUCOM) in Vallejo is a Jewish-sponsored osteopathic medical school. It has an annual enrollment of approximately 500 students and had graduated approximately 1700 osteopathic physicians by fall 2015, when this study was conducted. A roster of approximately 650 clinical adjunct faculty members located mostly in California but representing 37 states and the District of Columbia was selected from a database maintained by TUCOM's Clinical Education Department. The inclusion criterion was being a credentialed physician whose teaching appointment was current and based in year-3 and year-4 clerkship training. There were no exclusion criteria. A 28-item survey was distributed electronically in late October 2015 using the Qualtrics survey platform. A reminder was sent 3 days after the invitation, and the survey was closed in late November 2015.
The survey was not validated. It included 10 questions consisting of 28 items. Seven questions were single-item multiple-choice demographic questions regarding the setting of clerkship training and the frequency and years’ experience training students. A 10-item Likert-type question, from which outcome data were derived, asked respondents to compare TUCOM students with “students [they] have taught from other medical schools” (they did not identify the other medical schools) on 10 behaviors involving aspects of student-physician and student-patient professionalism and interpersonal and communication skills. Among the behaviors were 4 that were chosen because they align with definitions of empathy according to the NBOME
26 and AACOM.
27 The scale choices were “deficient,” “below,” “similar,” “better,” and “advanced,” in order of increasingly favorable comparison of TUCOM student behavior. A 9-item Likert-type scale question asked whether or not each of 9 given behaviors met respondents’ definition of physician empathy, and a final open item for feedback was included. The survey format conformed to the definition of a probability-based internet survey of specifically named individuals.
28
Responses were exported from Qualtrics into Microsoft Access, where they were tabulated and then imported for analysis into Microsoft Excel (Microsoft Corporation) and STATA / MP 13 (StataCorp LLC). Integrity of results was evaluated by calculating response rate and margin of sampling error. Response distribution was assessed for bias by calculating median, mode, and skew. Results were compared among demographic cohorts based on respondent background (osteopathic physician [ie, DO] vs allopathic physician [ie, MD]), experience teaching (veteran vs novice, other DO students, MD students, students per year), and selecting the same vs a different list of behaviors as definitive of empathy. Statistical significance of differences among cohorts was determined using a 2-sample z test of proportions. The minimum level of significance was set at 95% (P<.05) for all statistical tests. Assessment of these data was ruled exempt within the broader results of the survey of preceptor perceptions by the Institutional Review Board of Touro University California.