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INTRODUCTION: While studies report positive correlations between students' perceptions of the learning environment and their reported self-efficacy, the role of peer assessment is poorly understood in this context. This study examines the process and impact of peer assessment on self-efficacy and perceptions of the learning environment during a small-group discussion-based course required of first-year medical students. METHODS: After spending time in small-group learning, students completed three peer assessments and reviewed three assessments of themselves. Analysis of the peer assessments included thematic coding of comments and word counts. Prior to and following the assessment period, students completed a survey including the Generalized Self-efficacy (GSE) Scale, and six locally-developed questions regarding the learning environment and perceptions of peer assessment. We performed paired-sample t tests to determine whether there were differences between the pre- and post-peer assessment surveys. The SUNY Upstate Institutional Review Board reviewed the study and determined it to be exempt. RESULTS: Peer assessment narratives referred most commonly to students' participation style and the need for greater participation. Word counts ranged widely. A paired sample t test indicated that the difference between pre and post peer assessment GSE scores was significant (P=.009), but the effect size was small (d=0.32). Perceptions of the learning environment did not change after the peer assessments. CONCLUSION: Peer assessment offers a potential strategy for enhancing self-efficacy in medical school small-group learning environments and requires few resources to implement, relative to the potential benefits.

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This exercise satisfies the Liaison Committee on Medical Education Standard 7.3 for medical student training in the scientific method. The students are challenged, individually and in small groups, to state and test hypotheses based on real patient data concerning risk factors for the development of hepatocellular carcinoma.

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Lead is a major environmental toxin that presents numerous health consequences for children. Refugee children are at a risk of lead poisoning post-resettlement due to urban housing and environmental inequalities stemming from lack of funding, legislation, and advocacy. This article addresses lead exposure upon arrival and post-resettlement in 705 refugee children (age 0-16 years) attending a university clinic in Syracuse, NY, a city with a large refugee population. 17% of the newly arrived children had elevated blood lead levels (BLLs) (≥ 5 µg/dL); 10% had elevated BLL upon follow-up; 8.3% of the children's follow-up elevated BLL were new exposures. 30% were found to have increased BLL at follow-up regardless of arrival status. An analysis of new exposures found a significant proportion of children would have been missed on routine screening that targets children < 2 years old. Primary prevention efforts are needed to prevent exposure and address risks to improve the health of all children locally, including newly resettled refugees.

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Prior studies of immigrants to the United States show significant weight gain after 10 years of US residence. Pediatric refugees are a vulnerable population whose post-immigration weight trajectory has not been studied. We examined the longitudinal weight trajectory of 1067 pediatric refugees seen in a single university based refugee health program between the dates of September 3, 2012 and September 3, 2014 to determine how quickly significant weight gain occurs post-arrival. The most recent BMI was abstracted from the electronic health record and charts reviewed to obtain serial BMI measurements in 3 year increments after the date of US arrival. The mean arrival BMI percentile for all refugees was 47th percentile. This increased significantly to the 63rd percentile within 3 years of US arrival (p < 0.01). This rapid increase was largely attributable to African and South and Southeast Asian refugees. The overall prevalence of age and sex adjusted obesity rose from 7.4 % at arrival to 18.3 % within 9 years of US immigration exceeding the pediatric US national obesity prevalence of 16.9 %. Pediatric refugees are at increased risk of rapid weight gain after US immigration. Targeted interventions focused on prevention of weight gain in specific populations are warranted.

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