Oral Presentations Abstracts, 23^rd Annual Meeting of the International Association of Medical Science Educators, Roanoke, VA, USA, June 8–11, 2019

ASSESSMENT

THE UNUSUAL COMPLEXITY AND INVERTED ASSOCIATION OF MEDICAL STUDENT PERSEVERANCE AND THEIR VALUES

William J. Hueston MD | Kristina Kaljo PhD | Craig Hanke PhD | Molly Falk-Steinmetz MS | Diane Brown MS | Jeff Fritz PhD | Koenraad De Roo | Amy Prunuske PhD

Medical College of Wisconsin | Medical College of Wisconsin | Medical College of Wisconsin | Medical College of Wisconsin | Medical College of Wisconsin | Medical College of Wisconsin | Medical College of Wisconsin | Medical College of Wisconsin

AWARD NOMINEE

Purpose: Medical students are amazingly resilient in the face of academic challenges, studying relentlessly enormous volumes of course materials and having scant time for personal endeavors. Perseverance is a major element of resilience that requires persistence in pursuing something despite the difficulty in achieving success. Resilient individuals must therefore value the outcomes they strive to achieve. The purpose of this study is to analyze the relationship of medical student perseverance and values as impacted by gender. Methods: In 2017/2018, 205 of 500 M-1/M-2 medical students (106 males/99 females) voluntarily completed these self-reported surveys: RS-25 Resilience Scale and Human Values Inventory. Interitem reliability was determined with Cronbach’s alpha. Pearson correlations (r) and stepwise multivariate linear regressions were used for predicting perseverance scores from 10 value domains and 56 facets. IBM® SPSS® 24.0 generated statistical analysis. This research was approved by the institution’s IRB. Results: Perseverance (alpha = 0.7) scores were significantly (p < 0.050) and negatively correlated to all 10 human value domains: universalism (r = − 0.5), benevolence (− 0.4), conformity (− 0.3), tradition (− 0.3), security (− 0.4), power (− 0.4), achievement (− 0.4), hedonism (− 0.3), stimulation (− 0.3), and self-direction (− 0.4). The remaining four factors of resilience (authenticity, equanimity, purpose, self-reliance) had positive correlations with the 10 values. Linear regression results for male perseverance (R = 0.43, p < 0.001) were predicted by four value facets: excitement (beta = 0.3), obedience (0.3), wisdom (− 0.4), and safety (− 0.5). Linear regression results for female perseverance (R = 0.54, p < 0.001) were predicted by creativity (0.5), self-discipline (0.3), meaning in life (− 0.3), broadmindedness (− 0.3), enjoyment (− 0.3), and wisdom (− 0.4). Conclusions: Medical student perseverance increased as their self-enhancement values such as hedonism and power decreased, but also as their self-transcendent values such as benevolence did. Predictive modeling revealed greater complexity as resilient female students valued creativity and self-discipline and male students valued excitement, but both devalued wisdom while persisting toward goals. Values must be prioritized when in conflict.

ASSESSMENT

STUDENT PERSPECTIVES ABOUT READINESS TO PERFORM EPA TASKS: DOES A YEAR OF EXPERIENCE AFFECT SELF-ASSESSED NEED FOR SUPERVISION?

Victor Soukoulis | Maryellen E Gusic

University of Virginia | University of Virginia

Purpose: The AAMC’s 13 Core Entrustable Professional Activities (EPAs) identify tasks that students should be prepared to do with indirect supervision on day 1 of residency. A key consideration in entrustment decision-making is a learner’s trustworthiness, including ability to self-evaluate, discern limitations, and ask for help/supervision. We have reported the discrepancy between student and clerkship director perceptions about the level of supervision learners require for EPAs at the beginning of the clerkship year. In this study, we sought to evaluate how, with reflection on their experiences during the clerkships and in doing EPA assessments, these same students retrospectively and prospectively assessed their abilities and need for supervision. Methods: After the end of the clerkship year, students were asked to retrospectively rate the level of supervision they needed to perform each EPA, and to prospectively rate their supervision needs going into the post-clerkship phase. They were asked how confident they were in these determinations. Retrospective assessments were compared to pre-clerkship assessments and confidence. Results: Students (n = 33) reported that, in retrospect, they needed higher levels of supervision at the start of their clerkship year than they originally determined (2.93 vs 2.69; p < 0.015). The difference was statistically significant for a specific subset of EPAs related to commonly performed tasks. Looking forward, students reported low need for supervision for all EPAs as they entered the post-clerkship phase, with high levels of confidence in their self-assessment. Conclusion: For activities students commonly participated in and received feedback about during the clerkship year, students reported needing higher levels of supervision on retrospective self-assessment. Students’ high confidence in their supervision needs moving forward raises concern, however, about how to integrate learners’ abilities to self-assess in determinations about trustworthiness.

ASSESSMENT

FACULTY RESILIENCE, REFLEXIVITY, AND WELL-BEING: REQUISITE ELEMENTS OF SUCCESS

Kristina Kaljo PhD | Jennifer Apps PhD | Bipin Thapa MD | Kerrie Quirk MEd

Medical College of Wisconsin | Children’s Hospital of Wisconsin | Medical College of Wisconsin | Medical College of Wisconsin

Purpose: Academic faculty in the health sciences face many professional challenges from competing demands of teaching, scholarship, and clinical duties. Successful achievement of these ongoing demands requires the capacity to persevere when stress levels rise. The ability to manage challenging workloads and endure stress requires resilience. Research indicates that those who engage in reflexivity or self-evaluation of actions can persevere and be resilient due to an acute awareness and ability to problem-solve when challenges arise. The purpose of this study is to analyze differences in medical school faculty resilience as impacted by perceived levels of stress and determine how mindful development of reflexivity has the capacity to foster resilience and grit among faculty. Methods: In March 2018, 20 faculty were interviewed in person or on the phone by one of the authors at a private Midwestern medical college for approximately 30 min each about sources of stress that impacted their resilience. Qualitative analysis reported themes that were used for follow-up focus groups. Results: Major sources of faculty stress included systemic sources such as electronic health record (65%) and physician scheduling (45%) and individual sources such as work/life imbalance (30%) and little/no protected time for academic pursuits (25%). Reported mediators of perceived faculty stress included access to physical, psychological, and temporal resources; leadership, mentorship, and staff support; and use of positive psychology such as mindfulness training, use of nudge theory, and PERMA. Conclusions: Maintaining well-being and resilience includes having shared values with leaders and obtaining support for electronic health record and nonpatient care responsibilities. Flexibility on scheduling and planned redundancy in time will help with work/life balance.

ASSESSMENT

FORMATIVE ASSESSMENT AND SELF-DIRECTED LEARNING: UNDERGRADUATE MEDICAL STUDENTS’ NEEDS

Youn Seon Lim

Donald and Barbara Zucker School of Medicine

Objective: In self-directed learning environments, students must monitor and assess their learning progress themselves. Formative assessments (FAs) play a central role as instructional tools to train students in these self-assessment skills. Previous studies show that the effectiveness of FAs as a training instrument is highly correlated with the degree to which students participate in the design and implementation of their FAs. Nonetheless, in present-day undergraduate medical education (UME), FAs are typically devised and administered with minimal student involvement. This study seeks to identify UME students’ needs and expectations toward FAs believed to improve their self-directed learning. Method: A total of 140 volunteer UME students participated in an online survey that used open-ended questions about students’ general preferences concerning FAs and which specific characteristics of FAs students believed were most supportive in facilitating self-directed learning. The responses to the open-ended questions were quantified using thematic analysis. Mean comparison tests and relation tests were conducted to identify primary characteristics of FAs described as helpful by students. Of particular interest was how students perceived the role of feedback that FAs provide to them and which features students thought were especially helpful in learning self-directed learning. Results: Results showed that 67.9% of UME students appreciated the use of FAs to teach them self-directed learning skills. Gender, race, and years-in-school were related to significant differences: female students, Caucasian students, and students in their first years were more satisfied with current FAs practices. Overall, students pointed out that to help with self-directed learning, FAs should possess the following characteristics: transparency, accuracy, relevance, timeliness, and specific (study) directions. Conclusions: The majority of UME students were positive about the use of FAs to teach them self-directed learning skills, but the results also showed that there is still room for improvement, especially in regard to the involvement of minority students.

ASSESSMENT

EFFECTIVENESS OF THE HUMAN METABOLISM MAP IN MEDICAL BIOCHEMISTRY EDUCATION

Zeynep Gromley | Adam Gromley | Vinayak Nahar

Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN | Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN | Lincoln Memorial University - Center for Animal and Human Health in Appalachia, Harrogate, TN

Purpose: Understanding of the biochemical basis of disease is a crucial aspect of the medical school curriculum. One of the most commonly reported negative factors is the incorrect assumption that biochemistry requires rote memorization. In order to address this problem, biochemistry educators from Stanford developed a human metabolism map and made it freely available. To evaluate the efficacy of this metabolic map in an osteopathic medical school curriculum, we incorporated its use in our biochemistry course and evaluated its effects on student learning. Methods: We compared exam performances and item analysis from first year medical students in the fall of 2015 and 2016, where students did not have access to the map as a study tool, to first year medical students in the fall of 2017 and 2018, where students were given the map. We evaluated selected questions by scatter plot analysis and compared between the two groups. We also collected students’ perceptions using a survey. Results: Our study reveals that the class mean for the course was not significantly different between the two cohorts. Item analysis also shows that the performance of selected exam questions between the two groups did not change. Although we did not see a significant impact on grades or exam item performance, our survey results indicate that 85% of the students that utilized the map found it beneficial for their understanding of medical biochemistry, with the vast majority of them indicating that their ability to interpret clinical cases was enhanced. Conclusion: These results show that providing the metabolic map to medical students as a study tool did not have an effect on the overall performance of the class. However, those students that reported using the map said that it improved their understanding of medical biochemistry. Future studies are needed to further analyze the discrepancy between these two results.

ASSESSMENT

LEARNING MEDICAL HUMANITIES: DO MEDICAL STUDENTS’ CONCEPTIONS OF LEARNING MEDICINE AND APPROACHES TO LEARNING MEDICINE MATTER?

Yen-Yuan Chen | Kuan-Han Lin | Tzong-Shinn Chu | Tien-Shang Huang

Graduate Institute of Medical Education & Bioethics, National Taiwan University College of Medicine | Graduate Institute of Medical Education & Bioethics, National Taiwan University College of Medicine | Graduate Institute of Medical Education & Bioethics, National Taiwan University College of Medicine | Department of Medical Education, Cathay General Hospital

Purpose: The learning process and outcomes of medical humanities have always been concerned about by medical educators and learners. Conceptions of learning and approaches to learning have been identified as two of the most important factors affecting students’ learning. The main objectives were to investigate the association between conception of learning and approaches to learning, and to examine the association between students’ approaches to learning medicine and learning outcomes in medical humanities course. Methods: We used the Approaches to Learning Medicine (ALM) and Conception of Learning Medicine (COLM) questionnaires for measuring medical students’ approaches to learning and conception of learning medicine, respectively. We assessed learning outcomes in a medical humanities course using a weighted grade. Confirmatory factor analysis was used to validate the COLM and ALM questionnaires. We conducted structural equation modeling (SEM) to estimate the structural relationships among each dimension of the COLM, ALM, and the learning outcome. Results: A total of 272 first-year medical students completed the questionnaire. Based on SEM, medical students with high-level conception of learning medicine, i.e., preparing for tests, are positively associated with using surface strategy to learning medicine (p < 0.01) and negatively associated with deep strategy to learning medicine (p < 0.01). The low-level conception of learning medicine, i.e., preparing for tests, was also negatively associated with deep strategy to learning medicine (p < 0.01). In addition, medical students with surface strategy to learning medicine had a poor learning outcome as indicated by the weighted grade (p = 0.04). Conclusions: Medical students with the conception that medicine is only preparing for tests were more likely to learn medical humanities using surface strategies, and the surface strategies resulted in worse learning outcomes in medical humanities. Accordingly, medical students are encouraged to use deep strategies to learning medical humanities for resulting in a better learning outcome.

ASSESSMENT

DO SOAP NOTE-STYLE EXAM QUESTION STEMS OFFER ADVANTAGES OVER VIGNETTE-STYLE STEMS?

Terrence W. Miller | Kristina Lindquist | Derek S. Meeks | Ashlie Bloom

Touro University Nevada College of Osteopathic Medicine | Touro University Nevada College of Osteopathic Medicine | Touro University Nevada College of Osteopathic Medicine | Touro University Nevada College of Osteopathic Medicine

Purpose: The vignette-based, multiple-choice question (MCQ) is a common format in medical school exams. While each MCQ ideally assesses a learning objective, it may also inadvertently assess reading speed. We hypothesized that question stems written in a SOAP note format, rather than a vignette, allows the examinee to process information with less emphasis on reading speed. Methods: Vignette stems were rewritten with the same content presented as a SOAP note. Each of the 10 exams administered to 135 osteopathic medical students possessed four experimental questions. Each student got vignette and SOAP questions; for a given question, half got the vignette and the other half the SOAP. We compared (1) difficulty and discrimination indices for vignette versus SOAP questions and (2) exam-taker behaviors derived from Examsoft testing software snapshot files “time spent per question and number of times returning to questions” when answering the two formats. Results: The mean difficulty indices for the 40 SOAP and 40 vignette questions were the same (0.73). The mean discrimination index was somewhat higher for the SOAP questions (0.21 vs 0.17). SOAP stems averaged 30% fewer words, and students spent significantly less time on SOAP questions (98.4 vs 103.9 s, p < 0.05). This difference is mainly attributable to decreased viewing time during the student’s first encounter (75.6 vs 72 s, p < 0.05). Students revisited both question types with similar frequency (3.09 average visits for SOAP, 3.14 for vignette, p = 0.266). Conclusions: Students spent significantly less time on SOAP questions compared to vignette questions, mainly attributable to decreased viewing time on the student’s first question encounter. Note that students averaged more total time per question than allotted for either USMLE (90 s/question) or COMLEX (72 s/question) licensing exams. Data supports the hypothesis that the SOAP-style question reduced the emphasis on reading speed and may offer advantages over the traditional vignette question format.

ASSESSMENT

PRECLINICAL IMPLEMENTATION AND ATTAINMENT OF ENTRUSTABLE PROFESSIONAL ACTIVITIES: FIRST TIER OF A LONGITUDINAL ANALYSIS

Kimberly J. Taylor, Ph.D. | Brandon Isaacs, D.O. | James R. Keene, Ph.D., D.O. | Robert Sorrells, Ph.D. | Jonie Kerns, M.B.A.

Pacific Northwest University of Health Sciences | Pacific Northwest University of Health Sciences | Pacific Northwest University of Health Sciences | Pacific Northwest University of Health Sciences | Pacific Northwest University of Health Sciences

Brandon Isaacs, James Keene, Jonie Kerns, Robert Sorrells, Kimberly Taylor, Pacific Northwest University of Health Sciences, Yakima, Washington 98901

Purpose: This study aims to inform the preparation of our students for residency training and identify the factors that best predict preparation of our graduates to enter the postgraduate level. The research on this first tier of this analysis evaluates the implementation of the 13 EPAs in the preclinical curriculum by tracking delivery and student attainment, evaluates preclinical faculty development relative to EPA delivery, and evaluates the programmatic developmental aspects and trajectory of EPA attainment. Methods: Faculty were initially provided with basic information regarding the 13 EPAs and asked to tag exam items with either an EPA. The assessment office generated a report indicating the number of questions tagged with an EPA in specific courses, along with the student performance on each EPA. Faculty development sessions were then developed with the goal of showing how EPAs can be used to better correlate learning objectives with clinically relevant activities. The assessment office again generated a report on both course delivery and student attainment of the EPAs and developed an EPA-based preclinical curriculum map. Results: Results of this work include an increase in the number and frequency of EPAs delivered and assessed in the preclinical curriculum, enhanced integration of basic and clinical science elements in the preclinical curriculum, connection of basic science content to the EPAs, generation of a robust preclinical curriculum map outlining embedded EPAs, and qualitatively and quantitatively assessed EPA-oriented faculty development opportunities. Conclusions: Further research will employ the application of these findings to the next tier in the longitudinal analysis of EPA implementation: how to better prepare students for clinical training and eventually residency.

CURRICULUM

WHAT ABOUT US? THE IMPACT OF CURRICULUM REVISION ON STUDENTS IN THE LEGACY CURRICULUM

Giulia Bonaminio | Kari Nilsen | Anne Walling | Tony Paolo | Mark Meyer | Tomas Griebling

University of Kansas School of Medicine-Kansas City | University of Kansas School of Medicine-Wichita | University of Kansas School of Medicine-Wichita | University of Kansas School of Medicine-Kansas City | University of Kansas School of Medicine-Kansas City | University of Kansas School of Medicine-Kansas City

Purpose: Little is known about issues for students continuing in the traditional (“legacy”) curriculum during curriculum reform. We sought the views of legacy students on the new curriculum, its impact on their education, and their interactions with first-year students (MS1) in the new curriculum. Methods: We conducted focus groups of legacy students 8–9 months after initiating the new curriculum. Groups had the same facilitator and format. The video-recorded sessions were independently reviewed by two researchers to identify themes and illustrative quotes. Major themes were developed by consensus and reviewed by the research team. Issues were resolved by discussion and session review. Major themes were summarized and differences between classes/campuses explored. Internal validity was determined through interrater reliability checks. The themes identified were used to create a framework of categories to be analyzed for constancy and applicability. Groups were conducted until saturation of responses. Chi-square or Fisher’s exact test was used to identify associations among specific themes and class and/or campus. Cluster analysis was used to determine association among individual themes. Results: Legacy students were generally well-informed and supportive of the new curriculum. Groups identified consistent areas of strength, weakness, and challenges. They did not perceive any major impact from the new curriculum on the quality of their education, reporting examples of both faculty disengagement and efforts to make outstanding final presentations of legacy content. They reported significant loss of their ability to mentor incoming students and some resistance from MS1s to the traditional senior peer support. Students also identified lack of engagement by MS1s in student-run clinics and specialty interest groups. Conclusion: Legacy students did not perceive themselves at educational disadvantage and provided valuable insights on curricular reform. They were frustrated by loss of their mentoring role and concerned about decreased participation by first years in peri-curricular activities.

CURRICULUM

CONNECTING THE DOTS: EVIDENCE OF SUCCESSFUL COGNITIVE INTEGRATION AMONG PRECLINICAL MEDICAL STUDENTS DURING A SIMULATED VIRAL PANDEMIC

Jennifer M. Jackson, MD; Timothy R. Peters, MD

Wake Forest School of Medicine

Purpose: Previous studies suggest novices’ cognitive integration of basic science and clinical concepts leads to improved diagnostic performance. Although curricular integration efforts are increasingly more common among medical schools, studies show curricular integration does not guarantee learners’ cognitive integration, and because cognitive integration is not directly observable, demonstrating evidence of successful cognitive integration remains a challenge. We developed a novel problem-solving activity for preclinical medical students and performed qualitative analysis to assess for evidence of cognitive integration. Methods: During a 2-h simulated viral pandemic, 140 first-year medical students worked in teams to analyze epidemiological, clinical, and histological data and to formulate justified differential diagnoses for the pandemic’s etiology, infection containment recommendations, and treatment recommendations. Assigned tasks required application of previously encountered learning content from basic science, clinical skills, ethics, and biostatistics courses, in addition to self-directed learning of new health systems content. Qualitative analysis of students’ reports was performed to characterize cognitive integration tasks using both inductive and deductive coding, and themes and subthemes were generated. Distribution and frequency of integration tasks occurring among students’ reports were calculated using descriptive statistics. Results: Sixteen cognitive integration tasks were identified among students’ reports; tasks were clustered in themes of basic science content, clinical content, virus epidemiology content, biostatistics content, and ethics content. Identifying presenting symptom similarities between the case and known diseases was the most common clinical content integration task performed (100%). Identifying cellular structure similarities and justifying treatments based on the differential diagnosis were the most common basic science integration tasks performed (95 and 95%). Biostatistics content-related tasks were less commonly observed than other content types (15–45%). Conclusions: Evidence of learners’ cognitive integration can be made explicit through learners’ narrative justification of problem-solving tasks. Patterns of learners’ integration task performance can provide insights into their problem-solving approaches and development.

CURRICULUM

ASSESSING SELF-DIRECTED LEARNING IN THE MEDICAL CURRICULUM

Leslie A. Hoffman | Polly R. Husmann | Audra F. Schaefer

Indiana University School of Medicine | Indiana University School of Medicine | University of Mississippi Medical Center

Leslie A. Hoffman1, Polly R. Husmann2, and Audra F. Schaefer3, 1 Indiana University School of Medicine, Fort Wayne, IN 46805, USA, 2 Indiana University School of Medicine, Bloomington, IN 47405, USA, 3 University of Mississippi Medical Center, Jackson, MS 39216, USA

Purpose: Medicine is a dynamic field, with an ever-expanding body of scientific knowledge and constantly evolving clinical applications of that knowledge. This ever-changing landscape of medicine requires that physicians continue to learn throughout their practice; therefore, it is critical that medical students learn the skills and habits of self-directed learning (SDL) during medical school. The purpose of this study is to assess medical students’ development of SDL skills during undergraduate medical education. Methods: A validated assessment tool, the Self-Directed Learning Instrument (SDLI), was selected for the study based on the domains of SDL measured and psychometric characteristics. The SDLI was administered to medical students at three time points: at the beginning of the first year (T0), after the first semester of medical school (T1), and at the beginning of the second year (T2). Changes in SDLI scores were assessed using ANOVA. Results: There was a significant increase in total SDLI score between T0 and T2 (T0 = 81.05, T2 = 83.33, p = 0.012). Post hoc tests showed that the greatest gains were seen during the first semester (between T0 and T1). Further analysis indicated increases in total SDLI scores between T0 and T2 were driven by gains in the planning and implementing domain (p < 0.001) and the self-monitoring domain (p = 0.025). Conclusion: The results of this study suggest that students improve their SDL skills relatively quickly after entering medical school. In particular, students report that they are better able to set goals, select appropriate learning strategies and resources, monitor their time, and evaluate their progress.

CURRICULUM

PHARMACOLOGY AS A CONTINUUM: A CURRICULAR MODEL FOR SPACED REPETITION AND VERTICAL AND HORIZONTAL INTEGRATION

Jennifer Cleveland | Joanne Greenawald | Renee LeClair

Virginia Tech Carilion School of Medicine | Virginia Tech Carilion School of Medicine | Virginia Tech Carilion School of Medicine

AWARD NOMINEE

Purpose: The pharmacology content at Virginia Tech Carilion School of Medicine is horizontally integrated across several curricular elements. Historically, large group sessions focused on organ-based pharmacology, whereas problem-based learning (PBL) included all pharmacology presented in the featured case. This approach rapidly exposed students to numerous pharmacological agents, but the student-led PBL forum proved to be diffuse and frustrating as cases often included incidental drugs, not directly related to the pathological focus. Despite efforts to reinforce content in several curricular locations, data from the AAMC graduate questionnaire and student performance on end of block NBME exams indicated a need to reevaluate the delivery. Methods: We implemented a new curricular strategy to better coordinate pharmacology delivery across basic science and PBL. In each PBL case, we identified the drugs related to the content being presented in large group sessions and wrote specific objectives to highlight key aspects of the drug. Additionally, as students’ progress through the M1 and M2 years, drugs that had been addressed in previous cases were highlighted as a reminder to the students to review the content. Results: Student performance on pharmacology content on block NBME exams has improved dramatically (block I up to 5 points, block II up to 11 points, and block III 5 points when compared to exam performance metrics AY 16–17). Conclusions: The restructure of pharmacology across curricular elements allowed both students and faculty to focus on important aspects of a specific drug, reducing the stress and often extraneous nature of exploring all drugs in a PBL case. This modification has positively increased student performance and perception of pharmacology delivery. Integrated curricular design requires elegant coordination across elements, and in this case, we have been successful in focusing the student learning on relevant content and enhanced overall performance.

CURRICULUM

PUBLIC HEALTH IN THE MEDICAL CURRICULUM

Alaa Abusufian E. Dafallah | Mindaugas Galvosas

International Federation of Medical Students’ Associations (IFMSA) | International Federation of Medical Students’ Associations (IFMSA)

Purpose: As the scope and needs of medicine are changing, public health (PH) is becoming a crucial component of healthcare. On the contrary, in many undergraduate medical programs, PH subjects are not given enough importance to cover the needs of medical students as future professionals. The methodologies are lacking development of students’ interest. At the International Federation of Medical Students’ Associations (IFMSA), students have observed the lack in the depth of knowledge of PH and seek to advocate for its adequate inclusion. Methods: IFMSA held a worldwide online survey in order to compile students’ needs and perceptions about PH education in medical schools. Qualitative input was also collected during IFMSA meetings. A toolkit was developed for medical students and teaching institutes to educate medical students about the content and preferred methodologies for teaching PH, equip them with relevant advocacy skills. Results: Three hundred twenty-seven responses from 139 countries were obtained. An absolute majority (69%) of schools have PH as a mandatory course. Minority (15%) of schools offer MD and PH blended programs. There is no common concept on which years of study are best for PH content. The most prevalent teaching method is lecturing; however, it was not the most desired. More interactive methods such as workshops and community practice were highlighted. Conclusions: Based on the input, the toolkit on PH in medical curricula has been developed including sections on medical students’ perceptions, preferred PH content, teaching methodology, and advocacy. The impact of the toolkit will be subsequently evaluated by IFMSA. PH including global health is essential for all future healthcare providers. We need to educate about its importance and represent informed views. IFMSA is providing medical students with skills to understand, advocate, and implement the inclusion of PH in medical curricula globally.

CURRICULUM

LONGITUDINAL STUDENTS AS TEACHER PATHWAY

Jacqueline K. Kobayashi | Udit Bhavsar | Alexander Beckstead | Sarah Nguyen

University of Utah School of Medicine, Salt Lake City, UT 84132, USA | University of Utah School of Medicine, Salt Lake City, UT 84132, USA | University of Utah School of Medicine, Salt Lake City, UT 84132, USA | University of Utah School of Medicine, Salt Lake City, UT 84132, USA

Purpose: Every patient encounter is a teaching encounter. Physicians are responsible for educating patients, students, and colleagues, yet most medical students are not trained to be excellent educators. Despite the efficacy of student teachers in medical education, longitudinal programs to support this are uncommon. The Students as Teacher Pathway (SaT) at the University of Utah School of Medicine was developed to provide interested students with structured longitudinal opportunities to gain skills to become successful educators, as well as mentorship to help guide a career in medical education. Methods: The SaT pathway involves a 4-year curriculum that begins with introductory sessions during the first semester of medical school and ends with a capstone project during the fourth year. The SaT pathway includes the following: MS1: teaching fundamentals (eight sessions); MS2: clinical teaching (eight sessions); MS3: skills application; and MS4: advanced topics (four sessions), elective, capstone completion. Principles of this course are also incorporated into the broader medical curriculum to expose all students to the fundamentals of teaching as it will be utilized throughout their career. Results: The inaugural year of the SaT pathway had 14 MS1 and 2 MS2 students enroll. Student feedback was positive and expressed that the pathway provided early exposure to careers in academic medicine and educational principles. This pathway provides students with a foundational skill set regarding effective teaching methods which they can develop within a 4-year medical education, and continue to improve throughout their future careers. Conclusions: This longitudinal pathway is uniquely situated to prepare medical students to become excellent educators by establishing early interest, teaching skills and theory, and providing opportunities and structured experiences to develop advanced skills in clinical education methodology as well as mentorship to help guide a career in medical education.

CURRICULUM

INTERPROFESSIONAL SERVICE LEARNING IN MEDICAL EDUCATION: ASSESSMENT OF STUDENT PERSPECTIVES ON CURRENT EDUCATIONAL TRENDS

Malek H. Bouzaher

Virginia Tech Carilion School of Medicine

Purpose: In an effort to train providers who will be properly equipped to function in collaborative healthcare teams, medical schools around the country are integrating interprofessional experiences into their curriculum, many of which incorporate a significant service learning component. Community service learning has been extolled as an effective vehicle for interprofessional health education largely based upon studies assessing the short-term impact of these experiences on positive team behaviors and communication skills. Through this study, the authors explore the year-over-year outcomes of this trend in interprofessional health education to determine whether the short-term successes detailed in prior studies are sustainable over time. Methods: Course evaluations were collected from 168 first year medical students (M1) at Virginia Tech Carilion School of Medicine (VTCSOM) over a 4-year period beginning in 2013 and ending in 2017. All 238 current and former VTCSOM students were also prospectively surveyed and 87 (37%) responses were received. Results: M1 students perceived similar quality in the interprofessional health education program across years. However, statistically significant differences were observed between preclinical students and clinical students/physicians on measures related to similarities between service learning and clinical experiences, community impact, and overall service learning experience. Conclusion: Preclinical medical student perceptions regarding interprofessional service learning remain relatively consistent over time. However, as students progress through their medical education, they perceive the skills learned and obstacles encountered through these opportunities to be less generalizable to the clinical setting. These findings suggest a need to re-evaluate the context and goals of these experiences.

CURRICULUM

THE UTILITY OF PERSONALITY ASSESSMENTS IN MEDICAL STUDENT COACHING: A PILOT STUDY

Jennifer A. Villwock

University of Kansas Medical Center

Purpose: The rapid growth experienced during medical training is impacted by personality. However, insight into personality can be lacking. This study investigated the utility of personality assessments for use in student coaching. Methods: Fifty first year medical students were invited to complete the Hogan assessments and their results incorporated into coaching sessions all students receive as part of the medical school curriculum. Twenty-five students were invited to participate as controls, receiving standard coaching. The Perceived Stress Scale (PSS) and the 2-item Maslach Burnout Inventory (MBI) responses were recorded at baseline (August) and 2–3-month intervals corresponding to enrichment weeks between academic blocks. A nonparametric approach to two-way factorial repeated measures design was used to determine both between-group and within-group differences. A p value of < 0.05 was considered significant. Results: Thirty-one students completed the Hogan assessments. The students and their coaches received results and an associated mentor guide document. Fifteen students were controls. Student stress and burnout indices were not significantly different between groups. Time significantly impacted burnout indices and 40% (4/10) of PSS indices. Best scores in 8 of the 12 measures occurred in August. There was no significant interaction between group and time. Temporal trends were nonmonotonic, suggesting that elapsed duration of coaching and/or schooling was not the basis for significance. At baseline, burnout was positively correlated with being “angered because of things outside your control,” a feeling that “difficulties were piling up.” At the study conclusion, burnout was negatively correlated with feelings of being “able to control irritations”; 72% of the Hogan students recommended personality assessments to others, and 81% of the students in both groups would recommend them to future medical students. Conclusions: The underutilization of assessment results in formal coaching sessions represents a missed opportunity. The large proportion of students recommending these assessments indicates more formal study is needed to optimize curricula and develop best practices.

CURRICULUM

IMPROVING STUDENT TEAMWORK IN THE PRECLINICAL CURRICULUM

Henrike Besche | Daniel Kamin | Amy Sullivan | Barbara Cockrill

Harvard Medical School | Boston Children's Hospital | Harvard Medical School | Harvard Medical School

AWARD NOMINEE

Henrike Besche, PhD1, Daniel Kamin, MD2, Amy Sullivan, EdD1, Barbara Cockrill, MD1, 1Harvard Medical School, Boston, MA, 2Pediatrics, Children’s Hospital, Boston, MA

Purpose: Recently, we changed our preclinical curriculum to case-based collaborative learning (CBCL). In CBCL, students apply what they learn at home to a new case in class. Classroom discussions alternate between students working in small teams and group discussions. Classes are designed to foster critical thinking and students find CBCL classes stimulating and engaging. However, students reported problems in working as a team. Based on this feedback we set out to: (1) understand the experiences students were having and (2) test an intervention to see if team dynamics could be improved. Methods: A validated team performance scale was combined with two open-ended questions. This survey was administered to all teams in the course at several time points, including before and after an intervention. Mixed methods were used to categorize team effectiveness and identify common characteristics. Results: Without intervention, about half of the teams showed signs of dysfunction. The most successful teams had a process in place in how they went about their work and succeeded at creating a safe learning environment. When given a structured activity to set team norms, team function improved significantly. Importantly, both dysfunctional teams and teams that reported great interpersonal relationships struggled with creating respectful discourse. Conclusions: Interpersonal and communication skills are essential to the medical profession and traditionally taught in context of clinical care. The CBCL curriculum provides rich opportunities for students to hone interpersonal and teamwork skills in the preclinical curriculum if given appropriate resources. Supporting students in creating psychologically safe teams and raising awareness on “group think” is essential for students to form effective teams and engage higher order critical thinking.

CURRICULUM

FACING UNCERTAINTY IN THE GME LEARNING ENVIRONMENT: PERCEPTIONS AND EXPERIENCES OF INTERNAL MEDICINE RESIDENTS AND ATTENDING PHYSICIANS AT A US ACADEMIC MEDICAL CENTER

Mark Johnson, MD MMSc | Galina Gheihman | Horatio Thomas, MD MMSc | Arabella Simpkin, MD MMSc | Gordon Schiff, MD | Andrew Olson, MD

Harvard Medical School, Boston, MA | Harvard Medical School, Boston, MA | Harvard Medical School, Boston, MA | Massachusetts General Hospital, Boston, MA | Brigham and Women’s Hospital, Boston, MA | University of Minnesota Medical School, Minneapolis, MN

AWARD NOMINEE

Purpose: Clinical uncertainty is pervasive in medicine, yet many clinicians are uncomfortable with uncertainty and unwilling to acknowledge it. Studies link intolerance of uncertainty to burnout, ineffective communication strategies, cognitive biases, and inappropriate resource use. Little is known about how uncertainty manifests in the clinical setting and the perceptions of physicians and trainees facing uncertainty. Understanding clinicians’ experiences may help improve how physicians and patients acknowledge, manage, and cope with uncertainty, as well as identify educational strategies for promoting tolerance of uncertainty among trainees. Methods: This mixed-methods study investigated perceptions and experiences of uncertainty in the clinical environment among internal medicine residents and attending physicians at a single US academic medical center. A survey, semistructured interviews, and in-person observations were conducted. Results: Regression analysis of validated survey instruments assessing stress, burnout, and tolerance of uncertainty demonstrated resident physicians (n = 35) have more perceived stress from uncertainty than attending physicians (n = 14) (15.6 [5.0] vs. 19.0 [3.6], p < 0.05), and significantly higher symptoms of burnout (7.1 [2.9] vs. 4.9 [2.0], p < 0.05). Perceiving the learning environment as more competitive and/or stressful strongly correlates with an increased reluctance to disclose uncertainty (r = − 0.44, p < 0.01). Qualitative analysis revealed four themes: (1) a desire to communicate uncertainty to patients; (2) the influence of authority; (3) role modeling to promote tolerance of uncertainty; and (4) embracing uncertainty is not part of formal medical curricula. Conclusions: Uncertainty is inherent to medicine, yet strategies to tolerate and manage uncertainty in the clinical setting and teach residents such skills are lacking. We found that level of training and role impacts how uncertainty is emotionally perceived and its impact on stress and burnout. Attending physicians can play an important educational role by modeling explicit language and management strategies for uncertainty in clinical encounters. Medical curricula should include formal strategies to acknowledge, embrace, and manage clinical uncertainty.

CURRICULUM

LESSONS LEARNED IN CLERKSHIP INNOVATION: A QUALITATIVE STUDY OF THE DESIGN AND IMPLEMENTATION OF LONGITUDINAL INTEGRATED CLERKSHIPS

Michael J. Chilazi | Dana G. Callahan | Galina Gheihman | David A. Hirsh, MD | Mark A. Schuster, MD, PhD

Harvard Medical School | Harvard Medical School | Harvard Medical School | Harvard Medical School | Kaiser Permanente School of Medicine

Purpose: Longitudinal integrated clerkships (LICs) are growing internationally as an alternative to traditional block clerkships. In LICs, medical students participate in the comprehensive care of patients over time, maintain continuing learning relationships with preceptors, and meet the majority of core clinical competencies across disciplines simultaneously. In the process of developing the first multiyear, comprehensive LIC in the USA as its core clerkship model, the Kaiser Permanente School of Medicine recognized an absence in the literature of an empirical study, survey, or review of LIC leaders’ perspectives on LIC design. Therefore, we interviewed LIC leadership across the USA, Canada, and the UK to fill this gap. Methods: Using convenience sampling, we conducted in-depth, semistructured interviews with leaders (i.e., clerkship directors, discipline directors, or administrative coordinators) of established LIC programs to explore experiences related to designing and implementing LICs at their institution. We performed qualitative thematic analysis on interview transcripts. Results: We interviewed 29 participants representing 20 LICs. Major themes identified key challenges in LIC implementation and possible solutions. These included (1) administration: facilitating continuous learning relationships with preceptors and patients requires substantial administrative support and technological solutions; (2) faculty development and support: outpatient education necessitates targeted faculty development and support that acknowledge current practice and productivity demands; (3) buy-in: appealing to outcomes data and shared professional values promotes engagement of key stakeholders; and (4) comparability: rigorous program evaluation enables innovators to demonstrate comparable learning outcomes, validate innovations, and contribute to the literature. Conclusions: Program leaders experience similar challenges when designing, implementing, and expanding LICs, highlighting future opportunities for collaboration to identify solutions. Further, this analysis provides lessons that may be helpful to innovators in clinical education working on approaches other than LICs.

CURRICULUM

TEACHING THE “KIND CARE BUNDLE”: A TRANSITION TOWARD COMPASSIONATE CARE

Cynthia Cooper | Galina Gheihman

Harvard Medical School | Harvard Medical School

Purpose: Simple behaviors can have a dramatic impact on patient–clinician relationships. We developed a bundle of concrete verbal and nonverbal behaviors for showing attention, consideration, and compassion in patient interactions. The “Kind Care Bundle” curriculum was taught to medical students immediately prior to the start of their clinical rotations. This abstract describes the curriculum and the students’ assessment of the teaching session. Methods: The curriculum was taught over five weekday mornings in 3-h sessions. Students met with an author (CC) in five groups of eight peers and were asked to reflect on a time they felt cared for or witnessed compassionate care. The “Kind Care Bundle” or the Three Es was then introduced. The Three Es “Entrance, Encounter, and Exit” outline compassionate behaviors for each element of a patient interaction. Subsequently, pairs of students interviewed inpatients with the aim to practice the Three Es and solicit patients’ perspectives on compassionate care. A de-brief culminated the session. Participants completed a post-session evaluation to assess the curriculum and report their motivations to use the bundle in clinical rotations. Results: Thirty-seven of 40 eligible students participated. Students highly rated the curriculum’s organization, relevance, and their likelihood to use the bundle again. Qualitative analysis revealed students valued the Three Es as “simple ways to make a patient feel valued,” “very useful and important to keep in mind when facing burnout,” and “being a kind person is as important as understanding medicine.” Conclusion: The “Kind Care Bundle” curriculum was well received by participants, prompting medical students to identify memories and experiences of compassionate care and practice concrete behaviors to improve student–patient interactions. It may have use in other health professions, student and clinician populations, and at other institutions.

CURRICULUM

CURRICULUM CO-PRODUCTION: A WIN-WIN

Janet E Lindsley | Esther Nuebel | Sarah Nguyen | Sara Nowinski | Daniel Jones | Casey Hemmis | Paul Bluth

University of Utah School of Medicine and Department of Biochemistry | Department of Biochemistry and Howard Hughes Medical Institute, University of Utah | University of Utah School of Medicine | Department of Biochemistry, University of Utah | University of Utah School of Medicine | Department of Biochemistry, University of Utah | University of Utah School of Medicine

Purpose: The role of a medical school educator is in flux. The outsourcing of content delivery and knowledge self-assessment to myriad online resources has placed classroom-based faculty in a vulnerable position. The positive feedback that many of us once received from engaged students during interactive lectures appears to be diminishing. We question whether it was us who helped students master our content, or purchased videos and question banks. Small group teaching can provide the desired positivity, but is very costly. Curriculum co-production between learners and faculty is one solution to both issues. Methods: Two separate groups of learners, new second-year medical students (MS2s) and biochemistry post-doctoral fellows (postdocs) each self-identified learning goals related to becoming effective educators. The postdocs were specifically looking for a curriculum development opportunity to make them prepared for and attractive to primarily undergraduate institutions. Both groups approached a senior faculty member (Lindsley) looking for mentorship on creating a new course. Results: The MS2s and faculty co-produced an elective on the design and facilitation of case-based learning (CBL). The course goals included developing active listening and effective questioning skills, identifying strategies to improve team dynamics, and creation of CBL content. Each MS2 taking the course was assigned a separate faculty mentor who was a facilitator for an MS1 CBL team. The MS2s functioned as co-facilitators. Feedback from both the impacted MS1s and the faculty mentors was very positive. The postdocs and faculty co-designed a new advanced, intensive, undergraduate team-based learning course that the postdocs subsequently taught. The course evaluation results were well above the departmental average. Postdoc experience and biochemistry department faculty were so positive that the Utah Science Teaching Experience for Postdocs (U-STEP) program was created. Conclusions: Co-production of educational opportunities provides fulfilling faculty–learner relationships, as well as the benefits of near-peer teaching in a cost-effective manner.

CURRICULUM

PERCEPTION ON INTERPROFESSIONAL EDUCATION (IPE): AN ANALYSIS OF REFLECTIVE ESSAYS BY BASIC SCIENCE STUDENTS

Dr Amitabha Basu | Dr M Aurelio | Dr Abigail Wilding

St Matthews University School of Medicine | St Matthews University School of Medicine | St Matthews University School of Medicine

Purpose: This study was conducted to understand students’ perception of interprofessional education by analyzing their reflective essay. Methods: This study was a qualitative thematic analysis of 20 reflective essays on IPE written by 20 second-year medical students after visiting the emergency department of the local hospital or private clinic in 2018. Students were also asked to watch a video clip on teamwork from the basic life support (BLS) training video. This research method allowed an in-depth analysis of the texts for themes under four categories: What is students’ understanding of IPE? Why student’s think IPE is essential? Key to effective communication? Did they observe any barriers? Results: Each essay was read several times and hand-coded to identify significant themes under each category which are listed below: Student’s understanding of IPE? Working as a part of the multidisciplinary team, encourage active learning, nurses play a crucial role. Why student’s think IPE is important? Enhance efficiency in physical examinations, ensure the safety of the patient, reduce the stress of the providers, and prevent burnout. Key to effective teamwork? Constant verbal communication, knowing team members well, accurate planning, debriefing, understanding one’s role, trust, and respect. Did they observe any barriers to effective teamwork? Lack of manpower, poor work ethics, individualism, burnout, lack of training, hospital settings, and misuse of electronic record system. Conclusions: Multidisciplinary collaboration is key to effective care delivery and provides an opportunity to learn. Although teamwork is needed for effecting healthcare delivery, a clear hierarchy was noticed by many where nurses play a crucial role. Miscommunication can be averted by “talking it out” and with a proper plan. Burnout, mistrust, inexperience, and overcrowding in hospital settings could adversely affect patient care.

CURRICULUM

ESTABLISHING A SCHOLARLY ACTIVITY STRUCTURE FOR MEDICAL RESIDENCY PROGRAMS

Suporn Sukprparut-Braaten | Dewey McAfee | Stacy Zimmerman | Delaney Kinchen | Robert Wooten

Unity Health | Unity Health | Unity Health | Unity Health

Purpose: Scholarly activity and research are vital parts of evidence-based medicine (EBM) education to both residents and faculty. This session will focus on how to assist a residency program to facilitate residents and faculty to conduct research projects to enhance EBM knowledge and improve quality of care. Lack of scholarly activity among residents and faculty is one of the most ACGME cited problems. We have established a structure to successfully allow residents and faculty to work together on various research projects and case reports. Methods: Our scholarly activity structure starts with educating the residents and faculty on EBM fundamental knowledge. The journal club was used to iterate an understanding of scientific research. Research mentors are assigned to each resident. They consist of at least a clinical faculty and a Ph.D. level biostatistician. Residents are required to meet their mentors once a month during their first year and as needed later. At the end of the first year, residents must submit research proposals to appropriate research mentors and program director (PD) and obtain an Institutional Review Board approval. At the end of the second year, residents must complete the literature review, methods, and data collection. At the end of the third year, residents must submit an abstract and present at a local/regional/national conference or manuscript to a peer review journal. Research mentors and PD evaluate the residents semi-annually according to the ACGME milestones. Results: Since the residency programs have established in 2015, a total of 40 scientific posters and 3 podium presentations were presented at national, regional, and state conferences and 7 publications were published among 52 residents. All posters or presentations involve at least two faculty as research mentors. Conclusion: The scholarly activity structure provided transparent expectations from the residents and faculty, constructing a systematic evaluation and providing feedback for improvement.

CURRICULUM

DESIGN AND IMPLEMENTATION OF A POPULATION HEALTH CURRICULUM COMPONENT INTEGRATING EPIDEMIOLOGY, EXPOSURE TO BIG DATA, AND CRITICAL THINKING

John S Maier | Peter Drain | John F. Mahoney

University of Pittsburgh, Department | University of Pittsburgh, Department of Cell Biology | University of Pittsburgh, Office of Medical Education

Purpose: This educational activity is intended to provide learners with an understanding of population health through practical analysis and evaluation of publicly available data to define and explore questions related to health in a community. Methods: An introductory lecture to the whole class of learners is used to describe the exercise and tools that students can use to carry out the exercise. Each student is charged with selecting an individual county (no duplicates across the class) and using existing resources to get a summary of the population health in that county. Students prepare a brief presentation to their peers about the county and share that in a small group. Using publicly available data about health at the county level, a dataset is generated using the counties chosen by the students. This synthetic dataset is provided to students and they are charged to individually make a brief analysis with a focus of either exploring a hypothesis or generating a hypothesis. The exercise closes with the students discussing a second brief presentation of their analysis and associated hypotheses. Results: We successfully implemented this exercise in two consecutive years for second-year medical students as a pilot (N ~ 140 per year). Students demonstrate an ability to use these resources to find relevant information about population health and in sharing that information educate their peers about health in locations that are not necessarily familiar to them. Brief presentations of the analysis are in some cases initial explorations that could be developed into research projects. Conclusion: We are encouraged about the feasibility of implementing this exercise. It serves to get students familiar with aspects of population health, where to find up-to-date information about the health of a population in a particular location, and evaluation of data with respect to hypotheses they generate.

CURRICULUM

THE EFFECT OF A HUMAN ANATOMY COURSE ON SPATIAL ABILITY AND MENTAL EFFORT

Saskia D. Richter | Cailee E. Welch Bacon | Kellie C. Huxel Bliven

A.T. Still University | A.T. Still University | A.T. Still University

Purpose: Spatial ability is the capability to mentally manipulate objects in space, an important skill when contextualizing the human body, especially during movement or medical imaging. Courses such as anatomy require spatial ability skills; however, it is unclear if exposure to anatomy courses alone improves students’ spatial ability or the mental effort associated with spatial tasks. This study aimed to determine if a human gross anatomy course improves spatial ability and decreases mental effort associated with spatial ability tasks. Methods: Eighty-two of 130 graduate health profession students enrolled in a 10-week human gross anatomy course completed a spatial ability survey at the beginning and conclusion of the course (63% match rate). The survey included the following dependent variables: validated Mental Rotations Test (MRT; 0–24 points), perceived spatial ability (0–100%), and the validated Pass Scale for mental effort (1 = very, very low; 9 = very, very high). Time (pre-course, post-course) was the independent variable. Wilcoxon-signed rank tests were used to assess whether dependent variables changed over time (p < 0.05). Results: Post-course MRT scores improved by 14% (14.5 ± 5.3 pts) and were significantly higher than pre-course (11.3 ± 3.3 pts; p < 0.01). Post-course perceived spatial ability (64.3 ± 16.8%) was significantly higher than pre-course (59.9 ± 18.1%; p = 0.02). Mental effort post-course decreased 5% (5.6 ± 1.3), which was significantly lower than pre-course (6.1 ± 1.1; p = 0.04). Conclusion: The increase in spatial ability and the decrease in mental effort suggest students display more efficient and accurate spatial ability skills following an anatomy course. As anatomy educators, it is important to realize students may use more mental effort and have difficulty with spatial tasks in the beginning of a course; therefore, teaching strategies and assessments should be tailored to accommodate their developing spatial skills. Future studies should include educational interventions to further enhance spatial ability skills while simultaneously decreasing mental effort associated with spatial tasks.

CURRICULUM

EQUIPPING TOMORROW’S PHYSICIANS TO CARE FOR VULNERABLE POPULATIONS THROUGH COMMUNITY PARTNERSHIP

Gia DiGiacobbe, PMP | Nancy Denizard-Thompson, MD | Abbas Hyderi, MD, MPH | Amber Brooks, MD | Alexander Kaysin, MD, MPH | Marty Tennille, MD | Deepak Palakshappa, MD

Kaiser Permanente School of Medicine | Wake Forest School of Medicine | Kaiser Permanente School of Medicine | Wake Forest School of Medicine | University of Maryland School of Medicine | Helping Our People Eat | Wake Forest School of Medicine

Purpose: Healthcare providers are called upon to provide culturally competent care to increasingly diverse and underserved populations, yet physicians report that their training has not adequately prepared them to manage social determinants of health. Furthermore, the LCME mandates the inclusion of curriculum on health disparities and meeting the needs of medically underserved populations and encourages the use of service learning as a modality. This abstract describes an approach used by two medical schools to meet these challenges. Methods: The Wake Forest School of Medicine and The University of North Carolina at Chapel Hill School of Medicine are developing a longitudinal curriculum to address health disparities, pairing learning modules with community partner-based experiential activities. To provide students robust, contextualized learning experiences, we matched one relevant health disparity with each required clinical experience. We focused on gaining buy-in on subject matter and community need from both clinical course directors and community partner stakeholders, utilizing best practices in effective partnerships between community organizations and academic medical centers. We sought to ensure longitudinal exposure to communities and agencies by having students revisit the same populations in the context of different issues. One cohort of students has completed their experience, with about half of their clinical experiences associated with a health disparity; the second cohort is in progress and all of their clinical experiences are associated to health disparities. Results: In evaluations, students report positive experiences, while community partners have expressed satisfaction and sought to engage medical students on a continued basis. Results showed that students improved their knowledge of how to engage with community organizations and negotiate a plan of care with patients from underserved populations. Conclusion: A longitudinal curriculum that combines didactic learning and community engagement on the SDH was well-received and improved medical students’ confidence and knowledge of working with underserved populations.

CURRICULUM

COMMUNITY-BASED EXPERIENTIAL EDUCATION IN MEDICAL SCHOOL STUDENTS

Justin Zumwalt | Randy S. Wymore | Nancy Van Winkle

Oklahoma State University College of Osteopathic Medicine | Oklahoma State University College of Osteopathic Medicine | Oklahoma State University College of Osteopathic Medicine

Purpose: While going through a restructuring of our medical school curriculum, we decided to bring more community-based education to the students to better prepare them for patient encounters and to jump-start community-focused paths to help bring more physicians to low-income and at-risk populations. Methods: In the Service-Learning and Community Engagement course (SLCE), students have three main areas in which they interact with the community: the Senior Mentor Program, Community Action Project, and the Neighbors Along the Line free clinic. In the Senior Mentor program, two medical students are paired with one senior mentor to meet with twice a semester for 1 h for three semesters. The students develop their interviewing and interpersonal skills through such activities as discussing nutrition, obtaining a social or medical history, and discussing end-of-life issues. Working with a local nonprofit organization, Community Action Project (CAP), students help Tulsa health services staff conduct assessments and testing required for preschool children when enrolling in accredited early-childhood development programs. At the Neighbors Along the Line clinic, students participate with a physician at a local free clinic to see patients and practice interviewing skills and writing SOAP notes. Results: Students’ surveys and board exam results validate the success of the experiential elements in the SLCE course. Overall, students exceed the national average on their boards in the areas of professionalism, ethics, and community medicine. Student evaluations also show increased interest in helping underserved populations and having a better understanding of pediatric and geriatric interviewing techniques after their experiences. Conclusion: Courses focusing on community-based experiential education are a valuable component of medical education. Students’ learning about professionalism and care for underserved populations is enhanced by participating in activities outside of the classroom.

CURRICULUM

ESTABLISHING A SCHOLARLY ACTIVITY STRUCTURE FOR MEDICAL RESIDENCY PROGRAMS

Sukpraprut-Braaten

Unity Health

Purpose: Scholarly activity and research are vital parts of evidence-based medicine (EBM) education to both residents and faculty. This session will focus on how to assist a residency program to facilitate residents and faculty to conduct research projects to enhance EBM knowledge and improve quality of care. Lack of scholarly activity among residents and faculty is one of the most ACGME cited problems. We have established a structure to successfully allow residents and faculty to work together on various research projects and case reports. Methods: Our scholarly activity structure starts with educating the residents and faculty on EBM fundamental knowledge. A journal club was used to iterate an understanding of scientific research. Research mentors are assigned to each resident. They consist of at least a clinical faculty and a Ph.D. level biostatistician. Residents are required to meet their mentors once a month during their first year and as needed later. At the end of the first year, residents must submit research proposals to appropriate research mentors and program director (PD) and obtain an Institutional Review Board approval. At the end of the second year, residents must complete the literature review, methods, and data collection. At the end of the third year, residents must submit an abstract and present at a local/regional/national conference or manuscript to a peer review journal. Research mentors and PD evaluate the residents semi-annually according to the ACGME milestones. Results: Since the establishment of residency programs in 2015, a total of 40 scientific posters and 3 podium presentations were presented at national, regional, and state conferences and 7 publications were published among 52 residents. Every poster or presentation involves at least two faculty serving as research mentors. Conclusion: The scholarly activity structure provided transparent expectations from the residents and faculty, systematic evaluation, feedback for improvement, and valuable lessons.

ELEARNING

MEDICAL STUDENT ENGAGEMENT WITH TECHNOLOGY-ENHANCED LEARNING RESOURCES

James Pickering

University of Leeds

Anatomy curricula around the world are becoming increasingly populated with technology-based learning resources, creating blended learning environments. This drive toward the greater use of technology has many underlying factors, including the availability of cadaveric specimens and the logistics of their care, the general reduction in curriculum hours available to teach, and the changing societal and cultural landscape. Within this landscape, the educational literature suggests that technology can support students in achieving greater learning outcomes by increasing engagement; however, a direct correlation between this perceived increase in engagement and outcomes within anatomy education remains unclear. This study addresses two related issues. Firstly, it attempted to discern the various dimensions of engagement with technology-enhanced learning (TEL) resources within a medical program’s anatomy curriculum using exploratory factor analysis; secondly, outcomes from this survey were used to correlate the perceived levels of engagement recorded with assessment outcomes. A 25-item five-point Likert-based survey was developed and administered to first-year medical students. Subsequent analysis revealed three emergent factors: (1) satisfaction, (2) goal setting and planning, and (3) physical interaction, which closely aligned with previous studies. To explore the levels of engagement across three custom-made anatomy TEL resources, including (1) anatomy drawing screencasts, (2) an eBook, and (3) a massive open online course (MOOC), nonparametric analysis was employed. Usage data indicated that anatomy drawing screencasts via YouTube were the most popular resource, with the MOOC being used least. Some evidence suggested that those students who utilized the MOOC were more engaged. However, no correlations were observed between the levels of perceived engagement and TEL resource usage or assessment outcomes. The results from this study provide an insight into how students engage with TEL resources, but it does not reveal a relationship between levels of engagement, usage, and assessment outcomes.

ELEARNING

LEVERAGING E-LEARNING TO RESPOND TO THE OPIOID CRISIS

Jacqueline S. Barnett | Rachel Porter | Sandro Pinheiro

Duke University School of Medicine PA Program | Duke University School of Medicine PA Program | Duke University School of Medicine PA Program

Purpose: As part of a federal grant aimed to improve health professionals’ education to address the opioid crisis, the Duke Physician Assistant (PA) Program developed three online modules that are available without cost to health profession students and clinicians across the country. This abstract describes the project and its early outcomes. Methods: The Duke PA Program convened an interprofessional team and developed educational modules related to opioid use disorders. The interactive web-based modules include pre- and post-tests that assess knowledge, skills, and attitudes. We made the modules available to students and practitioners at Duke and across the country in July 2018. The three modules—safe opioid prescribing, recognizing and treating opioid misuse and abuse, and opioids and pain management—have been incorporated into the Duke PA Program curriculum, and efforts are underway to include them in other clinical education training programs. The modules were designed to meet the continuing medical education and licensure/certification requirements for providers who order or administer control substances in NC and other states. Individuals can access the modules without cost through Duke or at www.aheconnect.com/pcte, making them accessible across NC, the USA, and beyond. Results: After 3 months, we have recorded 190 module completions. Initial results indicate that as students and clinicians complete the modules, they are increasing their knowledge and skills around diagnosing and treating opioid use disorders and developing attitudes that take away the stigma of addiction. Conclusion: There are more individuals with an opioid use disorder than there are clinicians trained to care for them. This innovative education project will assist in efforts to better prepare current and future clinicians to participate in the care of those with an opioid use disorder and fill a much-needed gap in communities.

ELEARNING

DIGITAL BADGES IN MEDICAL EDUCATION: A SYSTEMATIC REVIEW

Patrick Welch | Julie Noyes

Ethos Veterinary Health | Washington State University

Purpose: A challenge to the competency-based model of medical education is the verification of skill acquisition. Digital badges represent an innovative strategy for credentialing competencies. Despite the growing interest in digital badges, there is currently no synthesis of the medical education literature regarding this credentialing strategy. The purpose of this research was to conduct the first systematic review of digital badges in medical education by comprehensively identifying, critically appraising, and meticulously synthesizing the literature base. Methods: A rigorous systematic search of major databases (PubMed, Web of Science, CAB Abstracts), key journals, and previous reviews from 2008 to 2018 was conducted and reported via Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies were appraised and methodological scoring was conducted with the Medical Education Research Study Quality Instrument (MERSQI) and the Newcastle-Ottawa Scale (NOS). Results: A corpus of 201 records was identified and assessed for eligibility resulting in 26 independent publications for analysis. Twenty-two sources were journal articles (84%) with 1 dissertation (4%), 2 book chapters (8%), and 1 conference proceeding (4%). All papers were published since 2013 with 70% after 2016. There were 17 review resources, 6 descriptive studies, and 3 quasi-experiments. Content areas included medicine (18), nursing (6), pharmacy (1), and veterinary medicine (1). The mean (SD) quality scores were 9.0 (2.2) for MERSQI (maximum 18) and 3.5 for NOS (maximum 6). Theoretical frameworks focused on motivation theories and components of social cognitive theory such as self-regulation and goal-setting. Badges were described as extrinsic motivators implemented within a gamification context. Studies focused on subjective and self-reported outcomes; however, validated instruments were utilized. Conclusion: The results of the research synthesis indicate a growing momentum toward utilizing digital badges as an innovative credentialing strategy to disrupt higher education and strive toward a new model of learner-centered, competency-based medical education.

INSTRUCTIONAL METHODS

EFFECTIVENESS OF SMALL GROUP DISCUSSIONS (SGD) IN PHARMACOLOGY COURSE AT AVALON UNIVERSITY SCHOOL OF MEDICINE

Sireesha Bala Arja

Avalon University School of Medicine

AWARD NOMINEE

Purpose: Small group discussions (SGD) are used in medical education to foster self-directed learning (SDL), communication skills, and professionalism. Small group discussions can involve a variety of tasks such as critical thinking, problem-solving, and brainstorming. The objective of this study is to find out if SGD can improve the students’ learning and their performance in assessments than individual SDL and lectures. Methods: This is a quasi-experimental study to investigate if SDL in groups (SGD) is better than individual SDL and lectures. Students were required to watch videos and do the self-directed learning before coming to lecture. Students attended the lecture for 50 min. At this point, students were assessed by a pre-test. After the test, students were involved in SGD. A post-test was given after the SGD. The data were collected for six topics in pharmacology course. At the end of the course, students received an evaluation containing quantitative questions and open-ended questions to gather feedback. Results: The students’ performance was compared between pre-test and post-test for six topics, and significant improvement was demonstrated in five topics (paired t test, p < 0.05). Student performance on the topics which were taught using SGD was compared with overall performance on pharmacology final exam, demonstrating a significant difference (paired t test, p = 0.031). Students’ overall performance in pharmacology with SGD was also improved compared to the overall performance of the previous class of students who did not have SGD (unpaired t test, p = 0.025). Finally, the questions on the Likert scale were analyzed for descriptive statistics, including mean, median, and mode. Student responses to the SGD were satisfactory. Conclusion: The small group discussions for the pharmacology course improved students’ learning and their performance in assessments at Avalon University School of Medicine. As the sample size is small, we plan to continue evaluating SGDs with larger sample size in the future.

INSTRUCTIONAL METHODS

CHANGING THE MEDICAL NARRATIVE: INCORPORATION OF ILLNESS STORIES INTO GROSS ANATOMY

Carrie Elzie

Eastern Virginia Medical School

AWARD NOMINEE

Purpose: Narrative medicine is an important and expanding new field that recognizes the value of storytelling. It involves recognizing, absorbing, metabolizing, interpreting, and being moved by the stories of illness. This valuable aspect of medicine was introduced into a medical gross anatomy course by transforming the illness stories of a living anatomical donor into interactive cases and discussions to complement the basic science and provide early patient exposure. Methods: The illness stories and medical records of a living anatomical donor were collected and used to create interactive cases to teach anatomy. Each case allowed the students to delve into the patient’s perspective while learning the underlying basic science and clinical principles. A follow-up session provided the students with the opportunity for personal connection and a forum to ask questions with the patient. Students’ reflections on the principle takeaways were collected. Exam questions and knowledge retention were analyzed compared to other case modalities. Qualitative feedback was collected from focus groups and course evaluations. Results: One hundred fifty students completed five cases with Mr. Clark. Thematic analysis of the students’ responses revealed two of the top three takeaways from each case were consistently humanistic rather than scientific/clinical with a focus on the patient’s feelings, reactions, and lifestyle. Performance on exams was similar to content taught in other modalities. Retention rates of patients’ diagnoses were 50% higher for cases that contained personal narratives. Feedback was overwhelmingly positive with an appreciation for the humanistic elements of this teaching modality. Conclusions: Changing the curriculum to include illness stories has shifted the medical narrative toward a more compassionate and humanized conversation without sacrificing medical knowledge. The addition of illness narratives has the potential to foster interpersonal development in affective, cognitive, and experiential domains thereby positively shaping the hidden curriculum into a more humanistic and empathetic message.

INSTRUCTIONAL METHODS

EXAMINING STRATEGIES TO PROMOTE COGNITIVE INTEGRATION OF BASIC AND CLINICAL SCIENCES IN NOVICE LEARNERS

Kristina Lisk

Humber College

AWARD NOMINEE

Purpose: The importance of integrated basic and clinical science knowledge is well recognized; however, supporting the development of learners’ integrated knowledge continues to be an educational challenge. Previous work suggests that learning strategies, such as self-explanation, might promote and support the development of cognitive integration. In this study, we examined the relative impact of two basic science instructional approaches (integrated and segregated instruction) and a learning strategy (self-explanation) on novices’ diagnostic accuracy. Methods: Allied health students (N = 71) were taught the clinical features of four musculoskeletal pathologies. Students randomly assigned to the integrated group were presented with descriptions that explicitly integrated the clinical features with basic science mechanisms. The segregated group were taught the basic science mechanisms and clinical features separately. The self-explanation group received the same learning materials as the integrated group, but were also prompted to engage in a self-explanation task immediately after learning each pathology. The self-explanation task required that they articulate why certain clinical features arose. All participants completed a diagnostic accuracy and memory test immediately after learning and 1 week later. Results: The integrated group outperformed the self-explanation and segregated learning groups on the diagnostic accuracy and memory test. Diagnostic accuracy declined across all three groups after 1 week, and the largest drop in performance was observed in the self-explanation group. Conclusion: Explicitly integrating basic and clinical science instruction positively impacts novices’ diagnostic performance and ability to recall clinical features associated with different pathologies. However, generating self-explanations while learning with integrated basic science materials did not enhance novices’ diagnostic performance. We hypothesize that the structure of the self-explanation task may not have supported the development of a holistic understanding of each disease. These findings highlight the importance of carefully considering how learning strategies are structured and applied in order to optimize learning of the basic and clinical sciences.

INSTRUCTIONAL METHODS

USING PEER EVALUATION TO PROMOTE STUDENT UNDERSTANDING AND SATISFACTION DURING TEAM-BASED LEARNING EXERCISES

Ziyodakhon Abdujabborova | Krystal Hunter | David Swope

Cooper Medical School of Rowan University | Cooper Medical School of Rowan University | Cooper Medical School of Rowan University

AWARD NOMINEE

Purpose: While initially recognized as an essential element in team-based learning (TBL) exercises, peer review is often omitted in biomedical TBL design due to minimal and often contradictory supportive evidence. The objective of this study is to evaluate the impact of peer evaluation on student performance, participation, and group dynamics during TBL sessions within a summer enrichment program at Cooper Medical School of Rowan University (CMSRU). Methods: Students enrolled in the CMSRU summer enrichment program participated in three TBL exercises within a traditional 6-week Biochemistry section. TBL teams of 5–6 students were established randomly and remained consistent throughout the program. Group dynamics was evaluated via audio recording and an anonymous survey (27 question, Likert scale). Three cohorts of students were evaluated in the study: a control group (n = 31); a group (n = 34) exposed to graded peer review (25% of TBL) that required self-assessment and evaluation of group members on preparation, participation, teamwork, professionalism, and overall production; and a group (n = 30) subject to ungraded peer assessment (0% of TBL) using the aforementioned peer review tool. Results: Addition of ungraded peer evaluation TBL incentive structure resulted in a significant increase in average iRAT scores compared to either no peer evaluation or graded peer evaluation. Moreover, student satisfaction and group dynamics, as assessed on an anonymous survey, were maintained with the inclusion of peer evaluation. Results also indicated a positive correlation between iRAT performance and self/peer reviews advocating the accuracy of the peer assessment mechanism. Conclusions: Evidence-based evaluation of the TBL design and implementation of innovative modifications are necessary for advancements in medical pedagogy. Preliminary evidence suggests that inclusion of ungraded peer review results in improved TBL performance and preserves student satisfaction. Continued appraisal of the positive outcomes of peer evaluation will help shape future student-centered learning practices.

INSTRUCTIONAL METHODS

THE IMPACT OF SIMULATION COMPETITION ON PRECLINICAL MEDICAL STUDENTS

Alexander Piszker, MS, OMS-II | Dennis Baker, PhD | Dianne Walker, BS | John Giannini, MD

Alabama College of Osteopathic Medicine | Alabama College of Osteopathic Medicine | Alabama College of Osteopathic Medicine | Alabama College of Osteopathic Medicine

Purpose: Simulation is utilized in medical education to teach clinical skills and clinical reasoning in a realistic yet low-risk environment. A simulation competition is conducted annually, by the American Medical Student Association (AMSA) chapter at the Alabama College of Osteopathic Medicine (ACOM). Our poster describes the 2018 competition and presents findings from a post-competition survey designed to assess the value of each element used in preparing students as well as the impact of the competition experience on perceived clinical skills and overall confidence. Methods: This year, 45 year 1 and 2 students (9 teams of 5 each) participated in the competition following 7 weeks of preparation in which teamwork and clinical reasoning were reinforced via structured faculty-led training sessions. All scenarios incorporated a high degree of realism and clinical complexity, requiring that students apply teamwork, clinical reasoning, and clinical skills as they worked through each scenario while being judged by a panel of clinical faculty. A 12-item survey was administered following the event and was designed to evaluate the educational value of the experience as well as the effectiveness of various components of the practice period. Results: Survey responses by students indicated that the simulation competition produced enhanced clinical reasoning and team-building skills as well as overall confidence in their developing clinical abilities. All 12 instructional methods (e.g., structured debriefing, realistic practice cases, etc.) used in the practice period were rated as “effective or very effective.” All survey data will be presented and discussed. Conclusion: An in-house medical simulation competition demonstrates value and effectiveness in developing preclinical students’ clinical skills and facilitates interpersonal development through teamwork that is invaluable to a healthcare professional. Participation in simulation competition enhances students’ confidence and preparedness for encountering real clinical scenarios that will be encountered in third year clinical clerkships.

INSTRUCTIONAL METHODS

REPLACING DIDACTIC LECTURES WITH INTEGRATED CASE-BASED SESSIONS IMPROVES STUDENT OUTCOMES IN AN INTEGRATED PRECLERKSHIP CURRICULUM

James Fong | Diana Pettit, PhD | Dolgor Baatar, MD/PhD | Dan Blunk, MD | Tamis Bright, MD | Jorge Cervantes, MD | Martine Coue, PhD | Ellen Dudrey, MD | Tanis Hogg, PhD | Herb Janssen | Niti Manglik, MD | Cynthia Perry, PhD | Curt Pfarr, PhD | Dale Quest,

Texas Tech, El Paso | Texas Tech, El Paso | Texas Tech, El Paso | Texas Tech, El Paso | Texas Tech, El Paso | Texas Tech, El Paso | Texas Tech, El Paso | Texas Tech, El Paso | Texas Tech, El Paso | Texas Tech, El Paso | Texas Tech, El Paso | Texas Tech, El Paso | Texas Tech, El Paso | Texas Tech, El Paso | Texas Tech, El Paso

Purpose: Lecture-based dissemination of information is the traditional approach to presenting curricular materials in medical schools. Recent studies suggest team-based or case-based learning sessions are more effective than didactic lectures. However, it remains unclear whether replacement of didactic lectures with case-based sessions would improve learning outcomes in medicals schools with integrated, clinical presentation-based, preclerkship curricula. Methods: We converted the 6-week endocrine unit from didactic lectures to monographs and narrated Power Point slides or interactive modules for use as self-directed learning materials. All materials included quizzes for self-assessment. At the end of each week, students were required to attend integrated case-based sessions. Each session started with an Individual Readiness Assurance Test (iRAT) on the material covered that week. iRAT scores comprised 12% of the unit grade. Integrated cases incorporated questions from all basic science disciplines for the week. At the end of the unit, a summative exam was administered which comprised 88% of the unit grade. Results: Summative exam scores were significantly higher than those of the previous class, which used didactic lectures (81.1 vs 76.6%, respectively, P < 0.01). The largest improvement was in the lowest quartile of summative scores, and the unit failure rate dropped from 11% (lectures) to 1% for integrated sessions. There was no significant difference in summative scores between the two classes for prior units which used didactic lectures for both classes. Conclusion: These results suggest that students benefit from the addition of weekly case-based integrated sessions. The addition of graded quizzes insures that students stay current and come prepared for the integrated sessions, which likely contributes to improved student outcomes on the summative exam. These results provide a rationale for replacement of lectures with interactive sessions as part of the preclerkship curriculum.

INSTRUCTIONAL METHODS

TEACHING THE ABCDE APPROACH: LECTURE VS VIDEO-BASED INSTRUCTION

Marije Hogeveen | Marjolein Linders | Jos Draaisma | Arno van Heijst | Mathijs Binkhorst

Department of Neonatology (804), Radboud University Medical Centre Amalia Children’s Hospital | Department of Neonatology (804), Radboud University Medical Centre Amalia Children’s Hospital | Department of Paediatrics, Radboud University Medical Centre Amalia Children’s Hospital

Purpose: The Airway, Breathing, Circulation, Disability and Exposure (ABCDE) approach is a widely accepted, expert-based algorithm for the management of emergencies in patients of all age categories. We evaluated whether video-based instruction is more effective than traditional lecturing in teaching the ABCDE approach. Methods: A randomised controlled simulation study was performed. Neonatal healthcare providers participated in multiple neonatal advanced life support (NALS) scenarios, using a high-fidelity neonatal patient simulator and realistic training environment. For each training day, the instruction method was randomised to an instructional video (VBI) or a conventional lecture (CL). One researcher, blinded to the received instruction type, evaluated adherence to the ABCDE approach with an assessment tool specifically designed and tested for this study. The primary outcome was adherence to the ABCDE approach, expressed as percentage score. Secondary outcomes were the scores of each profession category (nurses, neonatal ward physicians, fellows/neonatologists) independent of the study groups, and the scores for the domains (A, B, C, D, E) of the algorithm. Results: Seventy-two participants were assessed, resulting in 65 percentage scores (the performance of the 2 nurses in each scenario was combined). Overall mean (SD) percentage score was 31.5% (19.0). The VBI group (28 participants, 22 scores) performed the ABCDE approach better than the lecture group (44 participants, 43 scores), with mean (SD) scores of 38.8% (18.7) and 27.8% (18.2), respectively (p = 0.026). Distribution of age, function, previous participation and working experience was not different between both groups. The difference in adherence between both groups could mainly be attributed to differences in the adherence to domains B (p = 0.023) and C (p = 0.007). Neonatal ward physicians demonstrated better adherence than nurses. Conclusions: Video-based instruction was more effective than traditional lecturing in teaching the ABCDE approach during NALS training. Overall adherence to the ABCDE algorithm was low.

INSTRUCTIONAL METHODS

ALL THE WORLD’S A STAGE: A THEATRE WORKSHOP FOR IMPROVING COMMUNICATION SKILLS IN MEDICAL STUDENTS

Christie Kohut | Tori Spangehl | Claudia Krebs

MD Undergraduate Program, University of British Columbia | MD Undergraduate Program, University of British Columbia | Department of Cellular and Physiological Sciences, University of British Columbia

Purpose: Despite evidence that arts-based interventions are an effective tool for improving communication in medical students, they remain underutilised in medical education. The purpose of this project was to create a theatre-based workshop that can strengthen clinical communication amongst undergraduate medical students and can be implemented by medical faculties to enhance their existing communication skills curriculum. We examined whether attending our novel arts-based workshop fostered improvements in medical students’ communication. Methods: A 2-h pilot workshop was developed with input from medical students, drama teachers, theatre professors and medical communication experts and piloted at the University of British Columbia. Participants were recruited from years 1 to 2 of the medical undergraduate program. Eight medical students volunteered to participate. The workshop was facilitated by two second-year medical undergraduate students. A variety of theatre activities were utilised, including monologue delivery, role-play and theatre games. Goals included building on delivery, interpersonal and teaching skills; giving and receiving feedback; and reducing performance anxiety. Pre- and post-test data were collected using self-report surveys and objective assessment. Results: Preliminary data analysis showed that all participants (n = 8) believed that participation helped develop communication skills and 7 (87.5%) felt participation increased their understanding and awareness of speaking or interpersonal skills. These data will inform changes to the design and delivery of future workshops and iterations of the study. Upon further optimisation, we intend to publish the workshop as an open-source toolkit for medical schools who wish to implement the program into their curriculum. Conclusion: This theatre-based workshop is an effective and engaging supplemental approach to communication skills education that is easy to implement and is effective and engaging.

INSTRUCTIONAL METHODS

ADDRESSING A MEDICAL SCHOOL CURRICULAR GAP BY INTEGRATING PHARMACY AND MEDICAL STUDENT COURSES ON THERAPEUTICS

George Bergus | Susan Vos | Michael Kelly | Michael Ernst

Carver College of Medicine, University of Iowa | College of Pharmacy, University of Iowa | College of Pharmacy, University of Iowa | College of Pharmacy, University of Iowa

Purpose: Medical students and faculty reported that students in our new curriculum had gaps in their knowledge about therapeutics. Therefore, we designed a course to enhance this knowledge. Methods: We piloted a 2-week case-based course on therapeutics in which medical and pharmacy students collaborated in formulating treatment plans for clinical cases prepared by faculty. During daily class sessions, medical and pharmacy students presented treatment plans followed with discussions led by faculty physicians and pharmacists. At the end of each session, students were assigned a new clinical case for presentation/discussion the following day. Students completed self-assessment surveys using a Likert scale (1 = strongly disagree to 5 = strongly agree). Results: A total of 9 medical students enrolled in this course. Each third or fourth year medical student worked collaboratively with 1 to 2 pharmacy students to formulate treatment plans for 8 clinical cases: pneumonia, CHF, hypertension, thrombosis, gout, COPD, osteoporosis, and T2DM. At the end of the course, all medical students (n = 9) agreed/strongly agreed that (1) “Active learning activities were utilized in this course,” (2) “The course encouraged me to teach myself as well as my peers,” (3) “The knowledge gained in this course will help me take care of patients,” (4) “The cases allowed me to use my foundational science knowledge,” (5) “Because of this course I will make better prescribing decisions.” and (6) “I hope to collaborate with pharmacists when I enter practice.” Eight of the 9 students agreed/strongly agreed that “I benefited from the opportunity to work with pharmacy students.” As a result of this learning experience, medical and pharmacy students reported significantly increased comfort in providing collaborative care to patients (pre vs. post: p = 0.02, p < 0.01; respectively). Conclusion: Medical students reported knowledge gains from this case-based interprofessional course on therapeutics. Because of this experience, both medical and pharmacy students voiced greater support for collaborative care.

INSTRUCTIONAL METHODS

BREAKING WITH TRADITION: IMPLEMENTING ACTIVE LEARNING INTO GRAND ROUNDS

Jennifer M Keller, MD MPH

The George Washington University

Purpose: Active learning has been demonstrated in multiple studies to improve retention in education. This project describes one department’s (Obstetrics and Gynecology) integration of active learning into weekly Grand Rounds at our urban, academic medical center. This abstract includes preliminary data from this integration. Methods: Information on active learning techniques was provided to all speakers. Data was collected on the implementation of active learning techniques in each session. Evaluations of each session were collected. Two weeks later, attendees were asked to recall information from the prior sessions and if they had used what they learned in clinical practice. Results: Sixty percent of the speakers fully implemented active learning into their talks, and 20% did not implement any active learning techniques. The remaining 20% utilized some active learning techniques. Twenty-four percent of attendees were students, 34% residents, and 41% faculty (MD, CNM, NP); 83% of those completing evaluations were < 40 years old. Active learning techniques used by speakers included audience response, think-pair-share, and case discussions. The sessions were all rated very highly by the attendees. The mean evaluation score was 4.9/5. The evaluation forms contained positive comments about the format of the sessions. Attendees named case-based teaching, the interactive nature of the sessions, group discussions, and the engaging nature of talks in their evaluations. We will continue to collect data weekly through the rest of the academic year. We plan to look at correlations between age and evaluation scores, use of active learning, and recall and use of active learning and evaluation scores. Conclusion: The use of active learning techniques during Grand Rounds at an academic center is viewed favorably by those attending. Active learning has been demonstrated in other studies to improve retention, and we plan to look at this as an outcome as additional sessions are completed.

INSTRUCTIONAL METHODS

FACILITATING MEDICAL STUDENT LEARNING OF ANATOMY VIA RADIOGRAPHIC IMAGING

Cindy Funk, Ph.D.

Burrell College of Osteopathic Medicine

Purpose: Cadaver dissection is effective in teaching medical anatomy. Due to associated time and financial demands, there have been curricular initiatives to develop strategies to replace or supplement cadaveric dissection with imaging/virtual resources. At BCOM, anatomy is taught primarily through imaging (MRI, CT, ultrasound), with minimal cadaveric prosection. The current study describes the development and assessment of a teaching strategy to facilitate learning of anatomy through imaging. Methods: An action research design was used to develop and assess a strategy for anatomists to facilitate learning of anatomy through imaging. The strategy was implemented in the Musculoskeletal I course. The effectiveness of the strategy was assessed by utilizing a between-subjects design comparing test question performance between BCOM classes of 2020 (teaching strategy not implemented) and 2021 (teaching strategy implemented). Test statistics analyzed included difficulty and point biserial for identification and first-order and second-order questions. Student’s t test was utilized to compare data between classes. No individual student data were analyzed. Results: The most effective teaching strategy was one utilizing a small-group, problem-solving approach. Through active learning and collaboration, students engaged in problem-solving exercises that emphasized a knowledge of anatomical functions/relationships. At the end of each problem set, students worked through a learning catalytics-based self-assessment to insure that basic concepts had been attained. Student feedback, for continual improvement, was attained through learning catalytics. Data comparing test question performance between the classes of 2020 and 2021 were not significant, but were confounded by overall modifications to the MSK I curriculum. Conclusion: These data detail an effective method for facilitating learning of anatomy through imaging. This strategy can be utilized to support anatomical learning as a supplement to or in place of cadaveric dissection. Due to the novel nature of this anatomical curriculum, further data will be needed to assess how students perform on national licensing examinations.

INSTRUCTIONAL METHODS

THE ZOMBIE PANDEMIC: AN INNOVATIVE SIMULATION ON DISEASE OUTBREAKS AND DISASTER RESPONSE FOR PRECLINICAL MEDICAL STUDENTS

Jennifer M. Jackson; Timothy R. Peters

Wake Forest School of Medicine

Purpose: Understanding public health system processes, including disease outbreak investigations and disaster response and preparedness, is an important physician competency, though most medical schools provide limited training in this content. To address this gap, we designed and implemented an innovative simulation for preclinical medical students and performed a qualitative study of students’ reports to characterize their application of these concepts. Methods: One-hundred and forty first-year medical students participated in this 2-h simulated pandemic activity, implemented during the Virology course following core virology instruction. Prior to this simulation, students had not encountered formal instruction on disaster response or preparedness content. Students worked in teams to collect and analyze clinical, laboratory, and epidemiological data to formulate hypotheses for the source of a simulated pandemic manifesting with “zombie”-like signs and symptoms. Student teams then developed infection prevention, containment, and resource allocation recommendations. Qualitative analysis of students’ reports was performed to characterize the content of their public health recommendations using both inductive and deductive coding, and themes and subthemes were generated. Distribution and frequency of subthemes and of data source types observed in students’ reports were calculated using descriptive statistics. Results: Nine unique disaster response codes were identified among students’ reports; codes were clustered in themes of community-level interventions, individual-level interventions, infection investigation, healthcare facility interventions, and resource allocation recommendations. “Healthcare facility infection control measures” was the most common subtheme observed (90%) followed by “prioritizing healthcare personnel for prophylaxis and/or treatment” (55%). Other disaster response subthemes were variably observed (15–50%). Students cited six primary data source types, of which the Centers for Disease Control and World Health Organization websites were the most commonly cited (60 and 60%). Conclusions: Collaborative problem-solving during a simulated “zombie” pandemic provides preclinical medical students an effective and engaging opportunity to practice applying disaster response concepts.

INSTRUCTIONAL METHODS

UTILIZING A MOCK ETHICS COMMITTEE MEETING AS AN INTERPROFESSIONAL MODULE TO TEACH ETHICAL PRINCIPLES WHILE SOLVING AN ETHICAL DILEMMA

Janet Lieto

UNTHSC-TCOM

Purpose: Teaching medical ethical principles to first year medical students includes memorization and understanding definitions of ethical concepts and principles. These students have the ability to study and understand concepts, but are rarely given the chance to apply this knowledge. A module was developed to apply ethical problem-solving skills utilizing the “Four Topic” approach incorporating osteopathic medical students, physician-assistant students, and pharmacy students. This abstract describes the project and its outcomes. Methods: The module was developed as an interprofessional education (IPE) session for each of the colleges. Faculty from each of these colleges as well as the director of IPE and an ethicist helped develop 12 “scripts” representing all parties present at the Mock Ethics Committee meeting. Each of the scripts represented a different perspective such as the patients’ husband and sister, physician, physician assistant, pharmacist, nurse, hospital administrator, chaplain, social worker, lay person, committee chairperson, and recorder. Student leaders were chosen by the faculty and trained to be the committee chairperson. Each person’s script revealed different information about the patient. At the end of the 2-h session, the ethics committee needed to come to consensus and decide the outcome for a brain dead patient on a ventilator. Results: Four hundred twenty-three students participated in the 2-h module. Pre- and post-session survey questions were collected regarding ethical content and working as part of an interprofessional committee. The data demonstrated that students were more confident after the module in their ability to apply ethical principles to problem solve an ethical dilemma. In addition, they also realized the importance of an interprofessional team in helping to come to a committee recommendation. Conclusion: A mock IPE Ethics Committee meeting module increased student’s confidence in problem-solving an ethical dilemma while valuing the importance of the interprofessional team in making difficult ethical decisions.

INSTRUCTIONAL METHODS

IMPROVEMENT IN ACADEMIC PERFORMANCE USING A FLIPPED CLASSROOM MODEL COUPLED TO THINK-PAIR-SHARE

Phillip Carpenter | Allison Ownby | Aaron Poliak | Litao Wang | Peggy Hsieh

McGovern Medical School | McGovern Medical School | McGovern Medical School | McGovern Medical School | McGovern Medical School

Purpose: Traditional lecturing has generated student apathy marked by poor classroom attendance. To circumvent this, we coupled a flipped classroom with a think-pair-share (TPS) teaching strategy and demonstrated knowledge gain and value for attending class. This abstract describes the project and its outcomes. Methods: Multiple biochemistry-oriented pre-clerkship lectures were flipped where students viewed pre-recorded content before class. During class, students answered clinically relevant, application-based questions using the Poll Everywhere (PollEv) audience response system, in conjunction with a TPS activity. Students initially answered the questions individually without discussion. They then answered the same questions a second time after discussion with their peers. A satisfaction survey regarding their flipped-TPS experience was conducted after the sessions. Results: This study demonstrates that our flipped-TPS classroom attracted students to attend class as evidenced by up to 90% participation. Further, we found, on average, up to 50% knowledge improvement on PollEv questions after peer discussion. Survey results indicate that 75% of the students found the flipped-TPS classroom conducive to learning, 54% of students preferred a flipped classroom to 28% who preferred streaming lectures, and 86% of students perceived attending class to be worth their time (n = 213). Conclusion: Using a flipped-TPS model not only increases student enthusiasm to attend lectures, but more importantly, also allows for increased learning and higher level thinking through social construction.

INSTRUCTIONAL METHODS

PROCEDURALIZING THE ART OF CLINICAL SKILLS TEACHING

Sateesh Babu Arja

Avalon University School of Medicine, Curacao

Purpose: The two popular methods of clinical skills teaching are “Peyton’s four-step approach” and “Gagne’s theory of instructional design.” A hybrid method, a combination of both methods, was developed and implemented in clinical skills during the first 2 years of undergraduate medical education at Avalon University. The reasons for developing the hybrid method are to provide more opportunities for demonstration, practice by students, and immediate feedback. The hybrid method includes explaining the learning objectives, discussions based on the knowledge of basic sciences, demonstration with audiovisual aids, demonstration with commentary but no audiovisual aids, practice by students in groups, and students demonstrating in front of the instructor. Feedback was provided, followed by assessment, and feedback given again after the assessment. This study aims to evaluate the hybrid method of clinical skills teaching. Methods: This is a quasi-experimental study; the new teaching method was evaluated after its implementation. Data were gathered for the control group and three study groups in 2017 and 2018. An end-of-course evaluation was issued to collect both quantitative and qualitative feedback from students. It included 17 questions on a five-point Likert scale. Quantitative data also include students’ performance in assessments. Results: Student feedback (end-of-course evaluations) responses for the control group were n = 26, and n = 22, n = 14, and n = 10 for the three study groups, respectively. The student responses for all 17 questions revealed an increased satisfaction with improved median and mode. Differences in class performance were analyzed using the Kruskal–Wallis test. The average class performance on end-of-course examination showed a statistically significant improvement (p < 0.01). Conclusion: The hybrid method of teaching in clinical skills improved the students’ satisfaction and academic performance. This hybrid method of clinical skills teaching can be easily implemented, regardless of class size. In the future, we plan to continue evaluating this model with a larger sample size.

INSTRUCTIONAL METHODS

MAKING THE CONNECTION: TAKING INTEGRATED NOTES IMPROVES LEARNING AND RETENTION ASSOCIATED WITH CLINICAL REASONING

Douglas B. Spicer | Kathryn H. Thompson | Sean Kilgallen

University of New England College of Osteopathic Medicine | University of New England College of Osteopathic Medicine | University of New England College of Osteopathic Medicine

Purpose: The concept of cognitive integration refers to the value of understanding the basic science connections to clinical signs and symptoms. Practicing clinicians are often not aware of using these connections in clinical reasoning; however, many studies indicate the importance of integrating the basic and clinical sciences for learning diagnostic reasoning. Recent studies have suggested that cognitive integration is achieved when the relationships between the basic science and clinical domains are explicitly demonstrated to learners. Our initial studies exploring this suggested that enhancement of clinical reasoning required that the students build these connections themselves. To assess this, we designed a study to test the hypothesis that taking integrated notes while studying improves the ability of students to diagnostically discriminate between multiple endocrinopathies. Methods: Students were presented with a learning resource on the dysregulation of the hypothalamic–pituitary–adrenal axis that explained the causal links between the basic science and clinical features of each of the disorders. One piece of blank paper was included for note-taking. Students were told that they had 1 h to study the material before they would take two tests: one measuring recall and one measuring diagnostic reasoning. The intervention group was also instructed to specifically take integrated notes using basic science concepts to explain the clinical signs, symptoms, and laboratory values. Retention was measured 1 week later using similar tests. Results: Thirty-four first-year medical students completed the study. No significant difference between groups was found on the initial recall test. However, the group that was instructed to take integrated notes did significantly better on the initial diagnostic test and on both tests a week later. Conclusions: The results suggest that the act of writing integrated notes improves clinical reasoning and retention. This supports the value of giving students strategies to actively integrate and synthesize information.

INSTRUCTIONAL METHODS

MEDICAL STUDENTS’ EXPECTATIONS OF FACULTY AND STUDENT CONDUCT DURING LECTURE

David Lebowitz | Aaron Pollock | Melissa Kendall | Denise Kay

University of Central Florida College of Medicine | University of Central Florida College of Medicine | University of Central Florida College of Medicine | University of Central Florida College of Medicine

Purpose: Medical schools are experiencing diminishing classroom attendance in the preclinical years. Faculty observe inattentive, distracted, and/or superficially engaged students. This investigation captured student’s expectations of faculty and student conduct in lectures to better understand students’ perceptions of the faculty–student relationship in lecture-based learning formats. Methods: An open-ended and multiple-choice item voluntary survey was distributed to enrolled students at one medical school in June of 2018 (n = 360). One hundred forty-seven (41%) students responded to the survey. Faculty and students collaborated on qualitative analysis of open-ended responses. Results: In self-assessing, 25% of respondents endorsed that they were engaged during lectures 90% of the time, 14% about 75% of the time, 7% about 50% of the time, and 4% less than 50% of the time. Fifteen percent of students endorsed that they only use electronic devices to access the PowerPoint slides or take notes. Twenty-four percent endorsed that, if they multitask during lectures, it is related to their studies. Ten percent endorsed multitasking not related to their studies. The salient themes identified in students’ expectation of faculty during lecture were to be respectful, engaging, and present high yield, relevant information in a simple, clear, and concise manner. The salient themes identified in students’ expectations of each other during lecture were to be respectful, pay attention and participate/engage when appropriate, to not behave in distracting or disruptive ways, ask off topic questions, or use electronic devices for noncourse-related purposes. Conclusion: This local investigation suggests that faculty have the potential to enhance students’ appreciation of the lecture format by clearly, concisely presenting high yield content, incorporating opportunities for engagement and maintaining mutual respect among students and faculty. Students can contribute by increased awareness of potentially disruptive behaviors, for example, asking off topic questions or using electronic devices for purposes other than taking notes.

INSTRUCTIONAL METHODS

CLINICAL REASONING AND CASE-BASED LEARNING: DOES SIMULATION WITH A MANIKIN MAKE A DIFFERENCE?

M. Kathryn Mutter, MD, MPH | James Martindale, PhD | Neeral Shah, MD | Maryellen Gusic, MD | Stephen J Wolf, MD

University of Virginia School of Medicine | University of Virginia School of Medicine | University of Virginia School of Medicine | University of Virginia School of Medicine | University of Virginia School of Medicine

Purpose: Situativity theory posits that the development of clinical reasoning skills is grounded in context. In case-based learning, context comes from recreating the clinical environment through role playing with or without a manikin. Manikin-based simulation learning results in improved clinical management skills compared to case-based learning without a manikin. However, the specific impact of the manikin on clinical reasoning has not been elucidated. In this study, we sought to understand the difference in student clinical reasoning, as measured by script concordance testing, after facilitated teaching sessions involving case-based discussion with or without a manikin. Methods: Medical students enrolled in an internship readiness course at the end of fourth year of medical school were randomized into a control (case discussion without manikin) and intervention (case discussion with manikin) group. Each group discussed six chest pain case scenarios during the session. The format and content of the case progression and debriefing were identical between the two groups. In the intervention group, the manikin was used to simulate the patient care environment. A 64-question script concordance test (SCT) was developed, piloted, and administered post-session to compare clinical reasoning between the groups. Hospitalist and emergency medicine faculty scores served as the expert standard for exam scoring. The study was UVA IRB approved and students provided consent. Results: In March 2018, 96 students were randomized to case-based learning sessions with (n = 48) or without (n = 48) manikin. Ninety students completed the SCT. A statistically significant mean difference between the two groups was found (t = 3.059, df = 88, p = 0.003) with the intervention group scoring higher. Conclusion: In March 2018, 96 students were randomized to case-based learning sessions with (n = 48) or without (n = 48) manikin. Ninety students completed the SCT. A statistically significant mean difference between the two groups was found (t = 3.059, df = 88, p = 0.003) with the intervention group scoring higher.

INSTRUCTIONAL METHODS

CONTEXT OVER CONTENT: IMPACT OF INTEGRATION OF BASIC SCIENCE DISCIPLINES IN PRE CLINICAL YEARS

Sarmishtha Ghosh

International Medical University, Kuala Lumpur, Malaysia

Purpose: In the twenty-first century, with the advent of artificial intelligence, it is necessary for students to develop skill of effective management of information with applicability. This requires educational interventions to support meaningful learning and reducing cognitive load of facts and figures. The study reports two cases of such interventions and the response of the students to the same. Methods: A modified teaching–learning activity was planned. An integrated case-based learning resource was created on allergic rhinitis and obesity & its complications. The learning resource was created following the instructional design protocol and was made interactive with in-built quizzes. This was provided to the entire batch, 2 weeks before the actual session. A pretest was conducted followed by interactive discussions on short cases with critical concept-based questions (CCBQ). A debriefing was conducted. Feedback regarding the effectiveness of the sessions was obtained on a questionnaire. Scores were compared and opinions were noted. Results: Eighty-five percent of students considered this more acceptable than other existing teaching learning activities. Seventy percent of students stated that the use of cases in the discussions helped them understand the context of the study topic. Scores of CCBQs improved in the posttest. Percentage of students passing the test also improved significantly. Eighty percent of the students opined that this method helped them to grasp the concepts. Conclusion: This method appeared to be an innovative option providing more opportunities for students to be able to grasp contextual concepts, removing compartmentalization. This also helped in the understanding of application of basic science information to real-life cases. Immediate debriefing ensured better training of students through integration of basic science disciplines in a large classroom setting.

INSTRUCTIONAL METHODS

CHANGES IN GENDERISM AND TRANSPHOBIA IN RESIDENTS AFTER A TRANSGENDER SPEAKER PANEL

Leon L. Lai, MD

Medstar Washington Hospital Center

Purpose: Transgender patients report frequently avoiding medical care due to prior experiences of bias and culturally insensitive care by medical providers. The cooperative learning theory suggests that intergroup contact is key to reducing bias. In this study, we compared reductions in the validated scale Genderism and Transphobia Scale (GTS) in medicine residents attending a lecture alone versus lecture plus a transgender speaker panel. Methods: Residents were invited to attend an hour lecture on culturally competent care of transgender patients with an option to also attend an hour-long speaker panel with a transgender woman, a transmasculine activist, and the mother of a transgender boy. All 125 Internal Medicine residents at a community hospital were invited to complete paired pre- and post-intervention surveys and attend the intervention, although only 76 residents were able to attend the intervention due to scheduling. Pre- and post-intervention surveys were collected in the 2 weeks before and after the intervention, respectively. Results: In 45 pre-intervention surveys, respondents reported a mean of 2 h spent on LGBT issues in medical school and 40% reported no education on LGBT issues. Eighty percent rated their LGBT curricula as poor or worse. In 27 post-intervention surveys, 19 respondents attended both lecture and panel with a mean change in GTS by − 13.11 (SD 18.24). The remaining 8 respondents attended the lecture only and had an insignificant change in GTS by + 1.38 (SD 3.43). Student’s t test showed that the reduction in GTS was greater in those attending the panel than those who did not (p = 0.036). Conclusions: In this small nonrandomized study, residents attending an educational intervention that incorporated a patient speaker panel resulted in a greater decrease in measured genderism and transphobia than those attending a lecture alone. Medical education on transgender health will benefit from patient participation and representation.

OTHER

EFFECTIVENESS OF EDUCATING HEALTH CARE PROFESSIONALS IN MANAGING CHRONIC PAIN PATIENTS THROUGH A “SUPERVISED STUDENT INTERPROFESSIONAL PAIN CLINIC”: AN UPDATE

Ling Cao | Stephen Hull

University of New England | Mercy Pain Clinic

Purpose: To address the need for medical education on chronic pain and pain management, we implemented an interprofessional training program, “supervised student interprofessional pain clinic,” 3 years ago. Previously, we have demonstrated this training program’s feasibility and overall effectiveness in improving health care professional students’ skills in (1) chronic pain management and (2) working in an interprofessional team. Here, we reported the updated analysis examining students’ performance based on individual professions. Methods: From January 2016 to December 2018, we have assembled 12 interprofessional student teams (5–8 students/team) that included students from the following 6 professions at the University of New England (UNE): nursing, osteopathic medicine (OMS), occupational therapy (OT), pharmacy, physical therapy (PT), and social work (SW). During this 12-week-long training program, each team conducted the initial evaluation, generated treatment plans, and conducted follow-up examinations for its assigned patient under the supervision of a pain specialist at the Mercy Pain Clinic. Team members participated in a total of four group meetings and three patient appointments and presented their experience to the UNE community at the end of their training. To evaluate this training program, surveys were conducted with all participating students (pre- and post-program) and data were analyzed based on health professions. Results: Prior to the program, nursing students showed the greatest overall knowledge regarding pain physiology (revised Neurophysiology of Pain Questionnaire) and chronic pain management (KnowPain50) and the highest scores in perceived team skills (Team Skill Scale), while OT students showed the highest scores in attitudes and perception regarding interprofessional practice (Interprofessional Education Perception Scale). Upon the completion of the training program, improvement in various measures were observed in all professions. OMS, pharmacy, and PT students revealed statistically significant improvement in most areas. Conclusions: Our study demonstrated the effectiveness of this interprofessional training program for all participating professions.

OTHER

THINKING BEYOND THE NORM: IPE IN A BIOMEDICAL GRADUATE SCHOOL SETTING

Becca Gas, MS | Katie Cornelius, MPH

Mayo Clinic College of Medicine and Science

Purpose: The goal of interprofessional education (IPE) is to prepare learners for interprofessional practice. For biomedical science graduate students, this includes collaborative and multidisciplinary discovery, research, and dissemination. While there are many studies of IPE in the traditional healthcare setting, literature lacks documenting IPE in a biomedical science graduate school setting. Methods: We aimed to assess the current state of interprofessionalism/IPE in the Mayo Clinic Graduate School of Biomedical Sciences (MCGSBS) as perceived by MCGSBS PhD students. We created an 11-item questionnaire adapted from multiple validated IPE surveys. Ten questions were stratified into the pillars of IPE (values, roles and responsibilities, teamwork, and communication); participants recorded their level of agreement using a six-point Likert scale (1 = strongly disagree, 6 = strongly agree). An 11th question asked participants to describe the team makeup they considered while completing the questionnaire. Results: Seventy-two PhD students completed the survey (39% response rate). Overall, students valued a multidisciplinary team approach (avg = 5. 51). Mean scores for roles and responsibilities, teamwork, and communication were 4.92, 5.38, and 4.59, respectively. The lowest scored item was, “I feel comfortable expressing my own opinions in a team, even when I know that other people don’t agree with them.” Males (n = 32) scored higher on communication items, while females (n = 49) scored higher on items describing roles and responsibilities. Racially diverse students (n = 15) scored higher on all items with one exception, “I feel that I am heard when expressing my opinions.” Conclusions: This data suggests that students value interprofessionalism and teamwork but do not feel comfortable describing their role or the roles of others on their team. Similarly, the majority of students do not feel confident in communicating. Integrating formal IPE programming into curriculum may improve these scores.

OTHER

METACOGNITION AND MICROLEARNING: TRAINING STAFFS THROUGH A FACULTY DEVELOPMENT WORKSHOP

Sarmishtha Ghosh | Puvessha a/p Jegathisan

International Medical University, Kuala Lumpur, Malaysia | International Medical University, Kuala Lumpur, Malaysia

Purpose: In the light of IR 4.0, information delivery in small chunks, carefully aligned with desired learning outcomes, has been found to be effective in learning, along with planning, goal setting, and monitoring progress. This can be done by introducing metacognitively enriched learning sessions. A strong need is felt to develop faculty skilled in metacognition and microlearning. Methods: An introductory workshop was designed for educators on education strategies and practical tools for use in their own classroom. After an initial ice breaking session, participants were given a pre-test paper to check existing concepts. This was followed by two short interactive talks on “metacognition” and “microlearning.” Participants were invited to share their personal experiences regarding what they teach and how they teach. Group tasks were given on the topics whereby participants were required to prepare a short lecture, incorporating principles of metacognition. The second task was to prepare a microlearning session. The session concluded with group presentations, intergroup discussions, debriefing by facilitators, and post-test questionnaires to check improvement of knowledge, concepts, and satisfaction level of the participants. Results: Ninety percent of the staffs were aware of the terms, but 60% were not clear about the meanings and methodology involved in the two processes. There was significant improvement in the scores of post-test questions. In the free comment section, participants expressed their satisfaction with the conduct and the quality of materials delivered in the workshop and wanted a follow-up workshop. Conclusion: A day-long faculty development workshop can achieve the objective of creating awareness in staffs about metacognition and microlearning. Group tasks and flip chart writing followed by presentation appeared to be a satisfactory method of introducing importance of topics like metacognition and microlearning. This may in the long run improve teaching training of students to become self-directed and self-regulated learners.

OTHER

TEACHING SQUARES: AN INNOVATIVE APPROACH FOR DEVELOPING PEDAGOGICAL PRACTICES OF MEDICAL FACULTY

Gregory Schneider, M.D. | Tracey Weiler, Ph.D. | Sabayasachi Moulik, Ph.D. | Gagani Athauda, M.D. | Samantha M. Lemus-Martinez, Ph.D.

Florida International University, Herbert Wertheim College of Medicine | Florida International University, Herbert Wertheim College of Medicine | Florida International University, Herbert Wertheim College of Medicine | Florida International University, Herbert Wertheim College of Medicine | Florida International University, Herbert Wertheim College of Medicine

AWARD NOMINEE

Purpose: FIU Herbert Wertheim College of Medicine is a newer medical school with limited faculty development personnel and no formal/informal process for peer observation of teaching. We piloted “teaching squares” to initiate opportunities for faculty to observe their peers with a focus on pedagogical practices. Methods: Teaching squares are groups of four cross-disciplinary faculty who observe each other using multiple pedagogical approaches over 2–3 weeks. They are informal and flexible and require limited personnel for oversight. The process begins with a pre-meeting, followed by peer observation, and concludes with feedback and debriefing. The purpose is not to criticize but rather to identify effective pedagogical approaches that might be incorporated in one’s own classes. Feedback meetings are roundtable discussions of strategies individually observed by square members, leading to self-reflection regarding personal problems of practice for which strategies are provided. Debriefing with the faculty developer consists of creating individualized action plans with self-identified areas for growth and provides for personalized support to ensure successful implementation. Results: Peer observations resulted in the identification of effective pedagogical strategies employed by the faculty, and fostered their implementation in other classroom settings. Significant camaraderie developed among participants resulting in a community of practice where faculty feel comfortable re-engaging with the square to present new pedagogical challenges. Because of its informal, nonthreatening nature, members felt free to offer comments and encouragement to others. Those receiving feedback reported that the teaching square format promoted self-reflection on teaching practices and resulted in improvements to their own pedagogy. Conclusion: Participants enjoyed seeing the content and pedagogical expertise of their colleagues and were motivated to make changes to their own teaching practice. The teaching square built faculty development capacity, spreading effective and innovative teaching strategies throughout the medical school.

STUDENT SUPPPORT

STUDY STRATEGY INTERVIEWS SUGGEST OVERWHELMED AND OVER-RELIANT ATTITUDES IN FIRST-YEAR INDIANA UNIVERSITY MEDICAL STUDENTS

Amberly Reynolds | Dr. Polly Husmann

Indiana University | Indiana University

AWARD NOMINEE

Purpose: First-year medical students are inundated with resources for courses, both required and recommended. Additionally, each course often has lecture slides and/or notes provided. With a multitude of resources, students are expected to define their study strategies to reach successful outcomes, but how do they go about that and what are their attitudes toward that expectation? This research utilizes qualitative methods to analyze first-year medical student interviews about their study strategies and the rationale behind them. Methods: First-year medical students across all nine Indiana University School of Medicine (IUSM) campuses from 2016 and 2017 cohorts were interviewed (n = 58) regarding their study strategies for the Gross Human Anatomy course. Semistructured interviews were completed over the phone during the summer following the first year and generally lasted between 20 and 60 min. Interview questions focused on how students studied for both the lecture and lab components and what influenced their study strategy decisions. Thematic analysis of transcribed interviews pinpointed patterns regarding content resources, study habits, and student attitudes toward resources. Results: Thematic analysis revealed students’ overwhelmed attitude with the number of resources provided but a lack of guidance on how to use said resources. A second theme denotes an over-reliance on professor presentation slides. Comparative analysis between the two cohorts demonstrates differences in organizational strategies of both instructor and student regarding the use of resources. Conclusions: Medical education faces curricular changes as we work to provide future physicians with the proper content but also important is our ability to teach them the necessary skills of how to use the vast content resources. Particularly pertinent to anatomy educators is the need to instruct students how to choose and effectively use the multitude of resources. Instructors also need to ensure that students do not believe instructor slideshows contain the only important course content.

STUDENT SUPPPORT

PROMOTING ACADEMIC SUCCESS THROUGH AN ENHANCED PEER-TUTOR PROGRAM

Yen-Ping Kuo

Campbell University

Purpose: Many new medical students experience challenges in successful academic transition, and peer tutors could be valuable support during this critical time. However, academically successful students do not necessarily possess the skills of effective tutors. We redesigned our peer-tutor program to provide tutor training, certification, and feedback, encouraging the tutors to assist peers not only on learning specific subject material but also on fostering their effective learning and studying skills. Methods: We appointed second-year medical students as peer tutors for each course. The students who met the academic requirements of performing in the top 25% in the course with a minimum cumulative GPA of 3.3 were offered the opportunity to attend the tutor-training workshop. Only students who completed the training and met with the course directors became certified tutors. Questionnaires were completed by the tutors and tutees in order to assess the effectiveness of the training and program outcome. Results: Thirty-four students completed the training program and were assigned to 9 courses, ranging from 1 to 3 courses per student depending on their eligibility. The assessment data suggest that (1) through the tutor-training workshop, student tutors become aware of and foster the skillsets of effective tutoring and (2) the development of effective study skills has become an intentional outcome of the peer-tutor sessions. Conclusion: The enhanced peer-tutor program provides effective academic support for the new medical students, as evidenced by the increased tutoring service requests and sessions. Furthermore, as an added benefit, it sparks pedagogical interest and insight of participating tutors who may become successful medical academicians in the future.

STUDENT SUPPPORT

HELPING STUDENTS TRANSITION TO AND SUCCEED IN MEDICAL SCHOOL BY DEVELOPING A GROWTH MINDSET BY CONTRASTING MEDICAL SCHOOL LEARNING WITH STUDENTS’ PREVIOUS EDUCATIONAL EXPERIENCES

Scott Severance

Liberty University College of Osteopathic Medicine

Jennifer McGlauflin & Scott Severance, Liberty University College of Osteopathic Medicine, Lynchburg, VA 24502, USA

Purpose: Medical schools accept students who, by and large, have enjoyed much academic success prior to medical school. Academic success prior to medical school, however, is commonly equated with earning high grades. Often, this is achieved by “cramming” before exams using review materials provided by instructors. Consequently, students become efficient at studying information without understanding or learning it within a framework necessary for future retrieval and application. Because this method has been successful, students anticipate that this study strategy will continue to work in medical school. This approach to learning may play a major role in many medical school students’ struggle to adjust to the volume, pace, and expectations of medical school curricula. Methods: Early in the first biomedical sciences course in the OMS-1 year, we sought to help students overcome these struggles in two ways. First, we developed and disseminated a list of ways that medical school is different from the typical educational experiences most students have had prior to medical school. Second, we sought to identify and explain the often unspoken goals for each of the 4 years of medical school and for medical school itself. The lists consisted of over 100 differences and goals that were used to distinguish between methods that bring success in undergraduate and master’s work and methods that result in medical school success. Results: Although this initiative is in progress, discussions centered on learning like a medical school student have resulted in the number of course failures in the first two courses of the academic year being cut in half compared to previous years. Conclusion: Changing the paradigm from a fixed to growth mindset is helping medical students understand the true goals of medical school education and decreasing the number of course failures.

STUDENT SUPPPORT

PREDICTORS OF IMPOSTOR SYNDROME IN MEDICAL STUDENTS AT THE PRECLINCAL–CLINICAL TRANSITION

Beth Levant | Jennifer Villwock | Ann M Manzardo

University of Kansas Medical Center, Kansas City, KS | University of Kansas Medical Center, Kansas City, KS | University of Kansas Medical Center, Kansas City, KS

AWARD NOMINEE

Purpose: Impostor syndrome, a phenomenon in which individuals distrust their abilities and accomplishments, is a contributor to medical student burnout and an impediment to identity formation as physicians and can be most pronounced during periods of career transition. Accordingly, this study examined the incidence and severity of impostor syndrome in third-year medical students as they transitioned from the preclinical to clinical phases of their training. Methods: A voluntary, anonymous, 60-item survey was administered to third-year medical students at the University of Kansas School of Medicine in October–November of the 2018 fall semester. The survey included the Clance Impostor Phenomenon (IP) Scale, the Perceived Stress (PS) Scale, and demographic characteristics. Results: A total of 127 of 215 (59%) students surveyed responded with N = 111 completing the entire survey. Respondents were 83% Caucasian and 25.8 ± 3 years old (range 23–44). The mean IP score was 63.0 ± 14.6 (moderate-to-frequent impostor feelings) with 42.2% reporting moderate IP feelings, 37.8% frequent IP feelings, and 14.4% intense IP feelings. Females (N = 63) had higher IP (p < 0.05) and PS (p < 0.01) scores than males (N = 47). Females also had lower USMLE step 1 scores (p < 0.01). Regression modeling identified USMLE step 1 score as a driving feature for IP, which was strongly independently correlated with PS. Gender and age also independently predicted PS in the controlled analyses. Conclusion: The association of lower USMLE step 1 scores with impostorism suggests that students’ negative appraisal of their USMLE step 1 performance can undermine self-confidence, which may adversely affect wellness and, in turn, contribute to burnout and impede identity formation as physicians. This finding may guide the development of interventions to help students negotiate the transition from the preclinical to clinical phases of their training. Supported by the University of Kansas School of Medicine Academy of Medical Educators and NIH CTSA Award UL1TR002366.

STUDENT SUPPPORT

LASTING WELLNESS: A MEDICAL STUDENT LONGITUDINAL WELLNESS ACTIVITY–STRESS–SLEEP TRACKING WELLNESS INITIATIVE

Kara Sawarynski | Dwayne Baxa | Thomas Ferrari | Daniel Gildner | Scott Pickett

Oakland University William Beaumont School of Medicine | Oakland University William Beaumont School of Medicine | Oakland University William Beaumont School of Medicine | Oakland University Department of Psychology | Florida State University College of Medicine

Purpose: Medical students usually matriculate with good mental health status, but concerns often arise during their course of study. These include sleep disturbances, depression, and emotional regulation issues. Burnout can develop quickly through alterations in stress, mood, and sleep and frequently results in serious personal and professional repercussions. In this innovative initiative, we are analyzing biometric data and wellness scales via a longitudinal noninvasive mechanism. Methods: M1 and M2 participants wear FitBits (n = 53) and complete validated wellness surveys at salient time points. Research software tools enable biometric data collection (sleep, heart rate, and physical activity). Analysis is focused on relationships between wellness scale scores and biometric data, particularly as it pertains to curricular structure. Study results will be compared to national aggregate AAMC M2 and GQ surveys. Results: Baseline wellness areas with the highest rates of concern were for sleep quality and insomnia symptoms (60.5–90% of participants), with emotional regulation difficulties as the second highest group (53.7% of participants). Mid-year surveys show sleep and stress concerns trending upward in M1 students, while M2 students have decreases in stress levels. Although average total sleep amounts are in the healthy range, there is frequent fragmentation and inconsistency in sleep schedule. Sleep duration, quality, fragmentation, sleep debt, and physiological stress will be correlated to curriculum structure. Conclusion: The number of students with concerning wellness scores early in their academic training, and the strong student interest in the initiative, warrants further study. Lessons learned on the implementation of biometric data collection and analysis will be presented. Results from this study will add detail and context to the wellness aspects of the AAMC M2 and GQ surveys. Gaining a better understanding of our student population’s emotional and personal well-being, and how these factors relate to educational initiatives and mechanisms, will be extremely valuable.

STUDENT SUPPPORT

TYPES OF ERROR MADE IN FORMATIVE AND SUMMATIVE ASSESSMENTS

Andrew Binks | Emily Holt | Brock Mutcheson | Renee LeClair

Virginia Tech Carilion School of Medicine | Virginia Tech Carilion School of Medicine | Virginia Tech Carilion School of Medicine | Virginia Tech Carilion School of Medicine

Purpose: We propose assessment can be used to determine both student mastery of content and for them to determine the type of errors they make in exams. This data may be used to (1) determine whether increased focus on error-type reduces occurrence of that error in future assessments and (2) focus student support and determine its efficacy. We have begun to address the first of these objectives by measuring the type of error preclinical medical students make in formative (FE) and summative exams (SE). Methods: Students at VTCSOM completed a questionnaire during FE and SE reviews. The questionnaire gave students 10 possible error types that could lead to the student getting a question incorrect. Error types fitted into two broad categories of (1) cognitive errors or (2) study/exam-taking errors. Results: To date, 102 questionnaires have been completed over seven exam reviews (three FE, four SE) to encompass 1090 incorrectly answered questions. Comparison of errors made in FE and SE showed no difference in the number of errors (FE 11.3 ± 11.9, SE 7.3 ± 3.25, p = 0.176) or error types (p = 0.942). The most common form of error was the same in FE (35%) and SE (32%), “the content looked familiar but I couldn’t determine the correct answer.” Cognitive errors were nearly three times more common than study/exam taking errors (p = 0.006). Conclusions: We propose that the surprising lack of difference in the number of errors between FE and SE is due to the variability in how students use the FE (either taking it before or after preparation). The lack of difference in type of error between the two exams is consistent with students taking both assessments seriously, and the lack of exam-taking errors likely reflects our population was comprised of seasoned exam-takers.

STUDENT SUPPPORT

PROBLEMS OF LOW-PERFORMING STUDENTS AND COMPARISON OF STUDY HABITS TO HIGH-PERFORMING YEAR 1 MEDICAL STUDENTS

Jean Peduzzi | Erika Roberts | Matt Jackson

Wayne State University School of Medicine | Wayne State University School of Medicine | Wayne State University School of Medicine

Purpose: In an effort to advise year 1 medical students who were having trouble in classes, surveys of study habits were conducted of low- and high-performers at Wayne State School of Medicine (class size = 296) in a newly instituted systems-based curriculum with a robust practice of formative and summative assessments. Methods: This study identified problems of those who were at risk of failure (< 65%, n = 21) and compared the habits of low-performing to high-performing students (> 89%, n = 11) in the first two curriculum units. All students who did poorly were offered the assistance of a student instructional leader (SIL, year 2 medical students). Results: Struggling students (> 90%) found SILs helpful. Almost all study habits (e.g., outside resources, group studying) and other factors (e.g., exercise, sleep, prior knowledge) were similar in the two groups. The significant difference was that the majority of high-performing students did not fall behind, while most struggling students were often behind. The most common problem given by struggling students was that they did not have time to finish studying all of the material before the formative and summative exams. This correlation was more frequent for those who did poorly in the subsequent unit (n = 10, separate survey). Struggling students were also more likely to attend lectures (that are also streamed) versus high-performers. For material difficult to remember, high-performing students are more likely to try to talk it out, while low-performers were more likely to use repetitive writing of the content. Conclusion: This study identified distinctions between students who performed at the top of the class in comparison to those who were at risk academically. A well-developed and consistently executed study plan was a key indicator of success; other attributes of high-performing students will be discussed. These findings will be applied to future classes as part of the academic support program.

STUDENT SUPPPORT

ANALYSIS OF MEDICAL STUDENT EXHAUSTION AND PERSEVERANCE IN A 3-YEAR MEDICAL DEGREE PROGRAM

Molly Falk-Steinmetz MS | Diane Brown MS | Jeffery D. Fritz PhD | Amy Prunuske PhD | William J. Hueston MD | Craig Hanke PhD | Koenraad De Roo | Kristina Kaljo PhD

Medical College of Wisconsin | Medical College of Wisconsin | Medical College of Wisconsin | Medical College of Wisconsin | Medical College of Wisconsin | Medical College of Wisconsin | Medical College of Wisconsin | Medical College of Wisconsin

Purpose: Medical students are amazingly resilient in the face of academic challenges, studying relentlessly the complex dynamics of course materials, with minimal time for personal endeavors. The strain of these combined effects on students can lead to emotional exhaustion. Recently, the creation of a 3-year medical program at a Midwestern medical school suggested that there may be an increase in these challenges and elevate exhaustion levels further which can impact student wellness. The purpose of this study is to analyze the relationship of medical student perseverance and emotional exhaustion between 3- and 4-year medical degree programs. Methods: In 2017/2018, 205 of 500 medical students (130 M-1/75 M-2) voluntarily completed these self-reported surveys: RS-25 Resilience Scale and Maslach Burnout Student Scale. Interitem reliability was determined with Cronbach’s alpha. Differences in mean scores were analyzed with independent t tests and Cohen’s d effect sizes. Pearson correlations (r) were used for associating emotional exhaustion with perseverance. IBM® SPSS® 24.0 generated statistical analysis. This research was approved by the institution’s IRB. Results: Emotional exhaustion (alpha = 0.9) mean scores were significantly higher (d = 0.3, p < 0.011) for 3-year students (mean (sd) = 25 (6)) than 4-year students (23 (7)). Sixty-three percent of the 4-year program student exhaustion scores were above the instrument’s midline score = 20, which increased to 80% for 3-year students. Perseverance (alpha = 0.7) mean scores were significantly lower (d = 0.3, p < 0.015) for 3-year students (mean (sd) = 22 (7)) than 4-year students (25 (7)). Exhaustion scores were higher (d = 0.2, p < 0.192) for M2 students (23.9 (7.1)) than M1 students (22.8 (5.9)). Perseverance scores were significantly higher (d = 1.3, p < 0.001) for M2 students (24.7 (7.4)) than M1 students (17.5 (1.9)). Exhaustion was significantly correlated to perseverance (r = − 0.3, p < 0.001). Conclusions: Medical student perseverance remained higher in the traditional 4-year program where emotional exhaustion scores were lower. However, both perseverance and exhaustion scores remained higher for M2 students than M1 students. Therefore, student perseverance can counter exhaustion with adequate time.

TBL PBL

CREATING A SUCCESSFUL SUMMER RESEARCH PROJECT MODEL FOR INTERPROFESSIONAL (IP) HEALTHCARE STUDENT TEAMS

Karen O’Mara, D.O.

Rosalind Franklin University of Medicine and Science/Chicago Medical School

Karen O’Mara1 and Peter Kallio2, Rosalind Franklin School of Medicine and Science, North Chicago, Illinois 60068, 1 Chicago Medical School, 2 Program of Nurse Anesthesia

Purpose: We aimed to develop a Summer Research project model for an IP student team (medical—CMS, podiatric medicine—POD, and pharmacy—COP) to result in meaningful qualitative research for the shared professional objectives of patient education and treatment adherence. Methods: Eight IP applicants were recruited and instructed to function as a research team to investigate patient and provider barriers to m-Health app use for patient education and treatment adherence. The team was given the autonomy to develop their own research questions. Students received training in literature review, CITI training, and met regularly with faculty advisors to review and discuss research directions. Results: In Summer Research 2017, four CMS, two COP, and two POD students participated. Unique RFUMS m-Health app design and evaluation tools were developed. An IRB-approved, RFUMS provider/consumer survey was completed. The evaluation tool was tested on commercially available depression m-Health apps. Four posters were presented at two different RFUMS sessions, one poster at a national podiatry conference, and one oral presentation at a regional podiatry conference. Additional posters are under consideration for the 2019 national pharmacy conference. In Summer Research 2018, three CMS, three COP, and two POD students participated. Students completed literature reviews on healthcare provider recommendations for m-Health apps and assessment of impact of m-Health apps on patient health outcomes, reviewing eligible papers with a trained JBI faculty advisor. The RFUMS m-Health evaluation tool was revised and used to assess commercially available asthma apps. Four posters were presented at the RFUMS Summer Research Poster session. Additional poster presentations are in planning stages for 2019 presentations. Conclusion: A model in which IP students work as a team toward research objectives that are common to all involved professions’ future practices appears to maximize student engagement and research productivity.

TBL PBL

WEEKLY TEAM-BASED LEARNING SCORES AND PARTICIPATION ARE BETTER PREDICTORS OF SUCCESSFUL COURSE PERFORMANCE THAN CASE-BASED LEARNING PERFORMANCE: ROLE OF ASSESSMENT INCENTIVE STRUCTURE

Gonzalo A. Carrasco PhD | Kathryn C. Behling MD PhD | Osvaldo J. Lopez PhD

Department of Biomedical Sciences, Cooper Medical School of Rowan University | Department of Biomedical Sciences, Cooper Medical School of Rowan University | Department of Medical Sciences, Hackensack Meridian School of Medicine at Seton Hall University

Purpose: At our institution, preclinical medical students engage in two active learning strategies, case-based (CBL) and team-based (TBL) learning. Incentives for preparation and participation in these activities differ by virtue of differences in assessment allowing us to evaluate the role these incentives play in preparation and participation in these activities as well as overall course performance. Methods: This study took place during the 4-week, first-year Infectious Diseases (ID) course where a TBL exercise was held at the beginning of each week and, with the exception of the first week, required students to prepare content from the prior week including content discussed during CBL. Weekly TBL and CBL participation and performance as well as performance on the course final examination were recorded. Student participation was quantified and correlated with: (1) CBL preparation, participation, teamwork, and completion of learning objectives scores; (2) TBL Individual Readiness Assurance Test (iRAT) scores; and (3) final examination scores. Results: Final examination scores (n = 95) were more strongly correlated with TBL (r = 0.3796, p < 0.01) than CBL (r = 0.1779, p < 0.01) performance. No significant (p < 0.05) correlation was found between iRAT and CBL scores. Student participation (n = 24) was measured in three CBL groups (eight students/group) and four TBL teams (six students/team). TBL participation was more strongly correlated with final examination scores (r = 0.4052, p < 0.01) than CBL participation (r = 0.2420, p < 0.05). TBL participation was also correlated with iRAT scores (r = 0.2895, p < 0.01). Importantly, our analysis showed that CBL scores for preparation, participation, teamwork, and completion of learning objectives did not significantly (p > 0.05) correlate with iRAT scores or TBL participation. Conclusion: Performance and participation in weekly summative TBLs are better predictors of success on final examinations of medical knowledge than our assessments of CBL exercises. These results suggest that the assessment incentives and methods used in TBLs result in student performance that better predicts performance on summative examinations.

TBL PBL

DEVELOPMENT OF A DIABETES-FOCUSED TBL FOR INTEGRATING METABOLISM IN THE FOUNDATIONAL ELEMENTS COURSE AT CARLE ILLINOIS COLLEGE OF MEDICINE

Jaya Yodh G. | Kashif Ahmad | Kaustubh Bhalerao | Stephanie Ceman | Judith L. Rowen

Carle Illinois College of Medicine | Carle Illinois College of Medicine | Carle Illinois College of Medicine | Carle Illinois College of Medicine | Carle Illinois College of Medicine

Purpose: To address the challenge of how to provide sufficient coverage of basic science topics such as metabolism within the limited time frame of organ systems-based medical curriculum, the Foundational Elements course team at Carle Illinois College of Medicine developed a team-based learning (TBL) activity with a primary focus on the metabolic basis of type 1 diabetes. Methods: A TBL with a type 1 diabetes case application was implemented as the final integrative activity in the Foundations course week centered on “Systems and Tissue Basis of Pathology.” Student TBL preparation was multifold, comprising lectures, labs, readings, and problem sets taught by four faculty covering carbohydrate, lipid, protein metabolism, multifactorial genetics, transport mechanisms, biochemical systems equilibria, and control. Overview pre-assessment exercises included 24 practice questions and 6 Individual/Group Readiness Assessment (IRAT/GRAT) questions that focused on basic concepts, regulation, and integration of metabolic pathways in fed/fasted states. Students applied basic science knowledge to 6 TBL clinical case questions addressing the metabolic mechanisms for clinical manifestations in type 1 diabetics. Final assessment of students’ overall metabolism comprehension was obtained from 9 USMLE-style Firecracker quiz questions at the end of the week, with long-term retention measured using 6 NBME-customized exam questions 9 weeks later. Results: An integrative TBL was developed that combined big-picture metabolism readiness assessments with a diabetes clinical application for mastery of metabolic concepts. Pre-assessment showed 65% practice quiz participation, with the average IRAT score for all 32 students of 80% (range 59–90%); post-assessment showed Carle Illinois students performed 1.15-fold better compared to all participating schools (av. 89 vs. 78%) on the Firecracker quiz, and performed on par with national scores on NBME-customized step 1 exam questions. Conclusion: Incorporation of integrative TBLs within foundational medical curriculum is an effective tool for learning intermediary metabolism as evidenced by the Carle Illinois student performance on USMLE-based assessments.

TBL PBL

AN INNOVATIVE METHOD TO TEACH INFORMATION LITERACY AND RESEARCH ORGANIZATION SKILLS FOR TRANSLATIONAL SCIENCE GRADUATE STUDENTS

Erin M. Smith | Rita McCandless

Virginia Tech, University Libraries | Virginia Tech, Virginia Tech Carilion School of Medicine

Purpose: For 4 years, in two 2-h sessions, spaced 2 weeks apart, librarians provided a combination of lecture and hands-on database searching skills instruction early in the fall for first-year Translational Biology, Medicine, and Health (TBMH) PhD students. In 2018, we revised our approach, noting the success of team-based, problem-based learning (TB/PBL) at medical schools and in the sciences. Methods: Fifteen TBMH students participated in two 2-h workshops. Librarians explained why they were using TB/PBL, introduced the PBL scenario, and used a TBL team-formation approach to ensure each team had research skills diversity. Using a research life cycle hand-out, teams discussed where they got stuck, and we employed a “gallery walk” technique, where each team rotated and brainstormed challenges they have across the research lifecycle. Through this process, both students and instructors identified gaps in their knowledge as well as areas of strength. Using a rubric, each team devised a research plan to evaluate a database and/or tool. Teams presented their findings 2 weeks later. Results: In a six-question post-session survey regarding their experience both as workshop participants and presenters, 40% said they had prior experience with only one or two of the resources; 100% indicated that they plan to try at least one new resource; 86% said they were stimulated to think differently about their research organization; and 80% of them were motivated to do something differently with their own health sciences research project. Conclusions: Providing well-designed TB/PBL exercises may provide a better scaffold for learning than lecture and “hands-on”, exercises lead by content experts. More research is needed to see if some of the skills learned during these workshops are applied as they progress through their academic program.

TECHNOLOGY & INNOVATION

A NOVEL APPROACH FOR THE INTEGRATION AND APPLICATION OF MEDICAL BIOCHEMISTRY IN THE MEDICAL SCHOOL CURRICULUM VIA POWERAPPS APPLICATIONS

Paul Chastain II

University of Illinois, College of Medicine at Chicago, Rockford Campus

AWARD NOMINEE

Purpose: We have developed an app that allows students (either alone or in teams; self-guided or guided) to go on biochemical adventures that enable them to integrate their medical and biochemical knowledge with their clinical skills. Methods: Each adventure starts with a brief overview of the pathway of interest as well as links to relevant resources that allows them to have all the information they need in hand. Students are told an enzyme in this pathway is dysfunctional and the students have to use their biochemical and medical knowledge to predict how elements within various health status panels change in a person with this disorder. Next, the students have to decide how a person would present as a consequence of this metabolic defect. After they press submit, the answer along with a corresponding explanation is revealed to them. Finally, students are given a series of clinical presentations associated with defects in various pathways, and the teams have to determine which pathway/enzyme is defective and to defend how information within the vignette supports their answer. After entering the evidence, the team presses submit, and the answer along with a corresponding explanation is revealed to them. Results: Around 70% of the students rated the PowerApp adventures as excellent or good use of their time (the remainder thought it was a fair use of their time). Conclusion: We have found that students tend to use the app in groups and like to go on biochemistry adventures together. While most feedback has been extremely positive, most students would like even more clinical vignette examples. The value of the app modules/format is that students can continue using the app after class as a study aid. The app is easy to develop, alter, and share.

TECHNOLOGY & INNOVATION

HARNESSING THE POWER OF MOBILE DEVICES IN UNDERGRADUATE MEDICAL EDUCATION TO ASSESS THE COMPETENCE, PROFESSIONALISM AND PROGRESS OF STUDENTS IN THE CLINICAL LEARNING ENVIRONMENT

Prof Colin J Lumsden

University of Manchester

Prof Colin J Lumsden, University of Manchester, Manchester, UK

Purpose: Health science programmes leading to a vocational degree in clinical practice rely on experiential learning to develop the skills required to practice competently and safely. Experiential learning in clinical environments provides the richest learning experiences but is often opportunistic and unpredictable. Assessing performance in clinical placements has traditionally been challenging. The rise and ubiquity of mobile devices has opened the possibility of tracking, logging and assessing performance in the clinical learning environment. Methods: The Manchester medical programme was the first UK medical school to adopt the large-scale use of mobile devices in 2011. All clinical students are issued with iPad (mini) to facilitate their learning and engagement with the medicine programme. This development has allowed for the first time allowed curriculum designers to reliably assess the performance and development of learners in the clinical environment by scaffolding learning, logging evidence and allowing evidence-based defensible decisions on learner attainment in diverse clinical placements. This evidence forms part of an assessment matrix designed to assess multiple domains of learner development and provide evidence for high-stakes progression decisions. Results: To date, over 1400 students have engaged in the clinical workplace assessments. Data collected from a diverse array of clinicians, nursing staff and allied healthcare workers on performance has been collected, collated and displayed using individualised electronic dashboards on the proprietary Form2software system and iOS app. We report on the design, delivery, implementation and results of a comprehensive assessment matrix facilitated by the use of mobile devices. Conclusion: Mobile devices have become ubiquitous in society with nearly all learners, faculty and clinicians having access to such devices. Using such devices to assess and support learner development has been challenging. We describe a model implementation that could be applicable elsewhere in health sciences education.

TECHNOLOGY & INNOVATION

INTEGRATION OF SIMULATION-BASED AND AUTHENTIC LEARNING EXPERIENCES TO IMPROVE VETERINARY CLINICAL ANESTHESIA SKILLS

Julie Noyes

Washington State University

Purpose: Simulation training can prepare students for high-risk clinical procedures while protecting patient welfare. Multiple meta-analyses have revealed gaps in simulation-based research such as a paucity of instruction integrating simulation-based and authentic clinical experiences that are designed according to pedagogical frameworks and implemented directly into curricula. We sought to address these gaps by designing a multimodal veterinary clinical anesthesia course based on deliberate practice, implementing it into the curriculum, and evaluating student outcomes with live patients. Methods: A stratified random sampling method was used to select 16 second-year veterinary students for a 6-week course that integrated simulation-based and authentic learning experiences and a matched control group (n = 32). A simulated operating room environment was constructed using a canine manikin, an anesthesia machine and monitoring equipment, and an interactive patient monitoring computer simulation that depicted changes in multiparameter vital signs based on student decision-making. Authentic learning experiences were interspersed with simulation training. Clinical performance was recorded using head-mounted GoPro cameras during the first live patient anesthesia and surgery experience and evaluated by two blinded, boarded anesthesiologists from separate institutions using a standardized rubric assessed for content validity. Results: Results demonstrated the simulation group performed significantly better on clinical tasks, F(1, 30) = 5.95, p = 0.02 (d = 0.86), and professional skills, F(1, 30) = 4.01, p = 0.04 (d = 0.72). According to the rubric, the average performance rating of the control group, which represented training in the traditional curriculum, was “marginal: requires further training” (M = 2.73, SD = 0.75), while the average performance rating of the simulation group was “satisfactory: performance meets expectations for this level of training” (M = 3.35, SD = 0.69). Conclusion: Multimodal simulation-based training adequately prepared students for clinical anesthesia management versus the control group. This suggests that multimodal courses have value in preparing students for clinical practice.

TECHNOLOGY & INNOVATION

MULTI-INSTITUTIONAL COLLABORATION TO PROMOTE TRANSFER OF BASIC SCIENCE INTO CLINICAL PRACTICE

Leslie Fall | Michael Dell | Tracy Fulton | David Harris | James Nixon | Ann Poznanski | Amy Wilson-Delfosse

Geisel School of Medicine at Dartmouth and Aquifer | Case Western Reserve University School of Medicine | University of California, San Francisco School of Medicine | University of Central Florida College of Medicine | University of Minnesota Medical School | N/A | Case Western Reserve University School of Medicine

Purpose: The integration of basic science into clinical practice lies at the heart of medical education. Successful curricular reform to achieve this goal is dependent upon engaging all stakeholders and change agents in this process, including basic science and clinician faculty and students. We describe a multi-institutional, cross-disciplinary initiative in which students and faculty create tools to promote improved clinical decision-making through enhanced transfer of basic science knowledge. Methods: Following a call for participation in June 2018, 12 medical school teams comprised of one basic science and one clinical faculty lead and up to five senior medical students were chosen to participate in the initiative. Selection criteria included level of institutional commitment to integration activities, successful prior collaboration of faculty leads, breadth of basic science and clinical faculty engagement, degree of student engagement, and commitment to project deadlines. Schools were divided into two groups: one to author virtual patient cases and one to author integrated illness scripts, based on nationally developed integrated learning objectives and common clinical presentations. Following kick-off webinars, schools were initially assigned to author the same cases and scripts in order to calibrate product quality and best practices. Teams subsequently authored independent work, in collaboration with basic science and clinical mentors from the initiative leadership team who provided additional expertise and peer review of completed material. Results: Over 50 cases and integrated illness scripts are being collaboratively authored and peer-reviewed. Authoring guidelines, quality checklists, and peer review processes are being group-designed and utilized by all teams. Conclusions: Collaborative multi-institutional development of curricular tools to support cognitive integration is achievable and results in high-quality tools that meet a broad need. Faculty and students express a high degree of satisfaction from participating in the collaborative development process. Next steps include beta-testing and evaluation of the new tools.

TECHNOLOGY & INNOVATION

ADAPTING TEACHING DESIGNS FOR A NEW CHALLENGE IN HEALTH SCIENCE EDUCATION: EQUIVALENT LEARNING EXPERIENCES FROM MULTIPLE TEACHING SITES

Magdalena Pasarica | Denise Kay

University of Central Florida College of Medicine | University of Central Florida College of Medicine

Purpose: Our purpose was to adapt an established educational design to be delivered at multiple locations equivalently, without decreasing transfer of learning. Our goal was to address new challenges for current educators: (a) teaching to a generation of students that prefer and expect to learn the most in the least amount of time (and driving between clinical and teaching sites is part of this time) and (b) the presence of multiple teaching sites with requirements of equivalent experience. Methods: There are two groups of students: the control group received an original previously tested educational design and the intervention group received the adapted session design. The sessions focused on two lifestyle medicine learning outcome. Both groups completed a self-learning module. Then, the control group practiced the targeted outcomes by solving clinical cases in the physical classroom by working in groups. The experimental group solved the same cases virtually using technology (from the location of their choice), working first individually then in groups to provide peer feedback. Confidence and learners’ preference data was collected using de-identified surveys. Transfer of learning was tested by grading the performance on the targeted learning outcomes. Results: This adapted design was deployed 4 times in our clinical medical curriculum(for 25–30 students at a time). The intervention achieved similar (p = NS) learning as the control, as measured by their performance in class (4.8 ± 1.9 vs. 4.7 ± 1.7) and on a summative exam (33.2 ± 10.1 vs. 33.2 ± 10.6). Gain in confidence was similar (1.1 ± 0.9 vs. 0.9 ± 1.1). Learners and instructors preferred this type of design when compared to on-site sessions. Conclusions: This intervention used learners’ time efficiently and provided a collaborative equivalent learning experience, without affecting the targeted outcomes in learning and confidence. The instructor needed to spend more time for the session’s initial design. This innovative design could be used by other institutions striving to provide equivalent experience at multiple locations.

TECHNOLOGY & INNOVATION

IMPLEMENTATION OF A SIMULATION-BASED EDUCATIONAL PROGRAM TO IMPROVE MEDICAL STUDENT BAG-VALVE-MASK (BVM) VENTILATION AND CARDIOPULMONARY RESUSCITATION (CPR) FOR ENTRUSTABLE PROFESSIONAL ACTIVITY (EPA) #12

Vaia Abatzis MD

Dept of Anesthesiology, University of Virginia

Vaia T. Abatzis MD1, John Kwock2, Jessica Sheeran1, Lisa Morton1, Stephen Eason1, and Keith Littlewood MD1, 1 University of Virginia, Dept. of Anesthesiology, Charlottesville, VA 22908, USA, 2 Maine Medical Center, Portland, ME 04102, USA

Purpose: CPR and BVM ventilation are critical to learn and master in medical school as described by AAMC’s EPA #12 “Perform General Procedures of a Physician,” a requirement for all graduating medical students. It is not always possible to teach or evaluate these techniques in real time with patients. Simulation offers a unique, objective way for medical students to improve their BVM and CPR techniques. Methods: The Anesthesiology/Peri-Operative Clerkship is a required third year rotation at the University of Virginia School of Medicine. During this rotation, medical students performed BVM and CPR using the Laerdal SimMan 3G simulator on three separate days. The data from each session was reviewed with the student in between sessions. In addition, each medical student viewed real-time mannequin feedback for one of their sessions. Results: A total of 98 medical students completed the three BVM/CPR simulation sessions as well pre/post questionnaires rating their confidence from 1 (low) to 4 (high) performing BVM and CPR on a person. BVM confidence rated 1–2 decreased from 58.1% (pre) to 27.7% (post). BVM confidence rated 3–4 increased from 41.8% (pre) to 72.3% (post). CPR confidence rated 1–2 decreased from 53.6% (pre) to 32.2% (post). CPR confidence rated 3–4 increased from 46.4% (pre) to 67.8% (post). Conclusion: The use of a simulation-based feedback program for BVM and CPR with third year medical students increases their confidence in performing BVM and CPR on a person, two critical skills for mastering EPA #12.

TECHNOLOGY & INNOVATION

FACILITATING INTEGRATION OF HISTOLOGY WITH PATHOLOGICAL DIAGNOSTIC REASONING THROUGH SMALL GROUP ACTIVE LEARNING CLOUD-BASED INTERACTIVE EXERCISES

Holly Ressetar, Ph.D. | Bruce Palmer

West Virginia University School of Medicine | West Virginia University School of Medicine

Purpose: LCME accreditation requirements emphasize student self-directed (active) learning as well as integrative and clinically applicable teaching. In an effort to encourage group interaction and teamwork and promote development of clinical observational and diagnostic skills, we developed a set of virtual microscopy pathological diagnosis exercises. Methods: For the past 3 years, first-year medical students were assigned to groups and required to examine, describe, and diagnose unidentified pathological specimens. The specimens correlated with tissues/organs covered in histology lectures and labs. Students were provided with background pathology lectures and lab guidelines covering study approach and characteristic pathology features. We created a website where students could view and label the specimen, enter text, and share comments with group members and faculty. Students utilized web resources to correlate pathology with potential diagnoses. Students were allowed multiple attempts to submit their diagnostic report for each specimen and received faculty feedback. Results: The most significant revelation was encountering student resistance to comparing pathological specimens to normal and then describing the abnormalities. Students preferred to identify the tissue/organ then utilize web resources to search for all known diseases of that tissue/organ and compare web pathological images to the assigned specimen. Students would diagnose without labeling features. This finding prompted us to revise the exercises to include initial recognition and identification of key pathological features. This revision resulted in significantly better performance on the exercises including better description of features and more efficient diagnosis with fewer submission attempts. Another finding was the unequal distribution of labor among group members which lead us to incorporate programming features to ensure participation of all students. Conclusions: The active learning exercises greatly increased student interaction and teamwork in labs. The exercises facilitated student recognition of key pathological features, giving them the necessary framework to piece together tentative specimen diagnoses.

TECHNOLOGY & INNOVATION

DEVELOPMENT OF AN INTERACTIVE ON-LINE TOOL TO PROVIDE FACULTY WITH FRAME OF REFERENCE TRAINING FOR STUDENT EVALUATIONS

Archana Pradhan | James Galt | Sarang Kim

Rutgers-Robert Wood Johnson Medical School | Rutgers-Robert Wood Johnson Medical School | Rutgers-Robert Wood Johnson Medical School

Purpose: As sites for core clerkship experiences are becoming more geographically distributed, quality faculty development has become a pressing challenge. We developed an interactive on-line tool to teach faculty how to appropriately utilize our clinical evaluation rubric. Methods: In 2017–2018, Rutgers-RWJMS adopted a new clinical evaluation rubric, RIME-P (Reporter, Interpreter Manager, Educator-Professional). Modeled on Pangaro’s RIME evaluation framework, we modified it to include a component for professionalism and to allow each component to be assessed on a scale of 0–5, ranging from not meeting expectations to exceeding expectations, with addition of descriptive behavioral anchors. Faculty were trained on the use of the rubric by listening to one sample student presentation and commentary. For 2018–2019, the rubric was simplified to a 0–3 scale and a new training program was developed. Each clerkship director wrote sample case presentations and we developed “frame-of-reference” training via interactive on-line cases. With the new technology, faculty rate a virtual student presentation and then compare their ratings to those suggested by the clerkship director. The online presentation changes with each use, so faculty can practice their rating skills multiple times. Results: Clerkship directors will be able to use this tool for synchronous or asynchronous face-to-face or web-based frame of reference training sessions. We suspect faculty ratings will become more uniform across clerkships, and student concerns that faculty are not properly trained to evaluate via the RIME-P rubric will decrease. We will track this with our clerkship rating system and dean’s visits with students. Conclusion: In an attempt to improve the quality of summative evaluations, innovative tools for faculty development need to be developed. An interactive RIME tool that allows faculty to practice rating skills should help faculty better evaluate student performance on the clinical rotations and clarify expectations for student performance. Interactive Case Link: https://libguides.rutgers.edu/c.php?g=893306.