400 – Pre-Clinical Medical Student Perceptions of Radiology as a Career: Effectiveness of Department of Radiology Open House
Alison L. Chetlen, Pamela L. Brian, Madeline E. Leo, Dustin R. Kocol, Ayesha S. Ali, Erik B. Lehman, and Janet A. Neutze
Milton S. Hershey Medical Center and Penn State Health
PURPOSE: The purpose of this study was to determine whether a dedicated radiology open house activity directed toward first and second year medical students would change medical students’ attitudes toward the field of radiology. Our after-hours department of radiology open house was targeted to pre-clinical medical students to give them an informal exposure to the specialty and to resident and attending radiologists. The intent of this open house was to create interest in joining the radiology interest group, shadowing, and taking radiology electives with the ultimate goals of understanding what radiologists do and consider radiology as a specialty choice.
METHODS: An after-hours informal open house was held for preclinical medical students. Radiology residents served as tour guides, taking students to stations manned by subspecialty faculty. Pre and post-event surveys were given.
RESULTS: Forty-eight medical students attended the event, including 30 females and 18 males, 26/150 (17%) first-year medical students and 22/150 (15%) second-year medical students. 44 students completed both the pre and post event survey. Survey results indicated that the mean interest level of all students was significantly higher after the open house. There was a statistically significant increase in level of self-reported understanding of the field of radiology following the event.
CONCLUSION: Early exposure of medical students to radiology has the potential to increase the chance that students will consider or choose radiology as a career. Intellectual challenge, desire for patient interaction and flexible work hours were the three most reported important factors in choosing specialty.
401 – ALIGNING LIFESTYLE MEDICINE KNOWLEDGE AND CONFIDENCE: THE ROLE OF EXPERT MODELING
Magdalena Pasarica and Denise Kay
University of Central Florida College of Medicine
PURPOSE: There is strong evidence to support that changes in lifestyle behaviors, such as nutrition and activity, contribute to wellness and the prevention and treatment of diseases. Despite growing evidence in this regard, physicians are still hesitant to suggest lifestyle changes in their treatment recommendations, reporting lack of knowledge and confidence with these types of interventions. This highlights a timely need for lifestyle medicine education interventions.
METHODS: We designed an educational intervention to increase and align undergraduate medical education learner’s knowledge and confidence in using lifestyle medicine for the management of obesity. Intervention included a lecture and solving 2 clinical scenarios where students performed evidence based calculations for discussing weight loss goals. We deployed three sessions using 3 strategies. We adopted a systematic approach using class performance and lessons learned to adjust the teaching for each subsequent strategy in order to improve learning outcomes. The goals, knowledge concepts, and clinical cases remained unchanged. Strategy 1 (solving the clinical scenario and verbal discussion of the correct results and tools); Strategy 2 (using a collaborative activity and handouts with tools) and Strategy 3 (demonstration through expert modeling).
RESULTS: Confidence increased similarly with all strategies, however knowledge increased the most with strategy 3, where 53.8% of students increased confidence, 61.5% of students increased knowledge and 26.9% increased both knowledge and confidence. Strategy 3 had the highest alignment in knowledge and confidence (91%).
CONCLUSIONS: These results suggests that Strategy 3 is an effective model for increasing confidence and knowledge in lifestyle medicine. Expert skill modeling was the most effective for aligning knowledge and confidence. This educational intervention represents a step forward in teaching clinical medicine in ways that impact both student’s confidence and medical knowledge and a commitment to designing undergraduate medical education to enhance the practice of lifestyle medicine for improved patient care.
402 – COMPARISON of YEAR 1 vs. YEAR 2 MEDICAL STUDENT PERCEPTION AND UTILIZATION OF A PRE-RECORDED BASIC SCIENCE CORRELATION CLINICAL APPLICATION SESSION
Jennifer Montemayor and Cindy Funk
Rocky Vista University College of Osteopathic Medicine and Burrell College of Osteopathic Medicine
PURPOSE: As medical schools expand programs to additional campus sites, faculty adequacy and workforce demand is a significant consideration. Identifying technology options to support delivery of curriculum in a quality, cost-effective manner is increasingly important. This investigation assesses student perception and utilization of an online video recording of a Basic Science Correlation (BSC) clinical application session in the place of the large classroom setting to determine if this technology could be considered a viable educational tool for students at a new campus location.
METHODS: The format for delivery of “Male Hormones in Reproduction and Development” to Year 1 and 2 classes was solely covered in Directed Student Assignment (DSA) format. Office 2016 software package, PowerPoint Mix add-on program, Yeti recording microphone, and Microsoft Surface Pro were utilized to create a narrated, annotated video recording of the session, which included patient case discussions, basic-science concepts, open-ended and multiple-choice questions. A six-question survey was administered to determine if differences exist between Year 1 and 2 student perception and utilization of this teaching platform. Analysis of exam question performance was also performed.
RESULTS: A significant difference existed between Year 1 and 2 student perception of the video format. Year 2 students reported a more effective contribution to learning, a desire to have more pre-recorded BSCs in the future without the desire for a follow-up, in-person session with faculty. Year 1 students reported the method to be equivalent or less effective compared with Year 2 students. While there was no change in exam question performance for Year 2, there was a decrease in performance for Year 1 students.
CONCLUSION: Pre-recorded video technology in place of classroom time may be a viable option for delivery of curriculum across campuses, particularly for Year 2 medical students who, presumably, have developed a greater level of independence in their approach to learning.
403 – A Simple Happiness class design and implementation in sophomore medical students
Rungrat Jitvaropas, Winitra Nuallaong, and Supara Chaopricha
Faculty of Medicine, Thammasat University
PURPOSE: The life skill should be learnt coupled with the professional development for the medical education. Happiness is a skill and necessary for living. We have pursued a novel Simple Happiness class. This research is to determine the happiness level of medical students before and after attending a Simple Happiness class.
METHODS: One hundred seventy-one second-year medical students (92 female and 79 male) engaged in the Simple Happiness class more than 50% of total class time. Length of this class was 2 hr sessions, 4 times over 2-3 months. This class includes self-awareness, self-development, stress management, happy hour, goal setting, inspiration as well as sharing. In the present study, their happiness was evaluated using the Thai Happiness Indicators (TMHI – 15) questionnaire before and after class. Analysis of the data involved both descriptive and inferential statistics including means and paired sample T-Test.
RESULTS: The results revealed an improvement of their overall happiness after the classes. The average happiness scores after class were significantly higher than before learning (before: 31 or fair level; after: 33 or good level; p < 0.01). After attending the class, the amount of medical students who have a good level of happiness rate is increased from 39.8% to 51.5%.
CONCLUSION: The findings in this study indicated that the happiness level of medical students was increased after attending the Simple Happiness class. The results suggested that the happiness and life skill class was also necessary for medicine education. However, the follow up study should be further investigated.
Take-home message: Happy medicine education will change the world. Let’s start it NOW.
Poster Award Nominee
404 – A SHORT COURSE IN DYSMORPHOLOGY TO IMPROVE OBSERVATION SKILLS
Maria Cole and Linda R Adkison
University of Missouri – Kansas City and Trinity School of Medicine
PURPOSE: The study of abnormal phenotypic/morphometric features has reduced emphasis in medical curricula due to the rapid advancement of sophisticated laboratory tests and because phenotypic features rely predominantly on associations with particular diagnoses. We describe a short course in dysmorphology that engages the student in active learning for a better appreciation of development and clinical diagnosis.
METHODS: The course has three components: a didactic review of craniofacial and limb development with attention given to observable phenotypic variation; videos of patients with syndromes that have recognizable variations; and a presentation of a student project that required morphological measurements.
A pretest and post-test were administered to students to assess fundamental knowledge. “Pearls” of dysmorphology associated with specific syndromes were identified. Throughout, students were presented with photographs and asked to identify dysmorphic features and suggest a diagnosis to sharpen observation skills.
RESULTS: Groups with and without prior embryology exposure were assessed. There was an improvement in understanding and using information in both groups by an average improvement of 3.7% on the post-test.
Discussions of photographs were well-received by students and demonstrated reinforcement of concepts presented and practiced through video review.
Student selected an anatomical and physical feature to investigate and defined the study population. Outcomes included comparison data supported in the literature with a discussion of observed variation and insights. Students unanimously found this part of the course the most enjoyable.
CONCLUSIONS: Detailed course discussions of phenotypic variation in an interactive format allowed students to become familiar with terms and improvement of observational skills. These skills are instrumental for clinical evaluation, particularly before laboratory data may be available.
405 – PURPOSEFUL REFURBISHMENT TO A COLLABORATIVE LEARNING SPACE
Gary Hamlin, Sarah Long, and Ashley Stark
Bond University Australia
PURPOSE: Educationalists have advocated for the tertiary sector to develop student centered learning environments. Attention has been directed to the “flipped classroom” advocating for flexible delivery of content supported by classroom activities that enhance higher ordered competencies like application of knowledge and critical thinking. Research to date has primarily explored the design of learning activities with little investigation of relationships between the physical learning space, learning activities and learner engagement/satisfaction.
In 2015 Bond Faculty of Health Sciences and Medicine was awarded funding to purposefully redesign the flipped classroom space. This abstract describes the initiative and preliminary outcomes.
METHODS: In 2012 a space was sparsely furnished to support “proof of concept” of flipped classroom activities within the medical program. During 2013-2015 flipped sessions were implemented. Positive student feedback led to dedicated funding to purposefully design the space in 2016. Student perceptions of the redesign were collected at the end of one semester via a semi-structured survey tool. The survey investigated perceptions of global experiences, experiences in specific session types, engagement in learning, and satisfaction with the physical environment.
RESULTS: 172 surveys were completed, with ~90% completed by junior medical students. 82% of respondents were satisfied with their global learning experiences and the physical environment of the refurbished space. Students expressed highest levels of satisfaction with activities that involved interactive/collaborative learning or IT, with greater than 85% of students stating they were satisfied/very satisfied, and less than 4% stating they dissatisfied/very dissatisfied. Regarding the physical environment students expressed highest levels of satisfaction with, repositioning of projectors to support interactive quizzes, use of huddle boards to support group work and provision of chairs with built-in storage.
CONCLUSIONS: Purposeful redesign of learning spaces can enhance student satisfaction in the flipped classroom learning environment.
Poster Award Nominee
406 – HISTOLOGY LABORATORY FLIPPING
Richard R. Lindquist
University of Connecticut School of Medicine
PURPOSE: Engaging students in the usual histology laboratory has been problematic. In order to engage students in an active learning process, the laboratory was flipped by having students learn the educational objectives prior to the histology laboratory.
METHODS: The histology laboratory experience was flipped by having students view a website, which highlighted the structure and function of tissues and organs, prior to attending the histology laboratory session. The laboratory was equipped with the Aperio virtual microscope viewable on student laptop computers. Faculty was able to annotate the slides in real time with arrows, circles, etc. and ask students specific structure or functional questions. Learners responded to faculty questions using a web based personal response system. The results were immediately available to faculty for making a decision to promote further discussion, as when the answers varied, or proceed to the next learning objective. The learner’s database stored answers along with correct answers which were available for learners to assess their progress and for faculty to use in formative and summative evaluations.
RESULTS: Students were very enthusiastic about the flipped histology laboratory and for the first time in more than a dozen years of teaching in histology laboratory using the usual method voted me a major teaching award. Since all of our students perform very well on course end exams, there was no measurable increase in student examination grades.
CONCLUSIONS: Flipping histology laboratory is a process leading to greater student participation and satisfaction with the histology laboratory.
407 – STRATEGIES FOR PREPARING THE STRUGGLING FIRST-YEAR MEDICAL STUDENT FOR A SUCCESSFUL SECOND YEAR
Louise Jones, Bonnie Buxton, and Mary Owen J.D.
Philadelphia College of Osteopathic Medicine – Georgia Campus
PURPOSE: Pre-Clinical Faculty at GA-PCOM tasked us with finding a solution to the problem of promoting barely passing first-year medical students to the second- year and thereby increasing their chances for continued academic struggles. Without intervention, these at-risk students are at jeopardy for continued academic problems, increased stress, possible board failure and difficulty obtaining residencies of their choice.
METHODS: Our solution to this dilemma was to introduce multiple intervention strategies including an intensive summer bridge course between first and second years. This course was intentionally designed as a high intensity, high structure “boot camp” (8am to 8pm, M-F) for “at risk” students with goals that targeted not only academic progress but also psychosocial preparation for a successful second year. After identifying the attributes of successful medical students both in the literature and within our student demographic, we built a high-yield curriculum around a month-long remediation of the critical concepts of our first-year basic science curriculum. We utilized 21st century learning tools and approaches for adults, resiliency skills, time management and study skills training, as well as group support systems. Our goal was to model and train the students in the methods and attitudes of successful students while simultaneously providing an intensive, team-based approach to a comprehensive review of their first-year concepts. Success in this program would be measured by improved course grades, student grit and confidence survey and COMLEX-1 results.
CONCLUSION: This poster presentation is the summary of the lessons learned during our strategic planning process and development of the focused team-based curriculum built to weave academics, academic support, student affairs and mentors into an ongoing support team for the student group to strengthen their academic foundation and enhance their ability to meet the challenges ahead.
408 – Faculty Observations of Student Educators: Modeling Best Practices for Future Medical Science Educators
Jeanine Beatty-Chadha and Tiffany Whitcomb
Penn State College of Medicine
PURPOSE: As medical science educators, it is important to model the use of research-based teaching practices, especially during a course preparing fourth year medical students to teach. In the first iteration of a Students as Educators medical student elective, course directors stressed the importance of feedback, but did not require observations of student educators. A faculty observation process was developed to provide each future educator with non-evaluative feedback to support growth.
METHODS: A published observation tool was adapted for use during observations. Faculty observers are required to attend a one-hour interactive workshop session that includes an elective overview, practice using the observation tool with a video, and discussion of learner-centered feedback. Once matched with a trained observer, the student shares the location and teaching materials for the one- to two-hour observed session. After the observation, they meet to discuss the feedback and observation tool. The observer returns the tool to the course directors and each medical student writes a reflection describing how they will use the feedback. One observation is required for the elective.
RESULTS: Eight faculty observers have been trained for 2016-2017. As of December 2016, 7 student educators have been observed. Up to 35 student educators will be observed by April 2017. Students and faculty members have shared positive comments about the process. Students find it helpful to get detailed feedback from experienced educators. Challenges include scheduling conflicts that can make it difficult to match students with observers.
CONCLUSIONS: Organization and communication are crucial to the success of the faculty observation process. Observations should be scheduled early to allow learners to apply feedback and allow time for rescheduling if needed. Overall the faculty observation process has begun to serve as a model of the use of best practices as we encourage medical students to provide feedback to learners.
410 – DEVELOPMENT OF AN ONLINE CATALOGUE OF MUSCLE VARIANTS DISSECTED AT AN INSTITUTION OF CHIROPRACTIC EDUCATION
Logan Bale and Sean Herrin
University of Western States
PURPOSE: Muscle variants are routinely encountered during educational dissection. These structures can be important in the clinical diagnosis and treatment of various conditions. Muscle variants may not be directly emphasized in medical curricula and are often regarded with little importance at the time of dissection as students are focused on mastering normal anatomy. We have created on online catalogue of muscle variants discovered in our anatomy lab to allow self-directed learning amongst chiropractic students.
METHODS: Photos and videos are taken after discovery of a muscle variant during routine educational dissection. A literature search is performed and a brief case report is generated for the structure of interest, including a gross description and relevant clinical information. The case report and accompanying photo/video content is hosted online using a Moodle-based platform and made available to students. The online catalogue is continually updated as variants are found within the anatomy lab. Student feedback will be gathered to assess the value of this resource and to guide its future directions.
RESULTS: At its inception, the online catalogue of muscle variants features 9 case reports. Student feedback is pending.
CONCLUSIONS: Muscle variants are structures that should receive attention in medical sciences anatomical curricula. By providing students a self-directed learning opportunity focused on normal muscle variants, the understanding that variation is the only constant for humans can be fostered.
411 – Simulated Contamination to Train Healthcare Workers in Personal Protective equipment
Wenceslas Krakowiecki, Michael Patrick, and Peggy A. Seidman
Case Western Reserve University School of Medicine and University Hospital Cleveland Medical Center
PURPOSE: Health professionals are frequently required to don Personal Protective Equipment (PPE), but are frequently not trained in the proper “Don and Doff” sequence. Lack of proper training leads to contamination as seen in the recent Ebola crisis. We investigated how a simple experience in proper Donning/Doffing can significantly decrease learner’s contamination rates and improve their knowledge of when to use PPE.
METHODS: 33 2nd year medical students and 21 Anesthesiologist Assistant Student (AAS) were trained in proper doffing technique in standard CDC doffing sequence. Education consisted of video based instruction and deliberate practice with expert guidance. PPE consisted of two pairs of gloves, a mask, and an isolation gown. Dilute laundry detergent served as the simulated contaminant. Students proceeded with proper doffing and contamination was assessed by black light florescence. Students were scored as contaminated or clean. Participants completed a short questionnaire about their baseline knowledge of PPE. The individuals were assessed 3 month after initial experience to test retention.
RESULTS: Initial MS contamination rate was 18.18%, initial AAS contamination rate was 47.6%. 3 month data pending.
CONCLUSION: This trial at Case Western Reserve University is consistent with data gathered at Stony Brook University on over 240 preclinical medical students1. The students were trained with the same protocol as at SBU. The medical student data showed a lower initial contamination rate to the SB medical student data, while the AAS students had a higher initial contamination rate. We believe the longer undergloves used with the CWRU medical student trials accounts for the decreased contamination rate seen. We expect that simply changing the glove lengths available in healthcare settings can help decrease contamination rates seen in doffing protocols. If proven accurate this has implications for PPE across all healthcare professionals.
412 – THE USE OF CLINICAL VIGNETTES AS A TEACHING TOOL TO INTEGRATE MEDICAL BIOCHEMISTRY AND THE CLINICAL SCIENCES
Mariluz M. Henshaw, Judith M. Binstock, Vasudeva G. Kamath, and Sankhavaram R. Panini
Department of Basic Biomedical Sciences, Touro College of Osteopathic Medicine
PURPOSE: There is a perception by students that much of the Biochemistry material taught in medical school has little clinical significance and involves rote memorization of pathways. We developed integrated clinical vignettes to highlight the clinical relevance of Biochemistry and enhance the critical learning skills of students.
METHODS: 1) Vignettes were designed to apply Biochemistry concepts to the diagnosis and management of a clinical condition. 2) Vignettes were posted a week in advance of the discussion session with study questions designed to stimulate students’ critical thinking. 3) At the elective interactive sessions, faculty initiated a discussion, based on the medical history, physical examination and laboratory results, which culminated in the most likely diagnosis and treatment. 4) At the end of the session, students assessed their understanding of the vignette with iClicker questions. 5) An online survey was utilized to evaluate the usefulness of the vignettes and solicit student feedback.
RESULTS: 52 % of the class (149 students) completed the survey. The results indicated that (1) 64 % found the vignettes important in increasing their understanding of the relevancy of Biochemistry in Medicine, and (2) 70 % thought that the guide questions helped them develop critical thinking skills essential to patient management and differential diagnoses. Student comments indicated that time should be allotted for small group discussion prior to the interactive session.
CONCLUSIONS: (1) Clinical vignettes are important tools in developing critical thinking skills and in helping integrate the basic and clinical sciences in a discipline-based curriculum. (2) These vignettes can be effectively administered in a large group setting with limited faculty. As faculty, we are encouraged by students’ enthusiasm and engagement in vignette discussions. Future plans include allotting time for small group discussion prior to the interactive sessions and involving interdisciplinary faculty in the design and presentation of additional integrated clinical vignettes.
413 – Impact of In-House and National Medical Simulation Competition in a New College of Osteopathic Medicine.
Caleb Holder, John Giannini, Dianne Walker, and Dennis Baker
Alabama College of Osteopathic Medicine
PURPOSE: The purpose of this presentation is to describe how year 1-2 students at a new Osteopathic Medical School engaged in the process of learning clinical skills via simulation to be successful in a national competitive simulation event. This success led to the development of a local simulation event that has become a “new” tradition.
METHODS/RESULTS: In Fall 2014, five members of the year 1-2 classes asked a faculty mentor to prepare them for participation in the 2015 Simulation Competition sponsored by the American Medical Student Association. The faculty Director of Simulation led structured practice sessions using the school’s simulation facility. The school’s team placed second to a team that went on to win the international competition. This fueled enthusiasm within the student body for simulation learning and led to the first on-campus simulation competition at the school in November 2015. Local physicians and school faculty served as judges. Student responses to a structured survey indicated the competition was of high value and also provided feedback regarding training strategies. A survey of the judges indicated the competition incorporated realistic scenarios. These findings prompted a second in-house competition in Fall, 2016, with each of 8 student teams engaging in rigorous training sessions. Two top teams were selected based on scoring by community physician judges to compete in the 2017 AMSA simulation competition. Student participants and physician judges were surveyed using the same survey items used administered after the 2015 competition. This presentation will: 1. Describe in detail the processes used to prepare teams for the competition, and 2. Share data from surveys of students and judges.
CONCLUSIONS: Learning via simulation with effective instructional techniques, fueled with friendly competition among students learning in a team environment can lead to student success at the national level for simulation competition.
414 – LEARNING COMMUNICATION SKILLS THROUGH TEACHING IN ANATOMY ACADEMY AS PREPARATION FOR ADDRESSING PATIENT NON-COMPLIANCE
Amanda Nielson, Ryan Jensen, Casey Klein, Jonathan J. Wisco
Department of Physiology and Developmental Biology, Neuroscience Center, Brigham Young University and Department of Neurobiology and Anatomy, University of Utah School of Medicine
PURPOSE: In the learning environment, there can often be a student or two that have difficulty learning or even refuse to learn. Although the attitudes of these students are sometimes similar, solutions for inspiring them to learn can vary. In this study, we analyzed Anatomy Academy Mentor reflection data on how they maximized anatomy, physiology, and nutrition learning experiences amongst elementary school children once a week for seven weeks. Since achieving health literacy requires physicians to communicate with patients of all ages, Anatomy Academy helps pre-professional students learn and practice the skill of addressing non-compliance.
METHODS: After each teaching experience, Mentors (pre-professional college students and professional medical and dental students) completed an IRB approved reflection asking, “What strategies have you used to manage students who aren’t as eager to learn as you want?” Using a grounded theory approach, beginning with constructing a word cloud to reveal the most frequent words used in responses that informed subsequent detailed thematic qualitative analysis, we analyzed responses and generated themes on how Mentors could help struggling students better learn, and enjoy learning.
RESULTS: We found that struggling students often enjoy learning when Mentors preparelessons geared toward their specific interests. Mentors noted that all students in theirgroup benefitted from improved engagement as a result of better preparation.
CONCLUSION: By being better prepared for lessons and gearing them toward the interests of difficult students, a teacher can better facilitate learning to that individual and the other students. Anatomy Academy also helps prepare Mentors for future communication of clinical information and compliance of patients.
415 – ˜Self-Directed Surgical Skills”: A Modular Video-Based Elective to Teach Basic Knot-Tying and Suturing Skills to Medical Students
Vivian Qin and Norman Kumins
Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center
PURPOSE: Various strategies have been attempted to educate surgical novices, who are now expected to demonstrate competency in an increased skill set during decreased training time. This project aims to teach medical students basic surgical knot-tying and suturing skills through a novel, self-directed, video-based curriculum.
METHODS: The ‘Self-Directed Surgical Skills’ (SDSS) elective is a four-month-long course offered to medical students. The curriculum consists of two modules (Knot-tying and Suturing) containing a total of twelve stepwise tutorial videos ranging from 10 to 20 minutes that each include a demonstration of the skill with best-practice tips, information about use of the skill in surgical practice, and advice on practicing the skill. Thematically similar videos are released to students every 2-4 weeks. Students watch and practice at their own pace, self-report hours practiced, and submit completed practice materials. Three open practice sessions are held over the course for students to periodically receive in-person guidance on their progress. Students are assessed on their knowledge of surgical skills and on their performance of 6 knot-tying and suturing tasks.
RESULTS: Forty-one medical students are participating in the ongoing SDSS elective and preliminary results are presented here. Overall, students gave the videos a mean 4.37/5 Likert scale rating on their effectiveness for learning the skills taught. Students spent a mean 13.89 hours practicing skills taught in the videos and praised the video components for their clarity and concise yet thorough instruction. Students praised the in-person practice sessions for the helpfulness of individualized feedback. Students improved their knowledge of surgical skills over the course of the elective, scoring a mean 95% on the multiple-choice final exam, compared to a mean 56% on the pre-test.
CONCLUSIONS: Preliminary results suggest a video-based, self-directed curriculum can effectively teach basic surgical skills knowledge to medical students.
416 – Who you going to call? Creation of a Simulation Education Consultation Service
D. George Ormond, Tess Aulet, Patrick Forgione, and Cate Nicholas
University of Vermont
PURPOSE: Simulation-based education is a resource intensive learning method and requires a unique educational approach. The Clinical Simulation Laboratory (CSL) at the University of Vermont developed a Simulation Education Consultation (SEC) service. The goal of the SEC was to optimize use of simulation resources and create best-practice educational activities by assisting faculty with simulation equipment selection and development, evaluation and improvement, instructional design, and support for research.
METHODS: A needs assessment within the CSL uncovered a desire for more standardized process for initiating simulation activities. The Director of Simulation Education and Operations and the Surgical Simulation Fellows formed the SEC group. An initial intake form and two flowsheets, one for internal use and the second aimed at faculty to navigate the process were developed. The SEC Group works closely with the prospective faculty to complete the initial intake form and implement the simulation. An Inguinal Hernia Repair simulation served as a model for this process. The SEC service was then piloted for the development of an Open Common Bile Duct Exploration Simulation.
RESULTS: For the Inguinal Hernia Repair simulation, the SEC group was able to provide faculty assistance in locating and modifying a pre-existing curriculum, identifying learner preparation materials, equipment, and developing evaluations. Resident and faculty evaluations were overwhelmingly positive and utilized for continual quality improvement. Our pilot of a formal consultation with the SEC was arranged within 3 weeks of initial request. Initial intake meeting took 30 minutes and initial intake form was completed for faculty within one week of the initial meeting.
CONCLUSIONS: The SEC service is feasible and has increased the educational structure and access to simulation resources available to faculty. With continuation of the SEC program, we hope to achieve continued high learner satisfaction, create innovative curriculum, and simulation publication opportunities.
417 – String Theory – The Blurry Vision Project
Mark Biro, Henna Patel, Thomas Brantley, and Barbara Freeman
Case Western Reserve University School of Medicine
PURPOSE: Neurophobia is a descriptive term that captures student apprehension toward the nervous system. This project investigated the utility of using a 3D reconstruction of the visual pathway when teaching students basic anatomy and pathology as compared to traditional learning methods.
METHODS: A total of 26 graduate neuroanatomy students participated and were randomly divided into experimental groups. The control group utilized a traditional image representation of the visual pathway, while the experimental group used a 3D reconstruction. Each group completed an 11-page lesson with an introduction, a sequenced walkthrough of the pathway, and pathology section. Upon completion or after 40 minutes, students were provided a 15 question quiz and 5 part Likert questionnaire.
RESULTS: Two-tailed t-tests were used for analysis and significance was determined by p
CONCLUSION: Data from the experiment shows students significantly preferred the tactile 3D reconstruction over a traditional static representation of the visual pathway. Although students had lower mean post-test scores, these results lacked significance and may be attributed to inadequate time for the lesson. To more decisively determine the utility of the visual pathway reconstruction or other neurologic pathway reconstructions, students must be given adequate time to complete the experiment.
418 – CAN ALL STUDENTS LEARN IT ON THEIR OWN? EVALUATION OF THE EFFECTIVENESS OF INDEPENDENT LEARNING ASSIGNMENTS ON STUDENT LEARNING IN THE PRECLINICAL MEDICAL CURRICULUM.
Maria Sheakley, Tim Bauler, and Bonny Dickinson
Western Michigan University School of Medicine
PURPOSE: Didactic lecture, once the mainstay of undergraduate medical education, is diminishing in favor of more student-centered forms of learning in the classroom, and independent learning outside of the classroom. Teaching modalities that incorporate active forms of learning have been shown to enhance knowledge retention and exam performance, however, whether independent learning modalities also effectively support student learning remains to be rigorously examined.
METHODS: The pre-clinical basic science curriculum at our institution includes 5-7 hours of didactic lectures per week and 5-8 hours of independent learning per week. These independent learning assignments are faculty guided resources presented in an interactive electronic book (iBook) that students complete on their own. To assess the effectiveness of learning using this instructional modality, we compared student performance on end-of-course exam items for independent learning assignments and lectures for each course in our pre-clinical curriculum.
RESULTS: We first analyzed student performance on all exam items for didactic lecture and independent learning modalities in all courses in aggregate. We found no statistical difference in student performance on exam items from the different teaching modalities. This was also true when we analyzed data for each course individually. To determine whether class rank influenced student learning, we separated the data into cohorts (upper, middle, and lower performing students). We found that class rank had no effect on student performance on exam items from the different teaching modalities in any of the courses.
CONCLUSIONS: Our data suggest that independent learning assignments are as effective as didactic lecture in our curriculum for students in the upper, middle, and lower cohorts of the class. Thus, students can learn it on their own when independent learning assignments are well-designed, directed, and their importance in the curriculum is emphasized.
419 – Viewing Pre-recorded Video Lectures and Learning Outcomes
Helena Carvalho, Margarite McCandless, R. Brock Mutcheson, and Richard C. Vari
Virginia Tech Carilion School of Medicine
PURPOSE: The Virginia Tech Carilion School of Medicine (VTCSOM) Basic Science domain uses a variety of teaching methods in the second year, including the flipped classroom. The approach at VTCSOM includes providing pre-recorded video lectures prior to in-class learning sessions. We examined whether there was a correlation between the total number of minutes viewed and the student’s score on the end of block basic science exam.
METHODS: During a 6 week block focused on cardiovascular, respiratory, and hematological pathobiology, 41 students had the opportunity to view 22 pre-recorded video lectures prior to in-class learning sessions. The length of the videos ranged between 12-78 minutes, averaging 33.3 minutes. We correlated individual student time spent watching videos with end of block exam scores.
RESULTS: 63% of students elected to view the videos. Preliminary results showed a 0.33 correlation (p=.107, ns) between the amount of time (minutes) spent watching videos and exam scores.
CONCLUSION: Our preliminary results, while statistically not significant, show that students who spent more time watching the pre-recorded videos tended to score higher on the end-of block basic science MCQexam.
420 – DO MICROBIOLOGY WET-LABS FACILITATE STUDENT COMPREHENSION?
L. B. Lawson, C. M. Lind, J. W. Gibson, K. and Honer zu Bentrup
Tulane University School of Medicine
PURPOSE: The objective of this study was to analyze the impact of a voluntary hands-on microbiology laboratory session on students’ comprehension and ability to apply the underlying principles to exam questions in our Introduction to Infectious Diseases (IID) course.
METHODS: A two-hour voluntary lab session is offered during the first module of the second year of Medical School. During this session, students perform and interpret microbiological assays in the context of clinical case scenarios. Data were collected for 6 academic years. We compared the performance of students participating in the wet-labs with those who did not. We analyzed the two groups’ scores on exam questions directly related to the concepts presented in the laboratory session, and their overall scores on the IID module exam. Regardless of attendance at the hands-on lab session, all students had access to an online lab module.
RESULTS: An average of 27 students (average total class size = 190) participated in the voluntary lab each year. Participants consistently gave favorable comments regarding its usefulness. Students who attended voluntary lab sessions scored higher on exam questions related to lab exercises than students who did not attend (Mann-Whitney, p <0.0001). Additionally, the performance of these students on the overall module exam exceeded the performance of students who did not attend the laboratory session (Mann-Whitney, p=0.027).
CONCLUSIONS: Over the past 20 years, many medical schools have reduced or entirely eliminated teaching laboratories in medical microbiology courses. Our voluntary microbiology laboratory provided an opportunity to quantitatively assess the impact of a hands-on wet lab on student performance and comprehension. Our results suggest that students benefit from participation in a case-based laboratory session. We hypothesize that the improved performance is due to the opportunity to reexamine material originally presented during classroom sessions and to receive reinforcement of concepts in a no-stakes setting.
421 – Expansion of Anatomical Educational Offerings Through the Use Of End-of-Course Medical Student Dissected Cadavers: A Three-Year Experience
Kevin D. Phelan
Division of Clinical Anatomy, University of Arkansas for Medical Sciences
PURPOSE: Dissection of cadavers provides medical students with a hands-on opportunity to learn anatomy. However, similar opportunities for other health care profession and post-graduate students are limited due to cadaver availability and dissection time commitment. We have significantly expanded our anatomical educational offerings through the “reuse” of end-of-course freshman and senior medical student dissected cadavers.
METHODS:Our freshman medical student dissection course runs in the first 9 weeks of the year. A limited number of seniors also register for a dissection elective. Rather than immediately cremating these cadavers, we have begun selecting good dissection specimens (~24) from among the 44 course generated cadavers. The dissection tables are cleaned and the cadavers heavily wetted down and rewrapped with plastic. They are then reused for the remainder of the academic year to provide previously unavailable anatomical teaching opportunities.
RESULTS: In the last three years, this approach has enabled our program to offer anatomical review opportunities to over 600 students, residents and faculty in 20 separate programmatic events including: new junior nursing pathophysiology course labs, a new senior medical student elective, and undergraduate and resident anatomy review sessions. A major advantage is that collectively these cadavers provide an array of anatomical variants and pathologies that are readily available on demand. A disadvantage is the absence of superficial structures and organ removal though we routinely supplement with a cadaver with the thoracic and abdominal walls removed. The longer storage contributes to mold related loss of specimens over time but not enough to prevent course offerings.
CONCLUSIONS: Course related medical student dissected cadavers can serve as a useful and low cost resource to supplement educational anatomy opportunities. Careful selection and storage provides a resource that can be used as demand arises. This approach also honors the wishes of donors by using their anatomical gift to the fullest extent.
422 – Effectiveness of a simulated laboratory experience in enhancing understanding of the Scientific Method by First-Year Medical Students.
Daniel R. Webster, Brandon Bradley, Lisa Popp, and Tammy Carter
Texas Tech University Health Sciences Center
PURPOSE: Several LCME standards mandate that students will be instructed in the scientific method, will receive exposure to self-directed learning, and will have opportunities to interact with students in other degree programs. We designed and executed an exercise that fulfills all three mandates.
METHODS: Thirty-six first-year medical students (MS1) were presented with a hypothetical clinical scenario and then encouraged to make an initial diagnosis and suggest several laboratory tests to be performed from a provided list. One group of students (experiental, or EXP) was then brought to a clinical laboratory, where they observed several such tests being run. Students from the School of Health Professions (SHP) ran the demonstrations and answered questions from the MS1 students. The MS1’s then discussed their initial hypotheses concerning the correct diagnosis and whether or not further laboratory tests should be performed. A second group of MS1 students was asked to complete the exercise using a self-directed (SDL) approach, where they worked on the diagnosis by themselves but received the same written information as the experiental group. Both groups were assessed for knowledge of content before and after the case was presented and one week later. They will be surveyed and quizzed again in the near future.
RESULTS: The pre- and post-experience quiz scores for the EXP students rose from 37-65%, while the SDL scores rose from 32-45%. After one week, both group scores remained the same (63% and 49% correct, respectively), indicating successful retention of knowledge. A survey of SHP students showed increased confidence in their abilities to work interprofessionally and overall satisfaction with the experience.
CONCLUSIONS: Exposure to a laboratory environment heightened MS1 student awareness and relevant knowledge of clinical laboratory practices while using the scientific method. SHP students increased their experience and confidence in working in an interprofessional environment.
423 – POST-OPERATIVE DEBRIEF ON RESIDENT DECISION-MAKING AFTER LAPAROSCOPIC CHOLECYSTECTOMY
Katherine A. Hill, Eliza B. Littleton, and Giselle G. Hamad
University of Pittsburgh Medical Center, Department of Surgery and Department of Medicine
PURPOSE: Surgical autonomy can be reliably evaluated, but it is less clear how to promote it in the teaching OR. We sought to characterize resident development of autonomy – focusing on higher-level skills of operative decision-making. Immediately post-operatively, we asked surgical faculty and residents about observed instances of decision-making and what surgeons do to facilitate autonomy.
METHODS: 22 semi-structured interviews were completed, after 11 laparoscopic cholecystectomies, with 7 attendings and 7 residents in PGY-2 and -3. Both groups answered 5 questions:
What parts of the operation did the resident do?
What decisions did the resident make?
How did the attending help the resident progress or decide how to progress?
Were there times when the attending was operating, and why?
How did your relationship with this attending/resident affect the operation?
Responses were audio-recorded, transcribed, and evaluated for themes. Data were compared using Fisher’s exact, Wilcoxon rank-sum, and Cohen’s kappa tests.
RESULTS: Themes influencing decision-making included: atypical case characteristics (55%), anatomic uncertainty (50%), collaborative dialogue (50%), allowing safe struggle (50%). Less-common themes were: importance of retraction (41%), and time pressures (23%). Residents framed their teacher-learner relationship with prior operations together and attending preferences, while attendings cited the resident’s general personality traits (all p <0.05).
We encountered resident-attending mismatches, regarding the resident’s decision-making, and times when the attending was operating. Agreement between groups was fair (decisions: k=0.24, p=0.19, attending operating: k=0.35, p=0.06). When residents denied decision-making, the attending usually affirmed the resident’s decisions. Residents identified points when the attending operated, but at times the attending did not recall this until prompted.
CONCLUSION: Strategies to promote surgical resident autonomy range from decision-making dialogue to supervised practice. Checklists utilizing our themes could be developed, to facilitate decision-making and autonomy. It may be useful to learn what faculty and residents each perceive as autonomy, and foster dialogue to define a shared goal.
424 – Supplements designed to increase student satisfaction and confidence in a time-limited, Biochemistry, Molecular Biology, Cellular Biology, and Histology Medical School Course
Daniel R. Webster, Alec Egan, Kelly Flynn, and James C. Hutson
Texas Tech University Health Sciences Center
PURPOSE: In the medical school course entitled “Biology of Cells and Tissues” we have limited time to present a wide range of content. Therefore, we have added a number of supplemental activities and tools designed to increase student satisfaction, confidence, curiosity and enjoyment of the material presented.
METHODS: We have added the following activities and physical tools to our course over the last several years: video enhancement of our microscopes, peer-led, voluntary, weekly review sessions and mid-lab quizzes using an audience-response system, and a mandated self-directed learning (SDL) activity wherein students submitted a relevant vignette-style question and then took practice exams composed of their peer’s questions. We surveyed the students to determine student satisfaction with these enhancements and accrued preliminary data on knowledge retention from the review sessions by administering quizzes before and after each session.
RESULTS: Surveyed medical students were very satisfied with the upgraded microscopes as effective learning tools. Teaching assistants received high scores and positive narrative comments when medical students evaluated all their contributions. Medical student performance on pre- and post-review quizzes increased for two of the six weeks (by 12-21%), while in the other four they did not increase. Even so, participating students commented that they felt better prepared for faculty-generated exams. Finally, 53% of respondents thought that the SDL experience was valuable, and 68% agreed that it fit the definition of SDL.
CONCLUSIONS: The resources we have introduced have been well-received by the medical students. Student satisfaction and confidence derived from each of the activities has been positive. Although the SDL experience was thought to be arduous, a majority of students still found it to be valuable. We will continue our efforts to make quantitative assessments on student progress in our course.
425 – CONCEPT MAPPING AS A TOOL TO PROMOTE COGNITIVE INTEGRATION
Douglas B. Spicer, Sean Kilgallen, Rebecca J. Rowe, and Kathryn H. Thompson
University of New England College of Osteopathic Medicine
PURPOSE: In the last 20 years there has been a push for more integration of the basic and clinical sciences in medical school curricula. Recently, studies have suggested that cognitive integration is achieved when the relationships between the basic science and clinical domains are explicitly demonstrated. Concept mapping in response to a prompt, which asks students to create relationships among clinical and basic science concepts should provide explicit connections that lead to a deeper conceptual understanding of the material. We designed a study to test the hypothesis that concept mapping improves the ability of students to diagnostically discriminate between multiple endocrinopathies.
METHODS: Our experimental protocol was based on the design used by Dr. Nicole Woods, et al. We presented students with teaching material on the dysregulation of the hypothalamic-pituitary-adrenal axis. The study design included three groups. Groups 1 and 2 received separate basic science and clinical explanations of the material, but Group 2 was prompted to create a concept map to show the basic science mechanisms underlying the clinical presentations of the endocrinopathies. Group 3 received the same content but rewritten so that the causal links between the basic science and clinical features of each of the disorders was explained. Diagnostic ability was measured with a written exam immediately following the study session and one week later.
RESULTS AND CONCLUSION: From previous studies we expect that group 3 will outperform group 1 on both written exams. We expect that group 2 will do at least as well as group 3. Because the students in group 3 will need to discover and create the causal links as they map we propose that the learning will be stronger and more durable. The findings from this study will be presented and discussed.
Poster Award Nominee
426 – Peer-led review sessions for USMLE Step 1 preparation.
Daniel R. Webster and Brian Pomeroy
Texas Tech University Health Sciences Center
PURPOSE: Many year-2 medical students (MS2) feel unprepared to take the Step 1 exam. To aid in their preparation, we instituted a program of peer-led instruction that was delivered over the final semester of pre-clinical study.
METHODS: Students from both year 3 (MS3) and year 4 (MS4) classes volunteered to conduct review sessions for the MS2 class. We polled MS2 students early in the semester in order to conduct a topic-related needs assessment. The peer instructors developed their sessions, with help from the other instructors as well as the authors, over a series of 2-hour practice sessions before presenting the material to the class. They presented 13 sessions, informed by our needs assessment, covering topics ranging from renal physiology and pathology to the interpretation of anatomical images. MS2 attendance was voluntary and all MS2 students took the Step 1 exam within two months of the last session. We surveyed students before and after Step 1 and collected responses using 5-point Likert scales.
RESULTS: Student attendance was high at all sessions (range:71-108 students per session). From a survey taken immediately after the sessions ended (41 respondents), we found that most MS2 students would recommend them for next year’s group (88% agree/strongly agree vs. 0% disagree/strongly disagree). From a survey taken after Step 1 (69 respondents), participants felt that the sessions provided useful test-taking strategies (75% agree/strongly agree vs. 1.5% disagree/strongly disagree) and prepared them for the content on the exam (78% agree/strongly agree vs 3% disagree/strongly disagree). Finally, most of the respondents were satisfied with their exam scores (77% agree/strongly agree vs 17% disagree/strongly disagree).
CONCLUSIONS: Most MS2 participants felt that they benefited from instruction led by their peers. Ongoing analysis will determine if participants scored higher on their preparatory CBSE and Step 1 exams than those who did not attend.
427 – THE VALUE OF EARLY RESEARCH EXPOSURE DURING MEDICAL SCHOOL
Janice Schwartz and Rami Ibrahim
Michigan State University College of Osteopathic Medicine
PURPOSE: Research continues to be a valued part of the career trajectory for medical students. The skills needed to analyze clinical problems, identify and apply the best available evidence to diagnose and care for patients are not unlike those required to conduct a successful research project. The question of how well the competencies needed to perform research align with the competencies required for clinical practice remains unanswered. As a prerequisite to this inquiry, we are developing a medical student research program at the Detroit Medical Center campus of the College of Osteopathic Medicine at MSU.
METHODS: This program is based on research opportunities provided by local Hospitals, Institutes, and Universities; many within walking distance of the DMC campus. Currently we have 12 faculty-approved preceptors, all with a proven track record of excellence in research, funding, and the supervision of students. Students are selected on the basis of their academic standing, professional record, research interest, time commitments, and prior experience. Medical and scientific competencies will initially be evaluated using student interviews and questionnaires.
RESULTS: Students who are accepted into the research program meet with a faculty mentor who matches them with preceptors, explains the requirements of the program, provides a timeline and example documents from completed projects. Students must submit a research plan in order to enroll and provide a summary and progress report upon completion. As a work in progress, results are currently be obtained.
CONCLUSION: Students conduct research projects using a variety of formats ranging from electronic health record systems to xenograft models of cancer. Innovation, problem solving, applied learning, and other competencies are put forth in the accomplishment of these projects.
428 – Common Errors in History and Physical Report Writing
Liris Benjamin, Griffin Benjamin, and Nancy Selfridge
Dept of Clinical Medicine, Ross University School of Medicine, Princess Margaret Hospital, Dominica
PURPOSE: The first step to diagnosis is accurate history-taking followed by physical examination with precise medical reporting. History and Physical write-ups are part of the written communication skills taught to medical students. Discrepancies in this initial process can lead to serious patient errors including inaccurate or incomplete diagnosis and mismanagement of the patient. A recent study suggests that medical error is now the third leading cause of death in the United States (Makary and Daniel, 2016). Identifying medical errors from the root can reduce mortality. The aim of this study was therefore to identify the common types of errors in history and physical write ups in medical students.
METHODS: This was a retrospective chart review using a cross-sectional study design. History and physical write ups (200) submitted by the semester 2 medical students to the Department of Clinical Medicine that were corrected by faculty for the period September to December 2016 were reviewed.
Errors made by medical students in the history and physical write-ups on the standardized patients used for teaching purposes in semester 2 clinical skills course were utilized. The variables analyzed were grouped according to errors identified. Data analysis was conducted qualitatively using common themes and quantitatively using averages in excel program.
RESULTS: This is work progress. Preliminary results indicate that students made errors in the write ups of all four standardized cases (myocardial infarction, cholecystitis, stroke and hyperthyroidism). In each case, the errors were similar. They were identified in the chief complaint, history of present illness, past medical history, social history, and family history, review of systems, physical examination, labs, summary, problem list and differential diagnosis; spelling/grammar and miscellaneous.
CONCLUSIONS: Knowing in advance the errors students commonly make in History and Physical write-ups, sets to create better instruction or more targeted interventions for improved outcomes.
429 – DEVELOPING A NERVE BLOCK TEMPLATE USING SURFACE ANATOMY LANDMARK RATIOS FOR CONDUCTING BLIND-APPROACH POSTERIOR TIBIAL NERVE BLOCKS
Nicholas Pettit, Ali Abu-Alya, and Brion Benninger
Western University of Health Sciences COMP-Northwest ,Medical Anatomy Center, Departments of Medical Anatomical Sciences and Neuromuscular Medicine
PURPOSE: According to current literature, common methods for approaching posterior tibial nerve block (PTNB) include a fixed measurement (3cm) from the medial malleolus of the distal fibula. However, this approach does not address variance of human morphology or positioning into consideration. The objective of this study was to develop a nerve block template for blind PTNB using surface anatomy landmark ratios demonstrated and dissected from donor cadavers.
METHODS: Literature search was conducted regarding techniques for PTNB. PTNB was performed on 20 cadaveric ankles via palpation from axis between apex of medial malleolus (AMM) and apex of calcaneum (AC) described by R. C. Colgrove. Distances between AMM to posterior aspect of Achilles tendon (PAT), and injection site (IS), respectively, were taken using a topological surgical ruler. PTNB injection using 0.5mL of India ink, and subsequent dissection confirmed injection success. Distances from MM to PTN post-dissection were measured.
RESULTS: 19/20 blind injections using palpation landmarks were successful, and AMM-IS to AMM-PAT distance along axis of AMM-AC yielded a ratio of 0.47±.07 starting from AMM. The injection site was significantly different compared to post-dissection PTN location (p <0.1). However, the neurovascular bundle in which anesthetic is administered is much wider than the nerve, and further studies may determine width of fascia containing PTN. In a clinical setting, pulse from posterior tibial artery is commonly used to locate fascia containing PTN. In situations where locating the pulse/fascia is difficult, or training novice practitioners, it would be beneficial to have surface anatomy landmarks determining ratios identifying PTN.
CONCLUSION: This pilot study revealed a simple consistent surface anatomy landmark ratio template to perform PTNB and a method of training novice practitioners and students using donor cadavers during anatomy courses or as continuing education.
Poster Award Nominee
430 – Assessing Integrated Instruction of New Basic Sciences and Clinical Sciences in Medical Psychiatry to Prepare Medical Students for Future Learning for Complex Problem Solving
Zarah Chaudhary, Nicole Woods, Rachael Barnett, Sanjeev Sockalingam, and Maria Mylopoulos
The Wilson Centre for Research in Education, University Health Network & University of Toronto
PURPOSE: Previous research in medical education has shown that instruction that deliberately integrates basic biomedical knowledge with clinical features (cognitive integration) leads to better diagnostic performance and preparation for future learning (PFL). In addition to traditional biomedical knowledge, it has been suggested that knowledge of ‘new’ forms of basic science (e.g. social determinants of health, knowledge of systems of care etc.) is necessary for effective care. This 3-phase study will compare the effect of ‘new’ basic sciences integrated instruction to clinically focused instruction on diagnostic performance and PFL. The purpose of Phase 1 was to define new basic sciences for integrated physical and mental health care (medical psychiatry).
METHODS: In Phase 1, five medical psychiatry expert physicians were engaged in a modified Delphi process to iteratively identify categories of comorbid diseases, their signs and symptoms and the foundational mechanistic knowledge characterizing these categories.
RESULTS: Experts reached consensus on five common medical psychiatry disorders and their defining signs and symptoms. Mechanisms for new basic sciences to describe disorders’ underlying etiology included psychological (ex. attachment styles, response factors to illness like social conditioning and cognitive repertoire of coping strategies), evolutionary biological (ex. behavioural adaptability to one’s environment with respect to illness outcomes such as harm avoidance or risk aversion), sociological explanations (ex. economic theory, socioeconomic vulnerability, downward drift) in addition to traditional biomedical explanations (ex. inflammatory processes, neuronal and endocrine systems implicated in stress, genetic factors).
CONCLUSIONS: Phase 1 expanded the definition of ‘basic science’ beyond biomedical knowledge to include behavioural and social system processes that will serve as the foundation for Phase 2 in the development of study materials. This work has implications for educational design, particularly in developing integrated instruction for chronicity and complexity in undergraduate medical education that will foster abilities to concurrently manage patients’ physical and mental health needs.
432 – Implementation of Just-in-Time Teaching for Medical Student Learning of Cell Biology and Histology in an Integrated Curriculum
Augusta University (AU-UGA Medical Partnership)
PURPOSE: Active and engaged learning strategies are important for developing lifelong learning skills . Just-in-time teaching (JiTT) is pedagogy that shares many potential rewards of the flipped classroom but has the added advantage of informing instructors of student’s knowledge base and gaps prior to entering the classroom . The purpose of the current study was (1) to analyze student engagement with the preparation activities of JiTT, (2) determine if students thought this pedagogical approach was effective relative to other large group learning activities not using the JiTT pedagogy, and (3) to determine if the JiTT pedagogy was as effective as non-JiTT strategies in helping students acquire knowledge and skills.
METHODS: To quantify student engagement with pre-class materials, the number of students completing the pre-assessment and the average for each pre-assessment were determined. Student perceptions of the effectiveness of the JiTT intervention were determined by comparing student ratings of the faculty member before, during and after the JiTT intervention as well as to the average ratings of all other faculty not using the JiTT approach. Finally, student performance on similar test items was compared following JiTT or non-JiTT sessions.
RESULTS: The data show that student engagement with the pre-assessments waned over time and student perceptions of the instructor’s “overall effectiveness” was lower for JiTT sessions compared to non-JiTT sessions; although the average rating for all faculty remained unchanged. However, student scores on graded assessments following JiTT sessions were as high as those following non-JiTT sessions.
CONCLUSIONS: Students viewed the effectiveness of JiTT slightly less favorably compared to traditional lecture; however, student performance on graded assessment items indicate the two approaches are equally effective. Although several challenges to implementing JiTT were identified in this study, JiTT remains a viable approach for fostering the development of lifelong learning skills if these challenges could be overcome.
434 – REQUIREMENT OF PERFORMANCE ON ASSESSMENTS DETERMINES STUDENTS’ LEARNING IN ANATOMY LABORATORY
Kathleen Doane, Patrick Boyd, Kyle Chapman, and Ying-Ju Sung
The Commonwealth Medical College
PURPOSE: At The Commonwealth Medical College (TCMC) we have integrated gross anatomy into a first year course that includes physiology, histology, embryology and radiology. We modified dissection time such that students “platoon”, with two groups alternate using the same cadaver and teaching each other. We compare student performance prior and subsequent to this change, and other changes, to determine the optimal method for student learning.
METHODS: We analyzed averages of practical exam grades from 2011-2016. Anatomy practicals were changed in 2015-2016 to include both multiple choice as well as fill-in the blank questions. In addition, in this academic year it became a requirement that students obtain 65% or greater on the practicals.
RESULTS: There were no major changes in the faculty teaching during the time period specified. In 2011-2012, overall the average was 75.9. The next year the average dropped to 66.6, with no change in the subsequent year (66.1) when platooning was implemented. The following year demonstrated a significant drop in the average to 60.6. However, in 2015-2016, the grades significantly increased to 83. This increase correlates with the requirement to obtain 65% on the practical as well as passing the overall exam, and the inclusion of multiple choice questions on the practical.
CONCLUSION: Platooning did not affect grades, although a downward trend was observed. A requirement to pass the anatomy practical as well as the overall exam resulted in a significant jump in grades. Including multiple choice questions rather than only fill-in-the blank also could have contributed to the increase. Our data indicate that platooning is a useful way to teach gross anatomy, as long as there is an indication of the importance of anatomy dissection such as a requirement to pass the practical.
436 – Increasing Student Interest in Family Medicine Through Innovative Programming
Martha Seagrave and Candace Fraser
Robert B. Larner College of Medicine at UVM
PURPOSE: A study commissioned by the AAMC estimates there will be a shortage of between 12,500 and 31,100 primary care physicians in 20251. To distinguish Family Medicine as a unique specialty and develop confident, well-prepared clerkship students, leading to an increased number of family physicians, we introduced an innovative orientation week incorporating didactics, interaction with role models and active learning. The week provides students with the knowledge, skills and attitudes to be successful in their clinical settings starting the first day of their clerkship.
METHODS: Students spend the first week of their Family Medicine clerkship, branded TOPMEd Week (Team Oriented, Patient centered Medical Education) on the main campus. In the 10 half day sessions, students experience a curriculum maximizing hands-on sessions taught by resident, community and core faculty. Over 20 Family Medicine faculty participate in TOPMEd Week addressing our curricular objectives. Topics include: prevention, lipids, tobacco cessation, dermatological procedures, women’s health and procedures, intimate partner violence, communication techniques, musculoskeletal exams and primary care neurologic presentations. We employ standardized patient experiences during the week as formative experiences and at the end of the week for assessment.
- Family Medicine was voted Best Clerkship for three years in a row.
- Preceptors note at mid-clerkship meetings that students are well prepared.
- Students have increased understanding and appreciation of the diversity of Family Medicine as evidenced in evaluation comments.
- Higher average of residency matches into family medicine comparing the 3 graduating classes who received TOPMEd (13) comparted to the previous 17 classes (8).
CONCLUSIONS: TOPMEd week has been effective in meeting our objectives. It helped increase interest in Family Medicine highlighting family medicine procedures and increasing exposure to family physicians from diverse practice settings. In addition, TOPMEd Week increased student appreciation for Family Medicine regardless of residency choice.
438 – Student Health Fair: Mixed learning in Genetics, Science Education and Outreach
Matti Nikkola and Matthew Kirkham
PURPOSE: To introduce first semester medical students to the basics of scientific and outreach-type society-oriented communication using Human and Molecular genetics as the subject matter taught.
METHODS: A complex learning experience spanning 4 weeks was developed, integrated into the Cell biology curriculum of first year undergraduate medical students. Every course occasion works with a specific theme (such as Cancer, Diabetes or Obesity). They learn to search information on the theme with the help of the library staff, and have small group tutorials and lectures with faculty. The exercise is examined individually, based on student papers in the News and views format based on recent research into the genetics of the theme, and group wise, by creating a one day Health Fair open to the public, based on the same theme.
RESULTS: Based on the course evaluation, the students rate the learning experience and its different steps highly. It corresponds to the learning outcomes, has a large student-driven learning moment, and the students also report that it is meaningful, fun and inspiring, as well as a team-building opportunity during the first semester
CONCLUSION: Creating and organizing a mixed learning experience integrating subject matter outcomes with Science education and Communication is a complex but rewarding venture, requiring substantial planning and organizational resources.
440 – Principles to Practice: A Pilot Program in Preclinical Medical Ethics Education
Ella Sorscher, Alexa Kanbergs, and Jonathan Kole
Alpert Medical School of Brown University
PURPOSE: National accreditation leaders in medical school and postgraduate education drafted the Romanell Report in 2015 to review the current state of medical ethics education. Despite an agreed need for learner competency in professional ethics, they found no consensus methods to deliver this education. Our project was developed as an attempt to answer their call for new pedagogical approaches. Specifically, we endeavored to test structured case-driven curricula in preclinical medical students.
METHODS:We followed thirty-five first and second year medical students: twenty-five choosing to enroll in a Medical Ethics elective and 10 enrolling in a non-ethics elective, allowing the curricula to be assessed in a prospective case-control design. The course consisted of eight two-hour sessions, followed by anonymous surveys after each session to assess student reaction. To gauge learner knowledge acquisition and behavior change, all 35 students will also be assessed before and after the course with two timed open response case analyses. A rubric was created by two Master level ethicists and each exam was blindly graded by two independent evaluators to ensure reliability and concordance.
RESULTS: As the course completes in the middle of January, the full results of its impact are not yet available. To date, six of the eight sessions have been completed. Learners have reacted positively to the course material presented, with 88% of students reporting being satisfied to very satisfied overall with the course sessions and 91% of students rating the case studies as relevant or very relevant to their careers.
CONCLUSIONS: This pilot program serves as a model curricula to provide case-based medical ethics education for preclinical students. Future directions include reflective improvement of current material and evaluating extension of the program to new teachers and more students.