2018 Meeting Posters – Instructional Methods

401 – Maximizing student use of questions as a learning tool
Louise Jones, Jiehyun Lee, Meghan DiRito, Dennis Peffley, Michael Sampson, Skye Bickett, and Bonnie Buxton
Philadelphia College of osteopathic medicine

PURPOSE: Due to the rigor and pace of study required of professional level students, it is vital that they take full advantage of the testing effect (Roediger & Karpicke, 2006) as soon as they absorb new material. This means that they must quickly be able to access good quality appropriately leveled questions that progressively get more complex as their grasp of the content improves. Quizzing has been shown to be one of the most effective strategies for this level of students. However, students have a hard time knowing where to look in order to get the right topic, at the right level of difficulty at the right time. This is a big time waster when they should be developing content mastery. Students also view questions as something that they do at the end of the study cycle, rather than as a learning tool from the very beginning. This study behavior is ineffective at the professional level.

METHOD: Our goal was threefold:

  • Change student behavior – use questions as a learning tool
  • Make question searching at the correct level and topic as intuitive as possible with our school topic and formats
  • Align commercial and professor written banks to maximize use.

To do this, we are exploring how to use adaptive learning strategies linking library banks to our LMS; utilizing search themes such as Bloom’s taxonomy, MedU Core Concept, our learning outcomes to curated lists. Our idea is that eventually, we will be able to link a curated set of progressive questions (with teaching rationale) embedded within each content specific area of our learning management system so that the formative feedback of quizzing becomes a useful and integral part of the learning cycle.

CONCLUSION: We are in the very early stages of development and would welcome the opportunity to brainstorm with colleagues at IAMSE using our poster as a framework.


402 – IMPLEMENTATION OF A FULLY FLIPPED CLASSROOM WITHOUT INCREASING STUDENT WORKLOAD: FITTING A SQUARE PEG INTO A ROUND HOLE
Aaron Marshall and Mercedes Falciglia
Department of Medical Education, University of Cincinnati and Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism. University of Cincinnati

PURPOSE: The truly flipped-classroom has proven to be difficult to implement in a fast-paced, high-volume curriculum, such as medical school. The pitfalls begin with pre-session assignments; which if are recorded lectures and/or encyclopedic book chapters, adds to a crowded student workload and creates dissatisfaction. Some schools combat this by only utilizing certain elements of the flipped classroom, but not the whole process; mitigating the advantages of the method. Here we describe the process of designing a fully flipped-classroom for the endocrinology block that addresses student workload, encourages but does not require attendance, and leverages active learning.

METHODS: To convert from the fully scheduled didactic curriculum to a flipped-classroom with free time allotted for concept application sessions, we targeted the pre-session assignments for increasing efficiency. Assignments consist of video modules containing 100% of previously lectured content. To assess the success of the transition the following data will be collected: student access of assignments, performance on reused multiple choice questions from the traditional curriculum, and end of course evaluations.

RESULTS: We found that conversion of lecture content to video modules (i.e. pre-session assignments) resulted in an efficiency of 50% [22hrs reduced to 11hrs]. No basic science content was lost during conversion. Eight hours of case-based, application sessions were added (optional attendance). Importantly, no new information was presented during the application session, which abides by the flipped-classroom paradigm. Data on attendance at application sessions versus a didactic lecture, assessment performance, and student satisfaction will be reported (in progress-concluded by conference dates).

CONCLUSIONS: The LCME is now requiring detailed information regarding student workload. Thus, adding more time to the existing schedule in order to accomplish a flipped-classroom is not tenable. Incorporating the flipped-classroom model concomitant with creating efficiencies in the delivery of content is a viable path to meeting the needs of our students and accrediting agencies.


404 – Using Improv to Develop Communication Skills for Medical Students
Amy Baldwin, Jakob Feeney,  Kathleen Herring, and Edwin Sperr
AU/UGA Medical Partnership

PURPOSE: Strong communication skills are essential for clinicians, and clear and confident self-presentation is important for medical students as well. While these facts might seem self-evident, it can often be difficult to find dedicated time within the Curriculum to develop these skills. This abstract describes the development of a structured series of activities, based on improv theatre techniques, that is suitable for use with self-selected student interest groups.

METHODS: Using materials developed by two of the authors for an earlier elective, as well as examples described by others, an integrated series of improv theatre games has been developed. Many of the skills necessary for successful improv play (such as active listening and intellectual empathy) are also essential for other communication tasks. These activities are designed to be presented over the course of several short sessions, making them suitable for use in contexts outside of the classroom. By their nature, these activities focus on communication skills in an iterative way – mastery of ideas introduced at the beginning of the sequence is essential for playing games at the end.

RESULTS: This project is a work in progress. The first version of the activity sequence is currently being introduced with the campus Women in Medicine student group. Lessons learned will be used to refine the curriculum for use in later iterations.

CONCLUSION: Communication skills are an essential competency for medical students. Developing these skills via multiple modalities, both inside and outside the classroom, should be a focus of medical education.


405 – THE USE OF FILM TO REINFORCE THE TEACHING OF PSYCHOPATHOLOGY IN A MEDICAL SCHOOL NEUROSCIENCE COURSE
Bruce Giffin, Laurah Lukin, and Cijy Sunny
University of Cincinnati College of Medicine

PURPOSE: The efficacy of teaching psychiatry in medical school during the preclerkship curriculum can be enhanced when the lecturer interviews a patient during the class and lets the class ask questions of the patient. Students consistently give high ratings to “patient presentations” on the Brain, Mind, and Behavior course evaluations. Bringing actual patients to the lecture hall is difficult to schedule and manage. The goal of this project was to substitute patient presentations with film clips depicting psychopathology, and determine if there was a statistically significant difference in how these students performed on exam questions compared to those who did not view the film clips.

METHODS: In 2015 students were assigned film clips to watch from The Last Picture Show (major depressive disorder) and A Beautiful Mind (schizophrenia) concurrent with the lecture presentations covering these psychiatric disorders. Probe questions accompanied the film clips. Students uploaded probe question responses into the LMS and the questions were discussed during the weekly content integration sessions. A comparison was made between the student performance on the same exam questions (5 for major depressive disorder and 6 for schizophrenia) that were administered during the 2014 academic year (no film clips) and the 2015 academic year (film clips).

RESULTS: Statistical analysis of the major depressive disorder and schizophrenia exam questions showed a statistically significant difference in the average scores between the 2014 and 2015 groups with the 2015 group doing better.

CONCLUSION: Because of this pilot study, the Brain, Mind, and Behavior course is moving forward with the use of film clips to enhance the students’ understanding of a number of psychiatric disorders presented in the course. The use of film clips to depict psychiatric disorders is a viable alternative to patient presentations.


406 – IMPACTING MEDICAL STUDENT’S PERCEPTIONS OF PATIENT’S ABILITY TO ACHIEVE LIFESTYLE RELATED TREATMENT GOALS
Denise Kay, Magdalena Pasarica, and Rebecca Cameron
University of Central Florida College of Medicine

PURPOSE: In order to impact future physician’s understanding of the complexity of making and sustaining lifestyle behavior patterns, we included a personal goal setting requirement in an Internal/Family Medicine undergraduate clerkship. Our interest was in determining what impact  the experience of personal behavior change would have on students’ perception of patient care.

METHODS: After participation in one online and one face to face session that introduced the Specific, Measurable, Achievable, Realistic and Timely (SMART) goal framework and provided opportunities to practice goal setting, students were required to: (A) write a personal (anonymous) SMART goal they wanted to achieve during the clerkship, (B) reflect on goal attainment, (C) share their progress with a peer at 2 week intervals for 8 weeks, (D) submit a reflection chronicling progress and/or the barriers toward attaining their personal goal and how what they learned from this exercise would impact their future practice.

RESULTS: Fifty-Seven students completed the required exercise in two IM/FM clerkships. A majority (63%) of those students indicated that starting and maintaining their personal goal was difficult, with 36% of these students also reporting it was more difficult than expected. Social support and time management presented as two consistent themes students associated with goal attainment. 28% of responses included more empathic statements related to patient’s struggles with behavior change. Responses also highlighted that factors which proved successful in their own goal attainment, such as setting SMART goals, regular follow-up to address barriers to achieving goals and accountability, will be useful in patient care.

CONCLUSION: Student’s reflections suggest that this exercise did impact personal perceptions of the difficulty of setting and maintaining goals. An unexpected but desired outcome was that students also discovered, through personal experience, the mechanisms that allowed them to be successful and recognized how these could be useful in patient care.


407 – ADDRESSING SYSTEMS BASED PRACTICE COMPETENCY USING QUALITY IMPROVEMENT PROJECTS IN A LONGITUDINAL INTEGRATED CLERKSHIP/BLOCK HYBRID M3 CURRICULUM
Margrit Shoemaker, Daniel Glunk, and Diana Callender
Geisinger Commonwealth School of Medicine and UPMC-Susquehanna

PURPOSE: Curricular integration of Quality Improvement (QI) projects fosters early competency of Systems Based Practice.  At Geisinger Commonwealth School of Medicine (GCSoM), to enhance this aspect of our curriculum, we integrate QI projects identified by clinical stakeholders and health system QI staff in the M3 year.

METHODS: Student were divided into groups of 4 to 5 and assigned a faculty facilitator.  Twenty-three projects were run in 4 regions and 12 sites over 9 months. Fifteen were hospital based and 8 in outpatient settings. Groups have limited curricular time (5 hours) and meet otherwise independently. Project development timelines are enforced. Project posters are submitted and shared with students and faculty at a dedicated event. This required activity is graded Pass/Fail.

RESULTS: Lessons learned will inform changes impacting student groups, facilitators, project sites, and project assessment. Groups composed of both LIC and Block students were most successful. The 9 month project spans both semesters with limited meeting time during Block. Facilitator familiarity with processes under scrutiny was important.  Active EHR transitions impaired data access. Failure to establish a “Memorandum of Understanding” also delayed project progress. A systematic approach to sharing results with stakeholders was lacking.  Missed assessment opportunities included peer evaluation, facilitator evaluation, and poster evaluation.

CONCLUSION: QI projects for M3 students are a feasible approach to Systems Based Practice competency development. Early experience informs areas for process improvement in group composition, facilitator choice, site selection and student assessment.


408 – USE OF SELF-ASSESSMENT QUIZZES FOR BIOCHEMISTRY INCREASES SUBJECT SCORES ON SUMMATIVE EXAM
Heather Jones, Dolgor Baatar, and Tanis Hogg
TTUHSC PLFSOM

PURPOSE: Studies have shown that use of self-testing improves student performance on exams. This effect, however, has not been studied with medical students in biochemistry. This study analyzes the relationship between biochemistry self-assessment quiz usage and biochemistry summative score.

METHODS: Five biochemistry self-assessment quizzes were made using iSpring QuizMaker; each quiz corresponded to a required biochemistry session in the hematology (HEM) organ-based unit and consisted of 10-20 multiple-choice questions corresponding to specific learning objectives. The quizzes were made available for voluntary use to 101 first-year medical students at TTUHSC PLFSOM via the CANVAS LMS website at least 7 days before the HEM summative. Usage data was collected using CANVAS. Student rank was determined from previous biochemistry performance on the integumentary, musculoskeletal, and neurology (IMN) summative; top ranked students scored above 50% and bottom ranked students scored below 50%. Summatives consisted of multiple-choice vignette-style questions. The variables used for analysis were number of quizzes used, HEM summative score, and rank. Analyses included ANOVA, simple linear regression, and multivariable linear regression.

RESULTS: Quizzes were used on average by 40.6% of students. Students who used 3 or more of the quizzes had significantly higher (p=0.0010) biochemistry scores on the HEM summative (78.59% ± 13.35, mean ± SD) than students who did not use any quizzes (65.68% ± 16.24, mean ± SD). Linear regression showed a positive correlation between quiz usage and HEM biochemistry summative score (p=0.0004). Additionally, multiple variable regression showed that quiz usage was a significant predictor of HEM biochemistry score for bottom ranked students (p=0.0231), while previous biochemistry performance was not (p=0.8078).

CONCLUSION: The use of self-testing may increase student performance in biochemistry, particularly in low-performing students, and should be considered a beneficial addition to the medical school curriculum.


409 – USE OF TOPIC-SPECIFIC CASE REPORTS TO PUT BASIC SCIENCE PRINCIPLES INTO PRACTICE
Janice Schwartz, Annette Carron, Gary Willyerd, and Carolina Restini
Michigan State University College of Osteopathic Medicine and Henry Ford Hospital; MSUCOM

PURPOSE: The purpose of this study is to demonstrate how alignment between clinical case studies and early pre-clerkship courses can be built into a continuous learning framework that acknowledges the contribution of basic science to the principles and practice of medicine.

METHODS: We tested the ability of students to identify key elements in medical cases studies selected from the published literature and to form working definitions based information derived from ongoing pre-clerkship courses containing topic-specific content. Students were then asked to extract essential information from the cases , including the chief complaint, history of the present illness, physical exam findings, laboratory tests, as well as other diagnostic data, and instructed to use it in order to defend, question, or refute the diagnosis and treatment approaches taken (as stated by the authors of the same publication). A rubric and template were created for use as ‘score cards’ to assess the accomplishment of these goals.

RESULTS: This study was first piloted to assess the extent that students were able to integrate foundational and clinical information according to topic. Following this student group comparisons were made using first and second year medical students.

CONCLUSIONS: Our early findings indicated that aligning clinical case studies with content from basic science courses provides a valid platform for evaluating complex learning strategies that can foster initiative, increase retention, and promote the maturation of critical thinking skills that can be applied to clinical problem solving.


410 – Integrating theory and skills: The use of classroom gaming and video-assisted reflection to prepare nursing students for clinical practice
Jeanette Ignacio and Hui-Chen Chen
National University of Singapore

PURPOSE: Key to the overall goal of the nursing program is for students to acquire knowledge and skills essential in providing safe patient care. In the course of the nursing students’ undergraduate studies, much of the instruction is delivered through subject-specific independent modules. Learning thus becomes compartmentalized as students have limited clinical experience to aid in knowledge integration for application in the clinical setting. Additionally, there is heavy reliance on tutors during laboratory practice such that reflective learning, vital to knowledge integration, does not easily happen. The aim of this project is, therefore, to help students retain and integrate information from two modules using classroom game-based learning, and the use of video reflection during simulation sessions.

METHODS: A randomized controlled design study consisting of an intervention group (use of classroom gaming and video for self-reflection) and a control group (conventional strategy), was conducted. Knowledge was tested using a pre- and post-test quiz. A post-test simulation was also done with verbal qualitative feedback. Skills assessment results of the participants were used to determine the effectiveness of the intervention. Focus group discussions were conducted after the clinical posting to evaluate how the intervention helped during clinical placement.

RESULTS: Results of the quantitative component were unremarkable, perhaps due to the limited number of intervention sessions. Findings from the focus group interviews, however, showed that students perceived the intervention to be helpful. Three themes were generated: (1) usefulness for revision, (2) being engaged and active, and (3) ability to apply.

CONCLUSION: Classroom gaming was seen by  students as helpful in learning. Its use, together, with video-assisted reflection, has potential to help in the integration of knowledge and its application to the clinical setting. Further refinements, however, such as using multiple sessions, and involving more modules may be considered in the future.


411 – LEARNING BY TEACHING: ARTICULATING CLINICAL REASONING FROM MEDICAL STUDENTS TO MASTER’S STUDENTS, A PILOT STUDY
Joel Roberts, Jill Pitcher, Tina Underwood, and Francina Towne
Rocky Vista University

PURPOSE: Improving clinical reasoning in early medical education while avoiding significant addition of curricular time poses a unique educational challenge. Improved learning when teaching others is well described. We have pursued an innovative approach by integrating second year medical students and master of science in biomedical science (MSBS) students into an inter-disciplinary standardized patient simulation with emphasis on medical students articulating their clinical thought process. This abstract describes the pilot study and its outcomes.

METHODS: This encounter was integrated into an experience of a standardized patient presenting with respiratory complaints. Both student groups were learning about the pulmonary/respiratory systems in their respective didactic curriculum at the time of the simulation. 54 second year medical students volunteered to participate and 27 MSBS students participated, each in two encounters. In preparation, medical and MSBS students were oriented to the encounter. Students were paired and completed the encounter together under the leadership of the medical student. Afterward medical students discussed their differential diagnosis, primary diagnosis and clinical reasoning while answering any medical questions asked by the master’s students. Both attended a case debrief and the medical students proceeded to document their post encounter clinical notes. Both groups completed follow-up surveys.

RESULTS: Initial review of graded clinical documentation (SOAP notes) showed improved scores from previous SOAP notes. Initial survey responses show the majority of medical students reported that the encounter helped their understanding of the differential diagnoses and enhanced their ability to reason clinically.

CONCLUSION: Inter-disciplinary standardized patient simulations that facilitate learning by teaching may be a valuable tool to improve medical student clinical reasoning and note writing ability. Work in progress includes a second encounter with participant randomization and adjustment to encounter procedures.


412 – The Use of Experiential Learning and Academic-Community Partnerships to Teach Medical Students Teamwork, Professionalism and the Determinants of Health in a Community Setting
Joseph Kiesler, Lisa Kelly, and Bob Littman
University of Cincinnati College of Medicine and Freestore Foodbank

PURPOSE: There has been a call in medical education and public health to expand the training of physicians from the classroom to the community in order to better care for the health of patients and communities.

METHODS: In 2011, the University of Cincinnati College of Medicine implemented a new curriculum which included faculty facilitated learning communities (LC) of 12 students and a longitudinal course relating the physician’s role in society. The Physician and Society curriculum emphasizes community and population health, the business of medicine and the emerging physician identity. In order to teach first-year medical students the determinants of health, foster professionalism with colleagues and the community, and develop teamwork skills, the Physician and Society course links each learning community with a neighborhood and community agency in Greater Cincinnati for an experiential community health / service-learning curricula. In the fall semester, each LC assesses a determinant of health of their neighborhood by working with their community partner to help answer a need of that community. Each LC completes a service-learning project over the course of the year, presenting outcomes to community members, faculty and peers in a poster presentation. At the end of each semester, students complete a Team Climate Survey, reflections, and course evaluations. Team Climate Survey and reflections are discussed in LC’s to facilitate teamwork skills.

RESULTS: Learning community team identity increased through completion of the modules. Student reflections highlighted the role of the physician in and with the community. Challenges include coordination with community partners and fostering communication skills between students and community.

CONCLUSIONS: A service-learning based curriculum can be successfully implemented to teach the determinants of health, professionalism and teamwork in a community setting. Early introduction of medical students to the community and determinants of health through service-learning has the opportunity to influence future patient populations cared for by these physicians.


413 – A FLIPPED CLASSROOM MODEL FOR TEACHING HISTOLOGY RESULTS IN BETTER ASSESSMENT SCORES ON HIGHER ORDER QUESTIONS AS COMPARED TO LECTURES
Kathleen Doane, Ying-Ju Sung, and Patrick Boyd
Geisinger Commonwealth School of Medicine

PURPOSE: To compare three years of student performance on assessments of histology, using different pedagogical approaches.  We compare use of the flipped classroom approach to using lectures with a single interactive session prior to the exam.

METHODS: At GCSOM, histology content has been delivered using a combination of lectures, podcasts, and self-directed “laboratories” using virtual slides.  In this study we compare student performance with or without Socrativ in weekly interactive, large group sessions. Socrativ is a tool to collect anonymous answers for to use for real-time questioning and feedback.  We compared both of these flipped classroom approaches to traditional lectures in conjunction with a single interactive session prior to the test.  Testing items include fill-in-the-blank first-order (A) identify questions, higher order (B) function questions, and multiple choice questions.

RESULTS: Grades on the imaging test were slightly lower for B type questions when Socrativ was not employed (mean of 78.3 v. 73).  Grades dropped a great deal more when the material was presented in lecture format, to below a passing grade (mean=68.5).  This is an ongoing study and the remainder of exams for 2017-2018 will be analyzed and presented.

CONCLUSIONS: Overall, with the flipped classroom, performance on exams for A and B questions was fairly similar, although B questions usually had lower scores than A questions.  In contrast, grades dropped to below passing on the imaging exam with traditional lectures.  This implies that interactive sessions, whether or not Socrativ is used, are a valuable pedagogical approach.


414 – Soft Fixed Cadaver Models For Surgical And Clinical Procedure Training: A Comparison of Two Different Programmatic Approaches
Gregory S. Smith and Kevin D. Phelan
Department of Surgery, Saint Louis University School of Medicine, andDivision of Clinical Anatomy, University of Arkansas for Medical Sciences

PURPOSE: Soft fixed cadavers provide a more realistic anatomical model for surgical and clinical procedure training and allows for a wide range of educational possibilities depending on available programmatic resources. Here we describe approaches taken by two different medical school programs.

METHODS: The Department of Surgery at Saint Louis University (SLU) has been using soft fixed cadavers for 10 years.   The school typically embalms cadaver limbs and trunks to meet program needs. The Division of Clinical Anatomy at the University of Arkansas for Medical Sciences (UAMS) is in their fourth year of using whole body embalmed cadavers. Both programs use the Anderson (2006) method of light embalming.

RESULTS: The SLU program is primarily focused on surgical training of medical students, residents and faculty and has produced a series of videos for training PURPOSE S.  Representative surgical procedures include: cricothyrotomy, laparoscopic cholecystectomy and appendectomy, hand assisted laparoscopic nephrectomy, thoracostomy, open nephrectomy and surgical closure techniques. This calendar year the program has trained over 500 people using this approach and techniques.

The UAMS program is primarily focused on clinical procedure training of students, including interprofessional education events, and includes procedures such as: ultrasound guided placement of central venous lines, intraosseous lines, chest tubes, foley catheters, nasogastric tubes, lumbar punctures, nerve injections, bone marrow aspiration/biopsy, biopsy of liver/kidney, joint injection/aspiration, pericardiocentesis, and pleurocentesis. This calendar year the program has used 8 cadavers in 23 sessions that involved over 50 faculty, 100 residents/fellows and nearly 600 students (medical, nursing, allied health).

CONCLUSIONS: Soft fixed cadavers offer several advantages over conventionally embalmed cadavers including the preservation of anatomical structure, complete joint mobility that allows for clinically relevant positioning, true-to-life tactile feedback, and high quality ultrasound imaging. Programs can tailor use of these cadavers based on availability of resources.


415 – MENTORSHIP THROUGH ANATOMY ACADEMY CONTRIBUTES TO PRE-PROFESSIONAL AND PROFESSIONAL MEDICAL SCIENCE STUDENTS’ INTERPERSONAL AND COMMUNICATION SKILLS TRAINING
Kevin S. Steed, Jonathan J. Wisco, Amanda Nielson, Ryan Jensen, and Casey Klein
Brigham Young University

PURPOSE: Mentorship can be a very powerful teaching and learning tool. In this study, we examined how Anatomy Academy Mentors (pre-professional and professional school trainees) – who taught anatomy, physiology, and nutrition to elementary school children – perceived their role as resources for learning, and how the mentorship relationship affected their ability to communicate information.

METHODS: We asked Mentors the following IRB approved question: “’The trick of the Internet knowledge machine is that it only works with questions.  Without questions, you have the world’s largest distraction device.’ (Michael Wesch, Brigham Young University Forum, 01/22/13) Teaching and learning, learning and teaching, is a circle of life, or at least of education.  How does Dr. Wesch’s statement influence or impact the way in which you learn?  How does it influence or impact the way in which you teach?” Using a grounded theory approach, we constructed a word cloud to reveal the most frequent words used in responses. These results informed subsequent, detailed thematic qualitative analysis.

RESULTS: Mentors expressed the following themes: 1) simply disseminating information to students didn’t necessarily facilitate learning; 2) utilizing various electronic resources to help present material allowed students to discover information for themselves; 3) encouraging and facilitating students to “think and do” is crucial in effective learning; 4) mentorship includes helping students feel comfortable in the learning process; 5) Mentors were a trusted and readily accessible source of knowledge, which helped facilitate discovery in the learning environment.

CONCLUSION: Acquiring knowledge through discovery can be accomplished many different ways, but a vertical mentorship environment synergizes communication when all participants work together in an academically safe environment to explore resources and discuss applicability to improving health self-efficacy. In the future, we would like to study how horizontal, or near-peer mentorship helps trainees improve in their interpersonal and communication skills.


416 – IMPROVING LEARNER ENGAGEMENT AND DISCOURSE: AN INNOVATIVE USE OF AN ONLINE DISCUSSION ACTIVITY
Magdalena Pasarica and Monica Bailey
University of Central Florida College of Medicine

PURPOSE: To improve learner’s engagement and discourse in undergraduate medical education.

METHODS: We used two face-to-face learning sessions (one non-required and one required), which provide for two components of the community of inquiry framework, teacher and social presence. The session activities involved critical reviewing of an evidence-based article and solving a clinical scenario. We modified these sessions to provide for the third component of the framework, cognitive presence, with an online discussion activity as either a replacement (non-required session-approach 1) or a supplement to the in-class activity (required session-approach 2). We compared student engagement (participation in non-required session) and discourse (learner products and feedback to peer products). These sessions were delivered in the preclinical undergraduate medical curriculum in two subsequent academic years.

RESULTS: Participation in the non-required session increased from 21 to 81 learners, out of a class of 120. Learners produced three group products in the face-to-face activity vs. 81 individual products for the online activity. The peer feedback increased in amount (from three to 71 peer comments) and also complexity (as per instructor’s observation). In the second approach involving the required session with the supplemental online activity, there were 20 group products (as with face-to-face delivery) accompanied by 120 complex peer comments (increased from 10, somewhat simple comments).

CONCLUSION: Our results suggest that the online discussion increased learner engagement and discourse, providing for all three components of the community of practice framework. We propose that the online platform allowed time to reflect on peer’s products and the opportunity for peer role modeling in the discussion, which may have contributed to this improvement. The flexibility of participating in an online activity vs. face-to-face, contributed to increased participation. Other institutions looking to improve engagement and discourse should consider modifying their sessions to include or be replaced by online activities.


417 – AN INOVATIVE ACTIVE METHOD FOR TEACHING BEHAVIOUR CHANGE FOR HEALTH AND WELLNESS IN UNDERGARDUATE MEDICAL EDUCATION
Magdalena Pasarica, Denise Kay, and Rebecca Cameron
University of Central Florida College of Medicine

PURPOSE: There is strong evidence to show that behavior change improves health and wellness; however, most physicians are still hesitant to incorporate these recommendations into clinical management, reporting lack of time and knowledge. Using shared decision making for establishing SMART management goals (specific, measurable, achievable, reliable, timely) is critical for behavior change. We developed an innovative curriculum targeting the following learning outcomes: 1) summarize and interpret lifestyle information into a concise lifestyle profile and 2) use evidence-based recommendations to establish SMART lifestyle goals.

METHODS: Five sessions for 5 hours of curriculum time were developed. Using three interactive self-learning on-line modules, learners were introduced to the importance of, the evidence-based recommendations for and the SMART recommendation format for behavior change. Then, learners practiced these skills during two face-to-face sessions using role-play, then by collaboratively solving a clinical case (each case portrayed a patient with different clinical condition who needed behavior change). An Observed Standardized Clinical Encounter station (OSCE) was used to assess these skills. Learners reported their perception of this curriculum being worth their time in a very tight medical curriculum.

RESULTS: This required curriculum was delivered 6 times for 180 (total) undergraduate medical students in their Internal/Family Medicine clerkship. Curriculum was optimized using peer and/or learner feedback. All learners performed the targeted skills at levels above the minimal requirement, as shown by their OSCE performance. All learners agrees or strongly agreed that learning how to use lifestyle medicine for behavior change was worth their time.

CONCLUSIONS: This active learning approach combining face-to-face and on-line sessions was perceived by learners as valuable and resulted in achieving management skills for behavior change for health and wellness. This approach may be useful for other institutions looking to integrate active learning and/or lifestyle medicine with behavior change for health and wellness into their curriculum.


418 – Incorporating Multiple Learning Strategies in a Non-didactic Class Activity Enhances Student Learning
Mari Anderson, Sarah Lipp, and Mari Hopper
Indiana Univeristy School of Medicine

PURPOSE: Governing bodies for higher education have encouraged curricular reform supporting more engaged and integrative learning. In response, our large, muti-center medical school recently “renewed” its curriculum and required all courses to commit at least 50% of student contact time to non-didactic learning strategies.

METHODS: One particularly effective new learning exercise developed for use in the new curriculum was a collaborative small group activity designed to reinforce key concepts in renal processing of ions and nutrients, and at the same time utilize multiple learning strategies. Learning strategies incorporated in this exercise included:  small group collaboration, peer teaching, retrieval practice using “clickers,” and elaboration through discussion. This small group activity was distributed for use in an introductory basic science course involving 364 first year medical students at all nine regional centers of the Indiana University School of Medicine (IUSM). This active learning exercise followed a two-hour didactic lecture covering key concepts.

RESULTS: Anonymous student surveys provided positive feedback as to the effectiveness of this exercise with perceived usefulness and applicability scoring 3.61 and 3.7 out of a 4 point maximum. Response to open ended questions were also very positive. Customized National Board of Medical Examiner (NBME) exam scores further substantiated student perceptions. Student average was 79% correct responses compared to 76% for NBME universal results for questions matched to concepts of the exercise. These data indicate that although renal coverage for this course was considered introductory, students performed comparable to, or slightly better than, students previously completing this specific set of NBME questions.

CONCLUSION: This nephron mapping exercise provides an excellent model for designing exercises that promote use of Bloom’s higher order skills and engage students in methods proven to enhance learning.


419 – SIMULATION DAY-A TASTE OF REAL MEDICINE IN PRE-CLERSHIP YEARS IN INTEGRATED CURRICULUM
Marta Ambrozewicz, Senthil Rajasekaran, Arno Zaritsky, Lauren Mazzurco, Mary Rubino, and Temple West
Eastern Virginia Medical School

PURPOSE: Pre-clerkship medical students have limited opportunities to integrate basic science knowledge, clinical skills and medical decision making in a clinical environment, while simultaneously developing valuable social tools for conveying important news to patients. As the class sizes consistently increase, opportunities for feedback on these processes are limited. To complement the 11-week, 2nd year, Heart Lung and Kidney module a cardiogenic shock manikin-based case was developed and it was followed by sharing the serious new with the family member of the patient.

METHODS: Facilitated by a clinical faculty, teams of 6 students completed a manikin scenario of a patient presenting in cardiogenic shock due to mitral regurgitation complicating an acute MI. Students were assigned roles such as: scribe, history taking, physical exam, etc. by facilitators. Faculty, using session objectives, facilitated clinical thinking and immediate debriefing of the manikin scenario. Following the scenario, individual students discussed the patient’s condition with a simulated family member and standardized patients provided feedback on the delivery of serious news. A large group debrief session following the session summarized relevant concepts and closure for the case.

RESULTS: A total of 150 students participated in Simulation Day. Manikin scenario was scored by qualitative feedback and considered a great success. The average score for serious news delivery was 7.6 out of 10. Participating faculty found this experience invaluable as it demonstrated to be an effective learning tool, bringing participation of the students to a new level, and allowed almost one on one assessment of students’ basic knowledge and clinical reasoning skills.

DISCUSSION: Simulation is an underutilized tool in undergraduate medical education. It has a great potential to bridge the gap between basic sciences and practice. If used properly, it can allow for application of knowledge students are acquiring during their pre-clerkship years.


420 – USE OF A SINGLE-PALETTE PHILOSOPHY TO FOSTER CONCEPTUAL UNDERSTANDING OF PHYSIOLOGICAL PRINCIPLES IN PHASE 1 MEDICAL EDUCATION
Michael J. Russell
Augusta University/University of Georgia Medical Partnership

PURPOSE: Pressure to move quickly beyond basic content knowledge to critical analysis and application of physiological concepts can create a level of cognitive dissonance that impairs near-term performance and long-term retention for early-career medical students. Single-palette methods such as concept mapping can facilitate integration of ideas, but students in their first year often struggle to recognize connections presented in a single-palette style. This abstract describes the use of single-palette presentation concepts incorporated into slide-based presentations to promote analytical development and student engagement.

METHODS: Incorporation of non-linear features into a linear presentation format evolved over seven years. Designed to appear in early sessions as a slide-to-slide presentation, presentations are initially developed on a single-palette. Students are given slides that match presentations, and before-class review a podcast of basic principles. The “big picture” is then presented on the opening slide like a single-palette presentation. Visual disruptions that most single-palette programs present during slide transitions are minimized. Concepts are presented in patient-centered vignettes, and presentations become single-palette in later modules as students begin to connect and correlate concepts.

RESULTS: Large-group presentations incorporating single-palette concepts are now given in 12 of the 37 weeks that comprise our first year curriculum, and include physiology of membrane, musculoskeletal, bone, pulmonary, gastrointestinal, and endocrine/reproductive topic areas. Student acceptance of single palette delivery improves throughout the first year, and student performance remains stable in the face of progressively more integrated topics and analysis-based assessment items.

CONCLUSION: Students early in their medical education career struggle with transitioning from a memorization-heavy, slide-to-slide approach to learning to the integrated, concept-driven, and application-based learning required by a case-based, clinically oriented basic science curriculum. Constructing presentation methodologies that facilitate this transition help ease the cognitive burden on early career students and allow matching of classroom demands to student development.


421 – A STRATEGY TO INCREASE LIVE LECTURE ATTENDANCE AND ENGAGEMENT
Raquel P. Ritchie, Carol A. Wilkins, and Martha A. Faner
Michigan State Universite College of Osteopathic Medicine

PURPOSE: Class attendance offers opportunities for interactions with faculty and fellow students and for peer-to-peer teaching and learning, both of which foster inter-personal/communication skill development. At Michigan State University College of Osteopathic Medicine, we (Biochemistry course) have tested the use of i>clickerTM questions that contributed points toward course grade as an incentive for class attendance and engagement.

METHODS: Students had the opportunity to earn 3 points (2.4% of total course grade) by attending class and participating in clicker sessions. Each clicker session started with a “checking the date” question followed by 2-4 “scientific content questions.” To earn a point, a student had to answer at least one of the “scientific content questions” correctly.  The Biochemistry course contained 17 lecture days and 15 of these contained a clicker session.  At the end of the course, the faculty selected three dates (based on a combination of highest average score and attendance) that counted for one point for a total of 3 possible points.

RESULTS: In the four years since we implemented this clicker experiment, lecture attendance (~87%) was higher than in previous years (~10%).  Quite strikingly, on the day that there was a clicker session, the number of students accessing the live-streaming and on-demand lecture library was lower not only for the Biochemistry course but also in other courses (Physiology, Genetics) as well.  The number of students accessing the online lecture library for the other courses increased substantially when there was no Biochemistry clicker session.

CONCLUSION: Using clicker participation to earn points as an incentive, we have been able to increase class attendance not only in Biochemistry but also in allied science courses as well.  Attendance and engagement during class appear to be effective in comprehension of content, as evidenced by the lower number of students accessing the online lecture library.


422 – TRANSITIONING PHARMACOLOGY CONTENT FROM MEDICAL TO DENTAL SCHOOL EDUCATION
Robert Theobald
A. T. Still University of Health Sciences

PURPOSE: Many universities have multiple professional schools including medical, dental, and other healthcare professional schools, utilizing the same faculty to provide education to students of these schools. A basic science survey of pharmacology education in dental schools revealed substantial program variation in hours, faculty, curricula, and other properties (Gautam, etal, 2013).  Additionally, most faculty are not trained in education, and have difficulty transitioning content to provide student relevance in different schools.  This presentation describes our faculty process and progress in this transition

METHODS: The same ATSU-Kirksville Campus faculty deliver content to medical and dental school students.  The Missouri School of Dentistry & Oral Health, MOSDOH, curriculum is an immersion curriculum with content delivered in blocks. Pharmacology, a TBL formatted course, was blended into this model. The MOSDOH inaugural Class of 2017 had a very tightly controlled content delivery schedule with traditional content such as basic principles and autonomic pharmacology, antimicrobials and pain control in year D1 and systems pharmacology covering the rest of pharmacology in year D2.  To implement and integrate MOSDOH’s pharmacology curriculum, faculty met with MOSDOH’s director of curriculum for planning multiple times each year, adjusting curricula and content, particularly discussing the transition of medically relevant  content to dental relevant content.

RESULTS: Since MOSDOH’s inauguration, changes in the pharmacology curriculum have occurred yearly to improve student understanding and retention of content, including number of lectures per pharmacology topic, modified integration with other content, order of topic delivery, and changes in relationship to other content delivery. Curricular changes have improved student short term performance determined by quizzes and exams, and have not hindered student board performance with pass rates at or close to 100%.

CONCLUSION: Curricular changes improving student content short term retention during educational years does not have a negative impact on student board exam performance.


423 – A HYBRID PRECEPTOR-SIMULATED CLINIC FOR THE DELIBERATE TEACHING AND PRACTICE OF INTRODUCTORY CLINICAL SKILLS
Roshini Pinto-Powell, Adam Weinstein, Terri Eastman, Tony Kidder, and Charlotte Beaton
Geisel School of Medicine at Dartmouth

PURPOSE: It has been difficult to get community preceptor sites to teach clinical skills due to productivity demands, the EMR, and our rural location. We created a hybrid preceptor-simulated clinic for students to receive consistent, comparable clinic experiences in our Doctoring course.

METHODS: Our clinic runs 4 days/ week and requires 3 preceptors, 6 rooms, 6 simulated patients and 2 clinic managers/day. Students in pairs attend 10 clinics over 8 months and see 2 patients/session. Preceptors supervise 2 student pairs in two adjacent rooms, observing and providing immediate feedback. Students also receive feedback from the patients and from peers. History, physical exam and presentation skills are practiced each session. A competency based tool provides formative assessment, every third session. A comprehensive summative assessment is planned after the tenth session. Students will then transition to community clinics for the rest of Year 1 and 2. Students’ clinical skills are assessed with an end of Year OSCE.

RESULTS: Students value direct observation and feedback from preceptors, patients and peers. They felt the safe learning environment and guided practice would help ready them for their eventual community clinics. Preceptors note the joy of teaching without the burden of time pressures and EMR documentation. Coordination of cases with our syllabus and the ability to create “longitudinal” simulated patient cases were a bonus.

CONCLUSION: A hybrid preceptor-simulated clinic is a timely solution to the national crisis of recruiting clinical sites in the pre-clinical years. This innovation is generalizable and scalable. Funding this program at our institution has been a break even proposition in terms of cost.

We are studying best practices for this model in terms of preceptor oversight, optimal number of cases and how to fine tune the schedule. We are also studying outcomes in terms of satisfaction, changes in performance and preparedness for clinic in year 2.


424 – USE OF AN EXPERIENTIAL DRUG ‘SHOPPING’ TECHNIQUE TO DEVELOP MEDICAL STUDENT COMPETENCE AND CONFIDENCE IN NAVIGATING COMPLEX OVER-THE-COUNTER (OTC) THERAPEUTIC SCENARIOS
Susan Ceryak, Tracy L Yarbrough, Marieke van Haaren, Katherine Kennedy, Travis O’Brien, and Veronica Michaelsen
The George Washington University and California Northstate University

PURPOSE: As the availability of over-the-counter (OTC) remedies expands, medical students need to develop facility in patient-centered decision-making to best address the use, risks and benefits of OTC remedies in treatment plans.  The use of experiential techniques in preclinical pharmacology contexts may provide the opportunity to analyze OTC therapeutics in a safe environment wherein complex patient-centered scenarios can be explored.

METHODS: An explanatory mixed methods design, consisting of surveys and narrative reflection, was employed to address the following question: To what extent does the use of an experiential approach contribute to students’ understanding of the complexities in navigating OTC therapeutic scenarios?

Study participants included second-year medical students enrolled in a systems-based curriculum. Students participated in a retail OTC “shopping” experience to select remedies for virtual patient symptoms. In a subsequent workshop, these patient scenarios were then expanded upon, with discussion of patient-centered decision making. Students completed online surveys before and after the session, and descriptive statistics were derived. Student reflections were analyzed by open coding and theme identification, with cross-checking of codes and themes between investigators.

RESULTS: Student confidence in helping patients choose OTC remedies (assessed on 7-point Likert-type scale) was significantly increased from 4.89 to 5.32 post-session (p<0.001). In post-session reflections on patient-centered decision making, students cited the number of options, label readability, and patient understanding as potential barriers to selection of OTC remedies by their patients.  Moreover, students appreciated the need to advise patients on contraindications, adverse effects and drug interactions when selecting OTC therapeutics.

CONCLUSION: These data support the hypothesis that the use of a focused shopping experience improves student recognition of the complex interplay between patient-centeredness and evidence-based medical practice in evaluating OTC products.


425 – Piloting of an Interprofessional Education Case-based Module for Central Line Placement Training of Health Profession Students
Teresa Whited, Kevin D. Phelan, Mark J. Tanner, Gregory R. Snead, and Cathrin Carithers
University of Arkansas for Medical Sciences and University of Nebraska Medical Center-Kearney

PURPOSE: Health care profession students must learn to work in teams to deliver safe, effective health care. We have developed interprofessional (IP) case-based modules focused on clinical procedural training using lightly embalmed cadavers. Findings from the first module developed and implemented on central venous line (CVL) placement will be reported.

METHODS: An IP case-based scenario was developed for a patient needing CVL placement under ultrasound guidance with subsequent dressing change. Medical, baccalaureate nursing and advanced practice registered nursing students were placed on teams of 4-5 (e.g., 2 M1 medical, 2 junior BSN and 1 APRN). Teams were asked to preview an evidence-based journal article and online video. One team worked to treat the patient and place the CVL while the other team watched via a live-feed. The teams switched after a debriefing session. Pre/post session surveys included a modified 20-question Interprofessional Collaborative Competencies Attainment Survey and an online evaluation of the IP event.

RESULTS: All 20 of the collaborative competency questions significantly increased after the IPE session (7 point LIKERT scale, 10 with p<0.01 and 10 with p<0.001, paired t-test, n=14). The greatest increases were in the IP competency Roles and Responsibilities “understanding the abilities and contributions of IP team members, recognize how others’ skills and knowledge complement and overlap my own, and identify and describe my abilities and contributions to the IP team”. Students rated the IP experience as 9.25/10 and indicated they would attend other similar sessions. Communication and teamwork were areas noted by students as being both strengths and weaknesses.

CONCLUSIONS: The use of lightly embalmed cadavers allows for simulation of real clinical case-based scenarios in a stress free environment where students can apply clinical knowledge and skills and learn to work as an IP group. This approach builds communication and teamwork skills central to improving patient safety and quality outcomes.


426 – Achieving higher levels of learning using flipped classroom and TBL methods in conjunction
Thejodhar Pulakunta, Ali Alkhawaji, Akram Jaffer, and Gary Allen
Dalhousie University

PURPOSE: An Introductory Anatomy course available exclusively to students of the BSc Medical Sciences program was offered for the first time in  2017.  Most of these students aspire to go to Medical school. Since medical education has been evolving into the realms of active learning and self-directed learning, trying to achieve higher levels of learning , we wanted to give our students a taste of what is to come.

METHODS: Before class, students are expected to view short videos of  5-minute duration, that were made available along with other learning resources through the learning management system. During class, a TBL style quiz with IRAT and GRAT was conducted. This was followed by a discussion and the session ended with a 5-minute mini lecture. We collected student feedback on this method of learning and compared student performance on the summative tests on concepts taught this way against concepts taught with traditional lectures.

RESULTS: Students perceptions were strongly favorable to this active learning format. The students performed better on questions that involved application and integration from the content taught with this method than with traditional lectures. However, student scores on questions that involved foundational knowledge did not depend on how it was taught.

CONCLUSION: Early exposure to active learning methods will generate more positive perceptions towards them in later years of education. Flipped classroom TBL combo method has helped make better use of the class time to discuss application and integration of foundational knowledge whereas traditional lecture style only allowed time for teaching foundational knowledge.


427 – STUDYING INTERNATIONAL HEALTH RIGHT WHERE THINGS HAPPEN – ELECTIVE COURSE AT THE UNITED NATIONS IN GENEVA
Verena Meyer zu Westrup, Helmut Ahrens, and Klaus Berger
Münster University Medical School

PURPOSE: With the interest in global health issues steadily increasing among German medical students, med school faculties are required to integrate relevant international content into their curricula. Previously lacking any formal public health courses, Münster medical school introduced an innovative method to help students gain deeper insights into international public health topics.

METHODS: 25 medical students between 6th and 10th semester were selected to participate in the elective course “Introduction to International Health” according to previous experience with global health along with proven interest in international assignments. Following an initial meeting, participants were assigned specific internationally relevant health topics to prepare individually through self-initiated study. Results were presented and graded during two mandatory presence days followed by a three-day study tour to Geneva, Switzerland, covering several health-related United Nations agencies. Presentations by professional Geneva-based staff were combined with structured interviews of medical and technical officers. Data on students’ knowledge and attitudes towards global health work were collected before and after the course and compared to gain information on course impact. All compiled information was documented and published online to gain transparency into coursework, to trigger student performance and to increase learning impact beyond the circle of participants.

RESULTS: Participating students gained deep and firsthand insight into global health related issues through professional stakeholders and exactly at venues of current decision-making. Evaluation of the course revealed an even more increased interest and willingness to engage into global health assignments after graduation, especially towards health emergency crises settings.

CONCLUSION: The concept of self-learning boosted intrinsic motivation to self-analyze intellectual capacities and to gain knowledge according to professionally relevant individual interest. The success of and ongoing demand for this course ensured its enrolment into the curricula of future semesters at Münster medical school.


428 – IMPACT OF SMALL GROUP, SERIAL-CUE DATA ACQUISITION, ON DIFFERENTIAL DIAGNOSIS OF WHOLE-CASE VIGNETTES
Michael Oglesby, Saira Dar, Srichand Jasti, and Sumihiro Suzuki
UNTHSC

PURPOSE: We tested the hypothesis that practice with serial cue presentation of clinical case features would improve the ability of pre-clinical medical students to perform differential diagnosis.

METHODS: Our pre-clinical medical curriculum encompasses a systems-based organization with a patient presentation focus. A core skill we teach to and assess is differential diagnosis. In our large classroom, students (approximately 220 in the class) work with physicians on this skill utilizing typical National Board, full-case-vignette questions that address differential diagnosis of each patient presentation. Approximately two-thirds of these patient presentations were also addressed in small group format (12 students with a clinician), in which features were revealed one at a time as students asked about presence/absence of features (serial cue approach). We therefore tested whether scores on examination items associated with training on whole-case-vignettes-only differed from items associated with both whole-case and serial cue presentation.

RESULTS: There were 403 items that addressed differential diagnosis in these examinations. When Items were associated only with whole-case vignette training, students averaged 83.4%. When Items were associated with both whole-case and serial cue training, students averaged 84.5% (p<0.0001, Repeated Measures ANOVA).

CONCLUSION: Ability to perform differential diagnosis of complete case vignettes was enhanced by addressing the patient presentations associated with the vignettes in a serial-cue training session. Results are limited because these examination items differed by patient presentations that were addressed, by the format in which training took place, and by time on task (serial cue training arguably required more preparation by students). Nonetheless, the data support a methodology for improving diagnostic accuracy of pre-clinical students.


429 – INTEGRATED INSTRUCTION OF SURFACE ANATOMY WITH MASSAGE THERAPY: IMPACT ON PHYSICAL EXAM SKILLS
Darren Hoffmann, Dede Dancing, and Marcy Rosenbaum
The University of Iowa Roy J. and Lucille A. Carver College of Medicine and Dancing Prairie Massage Therapy College and Pain Relief Center

PURPOSE: To strengthen student learning of musculoskeletal surface anatomy and provide opportunity for interprofessional education, an optional workshop course on basic massage therapy skills was provided to medical students during their gross anatomy course. Because this course provided opportunities for students to practice touching patients in a comforting manner, we hypothesized this experience would impact students’ perception of physical examination skills.

METHODS: The course consisted of four 2.5 hour sessions. Prior to each session, students were required to view instructional videos on relevant anatomy and massage techniques to prepare. The course was conducted six times over a four year period. For the qualitative study of impact on physical exam skills, a mixed-methods approach was used. First, students completed a course reflection survey after the course that addressed many aspects of the course. Second, repeated focus groups were conducted with 6-8 students from each of six successive courses.

RESULTS: Thematic analysis of focus groups and course reflections highlighted aspects of the course as beneficial for physical exam skills: practice touching different people each week, learning how to drape while respecting patient modesty, and using anatomical landmarks to guide work. They reported that the course allowed them to develop several key physical examination skills: how much pressure is necessary, how to use your hands to comfort a patient, and how to address examination of sensitive areas (e.g. inguinal lymph nodes). Students also indicated that receiving massage and being draped allowed them to develop empathy for future patients.

CONCLUSIONS: The results of this study demonstrate that practicing touch in the context of surface anatomy is an opportunity for students to also learn about physical examination. This study illustrates an effective model for integrating anatomy with interprofessional education, and reveals unexpected benefits beyond the scope of the typical anatomy course.


Poster Award Nominee:
430 – Improved performance in gross anatomy and microanatomy using mind maps
Yenya Hu and Hong Gao
Wake Forest School of Medicine

Purpose: Mind map is a teaching and learning strategy where information is organized into hierarchies and illustrated diagrams and may help students organize materials and retain them over time as the strategy activates multiple sensory systems. The aim of this study is to determine whether this strategy improves the performance in anatomy and physiology in an integrated anatomy and physiology course

Method: Mind maps with course content were introduced to the class at the start of medical school and the software Mindomo was used to generate mind maps. Pre-made mind maps were provided for microanatomy and physiology contents and the students were encouraged to create their own maps. The performance for this cohort of 137 students in gross anatomy, microanatomy, and physiology were compared to those from the previous cohort of 130 students that took the same final comprehensive examination a year ago when mind maps were not formally introduced. Medical College Admission Test scores (MCAT) were used as the baseline for basic science knowledge. A survey was conducted to get the student perspectives on the use of mind map.

Results: No significance was found in the MCAT scores (F(1, 259)=2.04, p >0.15) between the cohorts. However, MS21 significantly outperformed MS2020 in both gross anatomy (F(1, 265)=9.26, p <0.01) and microanatomy (F(1, 265)=42.3, p<0.01), but not physiology (F(1, 265)=3, p>0.08). The survey respondents (74% response rate) found the pre-made maps were useful (77%). The maps were helpful in setting up frame work (77%), actively learning through synthesis and summarization of vast information (70%), simplifying and organizing ideas (81%), and facilitating integration of information (72%). Additionally, 40%, 43%, and 56% of them created their own maps for gross, microanatomy, and physiology, respectively.

Conclusions: Mind map could facilitate the organization and visualization of structures and impact knowledge integration.


431 – LEARNING BY OBSERVING: ANCHORING NEW UNDERSTANDINGS THROUGH LEGITIMATE PERIPHERAL PARTICIPATION, A PILOT STUDY
Joel Roberts, Jill Pitcher, Tina Underwood, and Francina Towne
Rocky Vista University

PURPOSE: Legitimate peripheral participation is akin to an apprenticeship in which a less experienced student observes a more experienced student. The apprentice develops an understanding of the skills and knowledge necessary to become a professional. Master of Science in Biomedical Sciences (MSBS) Programs heavily emphasize the didactics of basic sciences. Students struggle to assign appropriate value and retain basic science knowledge without adequate exposure to clinical and diagnostic applications. We have pursued an innovative approach by integrating MSBS students and second year medical students into an inter-disciplinary standardized patient simulation with emphasis on MSBS students gaining clinical context and deeper understanding of basic science.

METHODS: This encounter involved a standardized patient presenting with respiratory complaints. 54 second year medical students volunteered to participate and 27 MSBS students participated. In preparation, MSBS students researched 6 significant respiratory disease processes, wrote 10 discussion questions, and completed a pre-survey. Medical students and MSBS students were paired and performed the encounter together under the leadership of the medical student. Afterward students discussed the differential diagnosis, primary diagnosis, clinical reasoning, and discussion questions. Both attended a case debrief and completed follow-up surveys.

RESULTS: In the initial survey the majority of MSBS students reported an improved understanding of basic science concepts and how their basic science courses fit into clinical medicine. Survey data suggested that MSBS students may have felt a greater sense of student community after the encounter. Additionally, MSBS student average a scores for pulmonary physiology were the highest of any physiology assessment during the semester.

CONCLUSION: Inter-disciplinary standardized patient simulations may provide master’s students with clinical context and improved understanding of basic science curriculum. Additionally, master’s student’s feel more integrated into the overall university community. Work in progress includes a second encounter, and standard pre/post encounter knowledge assessments.


432 – Game On! Designing Educational Games for Healthcare Students
Melissa Murfin
Elon University

PURPOSE: Applying elements of game theory to the large volumes of material in medical education courses offers students a new way to process information and connect with what they’re learning. This benefits many learner styles as well as promoting a more engaging approach to knowledge attainment and retention. The variety of game formats available allows students to interact in team-based problem solving exercises or material review.

METHODS: Educational games based on popular television game shows and board games were utilized in pharmacology courses with cohorts of 38 physician assistant students over 5 years. Games focused on a variety of topics and were primarily used to review material prior to an exam. Games included: HIV Jeopardy, Antihypertensive Pictionary, Endocrinology Hedbanz, Pulmonary and Musculoskeletal CatchPhrase, Antibiotic Candyland, and Behavioral Medicine Clue. Each cohort of students was surveyed at the end of the pharmacology course series with an optional, anonymous questionnaire designed to determine their perception of the use of games in class.

RESULTS: A total of 102 students completed the surveys for an overall response rate of 54.3%. Students who completed the survey generally enjoy the games and were familiar with the formats utilized. Most students preferred multiplayer to individual games and preferred the games to traditional lecture-based review of course material. Respondents were split on whether the games helped improve their test scores, but generally felt the games helped in reviewing the course material.

CONCLUSION: At least half of the PA students in pharmacology classes in one PA program enjoyed the use of games-based learning techniques and preferred this format to traditional lecture-based review. Further study is needed to determine if games-based learning improves outcomes for students in the pharmacology course series.


433 – THE USE OF SELF-TESTS IMPROVES MEDICAL STUDENT PERFORMANCE ON NEUROSCIENCE EXAMS DURING THE PRE-CLERKSHIP PHASE
Diana Pettit, Dolgor Battar, and Subodh Potla
TTUHSC El Paso

PURPOSE: Cognitive psychology research suggests that repetition of new learning material is critical for retention. This repetition is more effective when it occurs as repeated testing. Previous work has shown that self-tests improve outcomes for formal Immunology exams. However, it is unclear whether these benefits would apply to all disciplines. Here we have examined the effect of self-testing on student performance on Neuroscience concepts. We have found that self-testing improves test outcomes for Neuroscience test items.

METHODS: To address this question we have created a series of short tests corresponding to specific learning objectives from our Neuroscience curriculum for first and second year medical students. Students had unrestricted access to the tests, and could take as many times as desired. Each self-test item was linked to an explanation of each the concept tested to provide immediate feedback. Self-test usage and scores were recorded and compared with the student performance on summative examinations.

RESULTS: Student surveys showed that self-tests are popular learning tools among medical students, earning high evaluation marks. We compared performance on Neuroscience questions of students using the tests against those of students who did not use self-tests. Regression analysis showed that self-test use significantly improved student performance for first and second year students on Neuroscience questions on our Summative and Formative exams.

CONCLUSION: We found that the use of self-tests is associated with improved performance on Neuroscience exams. Given the complexity of some Neuroscience concepts, these results suggest that Neuroscience self-tests should be a required part of medical education.