Session 1 – Assessment
1 – ESTIMATION OF CIRCADIAN RHYTHMS AMONG MEDICAL STUDENTS AS A TOOL TO HELP TIME MANAGEMENT ORGANIZATION
PURPOSE: Time management is one of the biggest problems of medical students. A lack of time management can lead to anxiety, stress and poor sleep habits. Effective time management methods are dependent on circadian rhythm. In this study, we examined the circadian rhythms of medical students and factors which may affect academic performance: perceived stress, sleep quality, time management.
METHODS: Seventy-three medical student volunteers (33 males and 40 female; mean age =24.7 years, SD =2.3) answered a Morningness-Eveningness questionnaire, the Time Management Personal Assessment questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Perceived Stress Scale questionnaire. Relationships between obtained data and academic performance were analyzed by multiple regression.
RESULTS: Chronotype distribution showed: 55% students with an indifferent type, 22.5% with a moderate morning type, 12.5% with a moderate evening and 10% with definite morning chronotype. The correlation (R=0.87) between chronotype and GPA was significant (P<0.001) showing a higher GPA in students with morning chronotypes.
The PSQI analysis showed 47% of the students had poor sleep quality; there was a correlation (R= – 0.56) between the PSQI and GPA (p< 0.04), supporting a link between higher GPA and good sleep. There was no significant relationship between GPA and perceived stress level (p>0.7). Results also showed a correlation (R=0.59) between time management and GPA (p< 0.01), implying that the students with excellent time management skills (10%) had excellent GPAs. Those with bad skills (10%) had worse GPAs. However for 65% of the volunteers, guidance is needed to increase skills.
CONCLUSION: Chronotypes, quality of sleep and time management, influence GPA and can be used as a guidance tool for academic advisors.
2 – DEVELOPING HEALTH SCIENCES FACULTY MEMBERS AS T-SHAPED PROFESSIONALS
PURPOSE: In business and STEM fields, employers are recruiting and developing “T-shaped” professionals, who possess a suite of soft skills, such as communication and leadership (top of the “T” diagram), along with comprehensive knowledge or expertise within a particular discipline or subject area (base of the “T”). Faculty development offerings at Baylor College of Medicine are being reframed to develop a suite of faculty professional competencies, and the abilities of faculty to teach these skills to students through active learning approaches.
METHODS: Institution-wide faculty surveys have identified soft skills learning needs related to career progression that are outside of faculty discipline-specific and technical competencies. The T-shaped professional model is being applied as a framework to define the scope of faculty development offerings and to distinguish those offerings from other kinds of technical or professional training (such as continuing medical education). New programs involve faculty members from clinical and basic sciences departments and focus on leadership, teamwork skills, career planning and active learning.
RESULTS: Retrospective pre/post evaluations from new programs indicate that participants’ self-reported knowledge and efficacy has increased (statistically significant), with high levels of program satisfaction and willingness to participate in future programs.
CONCLUSION: The T-shaped professional model is serving as a guide for the selection of topics, and program development and delivery for faculty development programs. Results after one year of implementation are positive and are driving further offerings.
3 – IMPLEMENTING COMPETENCY-BASED MILESTONES ASSESSMENT IN THE PRE-CLERKSHIP MEDICAL SCHOOL CURRICULUM
PURPOSE: Clinicians require skills and attitudes beyond medical knowledge, and pre-clerkship faculty play an early role in developing these attributes in students. However, because of the heavy focus on medical knowledge during pre-clerkship training, programs often struggle to design experiences and assessments that prepare students for all aspects of clinical work.
METHODS: As part of a larger curricular revision, the pre-clerkship phase was redesigned to promote desired competency outcomes by incorporating regular small group team-based active-learning sessions and patient-focused formats. This enabled a transition from grading pre-clerkship student performance primarily via knowledge-based examinations to evaluating students across multiple ACGME core competency domains: medical knowledge, practice-based learning and improvement, systems-based practice, communication and interpersonal skills, and professionalism. We now have four years’ experience using competency-based milestones language for qualitative feedback from faculty and peer assessors.
RESULTS: The use of competency-based milestones assessment has provided our medical students with rich and timely feedback on a diverse set of competencies during their pre-clerkship education. The competency milestones enable students to understand expectations across all domains. Pre-clerkship faculty feel this system acknowledges their ability to contribute to student development in all domains. The quality of peer feedback has become more specific and actionable.
The assessment strategy has allowed us to identify students with challenges in professionalism, communication, and systems-based practice that traditionally went undetected during pre-clerkship training. This has enabled coaching and remediation before students enter the clinical workplace. Students now expect and appreciate such feedback as part of their “coaching” to become better physicians.
CONCLUSIONS: The transition to competency-based milestone assessments encourages learners to shift their focus from grades to preparation for the profession and fosters habits of continuous self-improvement. Furthermore, it provides a richer learning environment for students and has allowed us to define predictors for student performance in the clinical years.
4 – Medical Student Benevolence: Characterizing the Effects of Personality, Emotional Intelligence, and Gender
PURPOSE: Scottish philosopher David Hume wrote that benevolence brings good-will and happiness through a person\’s generous concern and sympathy for others (Hume, 1751). Benevolence is a desirable quality for medical students to have prior to entry into medical school (Aswini, 2014), yet is difficult to detect in applicants, creating the need for an observable proxy. Associations between benevolence and personality traits (Lee, 2012) have been reported, but should be specifically examined for medical students.
The purpose of this study is to analyze the impact of personality, emotional intelligence, and gender on medical student benevolence,
METHODS: From 2014-16, 197 M-1/M-2 medical students voluntarily completed the following self-reported surveys: 50-item Five Factor NEO PI-R Personality Inventory (scale:1=very inaccurate/5=very accurate), 30-item Trait Emotional Intelligence Survey (1=completely disagree/7=completely agree), 56-item Schwartz’s Human Values Inventory (0=not important/7=supreme importance). Independent t-tests and Cohen’s d assessed mean score differences and effect sizes, respectively. Pearson correlations (r) assessed relational strength between personality, emotional intelligence, and benevolence. Analysis generated with IBM® SPSS® 24.0. This research was IRB approved.
RESULTS: There were statistically significant differences in benevolence (d=.22/p<.015), openness (d=.27/p<.034), agreeableness (d=.32/p<.032), neuroticism (d=.29/p<.029), and overall emotional intelligence (d=.27/p<.006) when split by gender, with females scoring higher than males in all domains.
Personality items of openness, conscientiousness, and agreeableness significantly correlated with benevolence for all students (r=0.3-0.5/p?050). Extraversion items correlated with benevolence for males; neuroticism items for females. Inter-personal emotional intelligence items (emotionality, sociability) significantly correlated with benevolence for all students (r=0.3-0.4/p?050). Correlations of benevolence and intra-personal emotional intelligence items were split by gender: well-being correlated for males, self-control for females.
CONCLUSIONS: Female medical students had higher benevolence scores than male students. Medical student benevolence is significantly associated with personality and emotional intelligence. Specific relational elements to benevolence are gender-specific: extraversion and well-being for males; neuroticism and self-control for females.
Session 2 – Curriculum
1 – Biomedical Science Undergraduate Major: Creating Academic Pathways to Advance the Health Professions
PURPOSE: In response to predictions of critical shortages of clinician investigators, the Biomedical Science (BMS) undergraduate major was created at The Ohio State University to attract incoming college freshmen with interests in scientific research and the health care professions. The intent of this major was to graduate an elite cohort of highly talented individuals who would pursue careers in the health care professions, biomedical research, or both.
METHODS: Students were admitted to the BMS major through an application and interview process. Admitted cohorts were small (22-26 students) and received individualized professional academic advising and mentoring. The curriculum included a minimum four semester research experience and specific BMS courses that emphasized research literacy, skills of a healthcare professional, independent learning, teamwork, and oral and written communication skills. An in-depth summer immersion experience provided a unique view of the actual life of a physician scientist or other health professional.
RESULTS: The average ACT score of our matriculants was 32.6 (university average, 28.9; national average, 21.0). The average high school class percentile was 95.5 (top 4.5%). 91% of graduates entered a post-baccalaureate program. In total, 120 manuscripts were published by the 121 students graduating from the BMS major (range 0-12, with 52 graduates (43%) having at least one peer-reviewed journal manuscript). Of the 60 students who participated in the summer clinical internship, 97% entered professional school (75% MD, 14% MD/PhD, 3% PhD, 5% other, 3% no advanced degree).
CONCLUSION: Ohio State’s BMS major has demonstrated its ability to enroll students with high aptitude, to provide students with meaningful undergraduate research and clinical experiences, and to create a pipeline for the health professions, academic medicine and biomedical research. Through this and similar programs, we may be able to develop the much-needed next generation of outstanding biomedical researchers, clinical investigators, and physician scientists.
2 – Designing and Implementing a Medical Humanities Longitudinal MS4 Elective Across Two Institutions
PURPOSE: Two significant challenges facing medical education are the decrease in empathy and increase in burnout over the course of medical school. Medical Humanities can help address these challenges by allowing learners to share stories and experiences with peers in response to written, visual, and performing arts. Utilized as a competency-based framework within a supportive learning environment, this work can positively impact students’ professional identify formation, as well as relationships with patients, colleagues, and society. We developed a longitudinal MS4 Medical Humanities elective at one medical school, which was subsequently adapted by a second medical school.
METHODS: The course is in its third year at Vermont and its first year at Hofstra Northwell. Students meet regularly with faculty over 10 months in off hours of their clinical rotations and receive credit for a two-week rotation. Brief assigned texts and open-ended writing prompts are provided and discussions are guided by the completed writing that students share in class. Participants draw on both personal and clinical experiences to create a supportive and engaged community of practice with peers and faculty facilitators. Data collection consists of pre/post completion of the Maslach Burnout Inventory (MBI), student writing and evaluations, and faculty impressions.
RESULTS: For both schools combined there are 22 students currently enrolled participating in 20 total weekly sessions that are each 2 hours long. Faculty members consistently observe students demonstrating self-reflection, empathy, and engaging in critical thinking about their own experiences and those of others. MBI results are pending and will be shared, in addition to student feedback.
CONCLUSIONS: Medical Humanities content structured in a longitudinal format offers opportunities for students to combat stress, find more empathy, and reconnect with the meaning they find in medicine. The core elements of the course are transferrable, and could be adapted at additional institutions.
3 – CURRICULUM IN QUALITY IMPROVEMENT – MEETING THE CALL IN UNDERGRADUATE MEDICAL EDUCATION
PURPOSE: There is wide-spread consensus by major professional and accrediting bodies, including the Institute of Medicine, American Association of Medical Colleges (AAMC) and the Accreditation Council on Graduate Medical Education in calling for an expansion and improvement of education in quality and health system improvement. One of the AAMC’s thirteen Core Entrustable Professional Activities for Entering Residency is “to participate in system improvement activities…plan-do-study-act cycles; root cause analysis, improvement projects”.
METHODS: A select group of thirty students, who participate in the quality improvement (QI) curriculum, see patients in the same clinic on a weekly basis over the course of their third-year of medical school. These students: 1) participate in a longitudinal series of interactive workshops that introduce QI methodology, 2) complete a group QI project, 3) complete interim assignments that guide them through the key steps of the QI process, 4) complete a summary poster and presentation. Students are encouraged to disseminate their work.
RESULTS: In year one of the curriculum, eight groups completed QI projects and presented the results of their work in a final oral presentation. Three of the groups disseminated their work at conferences; two of which received awards.
CONCLUSIONS: This curricular innovation is designed to provide graduates with practical experience and foundational knowledge in quality and health system improvement; a step towards closing the identified medical education gap to produce improvement-minded, systems-thinking providers that are better prepared to meet the future needs of our healthcare system.
Next steps include the implementation of published evaluation instruments to objectively assess the students’ knowledge of quality improvement and evaluate the quality of their QI projects: 1) Quality Improvement Proposal Assessment Tool, 2) The Quality Improvement Knowledge Application Tool Revised, 3) pre/post-curricular student self-assessment of proficiency in QI skills.
4 – Using Contact Theory to Improve First-Year Medical Students’ Compassion and Knowledge of Parkinson’s Disease
PURPOSE: The Parkinson’s Disease (PD) Buddy outreach program cultivated relationships between students and patients as an evidence-based method to help first-year medical students learn more about neurodegenerative disease and patient experience. Contact theory suggests that increased intergroup interaction reduces prejudice while increasing understanding and empathy. This study aimed to understand students’ knowledge about and compassion toward PD patients and whether such interactions decreased patients’ sense of isolation.
METHODS: First-year students from the University of Louisville were matched with PD patients from the Movement Disorders Clinic and the Parkinson’s Support Center. Twenty-five student/patient pairs participated in monthly social activities over nine months, and students received PD-related lectures. Students completed the following pre-post surveys: 1) a 25-item knowledge test, 2) a modified version of the Geriatric Attitude Scale (GAS), and 3) a relationship survey. Patients completed the following pre/post: 1) PDQ-39-assessing health-related quality of life in PD, 2) a short version Geriatric Depression Scale (GDS), and 3) a relationship survey. Three focus groups were conducted to understand relationship evolution/program improvement. Qualitative data was analyzed using thematic analyses.
RESULTS: Students’ PD knowledge scores significantly improved (M=14.2 to M=19.3, P<0.05) following the program. Students’ baseline GAS scores were high and did not show additional improvements. Eighty-two percent of students reported on their relationship survey that they were satisfied with their buddy interactions. The increases in patient’s PDQ (M=26.7 to M=31.6, P=0.48) and GDS (M=2.1 to M=3.1, P=0.23) scores were not significant, but qualitative analysis showed that patients found the experience to be invigorating and students gained a richer understanding of the PD patients’ experiences.
CONCLUSIONS: The PD Buddy Program utilized contact theory in addition to traditional content lectures to help medical students build a deeper understanding of the PD patient population. Students benefited from the non-medical learning experiences while patients benefited from increased socialization.
Session 3 – Student Presenters
1 – ASSESSING NOVEL SPECIFIC THORACIC FAST EXAM BY COMPARING PEER-TO-PEER VIDEO TUTORIAL VS “HANDS-ON” TUTORIAL USING VIMEDIX ULTRASOUND SIMULATOR
PURPOSE: The current successful FAST (Focused Assessment using Sonography in Trauma) exam essentially assesses the abdomen with minimal viewing of the thorax and pelvis. Life-threatening and/or serious pathology is common in the thorax. FATE (Focused Assessed Trans-Thoracic Exam) has also been described, using echocardiography to determine if fluid accumulation or structural insults occurred to the heart or lungs, consisting five views which are visualized from three locations on the patient’s surface anatomy. Point-of-care ultrasound can be utilized by the physician in acute and chronic clinical settings to rapidly assess structures of the thorax. The objective of this study was to compare the effectiveness of hands-on tutorial (HOT) vs video-tutorial (VT) with identical content for training medical students (MS) on conducting FATE.
METHODS: Literature search was conducted comparing video and hands-on tutorials training medical students on FATE. 29 MS who had no experience on FATE received a 5-min peer-to-peer tutorial (13HOT,16VT) on probe choice, probe placement, surface anatomy landmarks, structural identification and fluid accumulation of image acquisitions from Vimedix simulated ultrasound system (VSUS) in the thorax. MS were assessed on the FATE exam 24 hours post-tutorial on the criteria above (30-point system) and timed. MS scored their confidence on Likert scale out of 10.
RESULTS: Literature search revealed no known studies. MS scored 16±6 points and completed the FATE exam in 101±51s. MS who received HOT scored significantly higher (+4,p<0.05) and reported higher confidence (+5,p<0.05). There was no significant difference in completion time. Today’s learners acquire procedural skills more efficiently via multimodal stimulation, and HOT, which contains identical information with VT, combines palpatory, proprioceptive, and dynamic hand-eye coordination on top of auditory and visual information.
CONCLUSION: This study demonstrated hands-on demonstration enabled more efficient acquisition of FATE skills than video-tutorial on VSUS for novice practitioners. Regardless of tutorial method, this study suggests VSUS is a powerful simulator.
2 – MOTIVATIONAL INTERVIEWING WORKSHOP FOR FIRST YEAR MEDICAL STUDENTS: EVALUATING THE OUTCOMES OF A BRIEF INTERVENTION
PURPOSE: Motivational Interviewing (MI) is a patient-centered counseling technique used to promote behavior change in individuals. There appears to be a limited number of published outcome studies on the use of MI with pre-clerkship medical students. For this study, we designed a 2-hour workshop for first year medical students. We then measured knowledge gained about MI techniques, how likely participants were to incorporate MI into their future clinical work, and evaluated the workshop format and teaching techniques.
METHODS: Twenty-eight first year medical students participated in a MI workshop, offered at three different times. The workshop content and design were adapted from MINT’s (Motivational Interviewing Network of Trainers) Resource Library, and included an interactive lecture and a role-play activity. Students completed a pre- and post-test multiple choice quiz designed by the researchers based on the workshop content. A workshop evaluation included a Likert-scale and open-ended questions. The knowledge quiz was analyzed using a paired t-test to compare pre- and post-test mean scores. The workshop evaluations were analyzed using simple mean calculations and qualitative analysis of open-ended question.
RESULTS: The mean score of the knowledge quiz increased pre-and post-test from 59.3% to 83.2% (p<.001). All of the participants in the workshop reported that they would either be “very likely” (71.4%) or “somewhat likely” (28.6%) to incorporate MI techniques into their future clinical work. Responses to the open-ended questions on the workshop evaluation were overwhelmingly positive, e.g, “This was useful and I will be applying this to my next patient interview”. Many participants listed the role-playing scenarios as the most valuable part of the workshop.
CONCLUSION: A workshop to train first year medical students in the use of MI skills was successful and appears to have implications for future clinical work. MI skills are likely valuable throughout training, and ideally should be incorporated into the pre-clerkship curriculum.
3 – ROBOTIC VIRTUAL-REALITY: OPUS MINI HAPTIC ULTRASOUND SIMULATOR DEVELOPING POINT-OF-CARE SKILLS AND SPATIAL ANATOMY FOR INTERSCALENE BLOCK
PURPOSE: Point-of-care ultrasound local nerve blocks are commonly used in adults to attenuate postoperative pain and in pediatrics for fracture reduction and pain relief. Interscalene blocks are important for shoulder, wrist, and hand reconstruction, and upper limb fracture surgeries. Early training with ultrasound simulation integrated with live scanning may maintain or accelerate ultrasound skills. Medical students (MS) with ultrasound basics could allow residency programs to accelerate ultrasound training. The objective of this study was to assess if medical students can operate OPUS-Mini Medical Skills system (OMMS), performing interscalene blocks during cadaver dissections and examinations.
METHODS: Literature search was conducted regarding OMMS integrated into a medical school curriculum. OMMS is an ultrasound simulator incorporating haptics technology to create lifelike experiences on split screen viewing of cross-sectional anatomy/ultrasound imaging while performing interscalene blocks. First-year MS (n=18) received formal 20-minute tutorials using the OMMS with supplementary 3D clay model. Each student was mentored using OMMS and had access to practice 24/7.
RESULTS: Students successfully acquired skills and relevant anatomy for interscalene blocks. 94/105 (89.5%) accurately identified structures and performed blocks during formal anatomy assessment. Literature search revealed no known studies with OMMS. Ultrasound is a mandatory skillset in many residencies. Medical schools are introducing students to ultrasound fundamentals during basic science/clinical years, developing a baseline while cultivating probe-time and image acquisition. Cadaver dissection, 3D clay model palpation, observations, invasive procedures, cross-modal perception, and simulation were employed during an anatomy course. Likert scale survey revealed students strongly supported skills associated with OMMS, especially during dissections. This pilot study will now be applied to sciatic and scalene blocks during other dissections.
CONCLUSION: This study successfully integrated OMMS ultrasound simulation with haptic technology and split screen cross-sectional anatomy/ultrasound imaging, obtaining skillsets during an anatomy dissection course.
4 – Teaching cardiology in medical school with Microsoft HoloLens
PURPOSE: Microsoft HoloLens is an augmented reality headset that integrates three-dimensional holograms with reality. Its ability to demonstrate complex spatial relationships makes HoloLens well-suited for teaching anatomy. This study aims to determine whether HoloLens adds value in teaching cardiac anatomy and physiology, and to investigate the optimal strategy for implementation into a medical school curriculum.
METHODS: Subjects were 32 first-year medical students at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Two HoloLens modules were developed for the 7-week cardiology block. Students explored the first module, designed for self-study, individually during week 1 and the second module in a faculty-guided group during week 7. Surveys were sent out after each module, asking students to rank HoloLens and traditional components of the curriculum (assigned reading, other reading, online videos, seminar, and problem-based learning) in terms of cognitive load, efficiency, helpfulness, enjoyment.
RESULTS: We received 14 and 28 responses for the first and second survey, respectively. In comparing the two sessions, students felt the HoloLens contributed more to their learning during the second session (p=0.024) and that it was more enjoyable (p=0.081). There was also a clear trend that HoloLens decreased cognitive load in the faculty-led session (p=0.096). Additionally, the majority of students (64%) agreed that HoloLens would enhance the way cardiology is currently taught.
CONCLUSIONS: Our study reports the first impression of first-year medical students using HoloLens to learn concepts in cardiac anatomy and physiology. HoloLens appears to be a favorite among students in terms of efficiency in learning and enjoyment. Furthermore, HoloLens may be more effective as an educational tool and decrease cognitive load for students when taught in faculty-guided sessions as compared to self-study mode.
Session 4 – Instructional Methods
1 – Participatory Group Activity Approach for Teaching Biostatistics to Medical Students
PURPOSE: Introductory medical school instruction in biostatistics should be \”fit for purpose.\” Many clinicians need biostatistics solely to understand the literature, and for decision-making (with respect to choice of diagnostic tests, for example). Formal mathematical development, and software, can be forgone in favor of a firm intuitive grasp of clinically applicable concepts. This paper presents my original group activities which involve students cooperatively for best learning outcomes, effectively and efficiently imparting an understanding of statistical concepts.
METHODS: The primary example concerns sensitivity, specificity, and the influence of prevalence on the predictive value of a screening test. Only one instructor is needed for all the medical students. Groups receive data concerning sensitivity and specificity (identical for each group), and calculate predictive values using a specified prevalence (which secretly varies from group to group). During a class discussion of the utility of the test, students realize that changes in prevalence alone have caused inverse gradients in predictive values. This observation becomes a permanent part of their knowledge base and does not need to be memorized. In another activity, small groups draw samples from a shared population and construct confidence intervals on proportions. Some groups are then identified as having confidence intervals which would lead to erroneous conclusions due to peculiar samples. The observed impact of sampling fluctuation is memorable.
RESULTS: At the reaction level, student reviews of biostatistics instruction are enthusiastic. Students perform well on biostatistics course exams and statistics questions on national board exams. Residency directors consider our graduates capable at interpreting the literature.
CONCLUSIONS: A participatory group activity approach to teaching biostatistics can use minimal resources – one instructor per session across all small groups simultaneously – and can be a popular and effective technique for provoking an intuitive understanding of biostatistical concepts that future clinicians will need.
2 – Adapting Case-based learning to the Large Group Lecture Hall
PURPOSE: Large group lectures are an efficient way of presenting the volume of necessary basic science material to pre-clinical medical students in a standardized way. In contrast, small group exercises devote classroom time to problem sets or cases proctored by multiple subject matter experts. While there are several studies showing positive effects from utilizing the small-group model in medical education, barriers to implementation include the need for many faculty members participating simultaneously thus straining clinical efficiency. We present a hybrid model that combines the advantages of large-group lectures with small group exercises.
METHODS: A large-group interactive session was designed in which two subject matter experts present a series of 6 Reproductive Pharmacology clinical cases requiring knowledge of previously presented material. Students divide into multiple small groups within the lecture hall and work on answers in class which are then discussed aloud in the large group. Students were queried regarding the acceptance of this methodology as well as on their knowledge and confidence with the material. Attendance was not required commensurate with other large-group activities. Survey participation was voluntary, yet encouraged by including practice test questions.
RESULTS: The session was successfully implemented. Attendance was similar to the usual attendance at large-group lectures. Participating students expressed dismay at being asked to answer aloud on lecture-capture for the benefit of students who chose not to attend the session. Knowledge and confidence levels for the material covered in this fashion were comparable to levels for other material presented in the Reproductive Medicine Block.
CONCLUSION: A large group model that encourages collaboration and synthesis of knowledge within teams yet preserves the uniformity and efficiency of material delivery with limited instructors is feasible. Respecting differing learning styles is a challenge when choosing attendance policy.
3 – Collaborative learning activity utilizing evidence-based medicine and personalized patient care: instructing on lifestyle management for the prevention of cardiovascular disease
Purpose: Lifestyle medicine education (including nutrition and exercise) is emerging as an under addressed but highly important and timely topic in medical education.
Approach: We developed an innovative collaborative session in the pre-clinical medical curriculum that integrates evidence?based medicine (EBM), clinical decision making, nutrition, exercise and personalized patient care for the instruction of lifestyle management to prevent CVD. Several competencies in patient care were targeted. Learners critically appraised an EBM article on the effect of Mediterranean diet for prevention of CVD. In class, there was a collaborative activity where learners solved a common clinical scenario, of a patient with high risk for CVD. Due to the patient’s time and budget restrictions, he can only eat from local fast food restaurants. The collaborative task was to recommend an activity plan and a meal plan from a fast food restaurant, with caloric and nutritional content matching the Mediterranean diet. Change in the student’s confidence level in discussing lifestyle changes for prevention of CVD was assessed using a pre and post intervention question with a 5 point Likert scale.
Results: Before the session, students (N=21) reported being extremely confident (10%), very confident (5%), confident (29%) and slightly confident (57%). After the session, student’s confidence level improved as most students (44%) reporting being extremely confident, 28% very confident, 22% confident and 4% slightly confident. Qualitative analysis of each team’s product showed that all teams successfully completed the tasks. In addition to these, most groups recommended a particular exercise intensity and duration, a change in activity behaviors and the need for social support.
Conclusions: The session improved student’s confidence and knowledge for discussing lifestyle changes to prevent cardiovascular disease with their patients and moved students higher on Miller’s pyramid of clinical competence from the “knows” to the “shows how” level.
4 – REFLECTIVE WRITING IN UNDERGRADUATE MEDICAL EDUCATION AS A LEARNING TOOL
PURPOSE: According to educational theorist Donald Schön, medical education is based on “technical rationality.” Schön states that this approach does not address the “messy, indeterminate” problems faced in practice. He posits that the solution to such problems lies in a reflective practice that combines scientific knowledge with self-awareness, a critical aspect of emotional intelligence. The blueprint for next-century medical education sets as a critical goal the development of habits of inquiry and innovation – habits of mind and heart that support lifelong excellence. At the University of New England we use reflective writing in the pre-clerkship years as a tool to develop such habits.
METHODS: Iterations of this curriculum thread have been in place for over three years. MS-1 and MS-2 students respond to weekly reflective prompts following sessions on a variety of topics including ethics, patient populations, the health care system and other challenging issues. Initially, writings were read on a pass/fail system. In one study presented at IAMSE 2015, the authors selected 36 students and sampled six of their writings from the year. From this sample, themes relevant to physician practice were identified. This year, fewer brief assignments were given, and students were also assigned a longer essay, which was scored using the REFLECT rubric with aligned feedback.
RESULTS: Reflective writing enables students to develop the habit of mind and may also improve emotional intelligence. Studies are underway to test this hypothesis with one of our clinical partners. Examples of scored student work will illustrate results.
CONCLUSION: Reflective writing is a valuable tool to aid in the development of non-cognitive skills in undergraduate medical students.
Session 5 – Other
1 – IAMSE Members’ Perceptions of their Institutional Processes for Evaluation, Recognition, and Promotion of Medical Science Educators
PURPOSE: Guidelines for the evaluation and promotion of medical science educators have been available for some time, and yet it remains unclear whether they have been widely adopted by institutions and whether faculty are aware of them. The purpose of this study is to evaluate medical science educators’ perceptions of institutional processes for evaluating, recognizing, and promoting medical science educators by using a questionnaire developed by the Committee for the Advancement of Medical Science Educators, a subcommittee of the IAMSE Professional Development Committee.
METHODS: To determine whether a gap in awareness and/or adoption of guidelines for evaluating medical science educators exists, we created a questionnaire to learn more about IAMSE member institutional processes for evaluating, recognizing, and promoting medical science educators. The questionnaire collects basic demographic information and information regarding member institution name, member institution promotion and/or tenure practices, institutional metrics for evaluating medical science educators, and methods of institutional recognition and/or reward of medical science educators.
RESULTS: We will present the questionnaire results, which will provide an overview of how medical science educators perceive their institution’s current practices for evaluation, recognition, and promotion. We will then describe how the data will be used to create an IAMSE Best Practices guideline for the evaluation, recognition, and promotion of medical science educators.
CONCLUSIONS: This work directly supports the IAMSE mission to enhance appreciation of the crucial role of medical science educators in health care education.
2 – Medical School Student Promotions Committees: Ethical Orientations and Influences on Decision Making
PURPOSE: To elucidate committee members’ perceptions of the role of their committee; To illuminate the ethical orientations that guide promotions committee members; To identify student variables that influence decision making processes.
METHODS: An electronic survey designed to be completed by voting members of promotions committees was sent to 143 US medical schools. The survey utilized a theoretical framework contrasting an ethic of justice (in which decisions prioritize consistency and policy), with an ethic of care (in which decisions prioritize responsiveness to individual circumstances).
RESULTS: A total of 241 surveys were completed by participants from 55 institutions. Key findings include high levels of agreement with statements reflecting both justice and care orientations; limited gender differences in ethical orientations; prioritization of responsiveness by student participants; the highly influential nature of professionalism issues; and a lack of appropriate training provided for promotions committee work.
CONCLUSIONS: Additional attention should be paid to committee composition and to the delicate balance of input needed to both treat individual students in a manner befitting a healing profession, and to uphold our contract with society to graduate competent trainees. Promotions committee members would benefit from a clear delineation of our profession’s priorities in terms of justice and care, and of the specific student characteristics and circumstances that should or should not factor into deliberations. Training that focuses on institutional and professional values, rather than just on review of policy, may be effective in reducing variability and potential bias in approaches to complex student cases.
3 – EFFECTIVENESS OF EDUCATING HEALTH CARE PROFESSIONALS IN MANAGING CHRONIC PAIN PATIENTS THROUGH A “SUPERVISED STUDENT INTER-PROFESSIONAL PAIN CLINIC”, A PILOT STUDY
PURPOSE: Chronic pain is a serious health problem that continues to grow in prevalence. Yet, current medical education on pain management is extremely insufficient. As it has been demonstrated that chronic pain is better managed via multidisciplinary approaches, in the current pilot study, a newly designed “supervised student inter-professional pain clinic” training program was evaluated for its feasibility and effectiveness in improving health care professional students’ skills in 1) chronic pain management and 2) working in an interprofessional team.
METHODS: Since January 2016, we have assembled 4 inter-professional student teams (5-7 students per team) that included students from the following 6 professions at the University of New England (UNE): osteopathic medicine, nursing, occupational therapy, Physical therapy, pharmacy, and social work. The training program lasts about 12 weeks, in which each team worked with one chronic pain patient under the supervision of Dr. Stephen Hull at the Mercy Pain Clinic. Specifically, each team conducted the initial evaluation, generated treatment plans, and conducted follow-up examinations for its patient. Team members participated in several group meetings throughout the program and presented their experience to the UNE community at the end of their training. To evaluate this training program surveys were conducted with all participating students (pre- and post-program) and patients (post-program).
RESULTS: Students showed improvement in knowledge regarding pain physiology (Revised Neurophysiology of Pain Questionnaire), and chronic pain management (KnowPain50). There were an overall improvement in students’ attitudes and perception regarding interprofessional practice (Interprofessional Education Perception Scale) and a significant improvement in team skills (Team Skill Scale). Patients enjoyed their experience with respective student teams, believed they had learned a great deal about chronic pain, and loved the opportunity of contributing to medical education.
CONCLUSIONS: Our study demonstrated the feasibility and the overall effectiveness of this newly designed interprofessional training program.
4 – FOOD AS MEDICINE: INCORPORATING COMMUNITY-BASED NUTRITION PROGRAMS INTO MEDICAL STUDENT EDUCATION
PURPOSE: As unhealthy lifestyles continue to negatively impact population health outcomes it has become necessary to provide medical students with skills in preventive care and nutrition education. At Penn State College of Medicine, our Food As Medicine program provides multiple opportunities for future physicians to work hands-on in community health settings with diverse populations of at-risk patients. These opportunities include a culinary medicine 4th-year elective hosted at a local senior center, and a variety of “prescription produce” programs at local farmers markets and community gardens that enable students to work as “nutrition mentors” with at-risk patients, as well as homeless shelter residents and recently resettled refugees. Our presentation will share case studies of these initiatives and provide preliminary evaluation data.
METHODS: Launched in 2010, the Food As Medicine program has partnered with multiple community-based organizations—farmers markets and community gardens, homeless shelters, and refugee housing offices—to provide students with opportunities to develop preventive health skills as nutritional educators with low-income, high-risk patients. Additionally, we have established a “Culinary Medicine” elective for 4th-year students that is offered twice a year and hosted at a local senior center. In each of these community-based settings students have served as nutritional mentors with at-risk and underserved patients. We have carried out preliminary evaluation of each initiative through surveys and focus groups.
RESULTS: Over 60 students have been part of our Food As Medicine programs. We have learned that the process of mentoring patients in community-based settings contributes to their professional development by deepening an understanding of how barriers to health profoundly affect eating habits and influence health outcomes. Students also identify that such work deepens their sense of empathy for the challenges faced by underserved patients.
CONCLUSION: Community-based nutrition education programming that facilitates student mentoring opportunities can build complex preventive health skills and awareness in future physicians.
Session 6 – TBL/PBL
1 – Combined Team-Based Learning Exercises and Hands-On Course In Molecular Biology For Senior Undergraduate Underrepresented Students In Medicine Resulted in Strong Student’s Performance
Purpose: We previously reported that Team-Based Learning (TBL) exercises were instrumental in improving critical thinking and learning of course content in a microbiology course for undergraduate students underrepresented in medicine as part of a summer enrichment program at our medical school. In the current study, we examined the correlation between student preparation, participation and performance in TBL exercises conducted during a newly designed Research in Molecular Biology Course for this program.
Methods: Research in Molecular Biology is a six-week course that includes daily lectures and laboratory sessions. Groups of five students worked together on a project consisting of amplification, sequencing, and identification of genes involved in diseases such as Alzheimer’s disease, major depressive disorder, and chronic pain. Student groups designed and presented a research poster to the medical school community about the genes they studied. Twenty-six students participated in this study (57% female, 61% Hispanic or African-American). For three TBL sessions, student percentage time of par-ticipation during group readiness assurance tests (gRATs) was quantified. Correlations between percentage time of participation during gRAT exercises as well as iRAT (individual readiness assurance tests) , gRAT, and final examination scores were examined.
Results: Overall analysis detected a significant correlation between iRAT and gRAT scores (r2=0.5311,p<0.01). Subgroup analysis showed a significant positive interaction between final examination and iRAT scores (r2=0.5291,p<0.05) in female students. In male students, there were significant, positive interactions between iRAT and: (1) gRAT scores (r2=0.8572,p<0.01); (2) percentage time of participation (r2=0.5618, p<0.01); (3) final examination scores (r2=0.8787,p<0.01). Student evaluations showed high satisfaction with this combined TBL and laboratory course.
Conclusions: Our data suggest that overall performance and participation in this hands-on course is supported, particularly in males, by preparation for the TBL exercises. Additionally, combination of two different active learning strategies, TBL sessions and hands-on experimentation, may strengthen student acquisition of course content
2 – Team Based Learning: Implementation, Effectiveness, and Innovation
PURPOSE: As Team-Based Learning (TBL) evolves and figures more prominently in medical and health sciences education, a number of questions have arisen regarding implementation, effectiveness, and innovation. Incorporation of TBL into either a pre-existing or new curriculum takes careful planning. Discussing and sharing experiences in TBL implementation can save time and energy, as well as aid in building a sustainable TBL infrastructure that pleases and benefits both students and faculty. Once TBL has been implemented, the measure of effectiveness can be also be elusive. While there are much data to support its effectiveness, ambiguity still exists in the outcome data for health science education. Finally, medical and health science educators are in the unique position of having a wide variety of clinical scenarios from which to choose. Additionally, the use of technology, such as live, pre-recorded, or mannequin simulation during application exercises can provide a new layer of realistic clinical scenarios to spark discussion and decision-making.
METHODS: Here we share the experiences of our institution in the implementation, effectiveness, and innovation of TBL within its first two years of use. We formed a group that evolved into the TBL Advisory Board as part of the implementation process. We also analyzed grades and COMSAE scores of second year medical students both pre-TBL (2014) and post-TBL (2015). Finally, we investigated the use of innovative technology, such as simulation, during TBL.
RESULTS: A TBL Advisory Board was found to be necessary for communication, adherence to, and improvement of institutional TBL practices. Implementation of TBL resulted in successful academic outcome measures. The addition of innovative practices during TBL led to promising student feedback.
CONCLUSION: Sharing experiences with the use of TBL can benefit not only institutions implementing TBL, but can also improve the effectiveness of TBL in those with existing programs.
3 – Intermittent Doses of Team-Based Learning and Longer-Term Learning
PURPOSE: Several studies have evaluated both short-term learning outcomes1-3 and long-term retention of knowledge4 associated with use of team-based learning (TBL) in single disciplines. This investigation examines longer-term learning associated with intermittent use of TBL in a systems-based medical curriculum.
METHODS: Performance of 75 medical students was evaluated. A pre-test of 100 questions assessing 9 domains was administered before a 10-week block of cardiovascular, respiratory, and renal systems. Students experienced 7 TBL modules (3 cardiovascular, 3 respiratory, 1 renal) during the block. An identical post-test was administered 8 weeks after the courses. Pre-test vs. post-test performance was compared for subsets of 50 questions assessing TBL module content (TR) vs. 50 questions unrelated to TBL module content (TU).
RESULTS: The amount of improvement between pre-test and post-test was not significantly different for TR vs. TU questions (18.1% vs. 19.2%, p=0.428). However, performance on questions assessing combined cardiovascular and respiratory systems (n=70) was better for TR than TU questions (20.5% vs. 15.8%, p=0.002).
CONCLUSIONS: Use of intermittent TBL modules in systems-based courses is not associated with improved longer-term learning. However, there may be a dose-related benefit associated with the use of integrated TBL modules in a systems-based curriculum.
4 – VIMEDIX ULTRASOUND SIMULATOR PROVIDES INNOVATIVE CARDIAC LEARNING WHILE NURTURING PEER-TO-PEER TUTORING
PURPOSE: Caring for patients with heart conditions is a common and important aspect of a physician’s day to day care. Point-of-care ultrasound can be conducted to assess chronic and acute on chronic heart conditions. An echocardiogram exam consisting of three viewing windows via patients’ surface anatomy landmarks enables assessment of the heart and surrounding anatomy. Vimedix Ultrasound Simulator System (VSUS) provides real-time ultrasound simultaneously with 3-D virtual-reality anatomy and pathology for acquiring ultrasound skills to recognize stereostructural morphology. The objective of this study was to train 1st-year medical students (MS1) on conducting a three-view cardiac ultrasound exam (TV-CUE), and comparing hands-on tutorials (HOT) and video tutorials (VT) on an ultrasound simulator.
METHODS: Literature search was conducted regarding training of MS1 on TV-CUE. 16 MS1 with no previous experience on echocardiology received a 5-min tutorial (8HOT,8VT) on probe choice, surface anatomy landmarks, probe placement and manipulation, structural identification with an emphasis on valve morphology, and image acquisitions from VSUS of the heart. MS1 were assessed on the TV-CUE exam 24 hours post-tutorial on the criteria above (30-point system) and timed.
RESULTS: Literature search revealed no known studies. MS1 scoring range was 12-30 points averaging 23±6 pts and completed the TV-CUE exam in less than 10min. MS1 who received HOT scored significantly higher (+5.6,p<0.05). There was no significant difference in completion time (p>0.75), but VT students were also more likely to overlook procedures of the examination. Multimodal stimulation has repeatedly proven to allow learners to acquire procedural skills more efficiently, especially novice learners. Although HOT and VT contain identical information, HOT combines palpation, proprioception, and dynamic hand-eye coordination.
CONCLUSION: This study demonstrated that VSUS successfully trained MS1 echocardiographic anatomy and skills using HOT and VT tutorials, with significant advantages to those who received hands-on tutorials.
Session 7 – Technology and Innovation
1 – AN INNOVATIVE HANDS-ON “IMMUNE RESPONSE SIMULATION” SESSION TO ENHANCE MEDICAL STUDENT LEARNING OF ABSTRACT PRINCIPLES OF IMMUNOLOGY
PURPOSE: Immunology is a complex discipline to comprehend especially for medical students with little or no prior knowledge in this area. Furthermore, there is a need to develop innovative strategies to increase active learning sessions in pre-clerkship years as per The Liaison Committee on Medical Education’s requirements. We have developed a novel hands-on “immune response simulation” session to make immunology more understandable and improve its integration with medical microbiology. This abstract describes this medical education project and its outcomes.
METHODS: The session has run for 3 years in various health professions programs. Students are taught didactic immunology lectures followed by this active learning session where groups of students utilize their immunology knowledge to stimulate an immune response scenario to five major classes of pathogens in front of their fellow classmates. Students prepare these 10 min long enactments on their own and assign among themselves whether they want to act as a host immune cell or a pathogen. Faculty facilitates this learning session and administers the assessment tools. The session outcomes are evaluated by administering pre- and post immunology tests and validated surveys to evaluate students’ perceptions of this pedagogical intervention.
RESULTS: Preliminary results indicate that there is a significant increase in immunology knowledge gained and that students really enjoy learning immunology through this innovative pedagogy. Some students describe that they could never understand abstract principles of immunology till they participated in this simulation session.
CONCLUSION: Immune response simulation is an effective pedagogical novelty where students take control of their own learning and learn complex immunological principles in fun, hands on experiential learning session. This novel pedagogical intervention might prove valuable in teaching other medical science disciplines as well.
2 – Integrated Basic Science Simulations
PURPOSE: The current medical education literature heavily endorses the integration of strong basic sciences curricula with experiential learning to enhance the student’s understanding of the material as well as assist the student’s in making the correlation between the basic science and clinical care realm. This bridge has been built with an innovative program longitudinally linking years one and two when studying the cardiovascular/ pulmonary / renal system.
METHODS: The multi-station case-based simulations have been run for the past three years, allowing the students to move asynchronously through these case-based simulations, integrating the pace of instruction and scale of knowledge. Faculty have incorporated an immersive activity in year two that is linked by building upon what was taught in year one, allowing the students to begin to develop sophisticated clinical knowledge that will be applicable in their third (clinical) year. For each class, the students were divided into one of four sessions. Each 45 student cohort was divided into four small groups, who completed the four-station activity that included ultrasound technology (US interpretations of the heart and lungs), manikin-based technology (case-based code sessions), EKG interpretations and clinical skills with an Standardized Patient.
RESULTS: 175 MS II and 180 MS I students completed the four station sessions over a period of two hours each of the three years. A pre / posttest was initiated prior to and one week after the rotation of the students in each of the cohorts. Knowledge and skills gained was demonstrated in each of the eight cohorts. Feedback from the students allowed faculty to tweak the stations to advance the students forward in their understanding of the organ systems covered.
CONCLUSIONS: A more comprehensive understanding of the cardiopulmonary system was gained by the students completing these immersive activities as demonstrated by improved scores on their terminal course examinations.
3 – CaseMakerMD: Development of a Web-based performance tool for clinical case construction in an undergraduate medical education (UME) curriculum
PURPOSE: Clinical cases are broadly used in UME. Given the various users involved in case development and need to align cases with learning objectives, a novel tool was developed to create and house virtual family character clinical cases for the UME curriculum. This abstract describes this tool and lessons learned during its development and implementation.
METHODS: CaseMakerMD is a web-based performance support system to create and house virtual family character (VFC) clinical cases for the UME curriculum at EVMS. This tool allows foundational science and clinical faculty to collaboratively and efficiently construct clinical cases using a standard format. It prompts input of person-centered history and social determinants of health, manages case-related media, encourages development of management plans based on patient preferences/goals and allows for development of a faculty guide to ensure a uniform experience for our learners. Additional features of the tool include a fully searchable database of clinical imaging studies, clinical photos, videos, and reference articles and a laboratory section. This tool tracks case-related objectives and interactions with the VFCs to ensure longitudinal deployment of cases to meet the needs and learning goals of the curriculum.
RESULTS: Construction of clinical cases in CaseMaker MD required iterative development of the template, entry and editing process to ensure continuity given access to multiple uses across the curriculum.
CONCLUSIONS: CaseMakerMD allows for systematic integration of more quality cases than could otherwise be possible. Cases can be adapted in complexity to meet learning needs. We anticipate tremendous potential for use of this case development tool in various educational settings across UME, graduate medical education (GME) and even faculty development.
4 – Introduction of a research phase into Team Based Learning protocols reveals evidence of metacognitive limitations of self-directed and collaborative problem solving
PURPOSE: A study of the educational and catalytic effects of a variation upon team based learning (TBL) incorporating a group based collaborative research stage outside the classroom, following individual and group tests. This stage would enable learners to conduct further study and reflect upon earlier responses. Students were naïve to specific strategies required for problem solving in this test where identifying or constructing specific algorithms was inherent to this assessment.
METHODS: PHASE 1: A test consisting of 20 MCQs based upon determining the effects of ligands on pharmacological targets in neurons, was administered to students in three stages; as an individual test (under exam conditions), followed by a group test (an in-class collaborative activity), and the subsequent research stage (questions attempted in groups outside the classroom). Completed scripts were collected after each stage; answers were not provided. Subsequently a class review was conducted, in which answers were discussed and a worked example was provided.
PHASE 2: After a 2 week period, students were tested again through individual and group stages using a different set of questions, but requiring an identical algorithmic approach. Throughout all tests, confidence ratings were required as an adjunct to each question.
RESULTS: Performance improved through subsequent stages. In the first phase, the research stage provided the most noticeable improvement. However, a disparity between confidence rating of questions and correctness of answers was observed; where confidence increased through stages regardless of correctness. Exposure to a worked example describing a problem specific algorithm re-established parity between correctness of answers and confidence in phase 2.
CONCLUSIONS: The incorporation of a research phase is beneficial in providing an opportunity for learners to gather information and develop heuristic strategies for solving unknown problems. However, this study shows that worked examples are important for establishment of valid algorithms in learners, which may provide evidence of serious limitations for self-directed learning