2018 Meeting Posters – Curriculum

Yun Chu, Frazier Stevenson, Jesse Burk-Rafel, Kristine Krafts, Catherine A. Johnson, and Tao Le
Harvard Medical School, Conceptual Medical Education, New York University, University of Minnesota, ScholarRx, and University of Louisville

PURPOSE: Curriculum planning challenges for medical educators include limited time, resources, and standardized curricular templates. We describe a low-cost comprehensive repository of medical curricular materials that are student-written and faculty-designed, which can be customized to suit unique institutional curriculum needs. Curriculum bricks address multiple challenges, such as filling in course gaps, creating lectures, and reducing educators’ work burden. Our aim is to create, implement, and validate curriculum bricks through a Kirkpatrick evaluation model at several US medical schools.

METHODS: The core of our medical curriculum repository includes narrative “bricks” on health science education topics, each requiring approximately 20 minutes of learner time and integrating foundational and clinical sciences. We have designed and written materials for the Hematology, Cardiology, Respiratory, and Renal organ systems. For assessment, we use a Kirkpatrick model to evaluate student participation, learning, and retention among learners using our curricular bricks. This evaluation uses end-of-course surveys of students and faculty, student focus groups, and faculty interviews at multiple US medical schools.

RESULTS: Preliminary data from three allopathic and osteopathic universities show an overwhelmingly positive response to our curriculum materials. For the Hematology organ system, 60% (n = 78/130) of students at one university agreed or strongly agreed that the anemia bricks were helpful as supplemental sources for their Hematology course. More than 71% (n = 22/31) of students at another university would recommend our curriculum materials to peers. Feedback from student focus groups and faculty interviews described the bricks as friendly, engaging, and high quality with good curricular coverage.

CONCLUSION: Our curriculum bricks were largely well-received by students and faculty at multiple medical schools. Strengths include ease of use, high quality, and good curricular coverage. Additional pilot evaluations will study the use of bricks as primary curricular experiences and as components of problem/team-based and self-directed learning experiences.

Allison Grayev, Karen Krabbenhoft, Meghan Cotter, Elise Davis, Sarah Traynor, and Gary Lyons
University of Wisconsin School of Medicine and Public Health

PURPOSE: The disconnect of preclinical and clinical training during medical school has led many institutions to create integrated curricula incorporating basic sciences through clinical scenarios.  In order to  increase the integration of the basic and clinical sciences in both preclinical and clinical phases of undergraduate medical education, we have created a novel method for delivery of anatomy, histology and radiology content, reinforcing normal anatomical structures and recognizing pathology.

METHODS: We have created a model with synchronous lab dissections, asynchronous enduring learning objects (ELO) and synchronous medium-group in person sessions that give the students a solid knowledge framework while encouraging heutagogical exploration.  Timing was important in the curriculum design. Dissection was completed first, followed by the ELO and finally reinforced with the medium group in person session. ELOs were created that allow students to learn material with intermittent knowledge checks to allow for formative assessment. The in-person sessions were structured to allow coverage of the required content, but flexible enough to allow learner exploration. Each session was led by a teaching team composed of a radiologist and an anatomist or histologist.

RESULTS: Preliminary results from the students have been positive – “The anatomists consistently do a fantastic job during dissection and make excellent iRAHs. Would love to have them teach more. ”  Concerns from the students included the inclusion of material to which they were not previously exposed (abnormal histology), as well as the amount of information covered.

CONCLUSIONS: Future directions include right-sizing the amount of material covered and making sure that the learning objectives are clearly reflected in the amount of time devoted to dissection and interactions with enduring learning objects.  Additionally, as our students progress, we anticipate developing similar ELOs for use during clinical years across multiple campuses.

Poster Award Nominee:
204 – Cultivating Patient-Physician Communication about Vaccination in an Integrated Undergraduate Medical Education Curriculum
Amanda J. Chase and Mark A. Clark
University of the Incarnate Word School of Osteopathic Medicine

PURPOSE: Effective communication between physicians and their patients is crucial to 21st century medicine. It is imperative that medical students begin to apply communication skills early in medical education to promote the development of physicians who are better able to assess and guide their patients in making informed health decisions. The goals of this project were to develop assessments that measure baseline knowledge and attitudes of medical students towards vaccination and design learning activities that allow students to practice the communication of tough concepts to patients at appropriate literacy levels.

METHODS: A team, composed of a medical humanist, a basic scientist, and physicians, developed assessments and learning activities for first- and second-year medical students with the goal of improving communication skills about vaccination. A thorough review of the literature led to the development of an evidence-based rubric that assesses multiple positions on vaccination. In addition, assessments were developed to measure baseline knowledge of how vaccines work and risk/benefit vaccination communication.

RESULTS: We will present a rubric that was developed to measure baseline attitudes of medical students towards vaccination and confidence in communication with patients about vaccination. In addition, we will present several novel approaches that can be implemented in an undergraduate medical education curriculum to engage medical students in the fostering of communication skills regarding vaccination.

CONCLUSIONS: The development of an evidence-based rubric to assess medical students’ attitudes and pre-existing knowledge surrounding vaccination will enable educators to implement appropriate learning activities that optimize the application of advanced communication skills.  Future directions include evaluating the assessments and learning activities over several consecutive classes to validate their effectiveness and improve upon lessons learned.

Amy Prunuske, Robert Treat, and Jacob Prunuske
Medical College of Wisconsin

PURPOSE: Traditional 2 years basic science followed by 2 years clinical science curricula are being replaced by curricula with earlier clinical experiences and 3 year models that graduate students sooner with less debt. Literature on the benefits and challenges of resequencing is limited. The three-year Medical College of Wisconsin-Central Wisconsin (MCW-CW) campus provides a unique opportunity to compare curricular sequencing with the more traditional four-year curriculum of Milwaukee (MCW-MKE), as clinical clerkship experiences begin prior to the second-year basic science curriculum at MCW-CW and after the basic science curriculum at  MCW-MKE.

The purpose of this study is to assess the effectiveness of clerkship education prior to completion of the basic sciences courses.

METHODS: MCW-CW students complete a 10-week integrated clerkship (CWIC1) after year 1 and are evaluated with four Objective Structured Clinical Examinations (OSCE). These same OSCEs are completed by MCW-MKE students during their third-year internal medicine clerkship (after completion of the full basic sciences curriculum). We assessed the impact of the year 2 basic science curriculum on clinical performance by comparing N=25 MCW-CW to N=35 MCW-MKE OSCE mean scores using independent t-tests and Cohen’s d effect sizes with SPSS 24.0.

RESULTS: Scores were significantly higher for MCW-CW students for the Abdominal Pain case (Cohen’s d=0.68, p<0.011) and Rectal Bleeding case (d=0.53, p<0.049), but significantly higher for MCW-MKE students on the Difficulty Breathing case (d=0.71, p<0.007). No significant difference existed for the Chest Pain case (d=0.30, p<0.247). There was no difference in second-year basic science cumulative course scores between groups.

CONCLUSION: Completion of second-year pathophysiology coursework was not necessary for students to perform well on clinical OSCEs suggesting that students are capable of beginning clerkships experiences following their first year.  Early clerkship experiences are not associated with an improved performance in the second-year courses.

206 – Diversity and Inclusion: Prevention of Self-Harm and Suicide Through Education and Art
Cynthia Standley and Rebecca Fisher
University of Arizona College of Medicine-Phoenix

PURPOSE: We offered faculty, staff and students a leadership program that focused on Diversity and Inclusion as well as Suicide Awareness and Prevention.

METHODS: This 2-part program consisted of providing education and awareness on topics of cultural appropriation, micro-aggression, and suicide. Participants learned how to recognize signs of depression and self-harm and what to do when these arise using the QPR training method. Additionally, participants created artwork that illustrated or symbolically represented feelings of oppression, as well as their ideal space, a space where they felt free and comfortable. Artwork was displayed in the café of the Health Sciences Education Building. The exhibit opening was coordinated with First Friday events in downtown Phoenix and the public was invited to attend. A comment card box was placed near the exhibit to gather feedback from viewers. Participants completed a survey during the debriefing session on Day 2 of the program.

RESULTS: To date, 34 people have participated in the program. 100% of participants strongly agreed or agreed that this program increased their knowledge of the topics. Participants commented that they felt the sessions were useful, fun, a nice change of pace, clear, on topic and applicable. They particularly valued the discussions, interactive activities, and the storytelling about the artwork created.Viewers appreciated the power of emotions that can be depicted by fellow students, and felt welcomed and understood.

CONCLUSION: This leadership program and art exhibit have helped to transform the climate for students, staff and faculty into one that is safe, accepting and supportive and has also led to curricular change. We are incorporating a session in the 3rd year curriculum that focuses on “when the target of bias is the doctor”.

207 – Training Medical Students in the Use of Creative Expression to Improve Elder Care
Cynthia Standley and Gary Glazner
University of Arizona College of Medicine-Phoenix, Alzheimer’s Poetry Project

PURPOSE: The Art in Medicine Program at the University Of Arizona College Of Medicine – Phoenix and the Alzheimer’s Poetry Project (APP), provided a series of participatory arts training workshops for medical students to use with elder patients.

METHODS: Designed to enhance the traditional medical curriculum, this program consisted of 2 workshops and 4 webinars, to educate and train students in how participatory arts such as poetry, dance, music, storytelling and visual arts can enhance the quality of life of elders and people living with Alzheimer’s disease and related dementia. The students used these skills to lead on-site participatory arts workshops with elders and people living with memory loss. Students received service-learning credit while volunteering with the dementia arts programs at the Phoenix Art Museum, Mesa Arts Center, and the Suntree Adult Day Center. Using a dementia attitudes scale and a Wilcox sign rank non-parametric statistical test, we ascertained how medical student attitudes were affected by surveying them at the beginning of the program, and again after working with elders.

RESULTS: Of the 10 questions on the survey, seven of the questions showed statistically significant differences. Students felt the program increased their confidence, improved their skills, and felt much more prepared in their ability to communicate with this patient population. 100% of the students agreed or strongly agreed that they can do a lot to enhance the daily lives of people with dementia.

CONCLUSION: We conclude that this program helped prepare students to empathize and communicate compassionately as well as enhanced the quality of life of elders and those with dementia. We hope to train and educate additional medical students in the use of creative expression, as well as to continue to monitor student’s empathy for these patients as they progress through their medical training.

Deborah Russ, Chitra Pai, Trevor Ngorosha, Xornam Apedoe, Kal Winston, Shade’ Kormoi, Sherida Philip, and Dawn Roach
American University of Antigua College of Medicine

PURPOSE: Faculty attitudes were tracked for eighteen months during the planning, development, and implementation of a major curricular change at the American University of Antigua College of Medicine (AUA COM).

METHODS: In January, 2017, AUA COM changed medical instruction from discipline-based lectures to a fully integrated, systems-based small group format. To facilitate this change, a process of Generative Faculty Professional Learning was developed in a small group setting to explore faculty mindsets regarding educational philosophies, as well as techniques and methods for small group facilitation. Teams of faculty met to create facilitator guides for integrated small group activities, and training was provided in group dynamics and classroom management. Faculty attitudes were measured using the Primary Intervention Rating Survey (Lane, 2009) before implementation and will be repeated at the end of the first and second semesters. Ongoing professional learning and support has been provided and will continue throughout the first year.

RESULTS: Thirty-four of forty faculty completed the initial survey, which will be repeated in December 2017 and May 2018. The baseline survey indicated that 68.7% of faculty had a positive attitude toward the curriculum change and 68.8% believed the new curriculum will have a positive effect on student achievement.

CONCLUSIONS: Although preliminary, data collected to date suggest that faculty are supportive of a more integrated curriculum. The permanence of this effect and any potential impact on student performance will be assessed in future analysis.

Margrit Shoemaker, Diana Callender, Mario Cornacchione, Anthony Gillott, Thomas Martin, Brian Wilcox, and Sanjay Chandragiri

PURPOSE: Geisinger Commonwealth School of Medicine (GCSoM) utilizes a distributed hybrid LIC/Block model.  We have incorporated a weekly half day “Clerkship Education Day” (CED) to ensure exposure to core clerkship content for students across all regions and sites. Weekly discipline rotation allowed for 7-8 CEDs per clerkship.  Students were assessed based on Team-Based Learning (TBL) performance or case- based presentations which varied by discipline.  A need for improved objectivity in assessment prompted a switch to use of TBL in all core disciplines.

METHODS: Student performance during CED on clerkship content was assessed and comprised 20% of the final clerkship grade.  Internal Medicine, Family Medicine and OB/Gyn use TBL exercises based on preassigned readings (21 total).  Surgery, Pediatrics and Psychiatry used case-based student presentations (one/discipline) for grading.  Concern over grading subjectivity and minimal assessment opportunity, led us to switch to TBL in all disciplines. This doubled student workload of preassigned reading from 50% to 100% of weeks, while only decreasing presentations sessions by 3 per student. Supplemental sessions include Radiology, Reflection, EKG, Student Affairs and Quality Improvement project work time are no longer combined with clerkship content CEDs.

RESULTS: To address the increased workload, the new CED 2.0 model reduces clerkship CED sessions to 5 per discipline and TBLs from 44 to 30.  TBL pre-reading previously non-standardized, will be limited to about 2 hrs/ session. Supplemental sessions include Radiology, Reflection, EKG, Student Affairs and Quality Improvement project work time is scheduled during “off” weeks which occur approximately once monthly.  CED 2.0 allows adequate time for quality TBL discussion and improved student assessment.

CONCLUSION: By standardizing assessments, decreasing student workload and increasing engagement we hope to improve student outcomes.

Dolgor Baatar, Diana Pettit, Ellen Dudrey, Niti Manglik, Cynthia Perry, Janssen Herb, Dale Quest, and Tanis Hogg
Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso

PURPOSE: Studies in cognitive psychology have shown that repeated retrieval of information in the form of self-testing enhances future recall more than repeated studying. Previously we have shown that the use of self-tests (STs) improves medical student performance in one basic science discipline. Here we report that the use of STs in six basic science disciplines improves first-year medical student performance on formal examinations.

METHODS: STs were created using iSpring QuizMaker software (iSpring Solutions, Alexandria, VA). To deliver STs to students, we created a Student Self-Assessment course on our learning management system (LMS). Students were given unrestricted access to STs and could take them at any time and as many times as they wanted.  ST usage statistics and scores were recorded in LMS grade book and were compared with the student performance on summative examinations.

RESULTS: Surveys indicated that the STs became popular learning tools among medical students. Multiple regression analysis showed that the number of STs used is a significant predictive factor for examination scores. Importantly, student rank that was established prior to the implementation of ST was not a significant predictor of ST use.

CONCLUSION: These results warrant further studies to test the efficacy of STs for long-term retention of knowledge such as the effect on the USMLE STEP I exam scores. Evidence provided by this study and further studies should justify the use of the STs as a required part of medical education.

211 – A survey of opinions for teaching biochemistry and nutrition in undergraduate medical education
Emily Hays, Jake Levine, Sharmila Upadhya, Andrew Sobering, and Tracey Weiler
Florida International University – HWCOM and St George’s University

PURPOSE: Opportunities exist to optimize training in biochemistry and nutrition during undergraduate medical education. Existing research suggests that nutrition coverage is inadequate and the expansion of biochemistry content is arduous to learn and teach. This study surveyed physicians and educators about their opinions regarding the most important nutrition and biochemistry topics to teach to medical students.

METHODS: Physicians and educators from Florida International University (Miami, FL), St. Georges University (Grenada, West Indies), the Association of Biochemistry Educators, and the Association of Professors of Human and Medical Genetics were surveyed. Participants were asked to rank, in order of importance, the ten most important biochemistry and nutrition topics for medical students to learn during undergraduate medical education. The suggested topics provided by the participants were coded into standardized topics and organized into narrow and broad categories. Microsoft Access was used to categorize topics, and Microsoft Excel pivot tables facilitated analysis.

RESULTS: In total, 182 physicians and educators participated in the study, providing 879 suggested nutrition and biochemistry topics. Approximately 25% of participants did not provide any suggested topics.  Of the responses received, many were either vague or were overly broad. Commonly mentioned topics included metabolic disorders, inborn errors of metabolism, and relationships between nutrition and various clinical conditions.

CONCLUSIONS: We received approximately half the responses we expected from our participants.  We suggest that this reflects a historical lack of educational time devoted to biochemistry and nutrition and/or insufficient relevant clinical perspectives presented during medical school basic sciences.  The prioritized topics obtained from the survey can be used to focus development of learning objectives and case scenarios illustrating the clinical relevance of the most important topics in biochemistry and nutrition. We endeavor to improve medical education in this area and to increase the applicability of nutrition/biochemistry topics to clinical medicine.

Gabi N Waite, Diana Callender, Brian J. Piper, Kathleen Doane, David B. Averill, Cathy Wilcox, and John L. Szarek
Geisinger Commonwealth School of Medicine

PURPOSE: In the preclinical program at Geisinger Commonwealth School of Medicine, basic and clinical sciences are taught in separate courses or organ-system blocks, in parallel with two year-long courses, aimed at learning to solve clinical problems in a self-directed way. Since not all learners are equally motivated to apply the course/block material in a cumulative way to advance in clinical problem-solving, we are exploring methods to motivate students and monitor their growth. This ongoing study tests the feasibility of voluntary multiple-choice quizzes at the beginning of a course/block covering previous material and asks students about their usefulness in fostering self-directed learning.

METHODS: Faculty created quizzes that require use of previously learned material to solve clinical problems. The questions were vetted by discussing and writing extensive answers to the problems and distractors. The quizzes were voluntary to 2nd-year students, and no controlling verbiage (such as “should,” “will help you”) was used. Students’ perception was sought using a mixed-method survey.

RESULTS: In the ongoing study, approximately half of the class of 109 downloaded the quizzes in ExamSoft¼. Even though the students’ performance on the questions was poor, they appreciated the concept behind the exercise. Students’ survey comments fell into three categories: They liked the application nature of the questions; they commented on the need to frequently use past learned knowledge; and they agreed that they liked the self-directed nature of the quizzes.

CONCLUSIONS: Positive feedback indicates that the quizzes appropriately challenged the self-selected students such that they were motivated to identify their learning needs and revisit previously learned material. Our next step is to formally link quiz and course exam questions by progressive learning objectives. Additionally, we will monitor whether students who use the quizzes do better on exams, and/or reflect differently on their problem-solving ability in metacognition exercises and portfolio narratives.

213 – Activity sequence on internal medicine clerkship: its effect on subject knowledge attainment and clinical skills acquisition
Hong Gao and Cynthia Burns
Wake Forest School of Medicine

PURPOSE: This study is to investigate whether different sequences of activities on the required 3rd year internal medicine (IM) clerkship impact subject knowledge reflected by the National Board of Medical Examiner (NBME) subject exam (shelf) administered at the end of the clerkship and clinical skill (CS) acquisition as evaluated by house officers and faculty during the clerkship.

METHODS: Data for activity sequences on the rotation, shelf exam and CS evaluations from two cohorts, 228 students (MS2015 and MS2016) were accessed and analyzed. The 12-week IM clerkship is broken into three 4-week activity blocks: 4-weeks of IM subspecialties (SS), 4-weeks focused on general internal medicine (GEN), and 4-weeks focused on transitions of care (TCM). Each group of 30 students was divided into three groups, starting in either the SS, GEN, or TCM block. Students were evaluated on 8 parameters: medical knowledge, history taking, physical examination, patient presentations, clinical reasoning skills, patient rapport, health care rapport, and motivation and attitude towards learning. Mean clinical scores across the parameters were calculated. Regression analyses were conducted in SAS to detect group differences in shelf or CS evaluations.

RESULTS: Regression analysis indicated that there is no significant difference (F(2,225)=2.05, p>0.13)  in the IM  shelf performance and there is no differences in CS evaluation scores (F(2,226)=1.96, p>0.14) between the three groups.

CONCLUSION: Our analysis shows that there is no difference in subject knowledge attainment or CS acquisition related to the sequence of clerkship activities. This study illustrates that in the IM clerkship, there is no advantage or disadvantage to any particular sequence of clinical activities and that it does not matter in which order a student completes the activities of the clerkship with regard to subject knowledge attainment and clinical skill acquisition.

214 – Curricular Management, Renewal and Future Needs at 38 Veterinary Colleges
India F. Lane, Margaret V. Root Kustritz, and Regina M. Schoenfeld-Tacher
The University of Tennessee, University of Minnesota College of Veterinary Medicine, North Carolina State University College of Veterinary Medicine

PURPOSE: Curricular renewal is challenging and its impact is difficult to measure. The purpose of this study was to collect information about curricular management and renewal from multiple institutions in order to determine how curricula are managed, and the extent and nature of recent curricular change, in veterinary colleges.

METHODS: The academic leadership at all 49 Association of American Veterinary Medical College (AAVMC) member institutions was surveyed regarding the general structure of their curriculum, whether a major renewal had been undertaken in the past 5 years, and if so, what the major changes were.  Respondents were also asked about anticipated future curricular needs. The survey responses were exported to qualitative and quantitative analysis software for quantitative, text frequency and thematic analysis.

RESULTS: Responses were received from 38 member institutions. Approximately half of responding institutions reported a non-traditional curriculum (as defined by the survey) and most were managed by a collaborative curriculum committee (as required by accreditation). Twenty-eight (71%) reported undergoing a major curricular revision process within the previous five years. Most commonly, renewal efforts focused on adding integrated material, skills development or simulation exercises, early clinical experiences and integrated professional competency development. Innovative instruction and assessment methods were also incorporated into curricular designs. A few colleges included increased emphasis on on public health, OneHealth or preventive medicine in their new curriculum. Anticipated future needs mirrored the areas already mentioned, especially in assessment and instruction.

CONCLUSIONS: Curricular renewal is actively underway at many colleges of veterinary medicine. Colleges will have much to learn from each other as they experience and monitor curricular change.  A significant focus on professional skills and behaviors, in addition to evolving biomedical content, is likely to continue.

Kimberly Brown Dahlman, Mary A Hooks, and Vicki Keedy
Vanderbilt University Medical Center

PURPOSE: Over the last decade there has been a rapid expansion in the understanding of cancer molecular drivers. As a result, there is a need for future oncologists and cancer researchers to work together and understand the fundamental molecular biology driving a patient’s tumor, and how that information is translated to precision cancer patient care. This learning is effectively accomplished by integrating foundational science in a meaningful clinical context.

METHODS: In AY 15-16 the 4-week “Precision Cancer Medicine” course was launched to 3rd and 4th year medical students, and to 2nd year biomedical graduate students at Vanderbilt University School of Medicine. In this course, students study cancer foundational science concepts through a mixture of active learning modalities including online modules, student-led project presentations, and team-based learning and case-based learning activities. Notably, students also participate in individualized clinical experiences and tumor boards. Students are challenged to rapidly incorporate and apply discoveries from the primary literature to their clinical experiences, and to examine clinical phenotypes to reveal underlying the foundational sciences.

RESULTS: Immediately after completing the course in AY 15-16 and AY 16-17, 97% (n=33) of medical students who enrolled completed a course evaluation. Students who completed the survey (94%; n=31) ‘agreed’ or ‘strongly agreed’ that foundational science learning informed and enriched the clinical experiences. Furthermore, 100% of medical students thought that the clinical experiences informed and enriched the foundational science learning. The majority of medical students who took the course (88%; n=29) anticipated using the foundational science knowledge acquired in future clinical training and practice.

CONCLUSIONS: We launched a highly innovative and interdisciplinary course that integrates and assesses foundational science learning, within distinct oncology clinical experiences, and combines medical and biomedical graduate student learners. Yearly course modifications are necessary to “keep up” with the rapidly changing landscape of cancer biology.

Melinda L. Carter and James D. Foster
Alabama College of Osteopathic Medicine

PURPOSE: The Commission on Osteopathic College Accreditation recently established new guidelines requiring colleges of osteopathic medicine to demonstrate student involvement in research across their four-year curricula. The goal of this study is to clarify how diverse research skills prepare medical students for residency and ultimately contribute to patient safety.

METHODS: We examined how key elements of research planning, laboratory experimentation, data analysis, and reporting contribute to the thirteen core entrustable professional activities (EPAs) recommended by the American Medical Association and American Association of Colleges of Osteopathic Medicine as guidelines for curricular development to ensure that students are prepared to start graduate medical training. EPAs can be evaluated and quantified for each student, thereby providing a measurement of competency.

RESULTS: Aspects of research skills directly contribute to 9 of the 13 (69%) EPAs. Gathering focused information through critical assessment helps students learn to take a thorough patient history (EPA1), generate differential diagnoses (EPA2), and interpret common diagnostic and screening tests (EPA3). Literature review and project design help students develop writing skills that are essential to composing accurate medical orders (EPA4) and precise notes in patient charts (EPA5). In the explanation and defense of research projects, students hone presentation skills that will strengthen oral clinical case presentations (EPA6). They engage in data collection and statistical interpretation that enables them to evaluate clinical data and weigh evidence-based treatments and procedures to ensure safe advancement of patient care (EPA7). The experiences of research also enhance communication (EPA8) and collaborative skills (EPA9) that are essential to working effectively on an inter-professional team (EPA9).

CONCLUSIONS: Research skill development in medical students is essential to the undergraduate curriculum because the core experiences guide future physicians to approach patient care based on scientifically sound principals and procedures. A positive, engaging experience with research is also key to recruiting clinicians to academic medicine.

Michelle Beidelschies and Gail Cresci
Cleveland Clinic

PURPOSE: Nutrition is integral to preventing and managing various chronic diseases, yet few physicians are adequately trained to provide nutrition counseling to their patients. A nutrition thread was recently implemented at Cleveland Clinic Lerner College of Medicine. The purpose of the survey was to examine nutrition education interest and experiences among medical students prior to and during medical school at Cleveland Clinic Lerner College of Medicine. Data collected will ascertain the impact of the Nutrition Thread curriculum and guide future enhancements.

METHODS: An anonymous survey was created and delivered to a total of 164 medical students at Cleveland Clinic Lerner College of Medicine (graduation years 2018-2022). The 13 item survey was designed to evaluate nutrition education prior to and during medical school. The survey utilized Likert scales, dichotomous responses and open-ended questions. Data from the survey was collected and analyzed using a secure, web-based HIPPA compliant platform for managing surveys and databases. The study was approved by Cleveland Clinic Institutional Review Board.

RESULTS: A total of 65 students completed the survey (40%). The majority of students (92.3%) did not have formal undergraduate nutrition education, and 72% rated their nutrition education prior to medical school as average or poor. Approximately 48% of students rated their nutrition education during medical school as good or excellent, but 45% do not feel comfortable discussing peer-reviewed evidence regarding nutrition. Despite this, the majority of students (85%) indicated that nutrition is a necessary part of their education, and 69% said it has influenced the way they care for patients.

CONCLUSION: Medical students greatly value nutrition education provided during their training. Providing evidence-based nutrition education along with actionable patient care skills are warranted within medical school curricula.

Nancy P. Moreno and Alana D. Newell
Baylor College of Medicine

PURPOSE: Building a curriculum with meaningful active learning is challenging even for experienced designers. For 20 years, we have applied an evidence-based approach, using data to inform efforts and improve student outcomes, to develop a wide range of active learning experiences for students of all ages. Here, we present the model and examples of how it has been used to develop course modules and programs.

METHODS: Our model is particularly suited for developing student-centered learning experiences. We follow a curriculum development cycle aligned with principles of backwards design—in which goals for learners (what students should know or be able to do) are identified by a design team, followed by planning of student assessments. Next, active learning experiences are proposed, tested and evaluated. The evaluation provides formative feedback to the design team regarding student engagement and balance of activities, and generates quantitative information about attainment of learning outcomes. This information drives a second cycle of revision and piloting. In most cases, we involve a large group of learners (N > 600) in a quasi-experimental comparison of a new student-centered module or program with existing instructor-centered approaches.

RESULTS: Our model has been applied in six large-scale curriculum programs funded by NIH and NSF for students in elementary and secondary schools, as well as a course for advanced health sciences trainees. Learning gains by students have been statistically significant with large effect sizes.

CONCLUSION: Attempts to integrate active learning into instruction without PURPOSE Ful curriculum design can result in activity-oriented teaching that is not coherent or effective. We have applied an outcomes-driven, backward design curriculum development cycle in a range of contexts to guide program and course curriculum development and assessment. This session introduces the model and provides participants with approaches and tools to integrate active learning into their own programs.

Naomi L Lacy and Tanis Hogg
PLFSOM Texas Tech University Health Science Center El Paso

PURPOSE: Ensuring students have the self-directed learning skills and documenting achievement of those skills can be a challenge, particularly for schools which do not use PBL formatted curricula.  At PLFSOM, we wanted to add a curricular component that would ensure our students entered their clerkship with a common baseline skill level.

METHODS: As part of our M2 curriculum, we added a self-directed learning plan to the clerkship preparation course.  The syllabus provides students with an explanation of the importance of self-directed learning, the definition of the process, and the requirements of the plan.  The plan requires them to analyze available information on their performance, identify areas of learning for both passing Step 1 and preparing to be a clerk, identify resources and learning strategies, and identify how they will know if the plan is successful.  The syllabus includes information on Bloom’s Taxonomy and recommends learning plans be at or above the application level.  Students review their completed plans with their college masters, who use a common rubric to assess the plans, returning inadequate plans to students.  Students cannot pass the course until they can complete a satisfactory plan.

RESULTS: The SDL plan met with mixed reviews.  Some students and faculty felt it was busy work that interfered with preparation for Step 1.   Students who had positive reactions reported that the plan helped them identify strengths and weaknesses. One commented the plan “
 helped me pace myself and focus my studies in area where I needed to improve.  And it worked.”  College masters reported that, while our best students got little out of the SDL component, our weakest students benefited substantially.

CONCLUSIONS: A self-directed learning plan has a greater utility for marginal students.  Additionally, it ensures students have a common self-directed learning baseline and documentation of students’ achievement of self-directed learning.

Ritcha Saxena, Mithilesh Chandra, and Ritwik Raj
AUS School of Medicine, Indian Council of Medical Research, India, Department of Biomedical Engineering, Delhi Technological University, India

PURPOSE: As predicted by the World Health Organization, by the end of this decade, almost 70% of all disease would be due to poor lifestyle choices – about 90% of world’s burden of non-communicable diseases (NCDs).

Multi-omic variations and lifestyle preferences are important predictors of disease rates in an individual. Lifestyle medicine together with multi-omic analysis, is a pioneering arena in preventing and managing NCDs. The contemporary undergraduate medical curriculum is deficient in relevant training in these fields.

We propose a curriculum with novel changes to include a multi-omic approach integrated with lifestyle medicine which would prove vital for prevention, early diagnosis and tailored therapy of chronic diseases; a stepping stone for future physicians in the era of precision medicine.

METHODS: We introduce a new practical component in the curriculum that incorporates evidence-based lifestyle modifications relevant to risk factors for chronic disease, melded with multi-omic concepts in each organ system in all semesters of undergraduate medicine.

This curriculum comprises self-directed learning at home through compact pre-recorded digital lecture modules prepared by the faculty. In the classroom, students were engaged in small groups through team-based learning, panel discussions and clinical case presentation activities.

RESULTS: Students’ feedback and faculty members’ suggestions indicated that our student-centered evidence-based trans-theoretical educational model would potentially turn out as an efficient tool in better understanding of various concepts, and by self-directed learning at home, faculty time would be more efficiently utilized in small groups.

CONCLUSION: The current wellness paradigm is becoming untenable in the wake of rising NCDs. Incorporation of a lifestyle modification course along with multi-omic approach in all four years of a patient-inspired medical curriculum will greatly benefit patient wellness in the post-genomic era. By understanding lifestyle reformation through this curriculum, future physicians will be equipped with the knowledge needed to inspire change and motivation.

221 – The postbaccalaureate-premedical program at the University School of California, San Diego: Looking beyond medical school acceptance rates
Stephen D. Schneid, Chris Armour, Carolyn Kelly, Leslie Bruce, and Grace Miller
Uuniversity of California, San Diego

PURPOSE: UC San Diego Extension, in partnership with the university’s School of Medicine, launched an “academic enhancer” type of postbaccalaureate-premedical program in 2013. The primary goal of the program is to improve enrollees’ academic records and thereby improve their chances to gain acceptance to medical school. The program is designed to make them better learners and provide them with a strong basic science foundation for medical school. This abstract describes the program’s curriculum and its outcomes.

METHODS: During the yearlong program, students take 48 units of undergraduate courses in physiology, pharmacology, biochemistry, and other basic sciences from faculty within the Division of Biological Sciences and from Extension. All students are assigned a School of Medicine faculty advisor with significant medical school admissions committee experience. The program also provides MCAT preparation, mock MMIs, traditional interviewing skills workshops, and personal statement writing.

We calculated the medical school acceptance rate for the first three cohorts (N = 82) and analyzed end-of-year student reflections. In addition, alumni who had completed their first year of medical school were surveyed regarding how well the program prepared them academically.

RESULTS: Students demonstrated substantial academic growth that enhanced their medical school applications: the average incoming science GPA and overall program GPA was 3.1 and 3.8, respectively. Of students who applied, 91% were accepted to medical schools (64/70), with 83% attending MD programs and 17% attending DO programs. Improved time-management skills were the most frequently reported comment in the end-of-year reflections (60%), followed by use of group studying (49%). Most of the alumni who completed their first year of medical school (78%; 25/32) reported being “very prepared” for medical school.

CONCLUSIONS: The majority of participants in this rigorous, cohort-based postbaccalaureate program who applied to MD or DO schools were accepted and felt “very prepared” for their first year of medical schools.

Poster Award Nominee:
Jasmine capers and Laurel Gorman
Medical School Class of 2020, University of Central Florida College of Medicine, Dept Medical Education

PURPOSE: Despite the prevalence of pain and opioid over-prescribing concerns, literature is lacking on ways to integrate analgesic pharmacotherapy education across medical education. While evidence supports the effectiveness of spiral curriculum models, no studies have addressed how to implement analgesic  education across the continuum to facilitate responsible analgesic prescribing.  At the University of Central Florida College of Medicine (UCF COM), analgesic educational activities are implemented in years 1(M1), 2(M2), and clerkship(M3,M4). This pilot study’s objective is to evaluate if this analgesic curriculum meets the 4 criteria of the Harden and Stamper model for implementation of an effective spiral curriculum.

METHODS: Analgesic topics included NSAIDs, opioids, addiction, and non-opioid adjuvants.  Curriculum mapping systems evaluated coverage to determine if implementation met the criteria:  Topics were logically sequenced, reinforced with increasing complexity, new learning was related to previous, and knowledge/competency improved.  To assess learning, M2-M4 students were invited to take a knowledge quiz on analgesics.  Likert scale survey items rated perceptions of understanding, prescribing confidence, and awareness of opioid addiction and dangers.  Participants also rated the quality and clinical relevance of educational activities.

RESULTS: Analgesic topics were logically sequenced across 4 years with complexity increasing as M2 progressed.  In M2 and M3, active learning through cases, standardized patients, and team-based learning encouraged more complex thinking, reinforced the early topics, and provided clear curricular links. Knowledge of analgesic pharmacotherapy was significantly greater for more advanced clinical learners than for early learners.  Advanced M3-M4 learners perceived that their understanding, confidence, and awareness improved over time, and rated clinical relevance of analgesic education much higher.

CONCLUSIONS: Preliminary curricular analysis supports that UCF COM analgesic education meets the criteria for successful implementation of a spiral curriculum.  Knowledge and perceptions of analgesic therapeutic learning improved as the curriculum progressed, and clinical year learners perceived greater clinical relevance to analgesic education.

223 – Interdisciplinary Educational Approach in the Medical science Education
Shima Tabatabai
Shahid Beheshti University of medical science, Tehran, Iran

PURPOSE: The current literature supports the inclusion of Interdisciplinary education in healthcare education. Prior studies have noted the importance of Inter-professional education in making sense that the best care would be delivered by a team. this study provided the theoretical basis for program development through a new conceptualization of the concept of Interdisciplinary Educational Approach and to explore the impacts on the medical education in Iran.

METHODS: Critical interpretive synthesis (CIS) was used to carry out a qualitative synthesis of the literature from 20O6 until 2016.The search strategy was designed to access electronic databases to clarify the Interdisciplinary medical science education. From 450 retrieved articles, 40 articles related to the research objective were selected purposively. The main themes and sub-themes identified. The contradictory findings in different studies were synthesized.By CIS of categories related to the concept and the importance of Interdisciplinary approach in medical science education, new concepts and their relationships emerged.

RESULTS: There were strong relationships between interdisciplinary education and subsequent abilities of the medical educators. A frame of concept was created based on the position of interdisciplinary education in medical science, clarify its related health care and determine its boundaries from other educational approaches, and its use in the medical education system. Matching the existing educational context and structure with interdisciplinary education through removing barriers and planning to prepare the required resources and facilities can solve numerous problems associated with implementation and design of interdisciplinary medical education.

CONCLUSION: The conceptual model of interdisciplinary medical science education will assist the educational policymakers to consider interdisciplinary medical education as a useful strategy in the integrated medical education and healthcare system in our context and similar areas

Anita Glicken and Melinda Clark
National Interprofessional Initiative on Oral Health and University of Colorado School of Medicine, Albany Medical Center

PURPOSE: HRSA reports more than 52 million people live in dental health profession shortage areas with limited access to care. A 2011 IOM report called for an expanded interprofessional workforce, recommending non-dental health care providers (i.e. physicians, nurses, PAs) be educated to increase access through screening and prevention. The HRSA 2014 Integration of Oral Health in Primary Care Practice document identified core interprofessional oral health domains and competencies for these professionals. Oral health and disease are increasingly integrated in clinical coursework; however, science linking oral health and systemic disease is often overlooked in health care education. Emerging science confirms, however, that chronic low-grade infection in the mouth elevates systemic infection and impacts body systems. This abstract describes two national integration tools designed to increase knowledge and skills. Smiles for Life (SFL), is a free, online interprofessional oral health curriculum endorsed by 7 health professions. The Oral Health Delivery Framework is a practice integration model with associated implementation guide and toolset.

METHODS: Evaluation data on uptake/ integration of tools tracks national diffusion and outcomes of oral health integration including results of a survey sent to 5,312 registered users who completed online or downloadable SFL courses.

RESULTS: Over 1,025,000 users have viewed SFL, with more than 200,000 courses completed. A recent user study documents SFL impacts clinician and educator behavior. Twenty national organizations across health professions endorse the Qualis Framework. The accompanying Oral Health Integration Implementation Guide has now been piloted and evaluated at 19 US sites.

CONCLUSION: Data supports these tools are driving transformation in interprofessional health education and practice. Educators can use oral health to teach learners about the relationship of oral disease to overall health.

George Bergus and Peter Rubenstein
University of Iowa Carver College of Medicine

PURPOSE: In 2014 the University of Iowa Carver College of Medicine implemented an 18 month-long integrated basic science curriculum. On completion of this curriculum, medical students proceed through their core clinical year with rotations through traditional core clinical services. In our new curriculum clinical faculty are expected to revisit relevant foundational science concepts. We surveyed clinical faculty on their perceptions of this new curriculum following the students’ completion of the core clinical clerkships.

METHODS: A survey instrument was developed and sent to clinical faculty directing the core clerkships in Surgery, Pediatrics, Obstetrics and Gynecology, Neurology, Psychiatry, Family Medicine, Inpatient Internal Medicine and Outpatient Internal Medicine. Each clerkship’s director was asked to distribute the survey to 10 faculty in their department who “worked most closely with medical students” in the core clerkship. The survey asked the faculty to comment on student preparedness for the core clinical clerkships and to identify knowledge gaps.

RESULTS: A total of 66 clinical faculty completed surveys. 47 of the faculty (71%) reported that the students completing the integrated basic science curriculum were adequately to exceptionally well prepared for their core clerkship. Knowledge gaps in pharmacology (n=11) and anatomy (n=6) were most often identified. 50 (76%) of the clinical faculty reported that they often or usually revisited basic science concepts when having patient-related discussions with students on their core clinical rotations. 13 (20%) of the faculty reported that time, their own limited basic science knowledge and lack of knowledge about the preclinical curriculum were barriers to integrating basic science concepts in their clinical teaching.

CONCLUSION: The majority of clinical faculty reported that medical students were prepared for their core clinical clerkships by our shortened and integrated basic science curriculum although knowledge gaps in pharmacology and anatomy were the most frequently identified gaps.

George Bergus, Patrick Barlow, and David Asprey
University of Iowa Carver College of Medicine

PURPOSE: The University of Iowa Carver College of Medicine offers both a 4 year medical degree (MD) program and a 28-month masters in physician assistant (PA) degree program. Although these 2 programs have shared some coursework in the past, for the past 3 years MD and PA students have complete all their pre-clinical courses together. We previously reported that for our first cohort of MD and PA students performed equivalently across our 6-course foundational science curriculum. We now extend this comparison to include the first 3 student cohorts who have completed our 18 month long foundational science curriculum.

METHOD: Starting in August 2014 3 cohorts of approximately 156 first-year MD and 25 first-year PA students have completed a fully integrated, 18-month preclinical curriculum. The students have attended the same classes, completed the same exams, and have been held to the same criteria to determine passing performance in each course. Our primary focus of this study is the comparison of the performances for the first 3 MD and PA student cohorts using a 2×6, mixed analysis of variance. The complete data on the third cohort will be available by late December 2017

RESULTS: In 2016, we reported that the performances of the first cohort of MD and PA students completing the same foundational science curriculum did not appreciably differ in either a practically relevant or a statistically significant way (p=0.26). This analysis will be expanded to include the first 3 student cohorts of MD and PA students completing our18-month long foundational science curriculum.

CONCLUSION: The performances of MD and PA student in a 6-course foundational science curriculum will be reported for the first 3 MD and PA student cohorts completing our foundational science curriculum.

Katherine Hyland, Jessica Tenney, Heidi Kirsch, Lynnea Mills, Renata Gallagher, Tracy Fulton, Sara Clemons, Jonathan Pai, and Patricia Cornett
University of California, San Francisco, School of Medicine

PURPOSE: Rapid expansion in medical knowledge and scientific discovery is instigating a fundamental shift in medical practice, necessitating greater integration of foundational and clinical sciences during medical training. To address this need, the UCSF School of Medicine launched a fully integrated curriculum emphasizing spiral learning, inquiry, and continuous improvement of healthcare systems. Third year clerkship students participate in a longitudinal “Foundational Sciences in Foundations 2” (FS-in-F2) course to reinforce FS concepts, facilitate knowledge transfer, foster curiosity, and highlight clinical reasoning. Here we present two FS-in-F2 sessions that focus on genetics/genomics and precision medicine, starting spring 2018.

METHODS: Genetics/Genomics and Precision Medicine Day:

  • Interactive large-group on genetic/genomic testing techniques.
  • Case enactment illustrating clinical use of whole exome sequencing (WES) by clinical and molecular geneticists and ethicists.
  • Small-group cases (prenatal, pediatric, adult) exploring the diagnostic utility of genetic/genomic testing techniques.
  • Case-based assessments synthesizing knowledge of genetic/genomic testing.

Inborn Errors of Metabolism (IEM) Day:

  • Overview of New Born Screening, benefits and ethics of using WES.
  • Videos of patients with IEMs.
  • Small-group IEM cases linking clinical findings and lab results with underlying biochemical defect and treatment options.
  • Case-based assessments synthesizing knowledge of IEM.

RESULTS: Benefits of this innovation include spiraling FS concepts into core clerkships to illustrate clinical application, applying concepts to multiple specialties, and highlighting cutting-edge genomics at UCSF. Challenges include lack of time for student advance preparation and means to assess student application of FS knowledge during clinical experiences.

CONCLUSION: FS-in-F2 days are an innovative means of integrating FS with clerkship experiences. By reinforcing a FS framework for clinical practice, we aim to equip future physicians with the skills to address human health and illness through application of current scientific knowledge.

Outcomes and lessons learned will be addressed after implementation.

Peter A Rubenstein, Jennifer G Jetton, and George Bergus
University of Iowa Carver College of Medicine

PURPOSE: In our new curriculum, “pre-clinical” teaching was shortened from 2 to 1.5 years assuming that foundational science would be reinforced during clinical clerkships.  However, decreased physician teaching time, a reluctance of students and faculty to decrease exposure to the patient, unfamiliarity of clinicians with relevant foundational science principles, and some physicians’ beliefs that focus on foundational science concepts is not important for teaching clinical medicine have been barriers to this extension of foundational science education.

METHOD: We are addressing this problem within the context of our Pediatrics core clerkship. Foundational science educators identify 6-10 learning objectives from foundational science courses related to a selection of disease states identified by the clerkship director as relevant to the clerkship. Clerkship faculty determine which of these learning objectives will be incorporated into the clerkship syllabus, and then the foundational science faculty write questions relating to the connection between foundational science and the clinical scenarios.  Questions are then edited by both faculty groups.

RESULTS: We have initially used questions about immunization, diabetes mellitus and hyperbilirubinemia. Questions are either MCQ in which students have to identify the correct foundational science explanation for a clinical practice or a short answer question that can be answered in 3-5 sentences. Faculty feedback allows students to correct errors in their understanding of the concepts.  Faulty answers for both types of questions must be corrected in short answer format to pass the clerkship.

CONCLUSION: The foundational science questions allow students to reacquaint themselves with the foundational material, previously mastered, that underlies clinical practices they are learning on their clerkships. This approach minimizes physician effort in preparing lectures, finding teaching set-aside time, and writing questions that focus on these foundational science concepts and should be generally applicable to all of our clerkships.

230 – Brody School of Medicine (BSOM) Medical Student CXR Knowledge: A survey
Angela Vuong
Brody School of Medicine

PURPOSE: Chest x-ray (CXR) interpretation is a basic skill in medicine. Often, medical students believe their classroom-based radiology education to be inadequate, forcing them to learn on rotations or elsewhere. This study assesses the effectiveness of the current BSOM M1 radiology curriculum by evaluating the retention of CXR knowledge through increasing levels of undergraduate medical education.

METHODS: A Qualtrics survey was composed and emailed to M1-M4 students at the Brody School of Medicine. The 23-question survey consisted of 3 general demographic questions. There remaining questions tests student’s knowledge of normal CXR structures. The quiz was released prior to the start of the M1 radiology course.

RESULTS: Of 102 responses, 96 contained answers to the survey’s knowledge portion. Of the 96, 3 did not identify class status and were disregarded in the analysis. Additionally, of the 96, 30 didn’t complete the entire survey and were also disregarded. This left 16 M1s, 17 M2s, 17 M3s, and 13 M4s who completed the entire survey. The number of correct answers were averaged per class. Of the 20 knowledge-based questions, the average number correct for the M1, M2, M3, and M4 classes were 6.88, 11.59, 12.18, and 13.85, respectively.

CONCLUSIONS: Despite beliefs that the M1 radiology course is inadequate, the results show an obvious increase in knowledge between M1 and M2 years. This concludes that the course has been effectively exposing students to CXR structures. The results also show retention of this information and some increased knowledge in M3 and M4 years, though not as steep as between M1 and M2 years. This is reassuring that this knowledge isn’t lost as we move away from the M1 course. The study now highlights room for improvement in the BSOM radiology education, as correct answers ranged from 58% to 69%.

Catherine Wang and Jill Glassberg Azok
Case Western Reserve University School of Medicine, University Hospitals Rainbow Babies & Children’s Hospital

PURPOSE: The preclinical curriculum at many medical schools has left students ill-prepared to interact with pediatric patients during their clerkship. Medical students report feeling least prepared for their pediatrics clerkship compared to the other clerkships [1]. This research aims to address whether having additional exposure to pediatric patients by teaching development during the preclinical years would enhance feelings of preparedness for students.

METHODS: Exposure to pediatric patients will be provided to students in the Case Western Reserve University School of Medicine Class of 2020 (University Program, ~180 participants) in the form of a 60-minute mixed didactic/skills session. This session will include a 15-minute didactic session on developmental milestones and a 45-minute skills practice for groups of 3-5 students. We will administer a knowledge-based and attitudinal assessment after half of all students have completed their session. For the students who have completed their session, this will serve as a post-test. For the students who have not completed their session, this will serve as a pre-test and be used as a control. Using this randomized experimental design, we hope to assess differences in preparedness and confidence in performing a pediatric developmental screening between students who have and have not received the intervention.

RESULTS: We will present results demonstrating differences in students’ attitudes toward the importance of developmental screening and knowledge of pediatric development after this session. We will also present results showing differences in students’ perceived preparedness for the pediatrics clerkship after this additional session.

CONCLUSIONS: To date, the study highlights the importance of having both a faculty member and a student working on curriculum development. The perspective of each is invaluable in creating an interactive session that is high yield in terms of knowledge and skill acquisition.