2019 Meeting Posters – Curriculum

200 – The Rotating Radiologist
Peter Nesbitt and Molly Johannessen
Lake Erie College of Osteopathic Medicine

Purpose: A physician equipped with basic radiological information and reading skills will provide superior care for all patients. Unfortunately, very few physicians receive proper instruction needed during their medical school career and the foundation of radiological knowledge needs to be strengthened. Many schools have acknowledged this problem and have attempted to address it, and there is a call for a well-developed and uniform curriculum to train radiology to all medical students. In addition to medical schools, survey data of physicians show support and understand the necessity for a curriculum that will bring better education to future physicians.

Methods: This project presents the development of an online radiology curriculum for use by any medical schools or medical students intending to expand their radiological knowledge.  To efficiently integrate the material into students’ learning, a few approaches may be used: A clinical radiology four-week clerkship covering all avenues of radiological imaging and interpretation or a two-week supplementary educational curriculum. This flexible curriculum allows learning to fit in many different shapes and forms of the already full curricula of medical school.  Furthermore, allowing this material online will allow learners to access it at any time from any location when they are in need of refreshing knowledge.

Results and Conclusion: The goal is to educate future physicians, while also alleviating the overwhelming prospect of analyzing images by developing a widely accepted systematic approach to image analysis. The reality is that majority of radiological reports come back normal. With a focus on clinical medical students, this learning tool will enable students to view a radiograph in a real-life context and know exactly where to start.  An online resource featuring a partnership of instruction and practice radiological reports will help the medical community to become better prepared with radiologic knowledge.

201 – Do medical students appreciate lifestyle medicine and are they confident in their skills? A Needs Analysis for Educational Interventions
Magdalena Pasarica and Denise Kay
University of Central Florida College of Medicine

Purpose:  Two decades ago, integrating nutrition into the pre-clinical education of medical professionals received a strong push assuming that it will translate clinical skills and ultimately to clinical practice. As strong data on the benefit of changing other behaviors (like exercise and sleep) became available, the assumption was that it will also be integrated. Currently, studies show that medical providers are not using lifestyle changes for managing and/or preventing chronic diseases (defined as lifestyle medicine-LM), which was interpreted by American Medical Association (AMA) as a gap in LM training. Our purpose was to determine what items need addressing in the clinical years for filling the gap in LM education.

Methods: Medical students were surveyed during the first clinical year using a 5-point Likert scale about perception related to LM (from strongly disagree-1 to strongly agree-5) and about confidence in their LM skills (from not at all confident-1 to extremely confident-5).

Results: Students agreed that lifestyle management recommendations are a valuable use of limited patient-doctor time (Mean 4.4,SD=0.7); a valuable tool for prevention and management of chronic diseases (Mean 4.9,SD =0.3); and worth their time (Mean 4.7,SD =0.5). Student reported self-confidence in prescribing personalized lifestyle advice to patients with multiple common conditions (Mean 3.2,SD =0.8), obtaining comprehensive lifestyle history (Mean 3.8,SD =0.8); assisting patients with setting personalized, clear lifestyle goals (Mean 3.9,SD=0.1); and using motivational interviewing with patients for improving the outcomes of lifestyle interventions (Mean 3.2,SD=0.8).

Conclusions: Our study showed that both assumption were incorrect. LM requires an advanced clinical skill that needs formal expansion into the clinical years for learners to develop the confidence needed to integrate LM into their practice. When addressing the LM gap, educators should allow more time and effort for targeting the lower scored items, especially gaining confidence in providing efficient lifestyle management.

Lauren M. Granat, Anna Weinstein, Donna McMahon, Christine Hutak, Bhuma Krishnamachari, William Blazey, and Thomas Chan
NYIT College of Osteopathic Medicine

PURPOSE Many medical schools in the United States are transitioning to curricula that include clinical experiences during the didactic years. There are numerous advantages to early clinical exposure: improved physical exam performance, increased confidence in treating patients, and better integration of clinical and basic sciences. New York Institute of Technology College of Osteopathic Medicine (NYITCOM) has two distinct curricular tracks: the Lecture-Discussion Based (LDB) track, which primarily utilizes traditional lectures and the Doctor-Patient Continuum (DPC) track, which is problem-based. About 88% of the student body is enrolled in the LDB curriculum. Due to the small size of the DPC cohort, students have more opportunities for early clinical exposure, including shadowing and simulation-based patient and mannequin encounters. Students at NYITCOM are assessed using the Professional Assessment Rating Scale (PARS). The PARS is comprised of the following components: Rapport, Empathy, Confidence, Nonverbal Communication, Communication, Listening, Counseling, and Physical Examination. Students are given scores ranging from 1-9, with those achieving a score less than 4 flagged for intervention.  

METHODS PARS scores were compared between the curricular tracks using t-tests, with ? = 0.05.

RESULTS 1,086 LDB students and 129 DPC students were included in this analysis. DPC students received higher scores on each aspect of the PARS score, as compared to LDB students (p ? 0.0001), though both averages showed “satisfactory performance.” The aggregate PARS scores for both groups also showed “satisfactory performance,” with a statistically significant higher average among DPC students vs. LDB students (6.53 (SD 0.44) vs. 6.23 (SD 0.50); p ? 0.0001)).

CONCLUSION Additional clinical exposure may be helpful for students, leading to better patient communication and clinical skills. These initial results need be confirmed with a larger study and should account for selection bias using appropriate comparison groups.

203 – Early Human Development: integrated course of Embryology and Genetics
Iuliia Zhuravlova
Trinity School of Medicine, St. Vincent and the Grenadines

INTRODUCTION The integration of the disciplines is one of the main trends, which in many cases remains a challenge 1. The challenge includes not only the organisation of the process itself, but also the level of detail required for each of the integrated courses, as well as the relevance of the taught material. It is widely discussed in the literature, that integrated programs promote deep learning as well as the better retention of knowledge 2,3.

METHODS The new Early Human Development course included Genetics topics combined with the Embryology. To compare the outcomes, the Embryology standardised questions were used. We have compared the level of students’ performance in Embryology part of the material before the course was integrated with Genetics versus after. The students were also surveyed on their perception of the effectiveness of the integrated course.

RESULTS It was identified that the quality of responses to the standardised Embryology exam questions, after it was integrated with the Genetics course increased up to 17.7 % in 2016, and up to 18.3 % in 2017. In 2018 the tendency remained positive with 18.1 % increased level of students’ performance compared to the results before integration. The difference was statistically significant (p< 0.01). Overall amount of students evaluated during the period from Summer 2016 semester to Summer 2018 semester was 268. The students’ responses regarding the effectiveness of the integrated course were overall positive. Several responses suggested the faculty to rearrange several topics within the course for a better flow of the material. The level of feedback was 60.8% (163 students).

CONCLUSION With our study we have confirmed that integration of the Embryology and Genetics courses might help students to learn Embryology with the better outcomes. We plan to compare the standardised Genetics questions as the next step of our study.

Poster Award Nominee
Marek Svoboda, Yasmin Kamal, and Roshini Pinto-Powell
Geisel School of Medicine at Dartmouth

PURPOSE One of the goals of evidence-based medical education is to familiarize future physicians with the scientific method in order for them to comprehend scholarly literature and communicate it to their patients. However, many medical students lack the skills necessary to participate in research themselves. Here we describe an implementation of a comprehensive elective course which is designed to equip interested students with these skills through a series of workshops, one-on-one mentorship, and pursuit of a summer research experience.   

METHODS The elective course has been implemented for one year. Participating students are selected among first-year medical students based on their motivation to conduct basic, translational, or clinical research. No prior experience is required. Throughout the year-long course, students attend a series of 10 one-hour workshops designed to teach them the skills necessary to engage in research. Topics covered by invited faculty experts include resources management, clinical trial design, scientific writing, and funding opportunities available to medical students. Additionally, each student is paired with a peer mentor to help them navigate the research community. At the conclusion of the course, students complete and present a Specific Aims page based on their proposed study.   

RESULTS Nine students participated in the first year of the elective (2017-2018). All students secured a research position for the summer following their first year of medical school and four students also obtained nationally competitive funding. 78% of the students indicated that participation in the elective significantly helped them find and secure these positions and 88% learned valuable research skills not taught in their medical curriculum.   

CONCLUSIONS M1 participation in a well designed research elective has the potential to provide immediate value in the acquisition of a summer research position and to stimulate a lifelong interest in scientific inquiry.

Sarah H. Parker, Richard C. Vari, and Cynda A. Johnson
Virginia Tech Carilion School of Medicine

PURPOSE Systems safety is rapidly becoming common parlance in medical schools and hospitals. However, there is limited information available on when and how to integrate this content into medical school curricula. As students move from classroom to clerkship and into residency, it is critical that they know the language of health systems science, and have the capacity to understand system factors that influence team performance.

METHODS A team of clinicians, medical educators and systems safety experts developed a systems safety thread through all 4 years of the medical school curriculum. After completing a keyword curriculum mapping exercise, we focused on two overall objectives for the new systems safety curricular thread: 1) understanding the language of safety and being fluent in its use, and 2) understanding the science of safety through exploration of human error and individual and team performance limitations.

RESULTS Integration of our new systems safety thread through all 4 years of the curriculum began in fall of 2017.  During lectures in their first year, students were taught systems safety using the SEIPS (Systems Engineering Initiative for Patient Safety) model as a framework for systems safety. Throughout the first 2 years, systems safety concepts were addressed via new learning objectives within problem based learning (PBL) cases. Specific learning objectives related to team performance, leadership and systems safety were also integrated within the Interprofessionalism learning domain.

CONCLUSION Using PBL cases to address this content is a strength and provides students an opportunity to see how systems safety concepts are applied in a clinical setting. Significant development work is currently underway to integrate specific systems safety learning objectives across clerkships and sub-internship rotations including dovetailing our work with similar requirements for graduate medical education. Integrating this content across the curriculum requires significant faculty development to ensure fluency in these concepts.

Kristina J. Van Nuys and Robyn Dreibelbis
Western University of Health Sciences

PURPOSE Fewer than 14% of physicians believe they are properly trained in nutrition counseling, yet research shows that the chronic disease risk of chronic diseases can be decreased through healthy nutrition. Nutrition in Medicine (NiM) is an evidence-based, 8-session elective lecture series centered on nutrition and human health. We wanted to understand the impact that nutrition education has on medical student’s personal dietary habits as well as their confidence, willingness, and motivation to counsel others about nutrition’s impact on health.

METHODS First and second year medical students completed a survey before and after the 2017/2018 NiM lecture series. Surveys included questions about personal dietary habits, willingness and motivation to change personal dietary habits, confidence and motivation to counseling others on plant-based diets, and confidence in nutritional knowledge. Chi-square tables were used to test for statistical significance with 95 % confidence intervals.

RESULTS 472 students completed the surveys; 264 students had never attended a lecture (Group 1) and 208 attended at least one lecture (Group 2). Statistical significance was found in all categories of the study comparing post-surveys between Group 1 and Group 2. Students who attended at least one lecture were found to adopt a more plant-based diet, were more willing and motivated to adopt a plant-based diet, and were more willing, confident, and motivated to counsel others on nutrition’s impact on health and on the plant-based diet.

CONCLUSION Teaching medical students about nutrition is a unique way to solve the national burden of chronic disease. Nutrition education changes medical student’s diets, as well as their confidence and motivation to counsel others in nutrition as medicine. Mandating nutrition as a core competency of medical training has the potential to change the health of our nation.  

207 – SAFE- A Scaffold Curriculum to Teach Safe, Appropriate, Timely and Value Based Imaging to Medical Students
Janet A. Neutze, Allene S. Burdette, James M. Brian, Pamela L. Brian, and Alison L. Chetlen
Penn State College of Medicine

PURPOSE Students with diverse specialty interests often take a diagnostic radiology elective. Classically, radiology electives teach radiologic anatomy and pathology, reviewing the basics needed for clinical practice. Now at the forefront of radiology education, the issue of cost and safety are increasingly important to the public. Teaching responsible utilization of imaging and its relative costs can be incorporated into radiology education. A new curriculum was created to align with the American College of Radiology (ACR) Imaging 3.0 goals of providing appropriate, timely and value-based imaging to all patients and clinicians.  Students will gain skills to be able to choose the safe, appropriate imaging.

METHODS We created an educational program to improve patient care and increase value utilizing a new scaffold curriculum for medical students and learners of all levels.  Medical Student Education directors refined diagnostic radiology elective goals to not only fulfill students’ expectations but also to provide them with new non-interpretative skills. This new program includes evidence-based decision making and incorporates health care policy, economics, and patient centered care. The SAFE curriculum includes: Safety -Appropriateness-(interpreting) Films- Expedite and Execute. Without safety and appropriateness practiced first, even the best imaging interpretation may not result in the indicated and desired value-based, patient-centered care.

RESULTS Due to the positive responses from post-program surveys, we plan to broaden applications of the SAFE radiology concept throughout all four years of medical school curriculum in courses such as anatomy, clinical clerkships and other electives. We are also considering the creation of an “accomplishment designation” to recognize levels of achievement among faculty radiologists (Master Teachers of the SAFE concepts) with plans to integrate junior and senior radiology residents into the teaching curriculum.

CONCLUSIONS SAFE radiology is an easily learned, effective method to introduce learners to concepts of appropriate, timely and value- based imaging.

208 – Assessment of Medical Students’ Attitudes and Use of Complementary and Alternative Medicine at a Caribbean Medical School
Benjamin Karabasz
St. George’s School of Medicine

PURPOSE The goal of this survey was to examine the attitudes and use of Complementary and Alternative Medicine (CAM) of medical students from St. Georges University School of Medicine; the largest international provider of physicians practicing in the United States.   

METHODS A questionnaire was emailed to 2nd year medical students to collect data regarding respondents’ knowledge about and attitudes toward CAM as well as their personal use and experience with CAM modalities. A previously validated survey, The CAM Health Belief Questionnaire was supplemented with questions on student personal use of CAM, future use of CAM modalities to treat patients, and the sources for their knowledge about CAM.   

RESULTS The results of this survey indicate current medical students have more personal use of CAM modalities and are more likely to recommend patients and friends for CAM treatment than medical students in past surveys. Specifically, 95% of medical students have personally found CAM modalities useful, 82% would recommend CAM to patients, and 75% would refer patients to a CAM practitioner. Students reported a lack of evidence based knowledge about CAM and a desire for increased CAM education in their medical school curriculum.   

CONCLUSION The experience with and use of CAM modalities for themselves and for future patients has increased compared to previous medical student assessments. This is despite student frustration with the amount of objective and critically reviewed CAM instruction presented in class. Increased student use mirrors trends reported for the general U.S. population and supports the need for CAM education presented in an evidence based manner.

Yenya Hu and Andrea Vallevand
Wake Forest School of Medicine

PURPOSE Performance on the United States Medical Licensing Examination (USMLE) Step 1 is one of the major factors that can influence residency program selection. To maximize the potential for each student to deliver their best performance, we have developed and implemented a longitudinal, phase-specific, outcome-driven, and individualized Step 1 coaching program throughout the preclinical curriculum. The level of student engagement was monitored during the coaching sessions. We hypothesized that students who are engaged in the coaching process benefit more, as they are more willing to evaluate their strategies and monitor progresses, and thus perform better on Step 1.

METHODS A regression equation, based on preclinical performances, was generated to calculate the predicted Step 1 scores. Group and individualized coaching sessions were conducted throughout the preclinical phase and more intensified in second year. Analysis of variance (ANOVA) was undertaken to establish whether there are differences between the engaged and not-engaged groups on predicted and actual scores, and the difference between two.

RESULTS Multiple R for the regression equation equaled 0.839 (p < .001) and variance accounted equaled 70.4%. ANOVA revealed no difference in predicted Step 1 scores between the engaged (n=75) and not-engaged (n=23) groups (F[1, 96] = 1.864, p ? 0.175). The engaged group performed significantly better on actual Step 1 scores (F[1, 96] = 14.546, p ? .001) and on the difference between predicted and actual Step 1 scores (F[1, 96] = 19.007, p ? .001). Nineteen students did not participate in coaching. No statistically significant differences between their predicted vs. actual Step 1 scores were found (F[1, 37] = 0.051, p ? .823).

CONCLUSION Being engaged in the coaching sessions promotes accountability, self-reflection and deeper outcome-driven learning, which may contribute to a better performance on Step 1.

Mikalyn DeFoor, Lauren East, Shawna McCafferty, Paul Mann, and Carol Nichols
Medical College of Georgia at Augusta University and Medical University of South Carolina,

PURPOSE Due to the shifting trends of medical education away from traditional lectures, peer-facilitated, case-based instruction for teaching medical ethics is an innovative approach. The introduction of ethical principles and opportunities to practice them during the pre-clinical curriculum is essential to the development of future physicians.

METHODS Quarterly, peer-facilitated medical ethics case discussion sessions were added to the Year 1 curriculum. Each session was led by a group of second year medical students and incorporated a case with an ethical dilemma, a relevant review article, discussion questions and a short pre-and post-session survey. Students were asked for feedback on the post-session surveys and on an end of year curriculum survey.

RESULTS For the 2017-18 academic year, post-session survey results indicated better understanding of ethical dilemmas, including consideration of social disparities in biospecimens, patient privacy, reproductive assistance and informed consent. In response to the end of the year survey (n=82), 74.5% of students were neutral, agreed, or strongly agreed that the peer-facilitated discussions contributed to their development as a future physician. Narrative responses about the sessions were also encouraging with students requesting more time for discussion.

CONCLUSIONS Peer-facilitated medical ethics case discussions appear to be a novel and effective strategy for teaching medical ethics to students in the pre-clinical curriculum. The format allows students to discuss ethical principles and dilemmas in a nonthreatening, peer-facilitated environment. This model for teaching medical ethics is both effective and easy to implement in other medical education settings and programs.

211 – Translational Neuroscience Research Mentorship. A platform to integrate Scientific Research into Medical Education
Alberto Musto and Andrew Ojeda
Eastern Virginia Medical School

Scientific training in medical education could contribute to improve the understanding of clinical problems and improving health outcomes. This mentorship experience focuses on translational neuroscience research concepts in the medical curricula that will contribute to understanding the nervous system, pathologies associated, differential diagnosis, scientific method, laboratory techniques, biomarkers, and novel therapeutic targets.

METHODS This mentorship, promoted for first and second year medical students, was developed during the current curricular year. It used the current content of medical neuroscience with knowledge of basic and translational research to study real cases from clinical trials and current scientific research publications. Students selected a problem, create a hypothesis, and develop an approach to test in the laboratory. Assessments were based on: A) successful identification of scientific premises, description of the experimental designs, summary of results and alternative methods, impact of disease, presentation of results in of poster or manuscript; B) laboratory techniques, presentation and writing skills, professionalism, and teamwork; C) feedback was conducted before and after the program to evaluate this mentorship as a learning experience.

RESULTS During 2017-2018, 25 students, which represent a total of 14% of the medical student’s population requested to participate in this mentorship. They contributed to four publications in top-tier journals (one invited for resubmission), six abstract and poster presentations to professionals meetings, in addition to strengthening their medical scholarly in preparation for residency.

CONCLUSION This mentorship will allow the continuing improvement of the students’ approach to current scientific problems and medical necessities by promoting critical thinking, creativity, building strategic teamwork, and imparting the students with confidence to continue research in medical neuroscience.

212 – An Innovative Method To Promote Quality in Peer Feedback
Ashleigh CM. Bull, Alexander Beckstead, Shreya Sreekantaswamy, Rachel Huynh, Rachel Tsolinas, Cecilia Peterson, Veronica M. Urbik, William West, and Janet Lindsley
University of Utah School of Medicine

PURPOSE Peer feedback, though common in undergraduate medical education, lacks a consistent system to ensure quality. The University of Utah School of Medicine (UUSOM) integrated a quality grading system into the peer feedback component of Team Based Learning (TBL). Current TBL feedback methodologies focus on self-assessment and peer feedback of a student’s performance. There is no established modality, however, in which students grade the quality of the feedback they receive.

METHODS In preclinical coursework, UUSOM students provide feedback to their TBL teammates and rate the feedback they receive utilizing a 5-point rubric: Was this feedback actionable? Was this feedback specific? Was this feedback respectful? Was at least one positive behavior identified? Was at least one constructive suggestion given? The peer ratings students receive for their feedback count toward their final grade. The main limitation of this rubric is the potential for social pressure resulting in grade inflation. Student TBL feedback and ratings for MS2021 (5 courses) and MS2022 (2 courses), along with MS2020 peer feedback (prior to implementation of the 5-point rubric) are utilized. First, the rubric’s impact on feedback quality will be assessed by comparing blinded researcher ratings (using the 5 point rubric) for the MS2020 and MS2021/MS2022 cohorts. Next, the accuracy of the student feedback rating within the MS2021 and MS2022 classes will be assessed by comparing blinded ratings to peer ratings. Finally, longitudinal improvement in feedback quality will be evaluated by comparing blinded MS2021 feedback ratings over five courses.

RESULTS Preliminary analysis suggests a measurable improvement in feedback quality with the implementation of the 5-point rubric.

CONCLUSIONS This method provides a quantitative tool useful for measuring and improving the quality of student feedback. This 5-point rubric can be easily implemented into an established curriculum to improve the quality of peer feedback.

213 – Multiinstitutional Faculty Perspectives on Transitioning to Active Learning
Laurel Gorman, Monica Baily, Andrea Berry, and Magdalena Pasarica
UCF College of Medicine Dept Medical Education and UCF College of Medicine Dept Faculty Life & Development

PURPOSE While most medical education programs dictate that faculty employ active learning methods (ALMs) and reduce didactics, limited data exists on faculty identity and perspectives as curricula transition, shifting traditional teaching roles. To gain insight into faculty perspectives, we conducted a focus group of medical educators during the 2017 IAMSE meeting utilizing audience responses systems (ARS) and group discussion.  The purpose of this poster is to share themes arising from this session to inform a larger audience about faculty perspectives in this age of curricular transition.

METHODS Fifty-five medical educators with diverse backgrounds and levels of experience anonymously answered ARS questions and participated in small groups (N=6-8 per group, 8 small groups) followed by large group sharing using gallery walk deliverables. ARS and small group topics included self-identity, ALMs motivation, and barriers limiting success.  Themes were determined after the activity by reviewing anonymous group products and ARS survey data. 

RESULTS Survey data suggested faculty perceived ALMs were most effective for promoting retention (89% mostly/strongly agreed) but less agreed that ALMs received positive evaluations (25%) or were time efficient (42%).  The greatest motivator to using ALMs was increasing engagement (22% selected as top reason) with critical thinking and retention following (19% & 18%, respectively).  In terms of major barriers identified in group discussions, 5 groups identified topics related to institutional support/faculty development, 4 identified incentive misalignment, and 4 cited time.

CONCLUSIONS Results suggest medical educators are intrinsically motivated to use ALMs to promote engagement, critical thinking, and retention, but perceive major barriers to successful transition, including insufficient institutional support, external incentive misalignment, and competing time demands.  Given these issues generalize to all medical schools, sharing this data can clarify faculty needs to facilitate more successful program transitions.

214 – The Effectiveness of ScholarRx© as a Supplemental Resource Following Formative Assessment in Undergraduate Medical Education
Kelly Quesnelle, Jeffrey Greene, and Elyssa Weigand
Western Michigan University Homer Stryker M.D. School of Medicine

PURPOSE Studies in undergraduate medical education point to information organization and integration as the most common student difficulties in the pre-clinical years. Formative assessments are designed to help students identify areas of weakness. Thus, there is cause to investigate the effectiveness of a supplemental resource that is focused on organizing pertinent information following formative assessment.

GOALS The goal of the present study is to investigate whether high-quality supplemental curricular resources, such as ScholarRx©, can improve student satisfaction with formative assessments and student outcomes on the summative assessment. We hypothesize that high-quality, supplemental resources will improve student satisfaction with the formative assessment process, and improve summative assessment outcomes.

METHODS ScholarRx© is a medical curriculum containing singular units of instruction, termed “bricks.” During the Hematology and Oncology course at our medical school, students complete optional weekly formative assessments prior to the summative assessment. Following each formative assessment, ScholarRx© bricks were provided when associated with a learning objective sampled on the formative assessment. To assess student satisfaction with the formative assessment process, students completed surveys about supplemental learning resources. Summative assessment data is also being used to measure student outcomes associated with ScholarRx© brick use.

RESULTS Data analysis for this study is currently ongoing but is expected to be complete by May 2019. Preliminary analysis indicates improved student satisfaction with the formative assessment process among users of ScholarRx© bricks compared to non-users of ScholarRx© bricks.

CONCLUSIONS This study will provide data detailing the use of supplemental curricular resources following formative assessments. It will measure results based on both student perceptions and summative assessment performance.  

Riddhiben Patel, Ian A. Paul, Eddie Perkins, Tarif Bakdash, Loretta Jackson, and Sajani M. Tipnis
University of Mississippi Medical Center

PURPOSE For the past two decades there have been calls for medical education reform with an emphasis on systems-based teaching and early clinical exposure. To overcome faculty skepticism of such changes at our medical school, we opted to begin with a proof of concept by integrating the neuroscience and behavior in a pilot that began in spring 2017.

METHODS The program has been running for two years. The M1 class, Neuroscience and Behavior 1 (NSB1), integrated topics from neurobiology, neurophysiology, psychiatry, and neurology. Faculty collaborated to share lecture content. Teaching modalities in NSB1 include didactic learning sessions, gross CNS labs, active learning, laboratory demonstrations, case based learning, clinician wrap ups, and clinical experiences. In the NSB2 course topics from psychiatry, neurology, neurosurgery, neuropathology and CNS pharmacology were integrated. Twenty standardized patient encounters were added to advance the clinical educational experience and provide low stakes assessments.

RESULTS Prior to integration, the M1 curriculum consisted of a neurobiology course and an introduction to psychiatry with a standardized NBME exam at year’s end. In 2016 our class mean was 45.5 and in 2017 with the new NSB1 curriculum it was 47.7. The national mean for 2013-2015 was 49.6. The majority the content areas showed improvement. In NSB2 we administered a 150 item customized exam as there was no standardized NBME. This exam was designed with questions producing an average of 76% based on previous Step 1 performance. Our class mean for this exam was 77.9%. Individual content scores ranged from 74.2% in neuroscience to 82.6% in mental disorders.

CONCLUSION Despite concerns, the outcome of out pilot has demonstrated that performance improved and student faculty satisfaction is high. Post pilot the SOM will integrate all of the M1 and M2 curriculum. Clinically relevant elements can be introduced successfully to early students to clinically engage the learners.

David W. Musick, David B. Trinkle, Richard C. Vari, and R. Brock Mutcheson
Virginia Tech Carilion School of Medicine

PURPOSE The integration of interprofessional education (IPE) competencies as early as possible into health professions education programs “is a critical component of instantiating a team approach to care”1.  Many medical schools offer IPE content early in the curriculum, with mixed reviews by students.  We sought to determine whether medical student perceptions concerning the value of IPE change over time and, if so, how such changes were reflected in student feedback and other types of educational outcome data.

METHODS Anecdotally and based on years of IPE curricular experience, we observed that students’ perceptions concerning IPE were negative early in the medical school curriculum, but improved over time and with increasing levels of clinical experience.  To explore this issue, we examined a variety of longitudinal student feedback data with emphasis on tracking the IPE experience of a single class (2017) across all four curricular years.  Data sources included end of course/rotation evaluations, learning environment surveys, M3 clerkship assessment of students, residency program director surveys, AAMC graduation surveys, alumni surveys and LCME student surveys.

RESULTS Based on exploration of the identified data, we observed an overall positive trend regarding how students perceive the value of IPE over time.  Alumni survey data, collected from graduates in the midst of their residency training, were especially positive.  Increased clinical experience appeared to result in a more positive view of the relevance and importance of prior IPE experiences.

CONCLUSION In order to evaluate the impact of IPE curricula, it is likely necessary to examine data from a variety of sources.  Medical student perceptions of IPE vary across time and are likely to improve with additional clinical experience.  Longitudinal cohort studies would yield a clearer picture of the perceived value of IPE to medical students and, by implication, resident physicians who have experienced IPE during medical school.

217 – A New Medical Education Paradigm: Program Integration of Foundational and Clinical Sciences
Donna DeGracia and Heather Bidinger
St. Catherine University, MPAS Program

PURPOSE Medical education recognizes value in integrating foundational science and clinical science in new ways in order to provide students with the necessary tools for astute critical thinking and life-long learning. Evidence from around the world strongly suggests that integration is the preferred method of preparing students for current clinical practice expectations. Transition from traditional curriculum to integration is difficult for programs with limited time to deliver extensive mandated content. This presentation will introduce participants to an integrated curriculum, presenting students with a broad learning experience, bringing knowledge of foundational science to life and honing their critical thinking and analytical skills.

METHODS St. Catherine University’s Masters of Physician Assistant Studies (MPAS) Program, a 28-month program divided equally between didactic and clinical training, incorporates a longitudinal approach to integrating foundational and clinical sciences, understanding that clinical readiness necessitates understanding of basic sciences in connection with clinical problem solving. The curriculum utilizes multiple teaching methods and spiraling complexity to prepare students. A variety of assessment methods test critical thinking skills and ability to apply scientific concepts to clinical scenarios.

RESULTS Preceptor evaluations, employer surveys, alumni surveys, and national standardized test scores confirm success. Benefits include knowledge retention, critical thinking skills and interpersonal relations, all crucial to practice readiness. Challenges remain in faculty training, collaboration, and faculty load. Necessary components include program administration and faculty buy-in, creativity, and flexibility.

CONCLUSION The MPAS Program has successfully employed the integrated curriculum since 2012. This approach seems intuitive from a clinical perspective. Our experience has convinced us that integration of foundational and clinical sciences allows for longitudinal development of critical thinking skills and improves practice readiness. While integration requires forethought, the value of improved learning experience and increased clinical readiness makes the effort worthwhile.

Poster Award Nominee
David B. Trinkle, David W. Musick, Renee LeClair, Nathaniel L. Bishop, Cynda A. Johnson, and Joalenn Tabor
Virginia Tech Carilion School of Medicine and Jefferson College of Health Sciences

PURPOSE To design a new interprofessional culinary health curriculum for first year medical, nursing and physician assistant students (total=135).

METHODS As medical schools focus more on healthy communities, there has been a corresponding expansion of teaching on nutrition and healthy cooking concepts.  Students in the early years of training must learn about clinical nutrition and the dietary needs of special populations.  Other relevant concepts that play a role in culinary health include population health, clinical dietetics, health disparities, quality and safety, and service learning.  Interprofessional team activity in a large commercial training kitchen also offers many analogies to fast paced hospital care teams.  Working with two partner institutions, we launched a culinary health program that involved three components:  expanding students’ nutrition knowledge base, team-based meal preparation and service, and community outreach.  Interdisciplinary student teams worked together during two lab sessions in a commercial kitchen wherein they cooked and served five different types of meals based on special patient populations.  They also completed a nutrition oriented community service project involving inner city youth, performed a nutrition “self-analysis” exercise and worked through clinical nutrition cases.

RESULTS Students provided feedback on standardized course evaluation forms, rating the culinary health experience at 3.75 on a 5-point scale.  Excellent suggestions for course enhancement were received.  There was a range of student “buy in” regarding the analogy of a commercial kitchen being similar to a busy clinical environment.

CONCLUSION The successful implementation of a culinary health program involving students from three disciplines requires abundant logistical support.  Similar programs, during either preclinical or clinical years, may be scalable and easily accomplished.  Strengths included a large student base from three disciplines and the mandatory curricular requirement for the program.  Limitations included a single school intervention and one year’s worth of experience and student feedback data.

219 – Perceptions of End of Life Training: Is there room for improvement?
Tracy Wunderlich-Barillas
Oakland University William Beaumont School of Medicine

Purpose Many medical students admit to feeling inadequately prepared and uncomfortable when caring for patients in real-time end of life situations.  For the past two decades, over one-third of deaths occur in the hospital setting (CDC), which makes it imperative to provide comprehensive end of life training to students who will be charged with providing care. This exploratory research seeks to better understand how beliefs, values and different types of knowledge influence the way students learn about death and dying to offer insight into possible improvements in training.

Methods This research has been taking place for two years at an allopathic medical school.  Participants (faculty and students) were recruited using purposeful and snowball sampling methods, respectively.  Enrollment is ongoing.  The study involves observing students and faculty in academic settings (both classroom and clinical) as well as collecting qualitative data via semi-structured interviews with faculty (N= 5) who provide end of life training as well as third and fourth year medical students (N=10) who have experienced an end of life situation while rounding.  Thus far, both preliminary observation and interview data were coded using grounded theory to determine emerging themes and concepts.

Results Preliminary results from students and faculty suggest that the most impactful ways to learn occur by observing, listening and participating in end of life situations in the clinical setting.  However, this is difficult to accomplish given limited time in the curriculum and also limited occurrence of end of life experiences.

Conclusion Based upon preliminary findings, plans currently include development of more training in hospice settings, more end of life family panels and also creation of elective rotations in palliative and hospice care.  In addition, more opportunities for debriefing and discussion with peers regarding end of life experiences in the clinical setting are also being planned.

Olivia Coiado, Dipanjan Pan, and Kashif Ahmad
Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, and Department of Bioengineering, University of Illinois at Urbana-Champaign

PURPOSE Carle Illinois College of Medicine is creating a new model for medical education that integrates engineering principles and technology into a case-driven, active learning curriculum.  This novel engineering-infused curriculum will enable the training of a new class of physician-innovators who will design and implement transformative approaches for healthcare delivery.  To attract students that can meet this challenge, the college is hosting a series of showcases that immerses prospective students in this approach. A key showcase component is a problem-based learning (PBL) module comprising a patient scenario that integrates engineering, medicine, and teamwork concepts.

METHODS The PBL module was run in groups of four-students by a facilitator. After presenting the case about an injured hiker, the students were given two tasks: The first task required students to identify symptoms and list possible medical injuries for the patient.  The second task required students to build a boat out of playing cards to transport the patient and other hikers (figurines) across a river to safety.  The boats were tested to see if they could remain afloat while fitting four figurines.  The facilitator ended the session by summarizing the learning objectives.

RESULTS The outcome of the PBL was gauged via task completion and facilitator input.  All sessions achieved the final delivery goal of constructing and testing a boat that satisfied predetermined requirements. Facilitator feedback reflected a positive impact on students’ understanding of 1) how Carle Illinois PBL sessions will be facilitated, 2) the collaborative nature of student team-work and research required, and 3) how engineering concepts will be integrated into medical case scenarios.

CONCLUSION Development of its showcase PBL is one way Carle Illinois College of Medicine is leading recruitment of a new class of medical students and inspiring them to revolutionize healthcare through designing engineering-based solutions to current and future medical problems.

221 – Mentoring from the ground up: Improving mentoring relationships by empowering mentees
Marissa Hansen, Katherine Cornelius, and Heather Billings
Mayo Clinic

PURPOSE Mentorship is an important aspect of medical education at all levels, however most mentors are not provided education in how to be an effective mentor. Similarly, most mentees are not provided education or training on how to optimize a mentoring relationship for their learning and professional development (Ramani, 2006). Considering the evolving needs of our learners and intending to provide support to grow their mentoring relationships, we designed and facilitated an eight-hour program to better prepare learners to be empowered mentees as well as future mentors.

METHODS We utilized the Mentoring Competency Assessment (MCA) to measure learners’ self-perceptions of eight competencies through a pre and post-intervention survey design (Fleming et al., 2013). We adapted evidence-based curriculum (Pfund et al., 2014) to be delivered to learners across the health professions continuum and incorporated case based discussions, frequent low-stakes formative assessments, and peer-to-peer facilitation to heighten authenticity, relevance and immediacy to the learning experiences. Session participation by program alumni allows for contextual demonstration and competency application.

RESULTS Preliminary data demonstrates heightened perceived competency in most domains assessed. We found mentors generally rated their mentee’s skills at a higher level than the mentees’ perceived ratings. We also saw significant relationships in a few domains e. g. new vs. established relationships, females vs. males, etc. Individual session evaluations are extremely positive, and learners routinely report behavioral changes as a result of these sessions.

CONCLUSION We have demonstrated the successful adaptation and innovative facilitation of a successful mentorship develop program for learners throughout the continuum of health professions education. We propose that several factors discussed are critical in the success of this type of curriculum. Preliminary conclusion: A structured curriculum in mentoring relationships increases mentee’s empowerment and readiness to lead mentoring relationships at all levels of medical education.

Poster Award Nominee
222 – Reconnecting the Mouth to Medical Education

Mariah Rudd, Richard Vari, and Cynda Johnson, Bruce Johnson, Lynne Pearo, and Bud Conklin
Virginia Tech Carilion School of Medicine

PURPOSE: The absence of oral health education in medical education has resulted in physicians who are poorly equipped to diagnosis, treat, refer and collaborate on matters of oral health and disease. This poster describes the successful integration of an oral health curriculum, with measurable outcomes, into the medical curriculum.

METHODS: In the first two years of the curriculum all medical students are now required to engage in thirty-six hours of oral health education which includes a lecture presented by an international expert on oral health, labs on anatomy/oral health, PBL patients with dental diseases, lectures on oral manifestations of systemic disease, oral cancer screening, and inclusion of the oral exam into the HEENT exam. In year 3 oral health is a component of the Family Medicine Clerkship.  Assessments include a HEENOT (O=oral) exam with standardized patients, a written exam in year 2, student satisfaction of the oral health week, and a retrospective chart review comparing documentation of oral components  within student (n=100) and attending (n=100) HEENT exams.

RESULTS: The average score on the oral written exam has been 89%. Qualitative findings from dental week evaluations have been extremely positive. The retrospective chart review revealed that students were more likely to include the documentation of periodontal tissue (students 12%, attendings 9%), dentition (students 46%, attendings 15%), oral cancer screening (students 49%, attendings 32%) and mucous membranes (students 60%, attendings 35%) within their HEENT examinations.

CONCLUSION: In a partnership with Delta Dental, who provided financial resources for the curriculum, VTCSOM has completed 5 years of educating and training future physicians on the importance of oral health.

223 – Curricular Innovations: Critical Thinking and Problem Solving for Today’s Medical Student
Sarah Bezek, Nadia Ismail, Joan Friedland, Lauren Larue Walker, and Jennifer Christner
Baylor College of Medicine

PURPOSE At Baylor College of Medicine, an innovative course for first year medical students called Critical Thinking and Problem Solving (CTAPS) was established to develop critical thinking and medical problem solving skills.  Students learned about cognition, metacognitive awareness, decision making and self-regulated learning, exploring concepts independently through self-directed study, while problem solving, in teams.  These concepts were explicitly built into the course through integrated clinical cases with an emphasis on Anatomy.   

METHODS The course was developed with faculty, residents and students. The course leadership and 16 faculty facilitators received training in cognitive science and team based learning.  The first term focused on self exploration and reflection in the context of self-regulated learning, metacognitive awareness, and problem solving, individually and in teams.  The second term focused on thinking like a physician and included slow versus fast thinking, assumptions, inferences, diagnostic errors and prevention, cognitive biases, ambiguity in decision making, situational awareness, and decision making in teams. Assessment included peer/self-evaluation, individual/team readiness tests and learning strategy diagnostic tools.   

RESULTS Student feedback, short answer questions and project data indicate the vast majority of students have gained new insight into their learning processes, especially metacognitive awareness and the importance of considering how they think while solving medically relevant problems. They have also expressed insight into the power of teams in making complex decisions.   

CONCLUSIONS This effort will be judged by our students’ depth of understanding of learning processes and the ability to think deeply and reflect wisely as they progress. A lesson learned: 1:1 and team relationships for students and faculty can begin early.  With responsive faculty and student opportunity for engagement, students support the development of innovative courses. With the opportunity to voice ideas for change, students from this course have expressed desire to get involved in next year’s course.

Tracey Thurnes
Elon University

PURPOSE With recent developments in healthcare, physician assistants (PAs) will need to have leadership qualities and the willingness to serve in leadership positions as graduates. Due to an already heavy curriculum, PA programs as a whole, have not consistently implemented leadership pedagogy into their curricula.  This educational innovation provided four two-hour leadership sessions in the clinical phase of the PA curriculum with the hypothesis that: PA students who are exposed to leadership discussion and activities will find it to be a beneficial learning experience, students who have completed the leadership sessions will have a higher likelihood of accepting a leadership role in their career, and that students will have a better understanding of their leadership qualities after completing the leadership sessions.

METHODS During the clinical phase PA students return to campus for a total of three weeks. During those weeks, academic content is delivered to supplement students’ clinical learning, which yields an opportunity to deliver leadership strategies to students. Learning and instructional objectives were formulated for the leadership. Sessions included leadership theories, characteristic traits of successful leaders, personality assessment using psychogeometrics, leadership roles currently available to physician assistants, and team-based activities using Design Thinking pedagogy. Clinical phase PA students (n=76) answered a pre and post survey answering questions regarding their understanding of leadership and personal skills.

RESULTS 76 PA students (2 cohorts) have completed the clinical phase leadership module. Data suggest that students’ understanding of their self, values, and leadership skills improved following the module.  Students also reported that they feel more confident in their ability to hold a leadership position as a PA.

CONCLUSION An implemented leadership module for PA students increases their understanding of leadership and their confidence in personal leadership abilities.

Matt Jackson, Paul Walker, Rodney Braun, Robert Lasley, Sharon Ackerman, Jean Peduzzi-Nelson, Lawrence Lash, Simone Brennan, Jason Booza, Chih Chuang, Nakia Allen, and Theresa Kaminski
Wayne State School of Medicine

PURPOSE Wayne State University School of Medicine (WSUSOM) launched a preclinical curriculum redesign process in 2015. This was the school’s first significant curriculum change in over 30 years motivated by a need to define the competencies required for a successful transition to clerkships.   

METHODS A data-driven segment 1 review process that considered the opinions of all major stakeholders guided the change process. A team from the newly created Office of Continuous Quality Improvement was responsible for project management with the basic science course directors’ workgroup committed to a July 2018 launch date for the redesigned curriculum.   

RESULTS The new Fundamentals of the Healthy Patient curriculum comprised eight organ system units that were organized to accommodate Gross Anatomy dissection, which was a longitudinally integrated foundation of segment 1. Introduction of a First Patient thread in the 2015/2016 academic year utilized cadaveric dissection to reinforce team-building, self-directed learning, and the social and humanistic aspects of medicine. In recognition of the challenges that newly matriculated medical students encounter the Office of Learning and Teaching developed a two-week Advanced Learning Skills course as our first year students’ introduction to medical school. Narrative assessment was used for all small group-teaching experiences and faculty-authored multiple-choice exams were redesigned as weekly formative assessment that facilitated academic support. The customized NBME service was used to create end-of-unit summative exams used for promotion decisions.   

CONCLUSIONS Upon the completion of their first year in the redesigned curriculum, WSUSOM medical students demonstrated mastery of fundamental human processes and could develop a problem list from a patient encounter. Students demonstrated the capacity to apply the principles of social and behavioral science to clinical situations. Purposeful early integration between the basic science disciplines and new courses in the clinical and social sciences was a core theme through the change process.

226 – Fostering the Development of Scholars through Collaborative Learning & Practice
Mariah Rudd, Sarah Parker, and Shari Whicker
Virginia Tech Carilion School of Medicine

BACKGROUND Continued advancement of high-quality health professions education research is dependent upon the development of educators who can design research with the same rigor demanded in basic science or clinical research. Our teaching academy used a social constructivist approach to develop an interdisciplinary program comprised of a health professions education research curriculum in conjunction with an internal resource supported and mentor-guided, peer-review quality education research element as the final project.

METHODS Authors developed the Health professions Education Scholars (HERS) program, a 1-year, mentorship-guided program designed to facilitate participants through individual health professions education research project. A competitive selection process was established to identify program participants. A small group of experts was recruited as mentors and critical internal resources. Program curriculum included courses from the AAMC Medical Education Research Certification (MERC) program. Participants were also mentored through the design and execution of a health professions education research project.

RESULTS Eight individuals were selected to participate in the first year of this program. Participants represented a diverse group of health professions educators from across the health system. Participants were matched with an experienced mentor and required to protect one day per month to devote to participation in the program. At the end of the year-long program, participants completed a mentor-guided project of peer-review quality and became certified through the AAMC MERC Program.

CONCLUSION The primary goals of the HERS program were to provide participants with instruction in health professions education research principles and practical skills to do so effectively, foster collaboration within health professions education research, and develop our participants as leaders in academic medicine. The authors hope that the inaugural year improved the execution of health professions education at their institution, built a coalition of skilled medical education researchers, and ultimately contributed to national and international academic research on health professions education.

Andreas Seyfang
University of South Florida – Morsani College of Medicine, Department of Molecular Medicine

PURPOSE: At the beginning of an organ-system based medical school curriculum, most students are not familiar with standardized board exam-type questions that would prepare them for their USMLE Step 1 exam after the second year. Hence the purpose was to introduce medical students from their first course in the curriculum to Step 1 questions and to use performance on these questions as part of the course assessment.

METHODS: A customized NBME Step 1 subject exam was assembled from retired USMLE Step 1 questions that were within the scope of the lecture material covered in this first course of the medical school curriculum. This NBME final exam counted 20% of the final course grade. Individual scores of the NBME exam were subsequently z-scored to an 85% mean with a standard deviation of 7.5% and students had to reach a passline of 70% (mean 2SD) in order to pass this exam.

RESULTS: When first introducing this additional NBME subject exam in our basic science curriculum for academic year 2014-15 students performed at 7% below the national average for these NBME questions. This class performance has continuously improved to currently 3% above the national average for the NBME subject exam. Part of this improvement was due to an increased use of Step 1-type practice questions throughout the lectures and as exam preparation in this course.

CONCLUSIONS: The addition of a customized NBME subject exam to the basic science curriculum from the first course in the curriculum prepares medical students from the beginning of their medical school curriculum for their first board exams.

Poster Award Nominee
Carol Nichols, Barbara Russell, and Kathryn Martin
Medical College of Georgia at Augusta University

PURPOSE Undergraduate medical education curricula must include medical consequences of common societal problems. We have designed and implemented an interactive, pre-clinical curriculum where students learn about the role of public health in mitigating these problems at the local, state, national, and global levels.

METHODS The first year curriculum included a public health module that began with an Ebola outbreak simulation to highlight global health.  Social determinants of health, the opioid epidemic, and health policy issues at the state and national levels were discussed. Students participated in a poverty simulation to learn about community health.  The second year curriculum included Disaster Day training, an overnight bus tour to rural Georgia, and a trip to the Centers for Disease Control and Prevention (CDC). During Disaster Day, students activated a mobile hospital, triaged patients, participated in airway and breathing simulations, and received “Stop the Bleed” training. The trip to rural Georgia exposed students to healthcare in underserved areas.  During the CDC visit students explored global health, chronic disease prevention, emergency preparedness, and infectious diseases.

RESULTS Students investigated the top health issues in GA and developed Public Service Announcements and poster presentations that addressed various aspects of these issues.  Additional public health issues were explored through student-led case presentations. Evaluations of how well instructional materials/methods aided understanding of topics, the extent to which the content contributed to their development as a future physician, and overall quality of the curriculum all increased as a result of these curricular changes.

CONCLUSIONS The inclusion of horizontally and vertically integrated public health content into the pre-clinical curriculum has given students unique opportunities to participate in interactive, experiential learning sessions that highlight common societal problems and the role of public health in mitigating those problems.  

Elizabeth Painter, Michelle Davidson, and Megan McNamara
Louis Stokes VA Medical Center and Case Western Reserve University School of Medicine

PURPOSE Seven Centers of Excellence in Primary Care Education (CoEPCE), established by the Veterans Affairs’ Office of Academic Affiliations, are implementing and testing innovative approaches for interprofessional, collaborative, patient-centered practices that provide coordinated longitudinal care. As part of this initiative, the CoEPCE at the Cleveland VA has developed a comprehensive curriculum. Including domains: “Proactive Care”- principles/skills designed to prepare learners to provide culturally-sensitive care, participate in shared decision making, and identify psychosocial barriers to medical care, and “Real Time Real Patient”- recognizing the importance of reflection to foster professional development, effective interprofessional teamwork, and promote life-long learning. This innovation focuses on the development of a community outreach project with a reflective component.

METHODS Interprofessional CoEPCE learners participated in 6 community outreach events which provided education about available VA resources and completed a condensed physical exam for the initiation of VA health/mental health care. Upon completion of the events, learners were prompted to provide a reflection, which were shared and discussed during interdisciplinary didactics.

RESULTS In total, twenty interprofessional learners (10 Medicine/7 Nurse Practitioner/2 Psychology/1 Social Work) participated in 6 outreach events. During these events (including rural and homeless), 575 eligible veterans expressed interest in initiating VA healthcare, and CoEPCE learners conducted 135 of those physical exams. Reflections highlighted themes of reduction in bias, the impact of interacting with patients outside of the clinical setting, and the importance of appreciating each patient’s unique context.

CONCLUSION These events provided an opportunity, not only for a novel training experience and opportunity for reflection, but engagement with systems-based care, as the learners are integral to the success of these events. Through analysis of the reflections and feedback, learners have demonstrated an increased ability to involve patients in their care, engage in shared decision making, and incorporate patient context in their practice.

230 – Longitudinal efforts in integrative learning and preparing for Step 1  Designing of a “Step Up” thread
Yenya Hu
Wake Forest School of Medicine

PURPOSE Performance on the United States Medical Licensing Examination Step 1 is a prominent factor in residency program selection. Research has investigated Step 1 preparation strategies, study behaviors and anxiety management. However, comprehensive and individualized academic monitoring and longitudinal coaching that integrate the preclinical curriculum with Step 1 preparation has not been reported.

METHODS The longitudinal “Step Up” thread includes strategies for managing cognitive loads to improve retention and integrating foundation disciplines, such as biochemistry, into system learning, using the Step 1 review sources. “Step Up” also provides phase-specific, individualized and outcome-driven one-on-one coaching to all students. In addition, student performances on higher order questions throughout the curriculum are monitored and assessed.

RESULTS Students have been receptive to the practical and personalized integration of foundation knowledge, while longitudinally preparing for Step 1. Academic monitoring and individualized coaching help students identify knowledge gaps early and consistently, using their performance data, and target those gaps with customized review resources. Question banks are then utilized to assess the effectiveness of the specific reviewed disciplines or topics and to facilitate further learning. Coaching also helps students set feasible and measurable goals, develop individualized outcome-driven learning strategies and hold students accountable.

CONCLUSION In addition to the building and implementing of the “Step Up” thread, the level of the student engagement is also monitored. Our preliminary data indicates that students who actively participate in self-reflection and generate outcome-driven plans appear to perform better on Step 1. Further efforts are focused on using the preliminary data to encourage all students to be more engaged in their own learning.

231 – Resilience Through Parallel Charts (1) in Physician Assistant Education
Jill P. Grant
Wake Forest School of Medicine of Wake Forest Baptist Medical Center

PURPOSE This educational innovation demonstrates how learners at a physician assistant program in the Southeast engage in the creation of parallel charts to process meaningful patient encounters during their clinical training. In her book Narrative Medicine, Dr. Rita Charon describes what she tells medical learners: “…you write in the hospital chart about each of your patients…[the] patient’s current complaint…results of the physical exam, laboratory findings, opinions of consultants, and the plan. If your patient dying of prostate cancer reminds you of your grandfather, who died of the disease last summer, and each time you go into the patient’s room, you weep for your grandfather, you cannot write that in the hospital chart…And yet it has to be written somewhere. You write it in the Parallel Chart.” (1)

METHODS This innovation was piloted as part of an elective humanities curriculum, later evolving into the core curriculum; more than 200 students have participated. PA learners in the clinical phase of the curriculum create parallel charts in the form of a narrative, an essay, or a poem; students may also create visual art, photography, film, or music to describe their patient encounter. Students then share their parallel charts in facilitated small groups.

RESULTS Qualitative feedback from PA learners illustrates the benefit of creating parallel charts for “work[ing] through some of the emotional rigor that comes with learning to work with patients who are sick and dying.” Students have shared that this activity is useful for self-care, for “breaking down barriers,” and for teaching the value in “having coping methods.”

CONCLUSIONS Fostering resilience and self-care in medical learners and future providers is essential to reducing burnout and compassion fatigue. With primary costs centered only on space within the curriculum and faculty effort toward facilitation, this activity is both feasible and applicable to all healthcare learners and providers. (1) Reference attached.

Poster Award Nominee
232 – Collaborative Testing in Medical Education: Student Perceptions and Knowledge Retention

Jennifer Eastwood, Katherine Kleinberg, and David W. Rodenbough
Burrell College of Osteopathic Medicine

Purpose At BCOM, we utilize collaborative testing, in which students take exams individually, then again in small groups.  Prior research shows collaborative testing enhances short-term knowledge retention. We sought to understand how students perceive the value of collaborative testing and whether collaborative testing is associated with long-term knowledge retention.

Methods Quantitative data included student exam performance during the Renal 1 course, and on a post-test delivered 8 months later in Renal 2. We tested knowledge retention for two conditions: exam review and collaborative testing. After individual testing in Renal 1, groups of 2-3 students received half of the test questions with answers to discuss and half of the questions without answers to complete. The post-test included 10 comparable questions per condition from the Renal 1 exams. Knowledge retention was determined for each student as post-test score/pre-test score, and a paired t-test was performed. Qualitative data included responses to prompts on students’ perceptions of collaborative testing and exam review collected during Renal 1. Two researchers analyzed the data using grounded theory.

Results Quantitative results showed knowledge retention to be significantly higher for the collaborative testing condition as compared to the exam review. Qualitative results showed that students engaged in more discussion in the collaborative testing condition and valued the teamwork skills it fosters. However, students expressed that not receiving correct answers was detrimental to their learning.

Conclusion Collaborative testing enhances retention of knowledge and may be effective for students to maintain knowledge through board exams and beyond. Our findings suggest that the discursive process fostered by answering questions collaboratively is instrumental to retaining knowledge. Our data, however, do not support students’ perception that receiving correct answers is critical for learning. This may support promotion of an epistemic shift for students, encouraging them to value deliberative process over correct answers.

Surapaneni Krishna Mohan
Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia.

PURPOSE Teaching of basic science courses have been a challenge in the undergraduate medical education level due to the heavy use of didactic lectures and memorization of facts.  The purpose of this study is to introduce an innovative curriculum, the Integrated Clinical Case Based Learning Modules (ICCBLM) promote the teaching of the basic science course courses in terms of clinical context.

METHODS The participants (n = 150) were first professional medical students and were divided into two groups as the control group and the study group. The educational outcomes assessed were the marks in the written examination on the traditional Curriculum with didactic lectures and those on the innovative curriculum with ICCBLM. The participants evaluated the innovative curriculum with regard to 13 items on a 5 point Likert scale.

RESULTS The performance of the students in the innovative curriculum was significantly improved (P < 0.001) compared to the performance of the students in the traditional curriculum with didactic lectures in terms of the clinical knowledge. The participants perceived positively and rated positively on the effectiveness of Integrated Clinical Case Based Learning Modules.

CONCLUSION The introduction of the Integrated Clinical Case Based Learning Modules, an innovative curriculum model demonstrated not only improvement in academic performance in terms of clinical knowledge but also promoted the meaningful learning by virtue of integrating the basic sciences with clinical sciences, related to a particular diseases / clinical condition among the first professional medical students. This innovative curriculum motivated the students to improve their oral presentation skills and the students perceived that, this innovative curriculum to be a valuable learning tool that improved their reasoning, inter-personal learning skills, promoted deep understanding, and motivated them to learn the subject in clinical context, rather the rote learning.

Sara Maria Jensen
Trinity Medical Sciences University

PURPOSE Student clinical success is largely based on student engagement and participation in routine and novel opportunities. Competencies are well defined through medical school, residency, and practice, and achieved through self-study and hands-on training. Success of students in these efforts alone is commonplace, which overlooks a key factor-faculty mentorship and guidance. However, most clinically active physicians are ill prepared entering the role of educator. Once “great students” themselves seemingly does not later translate to “great educator”.  Here, we pursued how students achieve competencies through oral patient case reports with active strong faculty mentorship. We also studied if creating opportunities for student-faculty engagement improved faculty as educators.

METHODS Students completing their surgical core rotation each presented one patient case report before an audience of their peers. Patients were those encountered during rotation under physician supervision. Preparation of these reports included hospital faculty advisement.  Faculty included physicians that engage with students daily through their training. “Before” and “after” self-assessments were completed by students and faculty scoring aspects of competency. Faculty competencies include those under categories of: Leadership, Teaching, and Research.

RESULTS Student competency assessed through pre/post self-assessments had larger score improvements than those from previous student presenting sessions without strong faculty guidance. On average, physicians also observed large score gaps from before and after attributed to increased (1) self-awareness and (2) clear educator objectives.

CONCLUSION In its entirety, success of one student requires a twofold foundation: (1) student and (2) faculty competency. The majority of students claimed improved self-performance from increased interaction and guidance from faculty based on self-assessment scores. Faculty post-self-assessment scores were higher than pre-self-assessment. Faculty comments reported heightened awareness of their own skills not consciously practiced prior to this project.