2019 Meeting Posters – Instructional Methods

300 – Medical Education Systems Worldwide: An IFMSA Report
Marouane Amzil and Artur Carvalho
International Federation of Medical Students’ Associations (IFMSA)

PURPOSE The International Federation of Medical Students’ Associations (IFMSA) has had a long history in meaningfully involving medical students worldwide within their respective medical education systems. Understanding its structure and physiology on a global scale was the motive to identify the main challenges and stakes in Medical Education and to develop global strategies to solve them.

METHODS IFMSA conducted an online Google Form-based survey between March-May 2018 to explore how Medical Education Systems are formulated and to understand the diversity of medical curricula globally.

RESULTS 371 responses were collected, covering medical schools from 83 countries. The majority (72.2%) belong to the public sector. When it comes to curricula duration, most medical schools (65%) follow a 6 years program. Basic sciences are represented in 90% of medical schools’ preclinical curricula, whose teaching methodologies are mainly traditional courses (77.1%). As for the clinical training, 97% of subjects were mandatory, and use a combination of evaluation methods (written, oral and practical exams) to assess medical students in at least 29% of cases.

CONCLUSIONS The survey enabled us to highlight some medical education issues medical schools and students are facing, such as how traditional teaching courses dominate the teaching methodologies and practical skills are not adequately assessed. This survey is not meant to assess the quality of the educational institutions but rather to create a basis to discuss the various medical education systems. Understanding Medical Education Systems is an essential step towards developing a global approach to engaging medical students worldwide in their respective medical education systems, through a meaningful participation in developing their curricula. IFMSA has produced a detailed report to thoroughly present an overview of medical education systems worldwide, as a ground to develop its medical education approach to its global priorities.

Jeffery Fritz and Roy Long
Medical College of Wisconsin – Central Wisconsin Campus

PURPOSE To examine the influence of graded audience-response questions given during lectures on lecture attendance and learner performance in the second-year basic science medical school courses.

METHODS This on-going two-year study is occurring at a regional medical school campus with 20-25 medical students in each cohort. All lectures during the second-year basic science courses are delivered using distance learning technology in live-streaming and recorded video formats. In one study cohort, audience response questions answered correctly during the live-streaming lecture timeframe were credited toward final grades in each course. In the other cohort, audience response questions were not graded. All other course aspects were similar between study cohorts. For each study cohort, learners have the option to: (1) attend the live-streamed video lectures in a classroom setting providing real-time feedback with course instructors; (2) watch live-streamed video at a location of their preference; or (3) watch the lectures at a time and location of their choice (recorded). Learner attendance was measured as either attending lecture in a live-streamed format (comparable to in-class attendance in a traditional lecture setting) or in recorded format. Learner performance was based on final grades and summative exam performance in each course.

RESULTS Increased usage of live-streaming video was observed in the learner cohort with graded audience response questions, however, minimal difference was observed in learner performance between the two study cohorts.

CONCLUSION The use of graded audience-response questions during lecture increased “live” lecture attendance but the increases in learner attendance did not translate into improved learner performance on summative exams.

302 – TMET: a peer-led Medical Education workshop
Silvia Matilda Atefanei, Obada Yousef Al-Nahawi, and Muhammad Nouman Shuja
International Federation of Medical Students’ Associations (IFMSA)

PURPOSE Medical education should be at the core of each medical students’ interests, as it defines our practice. The International Federation of Medical Students’ Associations (IFMSA) aims to raise awareness about this matter, where its Standing Committee on Medical Education (SCOME) implemented TMET – Training Medical Education Trainers so students can acquire the necessary theoretical knowledge in approaching different issues in this field.

METHODS The first TMET took place in 2014. Each workshop has a set of 2-4 facilitators who are responsible for developing its content and have had previous training on the topic. The training takes place in 3-4 days, with a maximum workload of 24 hours in total and with no more than 25 participants attending. Participants explore concepts about Advocacy, Social Accountability, Medical Students Involvement, Assessment & Evaluation, Curriculum Development among others. Participants are required to perform a graduation training no later than 6 months after their forming took place, so they can harness their brand-new skills at their fullest, keeping themselves updated within this area.

RESULTS Since 2014, more than 40 TMET workshops have taken place, with more than 500 trainers specialized in medical education. Trainers represent all regions of the world, with the majority of them from the Eastern Mediterranean Region and Europe, followed by Africa, Americas, and Asia-Pacific. Tunisia, Portugal, Turkey, Sudan, Ecuador, and Taiwan are the countries with the highest number of medical education trainers, all of them being TMET hosts at some point throughout this period of time.

CONCLUSIONS Engaging students to take part in this type of event not only makes them better future physicians, but it also empowers them to take proper actions in their faculties or countries and to improve the medical systems

Thipsumon Tangsiwong, Pornpimon Kasemsook, and Tipsuda Tangsriwong
Buddhachinaraj Medical Education Center

PURPOSE The prospect of reducing such healthcare costs is challenging especially at a time of rising public expectations, soaring medical costs, and shrinking budgets. Practitioners are expected to have a working knowledge of health economics to better use resources and improve outcomes. This study aims to evaluate medical students’ understanding of health economics through experimental role-play.

METHODS Twenty fifth-year medical students from Buddhachinaraj hospital who attended a three-week radiology elective in academic year 2018 were piloted in a simulation-based scenario of health economics by using role-play. This activity was supervised over a two-hour class period by instructors. Meanwhile, participants undertook their random characters as a patient, relatives, doctors and observers. During the whole session, the participants not only acted out but also took part in group discussion which they focused on investigation for reaching a final diagnosis. Then, the observers shared economic-related information which was individually assigned to prepare in advance with each other. All of them remade a consensus of the appropriate investigation based upon evidence-based medicine, cost-effectiveness and patient safety after that. Items and costs of the first and final-deciding investigations were analyzed eventually. At the end of the session, students’ open-structural reflections were collected.

RESULTS Achieving knowledge of health economics during in-class discussion helped students make better informed medical decisions. Accordingly, four items out of nine which the students listed earlier were identified as superfluous investigations and the final cost was subsequently reduced by over 1200%. After session, the students appreciated overwhelmingly positive feedback in teaching method, facilitators and health economics as well.

CONCLUSION Role-play enables medical students to apply and understand economics in realistic clinical practice in order to enhance their professionalism. This initiative provides an added dimension to teaching and making health economics more clinical relevant, thereby better preparing undergraduate medical students for the real world.

Elise Zhao, Brian Piper, Diana Callender, and John Szarek
Geisinger Commonwealth School of Medicine

PURPOSE Peer teaching is used in health professions education but the effectiveness of student-led grand rounds as a modality has rarely been described. Focus groups revealed that our third-year medical students wanted to improve their presentation skills before starting fourth-year electives, where patient presentations in front of a group are expected. Our purpose was to develop an extracurricular program in which third-year medical students present their clinical encounters to students and faculty, and obtain peer feedback.

METHODS The IRB-approved pilot was run in the spring semester 2018. Volunteer presenters created 20-minute presentations consisting of a patient case and background information. Review of the disease state was included for the benefit of students preparing for USMLE Step examinations. Although the program was student-led, faculty members reviewed the presentations for accuracy. Presentation criteria were rated anonymously by audience members on a scale of 1-5 (highest) and written feedback also was provided. The average scores and feedback were given to the presenters together with a survey to complete regarding their experience.

RESULTS Eleven students gave 10 presentations and 34 audience responses were recorded. The average of all evaluated criteria was 4.5±0.08. Twenty comments received were overwhelmingly positive. Two representative comments were “Very well put together! I liked the interactive session. A little advanced for non-3rd years but something to look forward to when we get there.” And, “Great incorporation of cardiology, obgyn, and physiology. Great use of images to illustrate surgical techniques and physiology! Presenter was very knowledgeable!” Two presenters who completed the presenter survey recommended the program to future students.

CONCLUSION Student-led grand rounds not only benefit third-year medical students in providing practice in patient presentations but also provides an opportunity for preclinical students to interact with third-year students aiding their board review and planning for their own clinical years.

Abubaker S Qutieshat, Tala N Maragha, Mohammad O Abusamak, and Omar Rajjoub Eldik
Conservative Dentistry Department, Faculty of Dentistry, Jordan Uni of Sci and Tech., BDS student, Faculty of Dentistry, Jordan Uinversity of Sci and Tech, BDS student, Faculty of Dentistry, Jordan Uinversity of Sci and Tech, BDS student, Faculty of Dentistry, Jordan Uinversity of Sci and Tech

PURPOSE: This work is an attempt to explore the potential of a new educational method that integrates debate as a teaching tool.

METHODS This new teaching method was implemented into a single academic semester of an undergraduate bachelor of dentistry program. We sought to combine knowledge delivery with high-level debate between students, and with the active participation of the audience who were themselves students. The teaching method was introduced as an adjunct tool in the Conservative Dentistry course for fourth year dental students. The class was comprised of 281 students participating in this 10-week teaching method that comprised of three elements namely debates, reply speeches and policy papers. Debating followed the World School Debate Championship (WSDC) format. Debate evaluation involved five main categories; argument, rebuttal, style, definition and strategy, and points of information (POIs). Student perception toward this educational method was evaluated using a Likert-scale questionnaire.

RESULTS Students (N= 281) gained valuable knowledge from the experience as reflected by the favorable Likert outcome scores.  

CONCLUSION This work sheds light on the potential advantages of utilizing debate as a teaching tool from a student’s perspective. Implementing debate in teaching improved students’ ability to search and appraise scientific papers and proved to be meaningful and enjoyable. The carefully tailored 10-week format ensured good student responsiveness and engaged the entire class in an interactive, participatory setup. This educational method proved to be very effective in evidence-based dentistry teaching by promoting a deeper approach to learning that can help students to learn meaningfully and enhance their critical thinking skills.

307 – Role of Service Learning in Medical Students’ Acquisition of Entrustable Professional Activities
Kathryn J. Dolan
University of North Texas Health Science Center

PURPOSE Service learning is designed to provide students with community based experiential learning. Traditionally these opportunities are thought to be supportive of altruistic behavior and development of emotional intelligence. Now they can also support the development of the AAMC’s Entrustable Professional Activities (EPAs). This study aims to identify which EPAS can be supported by service learning opportunities. This study describes students self-reported findings regarding the value of service activities in terms of four of the thirteen EPAs: 1. Gather a history and perform a physical exam, 6. Provide an oral presentation of a clinical encounter, 7. Apply clinical epidemiology to basic preventive care, 9. Collaborate with interprofessional teams.

METHODS Osteopathic medical students perform service during the first two years as a required element of their ‘doctoring’ course. Service learning meets various learning objectives, including exercising skills for EPAs 1, 6, 7, and 9. Students rate each service activity for learning objectives which include exercising clinical skills, preventive health education, and working in collaborative teams, This study uses 7 semesters of data which is analyzed for significant differences using both parametric and non-parametric methods.

RESULTS Initial results demonstrate which services meet learning objectives for which EPAs: For EPA 1, services rated the highest as meeting the clinical skills learning objective are homeless services (94.3% strongly agree) and school and sports physicals (81.3% strongly agree). EPA 6, homeless services (88.4% strongly agree); EPA 7, indigent clinics (54.7%) and sporting events (61.3%), For EPA 9, services rated highest for meeting the collaboration objective are health fairs (94.5% strongly agree).

CONCLUSIONS Discernable differences exist between types of activities meeting various learning objectives and furthermore ratings ran in expected directions. Students’ comments offer insights into their professional values and empathy.

Lindsey Kent and Peter Ward
West Virginia School of Osteopathic Medicine

PURPOSE The humanities have been incorporated into medical school curricula to increase the breadth of student learning and to assess clinical competency beyond medical knowledge. Medical history is a topic that can reinforce learners’ medical knowledge while bringing attention to social, political, cultural, and spiritual influences on its development. To explore how we could integrate medical history into a dense medical curriculum, we piloted a series of medical history talks were hosted by student clubs.   

METHODS In conjunction with student clubs, we crafted a series of lunchtime sessions that explored the development of medicine. Sessions covered the history of medicine from ancient times, concepts of disease, diagnosis and treatment, surgery, and the history of excluded groups. Topics involve multiple clinical competencies (patient care, professionalism, systems-based practice, etc.) and how these competencies were present or ignored throughout medical history.   

RESULTS In 2017, 205 people attended at least one session and 105 people attended all six sessions, receiving a certificate of completion. Feedback was overwhelmingly positive. In 2018 students who wished to be recognized for extra engagement wrote short critical papers some aspect of medical history and how it related to clinical competence. These papers were critiqued and returned to the students for modification prior to being considered complete. Thereafter students were able to add them to their student portfolios.   

CONCLUSION Medical history has a tremendous potential to impact student motivation and to provide a nuanced view of how social factors impact the practice of medicine. Until these topics have a home in the medical school curriculum, it may be helpful for educators and students to explore venues such as student club meetings, to bring medical history into medical education. Giving recognition to attendees increases their engagement in the process.

John P. McNamara and Michael F. Nolan
Virginia Tech Carilion School of Medicine

PURPOSE Courses in human anatomy typically consist of lectures by faculty, readings in assigned textbooks and sometimes dissection exercises with cadavers. However, as student’s progress into the more clinically oriented phases of the curriculum, many discover that the anatomical knowledge they need is somewhat different from the kind they possess. We developed a series of applied anatomy learning activities structured around the general physical examination to help students appreciate the importance of anatomy in the evaluation and management of patients.

METHODS We developed seven “applied anatomy” laboratory sessions with content appropriate to each of three, regionally organized blocks in our anatomy curriculum: limbs and back, thorax and abdomen. The exercises involve inspection, palpation and other maneuvers commonly included in the general physical examination. Students are divided into small groups and instructed to perform each exercise on all other members of the group. Faculty circulate among the groups to guide students in the performance of tasks and to answer questions as they arise. Short written questions accompany many of the exercises that highlight anatomic structures and relationships associated with the body part or region under study. Students were surveyed at the end of each unit regarding their perception of the value of these exercises.

RESULTS Students generally liked the active learning format of these sessions, particularly their close relationship to the clinical skills they were learning concurrently in other courses. Students appreciated the fill in the blank questions which they viewed as “practice questions” for the upcoming final exams. Some students felt somewhat uncomfortable serving as subjects for their peers. This hesitancy gradually diminished as the year progressed.

CONCLUSION Students acknowledged the value of these active learning activities early in the curriculum as directly related to essential knowledge and skill sets that will be necessary in the clerkship and elective years.

Poster Award Nominee
Mari K Hopper
Indiana University School of Medicine

PURPOSE Fifty percent of course contact time in Indiana University School of Medicine’s (IUSM) “renewed” curriculum was dedicated to small-group learning. Course evaluations indicated that students did not value the approach, perhaps due to lack of training in this methodology. This study set out to determine if training in small group dynamics would improve student participation in and perception of this learning method.

METHODS Following IRB approval, case-based small-group sessions were audiotaped on two occasions prior to training (Pre), and two sessions following training (Post). Recordings were evaluated and scored by trained evaluators using a rubric including the following categories: Participation, Shared Roles, Focus on Learning Objectives, Approach, and Interpersonal Interaction. Category scores were averaged across the three evaluators both Pre and Post. To assess student perceptions, a 15-question survey was administered at three time periods: 1) before Pre small group sessions; 2) after recording Pre sessions and directly prior to training; and 3) after Post small group sessions. Topics such as personal preparation, interpersonal interactions, and prior undergraduate experience were included in the survey and rated using a Likert scale scoring one through seven.

RESULTS Although work is ongoing, preliminary analysis of audio recordings indicate that participation increased following training, with members participating more equally and encouraging input from others more frequently. There was little change noted in role sharing and addressing learning objectives. Survey responses following training revealed that students enjoyed small group sessions more, contributed more equally, and had fewer tangential discussions when compared to pre-training.

CONCLUSION These data indicate that training in small group dynamics prior to participation in small group learning activities will improve student discussion performance and perceptions of the learning experience.

Michael Bradbury and Mark Sheffield
A. T. Still University-Kirksville College of Osteopathic Medicine and California Northstate University College of Medicine

PURPOSE Self-directed learning (SDL) can aid in the development of life-long learning skills. Implementation of SDL is new to many, and methods used and topic chosen may affect successful implementation. As many students struggle with acid-base concepts, a session on basic concepts and clinical relevance was designed and presented. The session and the outcomes are described.

METHODS The session was adapted from the system developed at Albert Einstein College of Medicine. A basic scientist and clinician each developed 3 learning objectives for their respective areas. Students were provided with objectives in advance and assigned to work in groups. Students were to find resources to learn the material and be prepared to work with it during the session. In the session student groups answered basic science questions or performed calculations in front of the class. Later in the session clinical cases were presented which groups were asked to expand upon. If answers were incomplete, a second group was chosen to add information. After the session they had 24 hours to submit their learning resources documents. Each submission was reviewed and feedback was given.

RESULTS The session was attended by the entire class and all groups participated. Students worked through both the basic and clinical problems presented, though completeness of answers varied. The students remained engaged throughout. All groups submitted resource documents on time and received feedback on their choice and evaluation of sources. Exam performance on the material was satisfactory.

CONCLUSION Combining basic and clinical information in SDL format is possible and likely desirable. Students can complete an SDL task if given appropriate instruction on expectations. Student choice of resource material varies widely as does their evaluation of its utility. Material presented appeared to be learned based on exam results, so the exercise was deemed successful as a first effort.

David W. Musick, David B. Trinkle, Phyllis B. Whitehead, Chris Pile, and Joalenn Tabor
Virginia Tech Carilion School of Medicine

PURPOSE To expose medical, nursing, occupational therapy and physician assistant students to collaborative, case-based decision making featuring ethical dilemmas associated with patient care.

METHODS The health care team challenge is an innovative teaching method used in a variety of health professions education settings. The ability to resolve complex ethical dilemmas associated with patient care is an important part of health professions education. The opportunity to expose students to this training in an interprofessional context and to allow them to see a hospital ethics consultation panel at work is an innovative curricular approach. After an interprofessional course introducing bioethical principles to approximately 135 health professions graduate students, the entire student body was assembled for a cumulative Ethics Health Care Team Challenge event. After initial presentation of a clinical case, student teams were formed and defended an assigned ethical position related to a patient case featuring ethical dilemmas. The ethics consultation panel from our teaching hospital subsequently listened to student presentations and led further discussion of the case, ensuring that all spheres of ethical care (clinical, psychosocial, spiritual, legal and financial) were explored. At the conclusion of the panel discussion, the actual events and ultimate resolution of the case were presented.

RESULTS Over three consecutive years, student feedback was uniformly positive. Changes were made each year to better address nuances associated with student group activities, and to accommodate online learning by distance students.

CONCLUSION The health care team challenge format is adaptable and generalizable to a variety of instructional settings, and is low cost in terms of resources needed. This learning format combines several teaching methods, yet is relatively compact and easy to reproduce. Limitations include technology availability and length of the event (3 hours). Special care must be taken in selecting an appropriate clinical case which features ethical complexity.

Aaron Marshall and Heather Christensen
University of Cincinnati

PURPOSE Nutrition as a component of patient care is widely recognized for contributing to optimal clinical outcomes. Despite increased efforts to teach nutrition basics to trainees, nutrition counseling remains woefully underutilized. This study assessed the impact of a medical nutrition therapy (MNT) experience on medical students. The ultimate goal is to provide a personal experience that would equip trainees with tools to increase their use of nutrition counseling.   

METHODS Participants voluntarily adhered to an MNT diet for two weeks. At three timepoints, participants completed a Nutrition in Patient Care Survey (NIPS), which is a reliable measure of attitudes about nutrition in patient care. Data from the 45 multiple-choice questions within the NIPS are grouped by subscales: nutrition in routine care (NRC), clinical behavior (CB), physician-patient relationship (PPR), patient behavior/motivation (PBM) and physician efficacy (PE). To determine the use of nutrition counseling by medical students, we video-recorded and evaluated (using a validated rubric) clinical encounters between students (in groups of four) and standardized patients.   

RESULTS Results of the initial NIPS data (n=28) yielded the following subscale scores [average (SD)]: NRC=33.82 (3.98), CB=22.11 (1.95), PPR=35.25 (2.56), PBM=10.64 (2.39), and PE=19.46 (3.68) (internal test reliability confirmed by Cronbach’s alpha <0.6). Qualitative baseline data show that, prior to the MNT experience, the mention of nutrition in a standardized patient encounter is similar between student groups that include MNT participants and those that do not (complete data set available by conference date).   

CONCLUSIONS NIPS results indicate that study participants have similar attitudes and expectations about nutrition in medicine as those reported in other published cohorts. Initial scores from the NIPS Likert-scale questions allow room for differences to be identified, should the MNT experience alter participant attitudes. Preliminary data from clinical encounters indicates that a bias toward nutrition does not exist in the MNT participants.

314 – The Use of the 5E Instructional Model to Teach Respiratory Medical Physiology
David M Harris, Benjamin Daines, Andrea Berry, and Atsusi Hirumi
University of Central Florida

PURPOSE:  Although there are trends in medical education to increase active learning, there is limited literature on the use of learner-centered instructional strategies to develop curriculum material. We used the 5E (Engagement, Exploration, Explanation, Elaboration, Evaluation) instructional model to scaffold 13 hours of contact time to teach respiratory physiology.

METHODS:  120 first year medical students participated in this study.  For the Engagement phase students were introduced to a family with multiple respiratory conditions. The instructor provided resources, learning goals and expectations during this phase.  During the Exploration phase, students were given calendar time to produce 4 mechanism of disease (MOD) maps aindividually and submit..  During the Explanation phase, students worked in groups and formulated a group MOD map for each case based on negotiated understanding. The Elaboration phase occurred the following week where student groups generated MOD maps for more complex cases.   The Evaluation phase occurred across the other phases.  Faculty served as facilitators during each phase as they went group by group and also were responsible for providing feedback in a debrief style setting where a group presented their MOD map to other groups.

RESULTS:  A post experience survey was distributed to determine the strengths and weaknesses of the pedagogical approach.  Positive comments included thinking with groups or critically. Negative comments revolved around lack of a “faculty” version of the MOD maps.  Pretest questions given before instruction will be compared with summative exam questions covering frequent misconceptions in respiratory physiology.  Individual and group MOD maps will be analyzed for conceptual understanding.

LESSONS LEARNED: Help from an instructional designer was crucial for this project.  Instructors will face some criticism because learners have a different perspective of what makes learning “efficient.”

Jeanette Ignacio and Hui-Chen Chen
National University of Singapore

PURPOSE Undergraduate nursing education is consists of basic science knowledge that underpin the practice of patient management skills and clinical decision-making. Students are expected to link what they’ve learned from different modules in their curriculum. This integration, however, does not readily take place. A collaborative learning workshop was conceptualized to facilitate consolidation and integration students’ learning at the end of the semester.

METHODS A collaborative learning workshop was developed for Year 1 undergraduate nursing students enrolled in the following modules: Comprehensive Health Assessment, Pathophysiology & Pharmacology, and Medical-Surgical Nursing. In this activity, all students in these three modules were given materials for pre-reading prior to the workshop. During the workshop, the students gathered in a big lecture theater where they were presented with a clinical case study. After which, the students were split into small groups and discussed the case study in their own tutorial rooms. A faculty was assigned to each group to facilitate the discussion. After an hour, all the groups went back to the lecture theater where selected members of each group applied what they have discussed as they managed a standardised patient (SP) simulating the patient in the clinical case study they have discussed. The rest of the students observed. Feedback and consolidation were then done after the students have managed the SP to conclude the session. Focus group interviews were conducted after the students to evaluate the value of the workshop to their learning.

RESULTS Fourteen students participated in focus group discussions. Themes that were generated included: (1) having the correct mindset; (2) building-up confidence; and (3) tutor expertise.

CONCLUSION The collaborative learning workshop is a promising strategy to facilitate cognitive integration that prepares undergraduate nursing students for their clinical placements. Refinements to the workshop are needed to optimize its benefits to students’ learning.

Brian J. Robinson and Sarah J. Garvick
Wake Forest School of Medicine Physician Assistant Studies

PURPOSE There is limited literature on pre-health professional undergraduate students’ preference to be instructed by practicing medical professionals or by non-practicing full-time faculty. The objective of this evaluation was to determine student experience of practicing medical professionals in delivering an effective interprofessional course.   

METHODS Fifteen pre-professional, undergraduate students selected to enroll in an optional five week online and classroom hybrid course on interprofessional education that utilized web-based training as well as face-to-face sessions taught by clinically practicing physician assistants. The online training consisted of videos, discussion boards, and journal article reading. The live sessions consisted of small group learning, lectures, case-based activities, and panel discussions. Enrolled students completed pre- and post-surveys. Descriptive statistics were used to analyze the data.   

RESULTS All (n=15, 100%) students felt that having health professionals teach this course was beneficial to understanding and application of course material, beneficial to take prior to applying to their professional field, and would recommend this course to peers. All (n=15, 100%) students reported improvement in one or more of the following categories: communication, patient centered care, teamwork, and understanding of other health professions. A majority of students (n=11, 73%) commented in addition that professionals teaching the course improved the course experience and that the panel discussion at the end of the course involving clinicians from multiple healthcare fields was insightful. Four students (n=4, 27%) thought that increasing the amount of face-to-face time with healthcare professionals, opposed to online content, would improve the class overall.   

CONCLUSION Despite limited face-to-face instruction, students enjoyed this course and demonstrated improvements in all core interprofessional competencies. Future improvements to the course include increasing face-to-face time between students and clinicians. Future studies should include a larger cohort of students and address the noted preference for face-to-face discussion versus online instruction.

317 – A Health Literacy Activity to Enhance Medical Students’ Communication Skills
Kathleen J. Doane, Ying-Ju Sung, and Patrick M. Boyd
Geisinger Commonwealth School of Medicine

PURPOSE:  To enhance a health literacy activity designed to aid first year medical students’ understanding of how to speak to patients by having them develop and analyze patient education materials.

METHODS:  We will modify an activity designed for first year medical students (Doane and Boyd, 2016).  After the case discussion, students were asked to write patient education materials to help support the patient and their family in understanding and managing the disease.  Faculty analyzed these pamphlets using Suitability Assessment of Materials (Doak et al., 1996) and readability analyses available on-line.  For the next iteration, students will be asked to generate a pamphlet based on new cases, and then to modify them based on analyses with these tools such that they are at an appropriate level for patients with a 5th-6th grade level of education.  Students will write a brief summary prior to the activity and subsequently on how well they understand patient communication at an appropriate level.

RESULTS:  In the initial activity, students generated pamphlets that were not always accessible based on the readability level.  Students indicated that they understand the goal of speaking on an appropriate level with their patients, but that they are unsure if they are accomplishing this.  We expect that modifying this activity by having students use the suitability and readability tools to modify their pamphlets, they will better understand how to communicate more effectively with their patients.

CONCLUSIONS:  Learning how to speak to patients at an appropriate level is a vital component of health literacy and patient-centered care.  We predict that this activity will greatly increase our students’ understanding of patient communication.  We plan to enhance the activity further by making this an interprofessional education activity.

Michael F. Nolan and John C. McNamara
Virginia Tech Carilion School of Medicine

PURPOSE Previous research has shown that both structured feedback and retrieval practice facilitate durable learning. We have used both techniques separately in our curriculum and have now developed an activity incorporating both in a basic medical science course.

METHODS We divided our class into groups of seven students. We then projected challenging, vignette type MCQ’s for all groups to consider. After approximately 1 min. a randomly selected group was called upon to share their answer AND explain their rationale for choosing that particular answer. Other groups were then called upon similarly. Differences in answer choices and explanations between groups were then discussed and errors suggesting incomplete or incorrect learning were identified.

RESULTS All students appreciated the “practice question” format (retrieval practice). Students valued being challenged to explain their reason(s) for choosing a particular answer (effortful retrieval).. Most students appreciated the inter-active discussions (peer feedback) and all students appreciated the brief explanations provided by the instructor when needed. Some students did not feel comfortable speaking in front of their peers. Some students preferred the instructor to simply “speed through” as many questions as possible, forgoing any discussion or clarification that might have occurred during the activity.

CONCLUSION To maximize the value of the sessions the questions must be sufficiently challenging to identify weaknesses in understanding. Students must defend their reasoning clearly and all students must be satisfied with the conclusions reached before moving on to the next question. Instructors must be sensitive to students who may not wish to speak and not force a student to expose their uncertainty or unfamiliarity with the material. Resist the temptation to “speed through” the question pool, particularly when it is evident that some students are unclear or uncertain about a particular topic.

Kathryn H. Thompson, Douglas B. Spicer, Leslie A. Ouellette, and Meredith Kenneally
University of New England College of Osteopathic Medicine

PURPOSE Fifty percent of Americans live with one or more chronic illnesses. Poor diet is a risk factor for many of these diseases. Although health care professionals are uniquely positioned to help patients make healthier choices they often lack the training and conviction to deliver this guidance. Tulane University has successfully implemented a culinary medicine curriculum that combines hands-on cooking skills and food procurement with nutrition education to enable the development of a holistic approach towards counseling patients. In this study, we used two of the Tulane modules to measure the importance of the hands-on cooking activity on nutrition knowledge acquisition and retention and on attitudes towards nutrition counseling.   

METHODS A randomized crossover design was used for this intervention. Forty-three first-year medical school students participated in the study and were randomly assigned to two groups. During each week one of the groups participated in hands-on cooking instruction and group discussion while both groups completed the online culinary medicine modules. At the end of each week students were tested on the week’s content. Retention was measured one week later using a similar test. Attitudes towards counseling patients were surveyed and qualitative analysis of the data was completed.   

RESULTS Analysis of the effects of the hands-on cooking activity on learning and retention will be presented and discussed.  Students perceived that the activity improved retention of the material. Students commented that completion of the hands-on cooking activity gave them more confidence in applying nutrition concepts to daily life and they were more likely to discuss this with patients.   

CONCLUSIONS Participation in the hands-on cooking activity helped students realize that small, easy changes in meal preparation can have a profound effect on their patients’ health.  The modules provided scientific background to support nutrition recommendations and students recognized the value of this for counseling patients.

Kristin J Henderson and Ian M Smith
Wake Forest School of Medicine

PURPOSE Modern healthcare requires a variety of clinical, personal, and professional skills. Wake Forest School of Medicine exposes graduate students to interprofessional education (IPE) to improve critical thinking, preparedness, and patient safety. This abstract will discuss the 5 phases of IPE ultrasound education delivered in Nurse Anesthesia by PA faculty.

METHODS In 2016, CRNA faculty identified the need to implement an ultrasound curriculum. When administering peripheral nerve blocks (PNB), ultrasound guidance improves success rates and reduces complications. Previously, CRNA students received no formal ultrasound education before clinical instruction in PNB. The CRNA faculty sought to provide ultrasound instruction to improve preparedness and increase the number of PNB completed by CRNA students during their training. The faculty developed a 5-Phase process, wherein CRNA students learn ultrasound application through lecture, lab, and workshop in an IPE format.

RESULTS Since the implementation of IPE ultrasound instruction, successful PNB administration by CRNA students increased from a median of 9 (2016) to 20 (2018) (122% increase). Students attributed this increase in PNB placement to improved preparation and understanding the procedure.

CONCLUSION Ultrasound IPE has improved the preparation and skill in CRNA student’s placing PNB. Because of this collaboration, IPE activities between CRNA and PA faculty have continued to evolve.

Praveen Kottath Veetil
Avalon University School of Medicine

PURPOSE Flipped classroom techniques may improve student performance because they allow more time for active learning and formative assessment. When a custom-made commercial video is used for the video-based flipped classroom (VBFC), the hypothesis is that students may improve in scores as per the constructivism theory of learning, and may find it beneficial.

METHODS In Physiology course, students are required to watch custom-made commercial short (less than 10 minutes) videos followed by 1 to 5 MCQs, with facilities to monitor student watching for VBFC. The class hours are utilized more for an interactive learning followed by in-class formative assessment with feedback. Surveys were conducted pre and post-implementation. The isolated grades of Physiology exam were compared with the overall grades using the paired t-test and Physiology scores were compared between VBFC students and students with traditional lectures using unpaired t-test.

RESULTS In the survey, students uniformly agreed with the benefits of this method and showed strong agreement with three aspects; duration of each video, quality, and usefulness of 1 to 5 questions that followed each video, and the need to continue this method of teaching. Some descriptive comments in the survey will help to make future improvements. Physiology scores, which was significantly (p=0.0216) below the overall scores before VBFC, has improved and became equivalent to the overall scores after implementation of VBFC.

CONCLUSION Explained with the base of Piaget’s theory of constructivism, students improved Physiology scores by the process of accommodation and assimilation. Use of commercial videos helped to overcome limitations of a traditional VBFC like the need for technical skills, preparatory time, and monitoring. The limitations of this study are small population size and short study duration; before conclusive evidence, we need an elaborate study for this method of VBFC.

Amy Wilson-Delfosse, Michael Dell, Leslie Fall, Tracy Fulton, David Harris, Ann Poznanski, and Brian Wilcox
Case Western Reserve University School of Medicine, Aquifer and Geisel School of Medicine, University of California, San Francisco School of Medicine, University of Central Florida College of Medicine, and Geisinger Commonwealth School of Medicine

PURPOSE Illness scripts are knowledge structures in the minds of clinicians that organize epidemiology, clinical findings, and pathophysiology of medical conditions and help physicians determine if a given patient presentation fits the pattern of typical findings for a given disease. We propose that inclusion of basic science causal mechanisms that explain “why” a patient manifests each clinical finding will enhance clinical reasoning. Here we describe the development of the “Integrated Illness Script” (IIS) as a teaching and learning tool and document initial efforts toward building a library of exemplar IISs.

METHODS Six pilot schools with teams of basic scientists, clinicians and students were recruited to optimize the process for generation of IISs that support the most common conditions required by nine national core clerkship conditions. Following agreement regarding prototypical clinical findings of each condition, mechanistic details specific to each finding were juxtaposed with each clinical finding. Mechanism of disease (MOD) maps aligned with each IIS were also generated to integrate the fundamental basic science concepts and mechanisms that underlie each IIS.

RESULTS Pilot schools have worked collaboratively to optimize and identify best practices in the creation of IISs.  The use of this tool to promote clinical reasoning also has been introduced to numerous schools through national workshops and has been used in pre-clerkship and clerkship education at a number of medical schools.   With minimal instruction, students are able to effectively create IISs for diagnoses they are considering as part of their clinical or case-based experiences.

CONCLUSIONS The Integrated Illness Script is an easy tool to implement to ensure the integration of basic science mechanistic understanding into the clinical reasoning process. Next steps are to continue developing a set of exemplar IISs and to continue to pilot test the impact of IISs in clinical reasoning.

James W Lewis and Anna Lama
West Virginia University

PURPOSE With the advent of lecture capture, face-to-face teaching in medical school large classroom settings are increasingly under pressure to transition to online teaching, flipped classes, and blended learning approaches, or suffer from lower attendance and lower attainment. This places a greater onus on lecturers to include engaging, dynamic teaching methods in large classroom settings to convey key concepts in a manner that holds value beyond their recorded substitute. The purpose of the education innovations herein were to introduce and assess several specific on-stage “demonstrations” that can be presented in large classroom settings and convey information beyond textbook or gross lab experiences, slated for first year medical school and nursing school curricula.

METHODS Multiple demonstrations were implemented during traditional 1 hour class lecture slots, including teaching the fluidics of cerebral spinal fluid flow, the mechanics of hematoma formation, and teaching an overview of brain blood supply, among other topics. Likert scale (1-5 ratings) feedback and solicited comments were collected immediately after the course, as well as from a subsample of the students a year or more later to assess longer term retention.

RESULTS Student evaluations and comments from medical students accumulated over three years were assessed, providing input regarding refinements and modifications over the years. In addition to content relevance to national standardized exams, feedback provided insights into time allotment to demonstrations, and size and visibility of props for large classroom settings.

CONCLUSION While not all demonstrations may be appropriate for any single medical curriculum course, the ideas are transferable and generalizable to other schools and curricula under different logistical teaching circumstances. The overarching goal was to foster thoughts on how to encourage, rather than mandate, classroom attendance and retain the value of face-to-face teaching and roles for teachers in a changing environment competing with the technology-as-education reform.

324 – “Nothing operates in isolation”: Learning Biochemistry and Physiology via Drawing
Weichao Chen and Selina Noramly
University of Virginia School of Medicine

PURPOSE Despite the instructional benefits of drawing, recent literature review highlighted a need to explore strategies to effectively integrate drawing into teaching. Following four-year experimenting with different strategies, we started investigating undergraduate medical students’ perception of and experience with learning biochemistry and physiology via drawing.

METHODS A series of sessions were offered at the onset of the pre-clerkship period teaching biochemistry through drawing, including using drawing as a review vs. preview, giving a stand-alone drawing session vs. integrating drawing with other’s lecturing in one session, and providing life vs. pre-recorded demonstration. Afterwards, all 156 learners were invited to provide feedback on these sessions.

RESULTS Detailed outcomes from the theme analysis of student responses will be presented. Among the 124 students who had compared learning through drawing as a preview, integrated review, vs. stand-alone review, 123 found drawing helpful. Realizing that “nothing operates in isolation,” learners appreciated getting “a big picture” to “integrate all the metabolism pathways.” Specifically, students acquired “a road map” in the preview to orient their subsequent learning and tested their comprehension through the reviews. Acquisition of conceptual understanding was perceived both as a prerequisite for and outcome from learning related information through visualization. Such perception contributed to mixed perceptions about how mapping should be integrated with lecturing. Among the 127 students who had indicated their preference of drawing individually, with peers, or following instructor demonstration, 103 (81%) preferred instructor demonstration when learning new materials or more complex pathways. Learners explained their rationales of preference, discussed how they had integrated drawing into their self-study, and offered suggestions to further benefit from instructor demonstration.

CONCLUSIONS We will incorporate students’ comments to enhance the design of teaching physiology with drawing, to be offered during Spring 2019. Additional data will be collected, and findings will be shared.

Jonathan Fisher, Yerko Berrocal, Leslie Hammersmith, Andrew Darr, and Anthony Dwyer
University of Illinois, College of Medicine Peoria

PURPOSE Many U.S. medical schools are moving from traditional lecture-based curriculum in favor of ones that incorporate more student-directed, active learning strategies. The University of Illinois College of Medicine (UICOM) is undergoing a curricular transformation that promotes multiple active learning modalities like flipped classroom, wherein students prepare by watching microlecture videos prior to designated in-class sessions.

METHODS Topics for microlectures were identified at least 12 weeks prior to the scheduled in-class session. Faculty worked alongside instructional design specialists to develop the videos, which were recorded and edited using TechSmith Camtasia software. Faculty included custom-created animations and review questions in the videos to stimulate student engagement. Quality control was maintained through a peer review process to evaluate multiple factors, including managing segmenting, signaling and modality within the recording to ensure the videos met standards that promote student engagement. Throughout this process, the college has developed a solid base for the development and use of video microlectures as an effective tool for flipped classroom sessions.

RESULTS UICOM faculty produced over 300 microlecture videos in the last two years. The average length of these videos is 15 minutes. The total hours of video produced is 4573. Student feedback to the microlectures has been positive. Faculty peer review of video microlectures occurs both formally and informally as part of the regular design process.

CONCLUSION The microlecture format is an effective way to deliver content to medical students in preparation for flipped classroom activity, especially when authors design videos to meet standards for quality digital instructional media. UICOM continues to add to the microlecture pool and revise existing videos for incoming students.

326 – Teaching and Assessing Pharmacology Learning Using Different Approaches in UCSF’s Integrated Bridges Curriculum  Omnes viae Romam ducunt?
Marieke Kruidering-Hall and Rupa Lalchandani Tuan
University of California, San Francisco

PURPOSE There are many approaches to teaching pharmacology, but which approach best promotes learning and application of pharmacology knowledge is not well studied. Here we report on student pharmacology open-ended question (OEQ) performance across multiple blocks that have different teaching strategies. The UCSF Bridges curriculum is an integrated organ systems based curriculum. The pre-clerkship component, Foundations 1 (F1), is 18 months in duration and consists of 10 Foundational Sciences (FS) Blocks, Clinical Microsystems Clerkship, Inquiry Curriculum, and Assessment Reflection Coaching & Health weeks. Students learn via multiple modalities including 1) live lectures, 2) small groups, 3) online videos, 4) online PowerPoints to click through independently and 5) interactive, integrated case-based wrap-up sessions. Assessments incorporate the principles of testing for learning (1) through required weekly quizzes consisting of multiple-choice questions (MCQs) and OEQs.  Summative assessments are fully OEQ-based and require students to demonstrate application of knowledge in order to pass.

METHODS Setting: Academic years (AY) 16-17 and 17-18. We collected medical student (n = 152 per year) pharmacology OEQ exam performance from the introductory first block (which utilized modalities 1&2&3&5), the cardiovascular block (1&2&4), the renal, GI, endocrine & nutrition block (1&2&3&5+flashcards provided on exam), the infection, inflammation and immunology block (3&5+flashcards provided on exam) and the neuropsychiatry block (3&5).  OEQs were graded using a rubric: “meets expectations” (score 5,6), “borderline” (score 3,4) or “does not meet expectations” (score 1,2). Pharmacology performance will be compared across blocks using repeated measures analysis of variance.

RESULTS We are currently finalizing data collection and can guarantee that we have access to the data to undertake the analysis and present this work.

CONCLUSIONS From this study, we will gain insight into which specific teaching methods, if any, are more or less effective at facilitating application of pharmacology knowledge on OEQ exams.

REFERENCES Brown,P.C.et al(2014) Make it stick: the science of successful learning. Harvard University Press.

327 – Adapting the first-year integrated curricula in response to the needs of developing students’ self-regulated learning skills
Lu Xu, Shana Zucker, Blake Milson, and Hannah Lo
Tulane University School of Medicine

Purpose Medical schools aim to provide learning experiences that encourage the development of self-regulated and lifelong learning skills in medical students. However, it is unclear whether medical students become better self-regulated learners as they progress through the pre-clinical years. The objectives of this project are 1) to investigate whether the current pre-clinical year integrated curricula will improve self-regulated learning skills; 2) to investigate whether these skills are related to academic performance.

Methods We employed a longitudinal study design. The Self-Regulation of Learning Self-Report Scale (SRL-SRS), was administered to three student cohorts (2017-2020) 3 times: 1) at the beginning of first-year integrated curricula; 2) at the end of first-year integrated curricula; 3) at the end of second-year integrated curricula. This instrument was used to investigate whether there is a change in students’ self-regulated learning skills over time. The SRL-SRS scores were compared using unpaired two-sample t-test. The relationship between SRL-SRS scores and academic performance was analyzed using regression analysis.

Results  We have collected the first two datasets at the beginning and end of first-year integrated curricula. 76 out of 190 students have completed the first survey and 44 have completed the second survey. Six subscales (planning, self-monitoring, evaluation, reflection, effort, self-efficacy) measured by SRL-SRS instrument were analyzed. Results showed that students scored significantly higher (P < 0.05) on self-monitoring subscale when comparing the beginning and the end of the first year integrated curricula. Regression analysis revealed no correlation between each subscale of self-regulated learning skills and academic performance.

Conclusions This study shows that the Tulane first-year pre-clinical integrated curricula does improve one subscale of students’ self-regulated learning skills, self-monitoring. This would possibly be explained by the newly implemented self-directed learning teaching modality which emphasizes the LCME element 6.3 self-directed and life-long learning.

Gabi N. Waite, John L. Szarek, Carmine Cerra, Justin Collins, and Pamela Lucchesi
Geisinger Commonwealth School of Medicine

PURPOSE Medical school educators are challenged with simultaneously preparing students for patient care in their clinical years and for USMLE Step-1. Bricks (ScholarRxTM) are Step-1-level content items consisting of narrative text, images, mnemonics, and self-assessment items. Our purpose is to evaluate the use of the Bricks in achieving the dual goals of having students prepared for the clinic and being successful on Step-1.

METHODS We mapped complementary Bricks content to content in our hematology, cardiology, and pulmonology course blocks. The Bricks are available to MD2 students as non-mandatory exercises on the course portal. In addition to feedback on the usefulness of the Bricks from the class at-large, an incentivized cohort of students will be asked to keep a log-book of use and participate in a focus group at the end of the academic year. Students’ academic performance in their second year will be correlated with their performance in their MD1 year and Step-1 scores. We also will interview stakeholders including course educators, and staff of Faculty Affairs and of the Office of Curriculum and Assessment.

RESULTS Data collection and analysis using a mixed methods approach will be completed in May in time for presentation at IAMSE2019. Quantitative data will be the frequency of use of the Bricks and the academic performances of Brick users and non-users over two years. Feedback from surveys, focus groups and interviews will be analyzed using an inductive approach to identify initial codes, sub-categories, and themes.

CONCLUSION We anticipate that our study allows us to assess our hypothesis that the integration of complementary high-yield review material, in the form of Bricks, into our curriculum will help students balance the challenge of Step-1 preparation with the goal of readying themselves for patient care in the clinical years.

329 – Try this with everyone: a pilot course to improve interviewing skills in- and outside of clinical settings
Anne Zinski
School of Medicine, University of Alabama at Birmingham

PURPOSE Initiating and documenting clear, purposeful encounters in healthcare settings has important implications for patient satisfaction, workplace dynamics, and reducing medical error. However very little research in medical education has explored learners’ comfort, skill, and aptitude in interpersonal skills outside of clinical settings. Therefore, our goal was to design an elective, small-group format course to foster improvement in interpersonal communication with an emphasis on refining interview skills, with the assumption that planning, data gathering, and summarizing could be practiced outside of clinic.

METHODS The course included exploration of communication theory, self-assessment of skills across settings, didactic lessons, and scheduled homework. Learners further honed these skills via conducting and presenting findings from a series of service learning encounters. Each learner completed a self-assessment of perceived skills mastery consisting of 16 distinct interviewer behaviors on a 7-point Likert scale. Pre- and Post-course ratings of pertinent skills, including information gathering, body positioning, and summarizing others’ messages, among others, were compared using paired t-tests.

RESULTS Ratings from learners who had completed a pre- and post-course assessment were included in the analysis (n=41), 95% response rate. At post-course, the largest improvements in mean skills ratings were in utilizing open-ended questions, using probing questions strategically, avoiding interrupting others, and reflecting others’ ideas to check for understanding.

CONCLUSIONS In a course pilot that combined didactics, self-assessment, and strategic practice outside of clinic, medical students were able to improve effective interviewing behaviors, showing promise for strategic skills development outside of academic settings.

330 – Student Assessment of an Observational Experience of an Interprofessional Approach to Managing Medical Care for End-of-Life Cases
Jennifer Montemayor and Christopher Unrein
Rocky Vista University College of Osteopathic Medicine and The Denver Hospice

PURPOSE Medical students must understand interprofessional roles, responsibilities and contributions given the impact of effective teamwork on patient outcomes. Some schools experience challenges offering meaningful interprofessional opportunities for pre-clinical students.

METHODS Second-year students observed end-of-life case discussions through an interprofessional approach to managing patient care (including: bereavement counselor, chaplain, nurse, social worker, physician, volunteer, interdisciplinary group facilitator, music therapist), participated in a small-group debrief, and took an anonymous survey adapted from the Center for Health Science Interprofessional Education, Research, and Practice “Post Assessment: Interprofessional Team Simulation Training” to assess what was gained through the experience. IRB approval was obtained. Descriptive statistics were used to summarize data.

RESULTS Of 158 responses, 73% agreed/strongly agreed it was a valuable educational experience. 83% agreed/strongly agreed it strengthened their appreciation for the physician leadership role.  ?75% reported “often”/”frequently” observing leaders facilitating team function, creating information-sharing opportunities, discussing patient plans, and team members anticipating others’ needs, consulting others, using communication skills that decrease error risk, and asking questions.

CONCLUSIONS These results suggest an observational experience was a valuable educational opportunity to learn interprofessional team dynamics and member contributions to patient-care case-management discussions and observe their future role modeled as well as the roles of other professionals. Therefore, a required, structured observational experience allowed student exposure to interprofessional team dynamics and important team functions such as leadership, information sharing, requesting assistance, and communication skills. Other medical schools may find that student observation of an interprofessional approach to patient case management discussions can be a valuable addition to the interprofessional curriculum as a means of enhancing student understanding of the importance of medical team function, particularly for programs which lack an affiliated teaching hospital or other health professions programs.

331 – Incorporating home visits into a community health course to reinforce the importance of social determinants of health
Amy Baldwin, Achilia Morrow, Laurel Murrow, and Suzanne Lester
AU/UGA Medical Partnership and Mercy Health Center

PURPOSE Social determinants play a major role in health. Although medical schools have introduced this concept into their curricula, it is unclear whether students connect this coursework to patient care. A recent revision of our community health course has given us the opportunity to directly reinforce to our students the relationship between social determinants and clinical practice by introducing home visits. These early experiences will allow students to recognize and incorporate these factors into patient care throughout their careers.

METHODS  A group of 8-9 first year medical students and 2 faculty preceptors (one clinical, one non-clinical) work with one of our community partners, Mercy Health Center, which serves uninsured patients in our area. During home visits for selected patients, our students take histories which include social determinants of health. With guidance from their preceptors, they work to develop a plan and add notes about the encounter to patients’ charts. Templates and prompts are provided to help students gather information. Finally, students complete reflective writing and present “exemplar” patients to the entire class in a workshop format. Surveys will be used to formally gauge changes in student perspectives.

RESULTS Student learning opportunities have included topics of migraine treatment, depression, specialist referrals, fragmentation of care, navigating the health care system and treatment of various chronic diseases. Additionally, promotion of a team approach has led to the investigation of legal assistance, transportation solutions, and assistance from community agencies. Workshops and reflections have revealed that students have identified factors beyond patient control and have recognized the role of family and social support, while broadening their view of the uninsured.

 CONCLUSIONS Home visits are proving to be an effective way to teach students about the social determinants of health in the context of patient care, while providing a framework for the use of interdisciplinary approaches.

Poster Award Nominee
Tracy Fulton, Michael Dell, Leslie Fall, David Harris, James Nixon, Ann Poznanski, and Amy Wilson-Delfosse
University of California, San Francisco School of Medicine, Case Western Reserve University School of Medicine, Aquifer and Geisel School of Medicine at Dartmouth, University of Central Florida College of Medicine, and University of Minnesota Medical School

PURPOSE The Aquifer Sciences curriculum is a resource for the development of tools to support learners’ cognitive integration. We have recruited teams from six medical schools to develop virtual patient cases, each focused on the assessment of a single Integrated Learning Objective (ILO), and thus a single clinical decision, from the curriculum. These cases will provide clerkship students with deliberate practice in cognitively integrating, transferring and applying their basic science knowledge to safe and effective clinical decision-making.

METHODS Each school recruited a team of basic science educators, clinical science educators, and senior students to collaboratively design cases. Teams were provided case authoring guides and webinar training on authoring clinical decision questions, basic science justification questions, and integrated explanations. Teams were then assigned a “calibration case” (i.e. provided the same concept, ILO and common condition) in order to define best practices and to ensure a consistent approach to authoring cases that draw on the concepts, teaching points, and Harm Statements of the ILO required to make the decision.

RESULTS At this time, each school has completed a draft calibration case with questions and model explanations. Teams took different approaches to involve students, the number of answers for the clinical decision question, the length of the basic science justification, and the process for hand-off among and between team members. Most teams circulated drafts electronically but incorporated at least one team meeting. Results from the next phase of the project, in which each school will develop multiple cases to support either knowledge transfer or integration, will also be discussed.

CONCLUSIONS Curricula that support learners’ cognitive integration are challenging to design. The case development framework described here requires learners to demonstrate an understanding of a basic science concept in making a provisional decision, leading to an entrustment action.

333 – “Do you see what I see?”: Using art to introduce observation and perspective in large group Human Structure course setting
Lauren W. Mazzurco and Cody W. Long
Eastern Virginia Medical School and Chrysler Museum

PURPOSE Many schools are using art to build medical students’ skills of observation and diagnosis.  Experiences are typically offered in museums and/or small groups.  Using a large group format we introduced art to develop skills of observation, perspective, bias and communication in first year medical students.  This abstract describes the project and outcomes.

METHODS The session was attended by all first-year medical students (n= 150) on their first day of class.  As an introduction to their semester-long experience in the Human Structure Course with their anatomical donor and co-lead by a physician – educator and local museum educator, the session lasted 1.5 hours.  Using a think-pair-share format, students made and discussed observations and variances in perspectives regarding an initial photograph.  The museum educator then taught a systematic approach using a “look”, “describe”, “think” and “connect” framework with two different works of art. Using the think-pair-share format, students discussed and reflected on their personal perspective. Individually, they were asked to describe in writing how they thought this activity would impact their observational, collaboration and communication skills in their anatomical donor dissection small groups.

RESULTS Art-related experiences in the undergraduate medical curriculum are most commonly held in the museum or small group setting.  This was not a feasible option for us and thus, our session was designed in a large group, auditorium style lecture hall. Feedback from students and faculty was overwhelmingly positive.  Students most commonly noted heightened awareness of needing to consider others’ perspectives as well as their own bias/connection in their observational interpretation.

CONCLUSIONS Despite the large group, auditorium style setting, using a think-pair-share format, led by a physician-educator and museum educator afforded our first-year medical students an opportunity to engage with using art to explore their own observational skills, perspective, bias and communication skills prior to their anatomical donor introduction.

David K. Chumba
Moi University

PURPOSE Breaking bad news (BBN) to patients is one of the most common and often difficult responsibilities in the practice of medicine. The study sort to identify factors that constraints residents while performing this important task in the African context and to assess the effectiveness of training intervention using SPIKES protocol.

METHODS A quantitative research, quasi experimental approach, was utilized where a questionnaires were used to collect the data.  A purposeful sample of 80 physicians who are residents and provide treatment for patients with life threatening diseases in MTRH were selected for the study. The physicians were randomly assigned into two groups; experimental and control groups. Both groups filled a questionnaire then the experimental group were trained on delivering bad news to patients diagnosed with cancer.

RESULTS A total of 80 residents the school of medicine were recruited. There were more men than women male 44 (55%) and female 36 (45%). 100% of the residents break bad news to patients more than 5 times in a month. Among the skills, the most totally grueling was how to be honest and not take away hope (20)25% and dealing with patient’s emotions (29)36.3%. The perception of constraints did not change significantly after training when group A and B were compared. Time was not found to be a constraint as in other studies.

CONCLUSION Training residents in form a workshop, is not sufficient in difficult communication like breaking bad news. The findings in this study suggest that residents’ role in patient care may not be very clearly defined especially in breaking bad news tasks.

335 – Flipping or Flopping? Comparison of student performance and perception of the flipped classroom for the two-campus model
Jennifer Montemayor
Rocky Vista University College of Osteopathic Medicine

PURPOSE Commonly, medical schools’ additional-location campuses are required to have ? 50% of didactics originating on-site. Lectures are typically delivered bi-directionally via live-video technology to ensure equivalency. Flipped classrooms (FLIP) offer student-centered, active-learning opportunities. We asked if FLIP results in equivalent performance and perception between campuses, while enhancing curriculum origination per campus.

METHODS Year 1 cardiovascular-physiology assessment and content, delivered via 7 FLIP sessions (pre-recorded lecture, self-assessment quiz, required small-group application session), was identical between campuses. FLIP facilitator:student ratio was similar. Homoscedastic t-tests analyzed FLIP exam-question (n=52) and overall Year-1 exam (n=20) performance between campuses. Post-course survey responses were analyzed by Chi-Square to determine if differences in student FLIP perception existed between campuses.

RESULTS The difference in FLIP exam-question performance between campuses was not significant (2.21%, p = 0.42). However, overall Year 1 exam performance was lower for UT (p = 0.027). A significant difference was detected between Colorado (CO, n=56) and Utah (UT, n=53) student responses for 2 of 11 survey questions. A greater proportion of CO vs. UT “strongly agreed” they enjoyed FLIP (p=.042), and it was beneficial to learning (p=.028); whereas, a greater proportion of UT vs. CO “strongly disagreed”. No significant difference existed in responses for the other questions. The majority of CO and UT indicated these FLIP benefits: (1) collaboration opportunity with peers and faculty, (2) peer-collaboration on practice questions, (3) ease having questions answered vs. traditional lecture, (4) learning enhanced by pre-recorded videos and customized viewing experience. CO and UT ranked the top FLIP resources, also desired for future courses, as (1) application questions, (2) pre-recorded lectures, (3) self-assessment quizzes.  

CONCLUSION With similar, possibly somewhat improved, performance outcomes compared with traditional-lecture format across two campuses, FLIP offers an equivalent, collaborative, active-learning curriculum which supports institutional requirements of at least equal content originating from both campuses.

337 – Flipping with ‘Jeopardy’: Problem-solving from recall to analysis
Eve Gallman
AU/UGA Medical Partnership

PURPOSE I continue to seek ways to utilize active learning techniques in the classroom and to help my students develop enhanced critical thinking skills. Pre-class preparation coupled with in-class problem solving gives me an opportunity help my students learn how to apply information. Here, I describe my recent experience transitioning to a “Jeopardy” format for in-class problem solving.

METHODS Pre-class preparation: Students were provided podcasts to be completed before class. Students were also provided written guidance to help them to fully appreciate the skill level they were expected to achieve before class time. On-line practice questions were available to help them assess their level of preparation. In class activity: Questions were presented using a “Jeopardy” style template consisting of a table of cells with 5 columns and 5 rows. Each cell links to a hidden question. Questions in a given column explored one topic, identified in a column header. Cells were color-coded to indicate whether the question (a) was primarily recall; (b) required application of information; or (c) required a higher level of analysis.

RESULTS The arrangement of problems by topic and by degree of difficulty allowed students control over the pace and direction of the class time while ensuring that major target concepts would be encountered. Because the class got to pick the order of topics, they remained very engaged. Clear labeling of the types of questions available allowed students to build from simple to more complex concepts as they moved from recall to analysis.

CONCLUSION This format lent itself well to team discussion and good-spirited competition and helped the students to maintain interest. Importantly, it helped students learn to differentiate between ‘fact’ knowledge and analysis.

Bruce W. Newton
Campbell University School of Osteopathic Medicine

PURPOSE The perineal body is where three sets of muscles insert: the external anal sphincter, superficial transverse perineal, and bulbospongiosus mm. During cadaveric dissection, it is a nondescript point between the vagina or penile bulb and anus. Students have difficulty identifying its location in cadavers. Clinically, it provides support for the pelvic organs. If an episiotomy is needed, lateral incisions are preferred to avoid cutting the perineal body which increases the possibility of pelvic organ prolapse.

METHODS The demonstration, which can take place in the gross anatomy laboratory or lecture hall, consists of three students and a faculty member. Each of the four persons assumes the cardinal compass positions and extends a single hand toward the opposing compass point. The east and west persons represent the superficial transverse perineal mm.; the north point represents the bulbospongiosus m., the south point is the external anal sphincter. Standing fairly close together, the east and west points lock hands, then the north point grasps the top of those hands, while the south point grasps the other three hands from the bottom. You have now “made” a perineal body. Then ask each person to pull in their respective direction, this puts tension on the “perineal body”, while the faculty member, who is holding the bottom of the other three hands, lifts up slightly to further enhance the concept the perineal body provides pelvic organ support.

RESULTS/CONCLUSIONS During the demonstration, the faculty member discusses how to form the “perineal body” and its clinical importance, the students now understand its formation and relevance. The high yield demonstration takes less than two minutes.  After performing this demonstration in the gross lab for several sets of students, you can see them performing the demonstration to teach others.