Sunday Oral Session Abstracts

Session 1 – Assessment

1 – Adaptive Modeling Accurrately Predicits Student Performance on the USMLE STEP 1 Examination
Robert Carroll

PURPOSE: Student performance on the USMLE licensing examination is impacted by numerous factors, confounding interpretation based on test score alone. We developed a predictive model in order to identify students who will benefit from enhancing test-taking skills and to allow post-exam comparison of test preparation approaches.

METHODS: A multivariate equation incorporating prior student academic performance was used to model performance of those classes on the USMLE Step 1 examination. This model was used prospectively for the 76 members of the class of 2018 to develop a predicted USMLE score for each student. The model incorporated course grades while in medical school, performance on 4 NBME subject exams (physiology, microbiology, pathophysiology and pathology), and a NBME Comprehensive Basic Science Examination. Student ‘predicted’ score was then compared against the actual score on the USMLE Step 1.

RESULTS: The model prediction of class average matched the actual class average (229). The residual difference between actual and predicted score was 0.5, with a standard deviation 9.8 and a standard error of 1.1. The predicted score was ± 5 points of the actual score for 47% of students. The 5 students with predicted scores below 200 were monitored during their study period. From this group, 2 opted to delay taking the examination, 1 failed the examination and the other 2 passed the examination. Post-exam comparison of the impact of a commercial study program is shown below. ANOVA followed by Tukey’s test indicated there was no significant difference between the 4 groups. N (self-reported) USMLE Step 1 Average USMLE Predicted Average Residual Self-Directed 22 235.2 233.8 1.3 Commercial Course 24 233.3 233.2 0.03
CONCLUSION: Predictive modeling of exam performance allows both early intervention for students at risk and an in-depth assessment of test preparation strategies.

2 – Improvement in Medical Competence through Direct Observation During Clinical Clerkships
Leslie Ellis

PURPOSE: To assess the growth of professionalism, communication, organizational efficiency and oral presentations and entrustable professional activities (EPAs) during clinical clerkships employing direct observations in a standardized setting of medical students’ clinical encounters with real patients.

METHODS: All third-year medical students (57 men; 52.8% and 51 women; 47.2%) participated in the mandatory clerkship rotations (surgery, pediatrics, obstetrics/gynecology, internal medicine, psychiatry, emergency medicine, family medicine, neurology, radiology). We adapted the mini-CEX for use in the direct observation of third year clerkship students to assess medical competence.

Assessors (27 faculty members) were trained in a 90 minute workshop which consisted of didactic information (e.g., reliability, validity, rater bias, feedback techniques, medical competence, EPAs, etc.), practice in assessment using video recordings of student encounters with patients (pre-entrustable, entrustable, proficient / expert), group discussion (e.g., for inter-rater reliability), and self-assessments.

RESULTS: There were 627 assessments (mean=5.81/student; range: 3-12; mean time for assessment was 25.36 minutes; for feedback 18.92 minutes. A two-facet fully crossed generalizability analysis (assessors x students) resulted in an Ep2 = .78.

There was an increase in the means of professionalism, communication, organizational efficiency and oral presentations over time (p < .01) as theoretically expected. The mean increase in the overall assessment results in a large effect size (Cohen’s d = 0.87); growth followed an expected power curve (Thurstone Function). On average, entrustability was achieved at 15 days for professionalism, 32 for communication, 95 for organizational efficiency, and 100 for oral presentation.

CONCLUSIONS: The assessment system has good psychometric properties (item distributions, reliability, Ep2, validity) and shows growth of medical competence over the assessment period that follows an expected power curve. As the assessment system is feasible, has evidence of reliability and validity, can directly assess the growth of medical competence, it can be widely applied to determine entrustability of EPAs.

3 – Use of reference metabolic map in assessment: Updates from the NBME Metabolic Map task force and next steps
Janet Lindsley

PURPOSE: Medical knowledge rapidly expands and changes, raising parallel questions about what facts need to be committed to memory, and how to train learners to retrieve and utilize reference information. The Pathways of Human Metabolism (PHM) metabolic map, designed by medical educators at Stanford and vetted and approved by the Association of Biochemistry Educators (ABE), is a reference for learning and assessment that promotes a shift away from rote memorization. In July 2016, the NBME convened a Task Force to explore incorporation of this reference into the USMLE. Here we report the findings and next steps.

METHODS: Task Force members, including biochemistry and clinician educators, experienced National Board item writers, and NBME staff, 1) debated benefits and challenges to use of the map on the USMLE, 2) worked in pairs to create and critique new USMLE-style items that depend on skillful utilization of the map, and 3) reviewed existing items to determine the impact access to a reference map might have.

RESULTS: The Task Force identified a robust rationale for inclusion of reference material in general, and for including the PHM map specifically on USMLE. Current questions were identified that are rendered trivial with inclusion of the map, and best practices were identified for developing new questions. The group also identified risks and possible unintended consequences for medical education and learning.

CONCLUSIONS: A metabolic map is the first new reference resource being explored for inclusion on NBME assessments. We encourage other basic science education organizations to identify similar discipline-based reference materials. Future communication strategies and research should be directed at ensuring that inclusion of such reference materials results in the desired changes in student behaviors, perceptions and performance.

4 – An EPA-based OSCE to Assess Preparedness for the Clerkship Years
Pamela Baker

PURPOSE: In 2016-2017, we launched our first full scale Assessment of Core Entrustable Professional Activities (ACEPA), a comprehensive simulation-based, EPA-aligned OSCE. Our goal was to:

  1. Evaluate how well the M1/2 curriculum prepares students for clerkship rotations.
  2. Assess a student’s ability to manage a random case (much like they would experience on their rotation).
  3. Identify growth opportunities for students using formative feedback just prior to beginning their Clerkships.

METHODS: Using pilot data from 2016, the ACEPA was scaled to the entire M2 class. Over four half days, 170 students participated in two cases aligned to five of the 12 EPAs (1, 2, 3, 5, and 6) practiced during their first two years of medical school. Students were blind to both cases, one fixed across all four days, and the other randomized. All clinicians and standardized patients received training on providing formative feedback to the students. During each 45-minute encounter, students were required to perform a patient assessment culminating in either a written note or verbal presentation. At the end of each session, students were provided immediate feedback by a clinician or a standardized patient.

RESULTS: We will present results from the full scale ACEPA and share how the design process affected our ability to: 1) implement and scale the ACEPA using limited resources, 2) inform curricular improvement in the pre-Clerkship years, and 3) better identify students at risk.

CONCLUSION: Our ACEPA model can be used by other institutions as one mechanism to measure progression to Entrustment, evaluate preparedness for the clerkships, and identify areas for growth upon entering a required clinical rotation.

Specifically, this low stakes ACEPA can help:

  • better address and assess the EPAs
  • make curricular improvements
  • enhance learning experiences
  • support students in the progression to Entrustment

Session 2 – Curriculum

Tracy Fulton

PURPOSE: Judgments about the importance of basic science to clinical medicine may reflect the degree to which individuals’ basic science knowledge is encapsulated. Effective collaboration between basic scientists and clinicians demands tools that facilitate cognitive ‘unpacking’ of basic science knowledge and reinforcement of connections to clinical decision-making. Here, we describe the development of such a tool, a template for creation of “integrated learning objectives,” which we define as LOs in which basic science concepts are authentically applied to important clinical decisions.

METHODS: In a collaboration between IAMSE and MedU, groups of basic scientists and clinicians justified and prioritized basic science concepts relevant to multiple clinical disciplines and common clinical conditions. Initial attempts to create learning objectives for these concepts failed. Often, basic scientists wrote detailed learning objectives that lacked clinical applications while clinicians wrote objectives without apparent basic science underpinnings. A template evolved over more than a year of collaboration that gathers information from each “side” in an alternating step-wise fashion: core basic science concept, relevant common/core conditions, clinical decision area and discipline(s), basic science teaching point, and clinical harm statement. This approach guides a conversation that fully elaborates viewpoints and knowledge of each party, a pre-requisite for effective collaboration on integrated learning objectives.

RESULTS: Use of the template assures relevance of basic science concepts to the authentic practice of clinical medicine. We have used this template to develop approximately 600 integrated learning objectives mapped to ~130 basic science concepts.

CONCLUSIONS: The integrated learning objective template is an example of how basic science and clinician educators can collaborate to develop tools that promote the cognitive integration of the sciences basic to medicine with the practice of clinical medicine. This tool has been developed to guide virtual patient case construction but could be applied in a variety of curriculum development settings.

Laurie Leclair

PURPOSE: At the University of Vermont, Advanced Cardiac Life Support (ACLS) training for fourth year medical students focuses on methodology. Third year students are, however, exposed to ACLS codes without a framework with which to help them cope with unfamiliar and troubling outcomes. We created a simulation-based session in which students witnessed a code and patient death followed by large group debriefing with written and verbal components targeted to emotional stress and coping. We hypothesized that students would benefit both academically and emotionally from this experience.

METHODS: Medical students beginning their third year were introduced to a simulated patient who subsequently experienced cardiac arrest, underwent a simulated code, and died. Students wrote a one-word reflection to summarize their initial reaction, followed by a large group debrief with a panel of critical care, palliative care, psychiatry, and spiritual care faculty. Students completed brief pre- and post-code session surveys to assess knowledge and emotional preparedness, and to evaluate the value of the experience.

RESULTS: 105 students completed questionnaires. Following the session, knowledge of code team role and responsibilities improved (91% vs 100% (p=0.0035) and 83% vs 99% (p=0.0001) respectively); awareness of available mental health services increased (25% vs 90%, p<0.0001); and students’ perception that they were ‘not prepared’ to witness a code dropped significantly (24% versus 0%, p<0.0001). 94% of students felt the session was either “somewhat” or “very helpful,” and 99% “somewhat” or “strongly agreed” that the session was a valuable addition to the curriculum.

CONCLUSION: Students valued the code session as it improved their knowledge of code teams’ roles and responsibilities, increased their sense of preparedness for witnessing a cardiac arrest, and increased their awareness of mental health services. Future directions include a follow up survey of the third year students, now nine months into clerkship, to assess lasting impact.

Denah Appelt

PURPOSE: To increase deep learning, medical programs are incorporating student engagement and active learning strategies linked with higher-order assessments within pre-clerkship curricula. As a collaboration of the Neurosurgery residency program and the Clinical and Basic Neuroscience course, our Neurosurgery Conference was developed to engage second-year medical students in critical thinking and expose them to a hands-on skills workshop experience.

METHODS: The morning program comprised seven 30-minute talks by Neurosurgeons on topics ranging from a retrospective of the Neurosurgical field to novel surgical techniques currently employed. The afternoon cadaver skills workshops consisted of 11 stations, each sponsored by a corporate partner that loaned equipment and technical personnel. The stations simulated an operating room environment where neurosurgery residents and neurosurgeons instructed medical students with techniques and proper use of the equipment. The class of 261 students was divided into 4 groups, each of which was allocated 1 hour in the skills workshop. Attendance was assessed with an ExamSoft quiz.

RESULTS: Attendance at the Neurosurgery Conference was optional; however, students could earn credit for attending at 2 talks and 2 workshops. Median attendance was 3 talks and 4 workshops, with 96% of the class attending at least 1 talk or workshop station. Each talk was attended by ~40% of the class while workshop station attendance ranged from 18 to 56%.

CONCLUSION: Although the conference was not intended to produce neurosurgeons, the students’ attendance and quiz responses indicated that the program was appreciated as integral to their education. The hands-on skills combined with presentation of surgical techniques reinforced the students’ basic knowledge of neuroanatomy and clinical applications. Additionally, the program included interactions between students, residents, and neurosurgeons, thereby fostering students’ learning and social interaction in a professional environment.

4 – Pre-Departure Training for Global Health Electives in US Medical Schools
Anne Dougherty

Purpose: As interest in global health increases, US medical schools are challenged to adequately prepare students for overseas electives. Pre-departure training (PDT) has been suggested as a means to educate students on travel and personal safety, global health ethics and cultural competency. In 2013, the Liaison Committee on Medical Education (LCME) added a PDT requirement to its accreditation standard for all medical students participating in an international health elective. Despite this mandate, little is known about the current state of PDT programs in US medical schools. This study aims to characterize PDT across US medical schools and identify key elements for PDT curricula.

Methods: Data was sought from a faculty representative of either the global health office or the office of student affairs at all LCME accredited US medical schools from November 2014 through February 2015. Information was collected via a voluntary, self-reporting online survey. Descriptive statistics were used for analysis.

Results: Seventy three percent (104/143) of medical schools responded. Among respondents, 96% (100/104) allowed global health field electives. Though 91% (91/100) of those schools offered PDT and 81% (74/91) cited mandatory PDT programs, only 59% (54/91) had formal PDT curricula. Personal safety, travel logistics, cultural competency and ethics were commonly cited topics. Only 14% (13/91) reported a budget greater than $500 and 43% (39/91) had no budget for PDT.

Conclusions: The majority of medical schools allowing global health electives offer PDT. The content, time spent, and format of the programs vary widely. Budgetary support is scant. Attention at the national level needs to be directed toward developing standardized objectives and curricula for medical student pre-departure training.

Session 3 – Student Presenters

1 – HOW AND WHY MEDICAL STUDENTS LEARN: Characterizing learning strategies and motivations of students at the Geisel School of Medicine at Dartmouth
Erin D’Agostino

PURPOSE: To foster the development self-regulated and life-long learners in medical school, it is necessary to improve understanding of the learning motivations and strategies utilized by medical students.

METHODS: A battery of five previously validated survey instruments were used to evaluate learning motivations (intrinsic motivation, performance approach, performance avoidance, task value, grit, anxiety, self-efficacy, control of learning beliefs, theory of intelligence) and strategies (rehearsal, elaboration, critical thinking, organization, metacognitive self regulation, time and study environment management, effort, procrastination) across five class years of medical students at the Geisel School of Medicine at Dartmouth (221 students evaluated in total). The “learning profiles” generated were then compared to other learning profiles in the literature.

RESULTS: Several motivational factors (intrinsic motivation, performance approach, fear of failure, task value) decrease significantly between the first and second years of medical school and stabilize somewhat during the third and fourth years. Learning strategies remain largely consistent across all four years but decrease between years one and two in time management and effort. Medical students also have higher intrinsic motivation, fear of failure, task value, and test anxiety than college students, but do not have higher self-efficacy or performance approach. Medical students have higher grit than all populations of comparison except for West Point Cadets. All higher-order learning strategies were significantly higher in medical students than in college students.

CONCLUSION: During the first year of medical school, medical students lose motivation but maintain stable learning strategies, which are superior to those utilized by college students. However, medical students also display more anxiety and fear of failure than do college students.

2 – A novel approach to discovering perceived and unperceived learning needs to advance medical education
Ada Gu

PURPOSE: Physicians choose Continuing Medical Education (CME) events based on their own perceived learning needs; yet CME providers must tailor educational activities to meet both perceived learning needs and unperceived learning needs. Our method of assessing unperceived learning needs is using “challenging cases” as a framework to tap into “objective” needs.

METHODS: A 38-question survey was emailed to healthcare providers; we identified reasons for choosing CME activities, barriers preventing participation, and factors that changed learning needs. We asked participants to identify topics that they would like to learn about to assess perceived needs and to describe challenging cases to assess unperceived learning needs. Data was assessed in two parts: Part I included specialty specific codes, Part II excluded specialty specific codes; we then mapped responses onto CanMEDS Roles.

RESULTS: 1141 physicians responded to the survey. Reasons for choosing CME events included problems in practice, assessment of own learning needs and content enjoyment Barriers to participation included work missed, cost and timing. Factors affecting participants’ learning needs included technological changes, changes in patients’ knowledge, and changes in practice scope. Top 10 learning needs were cardiology, neurology, oncology, pharmacology, hematology, managerial role, surgery, mental health, critical care and pediatrics. Top 10 challenging cases were: oncology, communication, mental health, hematology, neurology, infectious disease, pediatrics, cardiology, surgery and critical care. Removing specialty specific codes in Part II resulted in differing patterns of learning needs and challenging cases.

CONCLUSIONS: If challenging cases provide insight into unperceived learning needs, discrepancies between learning needs and challenging cases highlight differences in perceived knowledge gaps and unperceived learning needs arising in practice. This information may enable CME providers to provide more effective, well-rounded educational activities for physicians.

Jessica O’Neil

PURPOSE: Directly contacting a faculty member with questions is a valuable resource for students when faced with a challenging concept. However the student contacting the faculty member is the sole benefactor of that interaction while other students may continue to struggle with the same concept. To address this, a group of first year medical students at Case Western Reserve University School of Medicine (CWRU SOM), founded CaseMed Minute (CMM), an organization that works collaboratively with faculty members to aggregate student questions and create short videos to address the challenging concepts that students encounter in the CWRU SOM curriculum.

METHODS: The organization has operated for three years. Video topics are selected based on input from a 12 student panel of CMM representatives responsible for engaging classmates to identify potential high value topics. CMM representative both recruit and work collaboratively with relevant faculty members to plan and produce short videos using a tablet application. Videos are promoted to CWRU SOM students using social media outlets such as Facebook and are shared publicly on YouTube.

RESULTS: This CMM student-driven, step wise process to creating videos has produced 101 publicly available videos with a total of 34,969 views (as of 11/18/2016). These views have arisen from the United States (54%), India (7%), United Kingdom (3.5%), Australia (2.4%) and a number of other countries.

CONCLUSION: CMM has developed a process for students and faculty to work collaboratively to create short videos tailored to the needs to CWRU SOM students. This process may be a valuable approach for other institutions. CMM is developing methods to evaluate and improve video quality.

Ariel VanLeuven

PURPOSE: Many medical schools employ collaborative learning activities. These methods promote active, deep learning while encouraging team development, both of which are necessary clinical skills. Yet, linking the collaborative learning experience of the team dissection to a collaborative assessment has not been done as much in the gross anatomy laboratory. This project describes the use of a two-stage gross anatomy laboratory practical wherein students first take the exam individually, then re-take the exam collaboratively with their dissection team.

METHODS: Each student’s final exam score is a combination of their two scores: 62.5% their individual score and 37.5% their team’s score. We performed an analysis of student scores, including comparisons to previous years without the two-stage exam, and conducted a survey of student satisfaction with and opinions of the new testing method.

RESULTS: Average scores for the team component were at least 10 points higher than the individual component. Average individual scores were higher when employing the two-stage exam than in previous years when there was no team component. Over 90% of students felt that the team component improved their understanding of the content and benefited their learning process. Most students felt a high level of responsibility to perform well given the team component, and would spend more time studying alone without it.

CONCLUSION: Our first year medical students in gross anatomy have historically been assessed via traditional laboratory practicals. Our results suggest that incorporating a team component into gross anatomy laboratory practicals has improved student performance, encouraged group study, and promoted formative feedback via discussion. Student opinions indicate that they greatly value the discussions among their group and the collaborative experience of the team portion of the exam. This technique may be effective for enhancing the learning potential of a gross anatomy laboratory practical.

Session 4 – Instructional Methods

Julie Kerry

PURPOSE: An integrated Foundational Science course was developed using principles of cognitive load theory. Performance of students on NBME assessments suggested that the approaches taken contributed to student learning.

METHODS: We implemented Cognitive Load Theory (CLT) in the design of an integrated Foundational Science course. The course was structured as following: two-hour overview lecture focused on “big picture” concepts, accompanied by 6-9 self-directed, interactive “learning units” (LUs) describing concepts in greater detail. Each LU was 10-15 minutes in length and included ungraded quiz questions. At the end of the week, students completed a 15 question MCQ, and participated in a Team-Centered Learning session designed to tackle questions of greater complexity. Each lecture and LU was accompanied by a “study guide” – a faculty developed concept map illustrating key concepts. Specific aspects of the course consistent with CLT were: (1) Moving from low to high complexity; (2) Chunking information; (3) Study Guides as “pre-developed schema”; (4) Minimizing extrinsic load; and (5) Incorporating self-explanation in Team-Centered Learning sessions.

RESULTS: Students were assessed by two summative assessments using questions from the NBME customized assessment service. The predicted mean on the midterm assessment was 71% and actual performance by students in the MD class (154 students) was 89.8% (SD 6.3). On the final assessment, the predicted mean was 74%, and the actual mean was 89.4% (SD 6.6).

CONCLUSIONS: The performance of students on the NBME exams was much greater than anticipated suggesting that the overall design of the curriculum had a positive impact on student learning. Of course, one weakness of this study is that it lacks a true control group. However, it should be noted that performance on customized assessments for similar content in the prior curriculum resulted in scores that averaged 8.8 pts higher than the predicted means.

2 – Basic Science in Real Life: The Impact of Interprofessional Case Discussions on Learning
Liesel Copeland

PURPOSE: Contextualization of basic science creates explicit connections with clinical practice, leading to long-term retention and clinical reasoning (Mylopoulos & Woods,2014). While other methods integrate basic sciences into a clinical context (TBL, PBL, CBL), Interprofessional Case Discussions (ICDs) go further by highlighting the healthcare team along with the patient’s experience in a low stakes self-directed large group discussion. Our objective is to explore whether ICDs enhanced the learning experience.

METHODS: ICDs begin with a lecture that explicitly integrates biochemistry with disease, followed by discussion with a patient, their family, the healthcare team, and M1 students. Course evaluations (2013-2016) included quantitative/qualitative items about ICD satisfaction. A follow-up survey was sent to current M3/M4 students about their retention of the biochemical basis of 17 diseases (ICD/non-ICD topics). Quantitative data was analyzed using descriptive statistics and repeated measures ANOVA. Comments were analyzed qualitatively with Atlas-Ti.

RESULTS: M1 students (N=660) agreed/strongly agreed that “ICDs helped to identify patterns and relationships between disease and lectures”(87%) and that the “ICDs met the learning goal of reinforcing concepts and integrating course materials”(94%). Student comments (N=464) fit into five categories (a)clinical usefulness of basic science (b)intrinsic motivation (c)affirming passion to be in medicine (d)empathy and (e)generic positive comments. M3/4 students (N=177) reported greater retention of the biochemical basis of diseases covered during ICDs (mean=4.5) than non-ICDs (mean=4.2) where 6=extremely well (F=17.84, p<0.001).

CONCLUSIONS: Various teaching modalities have highlighted the connection between basic and clinical science through the presentation of a clinical context or case (Ling, Swanson, Holtzman, Bucak, 2008), but ICDs bring the case to life by bringing patients and the healthcare team into the classroom, thereby increasing long-term retention of the basic science relevant to clinical practice. ICDs reaffirm students’ professional identity and intrinsic motivation given their limited clinical exposure in the first year of medical school.

Mary Steinmann

PURPOSE: Identifying patients at high risk of harming themselves and/or others is a crucial skill for all physicians, regardless of specialty. Developing appropriate and sensitive clinical questions to assess a patient’s risk is challenging. The Objective Structured Clinical Exam (OSCE) is a well-studied method of clinical skills teaching and evaluation for medical students, although limitations can include cost, time, and authenticity of the patient interaction. Role play can provide an interactive learning experience with potentially less investment. This abstract describes a novel 3-hour exercise using role play between medical students and advanced psychiatric residents to teach undergraduate medical students suicide and violence risk assessment skills.

METHODS: This activity has been included in the 2nd year integrated behavioral neuroscience course at the University of Utah for the past 5 years. 3rd and 4th year psychiatric residents received training in role play and character development. Students are divided into small groups of approximately 8-10 students. Residents rotate between small groups in a timed round-robin format, giving students opportunities to interact with various resident characters and receive individualized feedback.

RESULTS: Medical students and residents have rated this activity as an extremely popular educational experience. Medical students comment consistently on the authenticity of resident portrayals, opportunities to receive personalized formative feedback, the advantage of immediate debriefing after uncomfortable clinical scenarios, and important opportunities to experience a variety of patient portrayals and adapt assessments accordingly, all in a collegial environment. Residents enjoy the opportunity to engage in teaching medical students in a smaller non-clinical setting and to practice giving performance feedback to students.

CONCLUSION: Role play using psychiatric residents is an enjoyable and effective method of teaching suicide and violence risk assessment in the undergraduate medical curriculum. Medical students find resident portrayals of patients to be authentic and engaging.

4 – Using interview simulation to improve medical student performance in residency interviews
Elise Everett

PURPOSE: The Residency Match is becoming more competitive each year1. The National Board of Medical Examiners data from the 2015 Residency Match rates the importance of certain factors in ranking applicants. The top 3 factors are ALL determined during the interview2:

1) Interactions with faculty
2) Interpersonal skills
3) Interactions with house staff

Many medical students state they lack the skills, knowledge, and confidence to perform well in a residency interview. As the interview is a crucial factor in the match, it is important to train medical students to succeed in the interview.

METHODS: An interview simulation curriculum was offered to all fourth-year medical students at our institution applying into ObGyn and Surgery between 2015-2016. Students completed a pre-curriculum survey about familiarity and confidence with the residency interview process. Next students participated in a 20-minute didactic session and performed 2 simulated interviews with faculty, each followed by 10 minutes of formative feedback. Students had access to a video recording of their simulated interviews. Lastly, students participated in a group debriefing session, completed a post-curriculum survey and a post-first residency interview survey.

RESULTS: Twenty-nine applicants, 15 in ObGyn and 14 in Surgery completed the curriculum between 2015-2016. (Table 1) Students’ self-reported knowledge, skills, and confidence in residency interviewing before and after the curriculum are displayed in Table 2. Students’ attitudes about the curriculum after completing their post-curriculum survey are reported in Table 3. CONCLUSIONS

The interview curriculum and simulation improved students’ self-reported knowledge, skills, and confidence in the residency interview process. In the post-curriculum survey, 15 students commented that the individualized feedback was most helpful. Looking Forward:

  • Feedback via formal utilization of video recordings of simulated interviews
  • Post-Match student surveys quantifying curriculum’s ability to achieve a more successful residency Match.
  • Cohort study design and blinded faculty to evaluate video-recorded simulated interviews pre- and post-curriculum with control group who participate video-recorded simulated interviews but not the curriculum.

Session 5 – Other

1 – Internet Addiction: Impact on Academic Performance & Study Skills in Premedical Students
Anamika Sengupta

PURPOSE: Internet addiction is a mounting social issue of the 21st century affecting millions worldwide. Its ability to induce neurological and psychological disturbances, social phobia, cognitive biases and executive functioning deficits, has attracted significant attention from sociologists, psychologists, psychiatrists and educators worldwide.

METHODS: The study identified Internet addicts in a population of students enrolled in a medical school preparatory program, using a standard eight-item Internet addiction test (IAT). Independent samples t-tests and chi-square tests were used to verify effects and associations between the different variables. Multiple regression analyses were used to identify predictors underlying students’ Internet addictive behavior and to analyze the effects of excessive Internet usage on their academic performance and study skills.

RESULTS: 17% of the subjects met the criteria for Internet addicts. Age and time spent on the Internet per day were identified as predictors underlying students’ addictive Internet usage. Internet addiction had significant negative impact on students’ academic performance and study skills. A significant preliminary association between Internet addiction and students’ self-reported depression was noted.

CONCLUSIONS: This study helps establish evidences supporting the negative impact of Internet overuse on academic performance and study skills of students enrolled in premedical education. It highlights that the Internet, when abused by students enrolled in demanding curriculums related to medical education, can lead to poor academic performance and often academic failure.

2 – Focusing Student Preparation for Step 1: A Pilot Delivers Assessment Performance Analysis by Category
Sally Twining

PURPOSE: The goal of this pilot was to provide a small group of students access to an online report showing quantitative information regarding their M1 and M2 exam questions. This information could guide their studying for the USMLE Step 1 exam.

METHODS: MCW course directors coded exam questions relative to the USMLE content outline and competencies.

We documented the ExamSoft process steps for students to 1) login, 2) access their individual exam information and then 3) run their own report with date ranges, specific courses and assessments. A one-page instructional handout was tested with a pilot cohort of six.

RESULTS: We delivered this information in a hands-on instructional fashion and obtained immediate feedback from the students as to if and how they would use the Performance Analysis data.

CONCLUSIONS: The pilot student reactions ranged from extremely positive to an expressive fear of looking at the analysis by category. They agreed that this data could shape an M2\\\\\\\’s Step 1 study plan, concentrating on the categories marked as needing improvement (indicated on the report with a red check mark). Lessons Learned: 1) Start small. The pilot students had an opportunity to format their own data, get their questions answered and deliver feedback before we opened this process to the entire class. 2) Plan the rollout. After the pilot, we posted the instructional handout for the entire M2 class in our learning management system News. From feedback, a significant number of students investigated the ExamSoft Performance Analysis report and thought it was worthwhile. 3) Maintenance is ongoing. Coding questions in ExamSoft is a considerable task for our course directors. We need to audit each assessment on a regular basis to ensure that new questions are tagged.

3 – Fear and Loathing in Curriculum Change: Issues of Professional Trust and Support
Michelle Yoon

PURPOSE: Developing a medical school curriculum is a difficult, challenging, organizational change process that can elicit numerous feelings and thoughts, including anxiety, stress, fear, excitement, or resistance amongst faculty members and stakeholders. Those who support faculty in that process may be the recipients of a broad range of emotions from stakeholders, along with varying levels of trust, comfort, or openness to systemic curriculum development, and to receiving support in instructional design, evaluation or assessment.

METHODS: This presentation is for medical science educators, along with instructional design, evaluation, and assessment specialists who are involved in supporting faculty through new or ongoing curriculum development. It will present potential barriers to professional trust including: role-ambiguity or strain among faculty holding multiple roles, lack of communication, isolation/siloing, unclear goals, and lack of resources, and corresponding solutions.

RESULTS: Those who support faculty in key areas of medical education handle outcomes of good and bad practices in complex organizational contexts. Thus, they are uniquely positioned to offer some solutions to mis-trust, including: 1) mentoring or coaching faculty member \\\”clients\\\” in areas such as instructional methods, teaching strategies, curriculum evaluation, or assessment practices, 2) guiding a project from concept to reality, and 3) identifying solutions to facilitate collaborative work. Barriers and solutions will examined within a Concerns-Based Adaptation Model (CBAM) framework for change in individuals and organizations, examining seven Stages of Concern individuals might have that impact trust, and gauging eight Levels of Use in implementing changes/curricular innovation.

CONCLUSIONS: This presentation highlights the complex relationship between faculty and curriculum support. Challenges to trust, and solutions, will be framed in a CBAM context. This session provides processes for navigating the complex web of professional relationships, organizational structures, and shared goals in working through course development, curriculum reform, or leadership of a various teams within a health professions curriculum.

4 – Reflections from a Successful Elective Pre-Clerkship Clinical Experience
Monica Yepes-Rios

Purpose: Proficiency in clinical skills is a core objective in undergraduate medical education. Most, if not all, schools introduce clinical skills training at the beginning of medical school, and select various formats, locations and expectations of students. The potential benefits of Early Clinical Experiences (ECE) must be weighed against the demands of delivering a comprehensive syllabus of ever-expanding scientific knowledge, at a time of increasing teaching constraints in the healthcare system. Why should we be concerned with the burden of fitting ECE in pre-clerkship training? Is this essential or just desirable?

Methods: At the F. Edward HĂ©bert School of Medicine, we introduced a pilot, elective, early clinical experience that spans 12 months across the pre-clerkship with students participating at local Community Health Centers. With the Class of 2015, our institution embraced a national trend for curriculum reform to teach pre-clerkship education in organ systems-based modules with concurrent basic sciences and simulated clinical skills training. In response to student interest, and reports from the literature on the benefits of early, legitimate clinical participation, we introduced with the Class of 2017 an elective ECE at area Community Health Centers (CHC).

Results: The ECE has been very well received by students and by the CHC. Interest has grown from 3 students initially, to 45 students 3 years into the program. Student reflections validate that legitimate ECE reinforce clinical skills learned in the classroom, convey meaning to their classroom learning, model early professional identity formation, and help counter burnout.

Conclusions: Legitimate, elective ECE offer pre-clerkship students opportunities to bring classroom work to life, prevent burnout, and foster professional identity formation. Student involvement in design and implementation, preceptor selection and faculty development, and good communication between the school and the clinical sites are key for the success of ECE.

Session 6 – Technology and Innovation

1 – Game On! Designing Educational Games for Healthcare Students
Melissa Murfin

PURPOSE: Applying game theory to the immense volume of material required for healthcare students to master is ideal for increasing engagement with information for medical learners. Active learning via the conversion of pharmacology material to popular board games and game show formats is explored in a physician assistant program.

METHODS: A variety of pharmacology topics were converted to games for review of material in two pharmacology courses annually. Student learners were first-year PA students in the didactic phase of their program. Games were incorporated into a traditional, lecture-based series of two pharmacology courses that occur across two curriculum modules. Games were primarily used for review of material rather than attainment of new knowledge. Game play included large and small group formats and was utilized approximately once monthly across a six-month period of time. Adapted games included Behavioral Medicine Clue, Antibiotic Life-Sized Candyland, Antibiotic Trivial Pursuit, Antiepileptic Apples to Apples, as well as Catch Phrase and Hedbanz which encompassed several classes of medications. Students were surveyed at the end of the pharmacology courses regarding their demographics, impression of the games, the impact of the games on their learning, and which game formats they preferred.

RESULTS: One hundred fifty students comprising four, different PA classes were surveyed with a response rate of 54%. Survey results indicated the students generally enjoyed the games and preferred this method of learning over a traditional, lecture-based review of material. The students were neutral in whether they felt this method improved their test scores.

CONCLUSION: First-year PA students generally enjoyed games-based learning when blended into a traditional course. Further study is ongoing and aimed at determining potential for improvement in test scores, motivation to learn, and delivery of new content via a game format. Lessons learned include timing, useful game formats, and student preferences for learning.

2 – Addressing Multiple Physician Competencies Through Imaging Anatomy
William Pearson

PURPOSE: Evidence shows that hands on use of radiologic imaging in the anatomy lab setting positively correlates with improved performance on anatomy exams and enhances spatial ability among first year medical students. Furthermore, imaging in multiple modalities more closely simulates application of medical knowledge in clinical practice. We here describe a collaborative effort to develop a radiology-learning program that addresses multiple competencies within a modular, integrated organ system based first year curriculum.

METHODS: A de-identified digital teaching library of static and dynamic imaging of various modalities including normal and abnormal anatomy was established. Through hands on training students learn to manipulate images using Osirix DICOM software and annotate structures relevant to each anatomy lab session. Each module has a radiology lab that includes a brief overview by clinical faculty, small group learning with guidance from faculty and residents to review student findings, and a formative assessment. The formative assessment includes an individual and group quiz followed by a review.

RESULTS: Medical knowledge and patient care competencies relevant to radiology are assessed on written and practical lab exams. How personal health information on images is handled is assessed during an introductory session. Program evaluation survey data (n=65 of 192 responding) show that 88% of the sample had no previous experience with anatomical imaging, 70.8% reported they could reliably identify important anatomical structures using clinical imaging with only 1.5% disagreeing, and 58.5% of students reported that they could confidently use DICOM software to visualize structures with 20% disagreeing.

CONCLUSION: Multiple physician competencies can be addressed by including radiologic imaging in the first year curriculum. Program evaluation is critical for curricular development. Once the program is established, future directions include a rigorous study of this teaching strategy to include objective assessment of medical knowledge, patient care, and professionalism competencies.

Chris Brasel

PURPOSE: Recently, a flipped classroom model was adopted for the physiology course in the OU-Tulsa PA Program. For each session, students watch a video lecture before class, take an in-class quiz on lower-order objectives, and then work in teams on application problems. Objective measures were needed to evaluate the effectiveness of the flipped approach. This study describes a comparison of exam scores between offerings of the course when the teaching mode switched from a traditional lecture to a flipped classroom model.

METHODS: Performance on eight exams was compared between traditional (n = 26 students) and flipped (n = 26 students) offerings of the course. Exam scores were not normally distributed, so a Wilcoxon rank-sum test was used to determine significant differences in median scores. Only exam questions that were identical in the cohorts were used in the analysis. Median scores were also compared for a “combined exam” encompassing all exam questions. Last, Cohen’s d effect sizes were determined for each exam comparison.

RESULTS: The median scores for the cellular/autonomic and the gastrointestinal exams were significantly higher for the flipped cohort (p < 0.004 and P < 0.001, respectively). In addition, the increase in performance on both exams had a moderate effect size (d = 0.49 and 0.54, respectively). Comparison of the “combined exam” showed a borderline, significantly higher median score in the flipped cohort (p < 0.054) with a smaller effect size (d = 0.27).

CONCLUSION: This comparative analysis of exam performance between traditional lecture and flipped classroom offerings of a physiology course suggests the flipped model may lead to improvement on some exams. The sample size of both cohorts was a major limitation and resulted in use of more stringent statistical methods. Comparisons involving larger class sizes should more clearly assess any exam performance gains when teaching with a flipped classroom method.

Session 7 – Assessment 2

Verena Meyer zu Westrup

PURPOSE: One key competence for medical doctors is successful action in complex medical situations. Reflection is known to be an efficient way to identify gaps between challenge and performance. The experience obtained in LIMETTE is an active assessment which will help to avoid underestimation and overconfidence in future professional situations.

METHODS: At the University Medical School a prepared learning scenario called LIMETTE (learning center for individual training of medical activities and development) was established in October 2016 to emphasize individualism in medical education. LIMETTEÂŽs infrastructure enables medical educators to conduct competency assessment based on spontaneous behavior defined in entrustable professional activities (EPAs). Students role play a situation in an examination room containing a computer, a chair, an examination couch, with a simulated patient (SP). The students are given 10 minutes to read the instructions, interview and/or examine the SP, formulate a solution/recommendation/diagnosis and document the case. The learning facility can supply 24 simultaneous assessments on 2 floors. 24 students per hour enter a circuit containing 6-12 subsequent rooms concentrically arranged around a central point. The assessment is carried out from that central point by observers via two-way mirrors and live recordings based on EPAs. 4-12 rooms are evaluated at the same time per floor. Scenarios are recorded. LIMETTE-circuit settings allow a student-examiner ratio from 4:1 to 12:1. In a subsequent seminar, students discuss their experiences and ask questions based on their summarized results.

RESULTS: Time-dependent and complex role plays provoke emotional stress and reactions with a wide range of behavior. The results are discussed in the seminar and reflection can then take place about current capacities and knowledge gaps within their professional development.

CONCLUSION: The LIMETTE concept is a powerful option to evaluate the exact level of individual student’s skills, to identify gaps and to feedback observations and learning goals.

2 – Using Individual and Team Rubrics to Quantify Interprofessional Team Dynamics
Shelley Bhattacharya

PURPOSE: Interprofessional collaborative practice (IPCP) is essential to the healthcare needs of a growing older adult population. Teaching an IP model and developing assessment tools are needed to effectively implement IPCP care. The Geriatrics Interprofessional Teaching Clinic (GITC) incorporates learners from six professions to provide an IPCP model. We utilized two tools to evaluate learners and IP care teams, critical components for an IPCP model.

METHODS: The intervention emphasizes reflection on current GITC experiences and assessment of what learners perceive as needed for effective collaboration. Learners completed an online individualized assessment of IP team behavior using the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) at the beginning and end of their GITC experience. They were introduced to the GITC Standardized Patient Encounter Evaluation Rubric (SPEER) team evaluation during orientation. During their first day (“early”) and final week (“late”) in the GITC, teams were evaluated on their IP teamwork, roles, and patient care plans using the SPEER rubric. Students evaluated their team dynamic and the faculty indirectly observed the encounter via a live-feed video system and completed the SPEER. All discussed their findings at the end of the encounter. ICCAS and SPEER progression was tracked throughout the GITC experience.

RESULTS: Preliminary results from Dec. 2015-April 2016 had 5 “early” and 6 “late” student and faculty SPEER teams. Respondents were from medicine, pharmacy, physical therapy, occupational therapy, social work and dietetics. Statistical changes from “early” to “late” were noted in faculty surveys for improvement in: Communicating in patient-friendly terms; Having an organized approach; Communicating the plan equally; Addressing patient education needs. The pre and post-ICCAS surveys from 2014-16 were completed by 80/292 (27%) learners.

CONCLUSIONS: All ICCAS domains significantly improved after the IP experience. The most significant change on the SPEER was in the team’s ability to communicate the plan to the patient.

Colin Greengrass

PURPOSE: Assessment of the learning process, rather than merely its outcomes, is important in providing an accurate evaluation of student capability. The environment in which problem based learning (PBL) exercises are carried out is ideal for such assessment. The instrument developed in this study allowed for an individualisation of assessment, whereby group members are evaluated based upon their individual performance proclivities, contributing favourably to group productivity and collaborative learning.

METHODS: The embedded assessment instrument described, allows continuous scoring of performance throughout PBL sessions. It permits tracking of several aspects of group dynamics within PBL sessions and provides for the assessment of important performance attributes of group members.

RESULTS: Data obtained from this study provides interesting findings on how groups function in PBL with individuals adhering strongly to their characteristic performance attributes over time. There are clear consistencies in types of behaviour for individuals across sessions with a display of background knowledge with an alpha of 0.776, with questioning behaviour 0.63, and creative thinking 0.63. The total number of contributions gave an alpha of 0.88 demonstrating that levels of engagement in sessions of participants was consistent.

CONCLUSIONS: This assessment instrument permitted a form of individualised assessment. Where assessment forms usually consist of a set of criteria for which all participants must adhere to and perform well; participants in a collaborative thinking process contribute very much as individuals, not only providing individual knowledge, which is assimilated by the group thus allowing elaboration, but also providing differing behaviours which may contribute to the group thinking process and group functioning.

This novel form of assessment, allowing for those individual differences in behaviours of participants which contribute positively to the performance of the group, is unlikely to affect group dynamics as other PBL focussed assessment tools. This instrument should be considered for use in assessment of PBL and other group thinking activities.

Inaya Haijj-Hussein

PURPOSE: Medical education has been undergoing significant modifications for the past two decades focusing on reduction of contact hours and fostering self-directed learning. With the dramatic changes occurring in medical schools’ curricula, the histology discipline is facing an ongoing concomitant reduction in the number of hours devoted to lectures and laboratory instructions. In response to this, educators are relying on technology and advanced software more than ever to create online self-study modules that can cover a large amount of study material in limited time. A series of modules were created using SoftChalk aiming to provide a foundation for effective and efficient self-learning of the tissues and organs correlating to each block course and to supplement the reduced class-based lectures and laboratories’ sessions.

METHODS: These modules were designed to take an integrated approach to study normal tissues and organs’ architectures and introduce the major microscopic changes that occur during diseases. Histology-histopathology constituted the backbone of these modules where images of both normal and abnormal tissues, in various disease stages, were compared and discussed, thus shedding the light on disease process. Each module included pre and post tests, instructor’s narrative, labeled microscopic images, links to virtual images, interactive activities, examples of related diseases, photo album, clinical correlations, definitions, cases to foster critical thinking, a Score Center to collect responses and a student evaluation.

RESULTS: The modules were well received by students as a mean to identify gaps and make participation more flexible while taking into consideration the demands and pace of the student. Modules can also be easily revised and re-published by the instructor.

CONCLUSIONS: These integrated modules are offering a better structure for promoting self-directed learning, and achieving a high level of critical thinking. They will also lead to better time management and provide more ways and means to mandatory participation.

Session 8 – Technology and Innovation 2

1 – High Medical Student Satisfaction with MentimeterÂź: A Free, Dynamic, and Accessible Option in Audience Response Systems
Kashif Ahmad

Purpose: There is limited data existing to evaluate the effectiveness of ARS (Audience Response System) in medical school education and assessment. The aim of this project is to examine the usefulness of a novel web based tool MentimeterÂź, a collaborative and interactive ARS, in preparing first-year medical students for basic science exams. We hypothesize that MentimeterÂź will have a significant effect on student preparedness for basic science exams and could tremendously improve retention of difficult conceptual knowledge.

Approach/Methods: An IRB approved survey was conducted after students completed their first informal assessment (using Mentimeter¼) before taking their first physiology progress exam. After the session, students were asked to rate statements on a Likert scale, with 0 representing “strongly disagree” and 5 representing “strongly agree”.

Results: The following percentages of students reported either a 4 or 5 when asked about the following metrics of Mentimeter: 92.8% (n=42) found it “helped prepare [students] for their exam”, 87.5% (n=40) found it “beneficial”, and 76.7% (n=43) found it “accessible via [their] cell phones”. The utilization of Mentimeter¼, was well-received by students.

Significance: We hypothesize the effect of MentimeterÂź will be significant with respect to student preparedness for basic science exams, and could tremendously improve retention of basic science knowledge.

MentimeterÂź is a free online software that can be utilized by instructors in any classroom with internet access. It engages students by assigning them an avatar, and awards points based on accuracy and speed of answers submitted. It can be accessed on any device and minimal preparation is required to formulate the assessments.

Conclusion: Taken together we have demonstrated the usefulness and high satisfaction of using MentimeterÂź , a novel tool that can enhance learning in medical school curricula and encourage faculty to explore and incorporate these new tools in their course assessment and evaluation.

Peter de Jong

PURPOSE: A Massive Open Online Course (MOOC) is a complete course on a specific basic or clinical science topic that is entirely offered online. In January 2016 Leiden University Medical Center launched world’s first clinical oriented MOOC on Kidney, Pancreas and Islet Transplantation targeting (bio) medical students and health care professionals in the (pre)clinical transplantation field. During the first year over 7,000 learners from more than 90 countries subscribed to the course. In the course several digital learning opportunities are being offered, which have been implemented in the local on-campus curriculum.

METHODS: Integration of MOOC elements into the local curriculum took place in two regular on-campus courses in the second year. For the first course, different lectures and an online assignment were used replacing traditional teaching; in the second the different contents of the MOOC including lectures, movies, games, interviews, quiz and online discussion fora ,including 2 clinical patient case assignments have been offered. Students were asked for their experiences using a short questionnaire using a 5-point Likert scale (1=not at all, 5=a lot).

RESULTS: In total 325 second year students participated in the two courses and were invited to sign up for the MOOC. 56 students (17%) responded to the online questionnaire. The respondents indicated that the MOOC elements were an interesting addition to the face to face curriculum (score 3,3 ± 0.9) and that the online lectures and discussion forums were inspiring (3,1 ± 1). A part of the students even explored other parts of the MOOC other than those that were mentioned in the assignments (2,5 ± 1,4).

CONCLUSIONS: Students indicate they like the online materials in the MOOC as an inspiring addition to the traditional course materials and a part of them also explores other parts of the MOOC not directly related to the study assignments.

Bi-Hung Peng

PURPOSE: Narrated animated videos (NAVs) are educational content delivery resources that can be accessed via almost any device. Advantages of creating NAVs at our institution include: (1) no effort needed for search of online resources of variable quality; (2) no learner frustration due to ‘broken links’; (3) ease of meeting the changing needs of courses; (4) enhanced trust of the learning resource due to familiarity with the instructor; and (5) exposure of learners to identical quality and content of instruction.

METHODS: We have undertaken a modular approach for creating Histology NAVs. Five tissue categories have been selected: (1) epithelia, (2) connective tissue proper, (3) nervous tissue, (4) muscle and (5) specialized connective tissue. Fifty-eight short (generally < 5 min) NAVs have been created to describe elements of each tissue present in a particular organ. NAVs contain animated elements (diagrams, labels, arrows, etc.) that focus the learner to the most pertinent structures and reinforce learning. Statistical tracking of learner access to our NAV server is monitored throughout their instruction, and a single Histology examination is carried out upon completion.

RESULTS: Our NAVs are utilized as the primary source of instruction four our learners. Learners are expected to review ~10 NAVs per week of instruction. Four interactive ‘face-to-face’ large sessions are carried out to gage the rate and depth of learning. Statistical correlations between learner engagement (number and duration of NAV views) and performance will be carried out. Surveys of learning satisfaction will be undertaken.

CONCLUSIONS: NAVs appear to be an ideal format to foster self-and life-long learning of Histology. The modular nature of our short NAVs allow tailoring of to meet numerous needs and platforms of instruction, while ensuring uniform quality and technological reliability.

Zachariah Adham

PURPOSE: Medical school instructors face a challenge in covering a high volume of material with often too-little instructional time. Unfortunately, the high volume of material in medical school often means that not all concepts will be sufficiently communicated and understood. While the prospect of simply shifting course material out of instructional time towards online formats is tempting, it is a zero-sum game–medical students still will grapple with overwhelming volumes of information and challenging concepts. In a first-year medical physiology course–which can be highly conceptual and require multiple iterations of cognitive modeling–we have sought to develop an algorithm that uses EducreationsÂź technology to help large groups of students form and prune cognitive models via cognitive apprenticeship.

METHODS: In brief, we designed an electronic survey and solicited feedback on the efficacy of short (

RESULTS: 64% of students “strongly agreed” and 28.5% of students “agreed” that “the videos enhanced their learning in physiology” (n=42). Less than 1% students remained “neutral” or “disagreed” on the value of these videos in the course. In another survey question when students were inquired that the second exposure via these videos helped explain a difficult concept, 70% of the students “strongly agreed” and 23% “agreed” that the videos helped them understand a difficult concept.

CONCLUSION: With many medical schools striving to incorporate technology in their curriculum and few publishing their trials and results, we hope that our work will encourage other medical educators to ground their work in pedagogical theory and formally evaluate their technological implementations. We believe the strength of our student-feedback-driven algorithm is the digitilization of cognitive apprenticeship in a manner that is effective in reaching a large group of students.